While effective treatments exist for anxiety and depression, a large number of individuals fail to fully adhere or respond to treatment. A great deal of research in psychotherapy has focused on improving outcomes by developing alternative treatment strategies. In the proposed study, we take a different direction by evaluating a brief pretreatment to increase motivation for psychotherapy. This may be particularly fruitful given the high frequency with which ambivalence about change is encountered in psychotherapy. The motivational intervention chosen for this project, Motivational Interviewing (MI), has proven quite effective in increasing motivation and outcome in alcohol/substance abuse, particularly when used as a prelude to other treatments. Our research team adapted and manualized M! for anxiety and pilot data reveal that 3 sessions of this treatment, as a prelude to group Cognitive Behavioral Therapy (CBT) improved motivation, homework compliance, and CBT outcomes in a heterogeneous group of anxiety disorders. In the proposed study, individuals meeting diagnostic criteria for 1 specific anxiety disorder, Generalized Anxiety Disorder (GAD) will be randomly assigned to either a 4-session individual MIpretreatment or no pretreatment, prior to 14 sessions of individual CBT for GAD. We predict the MI pretreatment, compared with no pretreatment, will produce greater reductions in GAD symptoms in CBT, increased motivation for changing anxiety, and better engagement with CBT procedures (e.g. greater homework compliance). GAD was chosen for investigation since it is the least CBT-responsive anxiety disorder and those with GAD commonly hold both negative and positive beliefs about worry. Given this ambivalence, GAD is particularly appropriate as a population for an initial study of a treatment (i.e. MI) aimed at resolving ambivalence. The development of a motivational pretreatment has potentially widespread application since it can be used in combination with a variety of therapy approaches for a variety of prevalent and pernicious mental health problems beyond GAD.
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