Blending therapies improves treatment of severe anxiety

"Our research shows that therapists need to have two sets of skills -- to help people become ready for change, and then to help them accomplish that change," says Dr. Henny Westra, a psychology professor in the Faculty of Health at York U. "The study results suggest that integrating motivational interviewing (MI) with CBT is more effective than CBT alone for long-term improvement."

It is normal to feel conflicted about change, and motivational interviewing is an approach that therapists can use to help patients understand and validate the fear of change. It offers a patient-centered way of helping individuals work through their conflicting feelings in order to enhance motivation for change.

"Because MI is focused on listening and drawing out client ideas, patients feel more confidence in coping with issues facing them even after therapy ends in contrast to having to rely on the therapist's expertise," says Dr. Westra, who led the study with Ryerson University Professor Dr. Martin Antony and Professor Dr. Michael Constantino, University of Massachusetts Amherst.

The five-year study was conducted with grant support from the Canadian Institutes of Health Research. During the randomized clinical trial, 85 participants underwent treatment for severe generalized anxiety disorder (GAD). Cognitive behavioral therapy alone was given to 43 participants and the rest received a combination of CBT and MI from therapists trained in both.

Although the participants responded well to both the motivationally enhanced CBT and standard CBT during the 15-week treatment phase, those who received the motivationally enhanced treatment continued to improve, the results indicate. Those in the MI-CBT were five times more likely to be free of the diagnosis of generalized anxiety one year after treatment ended.

According to Dr. Antony, "this study highlights the importance of studying the long term impact of our treatments, as the enhanced improvements seen in people who received the integrated MI and CBT treatment were greatest sometime after treatment had ended."

The study titled Integrating Motivational Interviewing with Cognitive-Behavioral Therapy for Severe Generalized Anxiety Disorder: An Allegiance-Controlled Randomized Clinical Trial is published online in the Journal of Consulting and Clinical Psychology.