Category: Adult Anxiety - GAD
Motivational interviewing (MI) is a client-centered counseling style used to reduce treatment ambivalence (Rollnick & Miller, 1995). MI enhances treatment motivation in people with anxiety disorders (Westra & Aviram, 2015), so those most ambivalent at treatment onset may be especially likely to benefit from it. Indeed, among people with generalized anxiety disorder (GAD), those receiving MI and CBT (vs. CBT alone) have shown less worry at 1-year follow-up (Button et al., 2016); this difference was especially prominent for those high in ambivalence. Button et al. (2016) assessed ambivalence using observer-coded counter-change talk (CCT) statements (e.g., “I am not ready”). While useful, CCT does not assess clients’ own account of ambivalence and does not meet the precondition of moderation (i.e., a baseline variable occurring prior to treatment). In contrast, the Treatment Ambivalence Questionnaire (TAQ; Rowa et al., 2014) is a self-report measure assessing content of negative beliefs about treatment (e.g., “It will change me”). The TAQ may complement CCT by revealing the nature of clients’ treatment concerns.
We tested whether TAQ moderated the relationship between treatment group and outcome. Data were collected as part of a randomized clinical trial exploring the integration of MI with CBT (MI-CBT) for people with GAD (Westra, Constantino, & Antony, 2016). Participants were randomly assigned to 15 sessions of CBT (N=43) or MI-CBT (N=42) and completed the Penn State Worry Questionnaire (PSWQ, Meyer et al., 1990) and GAD-7 (Spitzer et al., 2006), a measure of symptom severity, at baseline and posttreatment.
Total TAQ did not moderate the relationship between group and change in symptom severity from pre to posttreatment. The potential moderation effect of TAQ “adverse reactions” scale (TAA) scores (i.e., beliefs that treatment will cause harm) was then tested. Despite a nonsignificant interaction, we examined simple slopes to explore a priori hypotheses. For people high in TAA, those receiving CBT had greater reduction on GAD7 scores than those receiving MI-CBT (B=1.78, SE=.87, p=.046). For those low in TAA, group was unrelated to change in GAD7 scores (B=.30, SE=.85, p=.729). That participants with higher TAA scores had greater reduction in symptom severity in CBT alone was unexpected. Whereas MI may be best for addressing general ambivalence, TAA concerns may be best targeted by CBT alone. These results must be interpreted cautiously due to inconsistency across outcome measures. Further research is needed to determine for whom CBT vs. integrated MI-CBT will provide the greatest benefit.
Ariella Lenton-Brym– Graduate Student, Ryerson University, Toronto, Ontario, Canada
Kathleen Stewart– Ryerson University, Toronto, Ontario, Canada
Alice Coyne– University of Massachussets Amherst
Henny Westra– Professor, York University, Ontario, Canada
Michael Constantino– Professor, University of Massachusetts Amherst
Martin Antony– Professor, Ryerson University, Ontario, Canada