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.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Planning Grant (R34)
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Study Section
Interventions Research Review Committee (ITV)
Program Officer
Kozak, Michael J
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York University
Zip Code
M3 1-P3
Sijercic, Iris; Button, Melissa L; Westra, Henny A et al. (2016) The interpersonal context of client motivational language in cognitive-behavioral therapy. Psychotherapy (Chic) 53:13-21
Button, Melissa L; Westra, Henny A; Hara, Kimberley M et al. (2015) Disentangling the impact of resistance and ambivalence on therapy outcomes in cognitive behavioural therapy for generalized anxiety disorder. Cogn Behav Ther 44:44-53
Lombardi, Diana R; Button, Melissa L; Westra, Henny A (2014) Measuring motivation: change talk and counter-change talk in cognitive behavioral therapy for generalized anxiety. Cogn Behav Ther 43:12-21
Ahmed, Mariyam; Westra, Henny Alice; Constantino, Michael J (2012) Early therapy interpersonal process differentiating clients high and low in outcome expectations. Psychother Res 22:731-45
Westra, Henny A; Aviram, Adi; Connors, Laura et al. (2012) Therapist emotional reactions and client resistance in cognitive behavioral therapy. Psychotherapy (Chic) 49:163-72
Aviram, Adi; Westra, Henny Alice (2011) The impact of motivational interviewing on resistance in cognitive behavioural therapy for generalized anxiety disorder. Psychother Res 21:698-708
Westra, Henny A (2011) Comparing the predictive capacity of observed in-session resistance to self-reported motivation in cognitive behavioral therapy. Behav Res Ther 49:106-13
Westra, Henny A; Constantino, Michael J; Arkowitz, Hal et al. (2011) Therapist differences in cognitive-behavioral psychotherapy for generalized anxiety disorder: a pilot study. Psychotherapy (Chic) 48:283-92
Marcus, Madalyn; Westra, Henny; Angus, Lynne et al. (2011) Client experiences of motivational interviewing for generalized anxiety disorder: a qualitative analysis. Psychother Res 21:447-61
Westra, Henny Alice; Aviram, Adi; Barnes, Marissa et al. (2010) Therapy was not what I expected: a preliminary qualitative analysis of concordance between client expectations and experience of cognitive-behavioural therapy. Psychother Res 20:436-46

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