The predictive capacity of self-reported motivation vs. early observed motivational language in cognitive behavioural therapy for generalized anxiety disorder.

Client motivation to change is often considered a key factor in psychotherapy. To date, research on this client construct has largely relied on self-report, which is prone to response bias and ceiling effects. Moreover, self-reported motivation has been inconsistently related to treatment outcome. Early observed client in-session language may be a more valid measure of initial motivation and thus a promising predictor of outcome. The predictive ability of motivational factors has been examined in addiction treatment but has been limited in other populations. Addressing this lack, the present study investigated 85 clients undergoing cognitive behavioural therapy (CBT) alone and CBT infused with motivational interviewing (MI-CBT) for severe generalized anxiety disorder. There were two aims: (1) to compare the predictive capacity of motivational language vs. two self-report measures of motivation on worry reduction and (2) to examine the influence of treatment condition on motivational language. Findings indicated that motivational language explained up to 35% of outcome variance, event 1-year post-treatment. Self-reported motivation did not predict treatment outcome. Moreover, MI-CBT was associated with a significant decrease in the most detrimental type of motivational language compared to CBT alone. These findings support the importance of attending to in-session motivational language in CBT and learning to respond to these markers using motivational interviewing.

Comparison of MI-oriented versus CBT-oriented adjunctive treatments: impacts on therapeutic alliance and patient engagement during hospital treatment for an eating disorder.

BACKGROUND: Our aim was to compare MI-oriented versus CBT-oriented adjunctive treatments to test whether an MI approach is superior in terms of improving therapeutic alliance and engagement among individuals with an eating disorder. The current study was a pilot randomized controlled trial with random allocation to either MI-oriented or a CBT-oriented adjunctive treatment group completed concurrently with a hospital-based group program for adults. Both adjunctive treatment conditions consisted of three individual therapy sessions and a self-help manual. METHODS: Sixty-five outpatients receiving hospital treatment for a diagnosed eating disorder were randomly assigned to a treatment group. Measures of working therapeutic alliance, engagement, treatment completion, and clinical impairment were completed at preadmission, mid-treatment, and at the end of treatment. RESULTS: Working alliance increased equivalently in both conditions over time in treatment. Similarly, there were no differences between conditions in terms of engagement. Regardless of therapy orientation, greater use of the self-help manual predicted lowered eating disorder risk; stronger patient ratings of therapeutic alliance predicted decreased feelings of both ineffectiveness and interpersonal problems. CONCLUSION: This pilot RCT provides further evidence that both alliance and engagement are important for treatment of an eating disorder; however, there was no clear advantage of MI over CBT as an adjunctive treatment approach to improving alliance or engagement. TRIAL REGISTRATION: ClinicalTrials.gov ID #NCT03643445 (proactive registration).

Drop-out is common among eating disorder treatment programs. Patients' engagement in treatment and a positive relationship with their therapist may both be variables that are key to predicting treatment success. In this study we examined whether integrating MI-oriented individual therapy sessions plus a self-help manual would result in improved therapeutic alliance and/or engagement for adults attending a partial day hospital treatment program for an eating disorder as compared to similar CBT-oriented treatment. The MI-oriented treatment group was based on motivational interviewing principles that emphasize empathy, overcoming resistance to change, and individual's autonomy over decisions that are in line with one's values. The CBT-oriented treatment group was based on cognitive-behavioural principles that emphasize the need to change and the consequences of symptoms of an eating disorder. Patients' ratings of the quality of their relationship with their therapist increased in both conditions over time. A stronger working alliance with one's therapist was associated with lowered feelings of ineffectiveness and interpersonal problems, which are characteristics that are common among individuals with an eating disorder. Use of a self-help manual of either type showed some benefit at predicting reduced clinical impairment.