Although cognitive behavioral therapy (CBT) has been consistently supported as highly efficacious in the management of various anxiety disorders, a significant number of individuals fail to respond to treatment. In this article, the authors present an attempt to operationalize and implement alternative interventions in two cases of CBT non-responsiveness for anxiety management. Both cases were identified as CBT nonresponsive through repeated psychometric assessment of symptoms, and the focus of therapy was shifted to motivational enhancement techniques. These alternative interventions were conceptualized using the Stages of Change Model, which advocates stage-matched interventions based on individual differences in readiness for change. In the first case of generalized anxiety disorder, motivational enhancement interventions were associated with marked improvement in anxiety symptomatology, whereas the second case of social phobia failed to respond to these interventions. Discussion is focused on possible mediators of differential treatment response to motivational interventions with a view to proposing future application and evaluations of these novel techniques.
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References
1.
Barlow, D. H. (2002). Anxiety and its disorders: The nature and treatment of anxiety and panic. New York: Guilford.
2.
Barlow, D. H., & Craske, M. G. (1994). Mastery of your anxiety and panic II. San Antonio, TX: Psychological Corporation.
3.
Beck, A. T. (1990). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893-897.
4.
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J. E., & Erbaugh, J. K. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561-571.
5.
Beitman, B. D., Beck, N. C., Deuser, W., Carter, C., Davidson, J., & Maddock, R. (1994). Patient stages of change predict outcome in a panic disorder medication trial. Anxiety, 1, 64-69.
6.
Burns, D. D. (1994). Therapists tool kit. Unpublished manuscript.
7.
Chambless, D. L., & Gillis, M. M. (1993). Cognitive therapy of anxiety disorders. Journal of Consulting and Clinical Psychology, 61, 248-260.
8.
Chambless, D. L., Sanderson, W. C., Shoham, V., Johnson, S. B., Pope, K. S., Crits-Christoph, P., et al. (1996). An update on empirically validated therapies. Clinical Psychologist, 49, 5-18.
9.
Clark, D. M. (1997). Panic disorder and social phobia. In D. M. Clark & C. G. Fairburn (Eds.), Science and practice of cognitive behavioural therapy (pp. 119-154). New York: Oxford University Press.
10.
Clum, G. A. (1989). Psychological interventions vs. drugs in the treatment of panic. Behaviour Therapy, 20, 429-457.
11.
Craske, M. G., Barlow, D. H., & O'Leary, T. (1992). Mastery of your anxiety and worry. New York: Graywind.
12.
Cummings, N. A., & Hayes, S. C. (1996). Now we are facing the consequences: A conversation with Nick Cummings. Scientist Practitioner, 6, 9-13.
13.
Dijkstra, A., DeVries, H., Roijackers, J., & van Breukelen, G. (1998). Tailored interventions to communicate stage-matched information to smokers in different motivational stages. Journal of Consulting and Clinical Psychology, 66, 549-557.
14.
Elkin, I. (1994). The NIMH Treatment of Depression Collaborative Research Program: Where we began and where we are. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change (4th ed., pp. 114-139). New York: John Wiley.
15.
Elkin, I., Shea, M. T., Watkins, J. T., Imber, S. D., Sotsky, S. M., Collins, J. F., et al. (1989). National Institute of Mental Health Treatment of Depression Collaborative Research Program: General effectiveness of treatments. Archives of General Psychiatry, 46, 971-982.
16.
Foa, E. B. (2000). Psychosocial treatment of posttraumatic stress disorder. Journal of Clinical Psychiatry, 61, 43-48.
17.
Gusella, J., & Schurter, M. (2000, May). From readiness to recovery: Can group therapy help adolescent girls with eating disorders to move forward in their stage of recovery? Paper presented at the International Conference on Eating Disorders, New York.
18.
Hayes, S. C., Barlow, D. H., & Nelson-Gray, R. O. (1999). The scientist practitioner: Research and accountability in the age of managed care. Boston: Allyn & Bacon.
19.
Hollon, S. D., DeRubeis, R. J., Evans, M. D., Wiemer, M. J., Garvey, M. J., Grove, W. M., et al. (1992). Cognitive therapy and pharmacotherapy for depression: Singly and in combination. Archives of General Psychiatry, 49, 773-781.
20.
Leary, M. R. (1983). A brief version of the fear of negative evaluation scale. Personality and Social Psychology Bulletin, 9, 371-375.
21.
Marks, I. M., & Mathews, A. (1979). Brief standard rating for phobic patients. Behaviour Research and Therapy, 17, 263-267.
22.
Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28, 487-495.
23.
Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people to change addictive behaviour. New York: Guilford.
24.
Otto, M. W., Pollack, M. H., & Maki, K. M. (2002). Empirically-supported treatment for panic disorder: Costs, benefits, and stepped care. Journal of Consulting and Clinical Psychology, 68, 556-563.
25.
Pennebaker, J. (1997). Opening up: The healing power of expressing emotions (Rev. ed.). New York: Guilford.
26.
Peterson, R. A., & Reiss, S. (1992). Anxiety Sensitivity Index manual (2nd ed.). Worthington, OH: International Diagnostic Systems.
27.
Prochaska, J. O. (2000). Change at differing stages. In R. E. Ingram & C. R. Snyder (Eds.), Handbook of psychological change: Psychotherapy processes and practices for the 21st century (pp. 109-127). New York: John Wiley.
28.
Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51, 390-395.
29.
Prochaska, J. O., Norcross, J. C., & DiClemente, C. C. (1994). Changing for good: A revolutionary six-stage program for overcoming bad habits and moving your life positively forward. New York: Avon.
30.
Schmidt, N. B., & Woolaway-Bickel, K. (2000). The effects of treatment compliance on outcome in cognitive-behavioral therapy for panic disorder: Quality versus quantity. Journal of Consulting and Clinical Psychology, 68, 13-18.
31.
Scholing, A., & Emmelkamp, P. M. (1999). Prediction of treatment outcome in social phobia: A cross-validation. Behaviour Research and Therapy, 37, 659-670.
32.
Snyder, C. R., Ilardi, S., Michael, S. T., & Cheavens, J. (2000). Hope theory: Updating a common process for psychological change. In C. R. Snyder & R. E. Ingram (Eds.), Handbook of psychological change (pp. 128-153). New York: Wiley.
33.
Stewart, J. W., Mercier, M. A., Quitkin, F. M., McGrath, P. J., Nunes, E., Young, J., et al. (1993). Demoralization predicts nonresponse to cognitive therapy in depressed outpatients. Journal of Cognitive Psychotherapy: An International Quarterly, 7, 105-116.
34.
Westra, H. A., Dozois, D. J. A., & Boardman, C. (2002). Correlates of treatment change and engagement in cognitive behavioural group therapy for depression. Journal of Cognitive Psychotherapy: An International Quarterly, 16, 227-241.
35.
Westra, H. A., & Stewart, S. H. (1998). Cognitive behavioral therapy and pharmacotherapy: Complementary or contradictory approaches to the treatment of anxiety? Clinical Psychology Review, 18, 307-340.
36.
Westra, H. A., & Stewart, S. H. (2001, June). The validity of the Fear of Negative Evaluation Scale-Brief Version. Paper presented at the annual meeting of the American Psychological Society, Toronto, Canada.
37.
Wilson, M., Bell-Doran, D., & Beitman, B. (1997). Application of the stages of change scale in a clinical drug trial. Journal of Anxiety Disorders, 11, 395-408.
