Combination of CBT, motivational interviewing effective for severe anxiety

Integration of motivational interviewing and cognitive-behavioral therapy was effective for severe generalized anxiety disorder, according to results from a 5-year randomized clinical trial.

“Generalized anxiety disorder is a very stubborn condition, and even with a full course of [cognitive-behavioral therapy (CBT)], which is the long-time gold standard of treatment, less than half of patients respond. We wanted to do something about improving mental health treatment outcomes for this very commonly encountered disorder,” study researcher Michael Constantino, PhD, of the University of Massachusetts, Amherst, said in a press release.

Michael Constantino

To compare efficacy of CBT alone and a combination of CBT and motivational interviewing, study participants received 15 sessions of CBT alone (n = 43) or four motivational interviewing sessions alone and 11 CBT sessions integrated with motivational interviewing to address patient resistance and ambivalence (n = 42). Study participants were predominantly white female adults with a high rate of diagnostic comorbidity.

There were no group differences in outcomes from pre- to post-treatment, according to piecewise multilevel models.

However, there were treatment effects over the follow-up period. Combination CBT and motivational interviewing led to a greater decline in worry (P = .03) and general distress reduction (P = .01) than CBT alone.

Participants who received combination treatment were approximately five times less likely to meet generalized anxiety disorder diagnostic criteria at 12 months, than participants who received CBT only.

Dropouts were twice as high among participants who received CBT only, compared with those who received combination treatment (23% vs. 10%; P = .09).

“We think that because [motivational interviewing] is more patient-centered, those who got [motivational interviewing] were better equipped to resolve their own struggles and challenges after therapy ended, even though they didn’t have the help of a therapist anymore,” Constantino said in the release. “We believe that [motivational interviewing] strategies may give them more autonomy, and may help them help themselves more readily over the long term.” – by Amanda Oldt

Disclosure: Please see the full study for a list of all authors’ relevant financial disclosures.