Category: Adult Anxiety - GAD

PS10- #A24 - Treatment Ambivalence and Change Motivation as Predictors of Worry and Symptom Severity in Psychotherapy for GAD

Saturday, Nov 18
11:00 AM – 12:00 PM
Location: Indigo Ballroom CDGH, Level 2, Indigo Level

Keywords: GAD (Generalized Anxiety Disorder) | Motivation | Psychotherapy Process

Client motivation for change correlates positively with various adaptive variables in cognitive-behavioral therapy, such as client engagement and commitment to therapy (e.g., Antony, Ledley, & Heimberg, 2005). Low motivation for change may be tied to ambivalence about engaging in therapy; that is, while recognizing the potential therapeutic benefit of treatment, some individuals may also experience concerns about what treatment could mean for them or require of them. The Treatment Ambivalence Questionnaire (TAQ; Rowa, et al., 2014) was developed to capture the degree of ambivalence, as well as the specific concerns the client has about treatment. If the two constructs are related, it is possible that one is more predictive of treatment outcome than the other. The present study tested the hypotheses that in individuals with generalized anxiety disorder (GAD), higher pretreatment ambivalence as measured by the TAQ would be significantly negatively correlated with pretreatment self-reported motivation for change, as measured by the Change Questionnaire (CQ; Miller & Johnson, 2008), and ambivalence and motivation for change would be significantly related to greater difference in worry and symptom severity pre- to posttreatment.


The data were collected as part of a randomized clinical trial (Westra, Constantino, & Antony, 2016) in which participants with severe GAD were randomly assigned to receive 15 sessions of CBT alone (n=30) or CBT integrated with MI (MI-CBT; n=36). Participants completed the TAQ and CQ before starting treatment and completed the worry measure (Penn State Worry Questionnaire; Meyer, Miller, Metzger, & Borkovec, 1990) and GAD severity measure (Generalized Anxiety Disorder-7 Item; Spitzer, Kroenke, Williams, & Lowe, 2006) at baseline and immediately posttreatment.


In line with our first hypothesis, ambivalence and motivation were moderately negatively correlated such that higher ambivalence was associated with decreased motivation for change at baseline (r=-.28, p=.011). Contrary to our second hypothesis, the TAQ did not explain variance in differences in the level of worry or in GAD severity when controlling for CQ. CQ, however, was uniquely related to an improvement in severity (B=.23, SE=.07, p=.002). These findings raise the question of how motivation for change (as measured by the CQ) and ambivalence (as measured by the TAQ) are similar and different. This study demonstrated that although the two constructs are related, motivation for change may be more important with respect to treatment outcome. Ambivalence may be a useful construct if it is able to bring to light reasons for a lack of motivation, which could then be addressed before beginning therapy.

Kathleen E. Stewart

Ryerson University
Toronto, Ontario, Canada

Ariella P. Lenton-Brym

Graduate Student
Ryerson University
Toronto, Ontario, Canada

Alice Coyne

University of Massachussets Amherst

Henny A. Westra

Professor
York University, Ontario, Canada

Michael J. Constantino

Professor
University of Massachusetts Amherst

Martin M. Antony

Professor
Ryerson University, Ontario, Canada