Recent meta-analytic findings have revealed that the addition of motivational interviewing (MI) to cognitive behavior therapy (CBT) for anxiety disorders improves treatment outcome. However, for the most part, previous research has limited MI as a prelude to CBT. This article explored the benefits and complications of a more integrated approach by adapting and examining an already established transdiagnostic CBT protocol to include intermittent MI strategies. The presented protocol is described and illustrated using a case study of a woman meeting criteria for four anxiety disorder diagnoses. This study presents session-by-session treatment accounts, as well as pre, post, and follow-up data. Results indicated clinically significant improvement, supporting the utility of intermittent MI strategies within CBT. Implementation recommendations and future research directions are discussed.
AlfonssonS.OlssonE.HurstiT. (2016). Motivation and treatment credibility predicts dropout, treatment adherence, and clinical outcomes in an internet-based cognitive behavioral relaxation program: A randomized controlled trial. Journal of Medical Internet Research, 18(3), e52.
2.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
3.
ArkowitzH.BurkeB. L. (2008). Motivational interviewing as an integrative framework for the treatment of depression. In ArkowitzH.WestraH. A.MillerW. R.RollnickS. (Eds.), Motivational interviewing in the treatment of psychological problems. New York, NY: Guilford Press.
4.
AviramA.WestraH. A.ConstantinoM. J.AntonyM. M. (2016). Responsive management of early resistance in cognitive-behavioral therapy for generalized anxiety disorder. Journal of Consulting and Clinical Psychology, 84, 783-794.
5.
BalánI. C.LejuezC. W.HofferM.BlancoC. (2016). Integrating motivational interviewing and brief behavioral activation therapy: Theoretical and practical considerations. Cognitive and Behavioral Practice, 23, 205-220.
6.
BarreraT. L.SmithA. H.NortonP. J. (2016). Motivational interviewing as an adjunct to cognitive behavioral therapy for anxiety. Journal of Clinical Psychology, 72, 5-14.
7.
BeckA. T.SteerR. A.BrownG. K. (1996). Manual for the beck depression inventory: II. San Antonio, TX: The Psychological Corporation.
8.
BlainL. M. (2013). Motivational interviewing as an augmentation to increase effectiveness in cognitive processing therapy for PTSD: An initial trial (Doctoral dissertation). Retrieved from http://irl.umsl.edu/dissertation/295
9.
BrownL. A.WileyJ. F.Wolitzky-TaylorK.Roy-ByrneP.SherbourneC.SteinM. B.. . . CraskeM. G. (2014). Changes in self-efficacy and outcome expectancy as predictors of anxiety outcomes from the CALM study. Depression and Anxiety, 31, 678-689.
10.
BrownT. A.BarlowD. H. (2014). Anxiety and related disorders interview schedule for DSM-5 (ADIS-5): Adult version—Client interview schedule. New York, NY: Oxford University Press.
11.
FernandezE.SalemD.SwiftJ. K.RamtahalN. (2015). Meta-analysis of dropout from cognitive behavioral therapy: Magnitude, timing, and moderators. Journal of Consulting and Clinical Psychology, 83, 1108-1122.
12.
FlynnH. A. (2011). Setting the stage for the integration of motivational interviewing with cognitive behavioral therapy in the treatment of depression. Cognitive and Behavioral Practice, 18, 46-54.
13.
GuyW. (Ed.). (1976). ECDEU assessment manual for psychopharmacology (Revised ed.). Rockville, MD: Department of Health, Education and Welfare.
14.
HaraK. M.WestraH. A.AviramA.ButtonM. L.ConstantinoM. J.AntonyM. M. (2015). Therapist awareness of client resistance in cognitive-behavioral therapy for generalized anxiety disorder. Cognitive Behaviour Therapy, 44, 162-174.
15.
HettemaJ.SteeleJ.MillerW. R. (2005). Motivational interviewing. Annual Review of Clinical Psychology, 1, 91-111.
16.
HunterJ. A.ButtonM. L.WestraH. A. (2014). Ambivalence and alliance ruptures in cognitive behavioral therapy for generalized anxiety. Cognitive Behaviour Therapy, 43, 201-208.
17.
KaczkurkinA. N.FoaE. B. (2015). Cognitive-behavioral therapy for anxiety disorders: An update on the empirical evidence. Dialogues in Clinical Neuroscience, 17, 337-346.
18.
KazantzisN.DattillioF. M.DobsonK. S. (2017). The therapeutic relationship in cognitive-behavioral therapy: A clinician’s guide. New York, NY: Guildford Press.
19.
KhattraJ.AngusL.WestraH.MacaulayC.MoertlK.ConstantinoM. (2017). Client perceptions of corrective experiences in cognitive behavioral therapy and motivational interviewing for generalized anxiety disorder: An exploratory pilot study. Journal of Psychotherapy Integration, 27, 23-34.
20.
MarkerI.NortonP. J. (2018). The efficacy of incorporating motivational interviewing to cognitive behavior therapy for anxiety disorders: A review and meta-analysis. Clinical Psychology Review, 62, 1-10.
21.
MarkerI.SalvarisC. A.TollidayT.ThompsonE.NortonP. J. (2019). Client motivation and engagement in transdiagnostic group cognitive behavioral therapy for anxiety disorders: Predictors and outcomes. Cognitive Therapy and Research. Advance online publication. doi:10.1007/s10608-019-10014-1
22.
MerloL. J.StorchE. A.LehmkuhlH. D.JacobM. L.MurphyT. K.GoodmanW. K.GeffkenG. R. (2010). Cognitive behavioral therapy plus motivational interviewing improves outcome for pediatric obsessive-compulsive disorder: A preliminary study. Cognitive Behaviour Therapy, 39, 24-27.
23.
MillerW. R.JohnsonW. R. (2008). A natural language screening measure for motivation to change. Addictive Behaviors, 33, 1177-1182.
24.
MillerW. R.RollnickS. (2012). Motivational interviewing: Helping people change. New York, NY: Guilford Press.
25.
MoyersT. B.HouckJ. M.GlynnL. H.ManuelJ. K. (2011). Can specialized training teach clinicians to recognize, reinforce, and elicit client language in motivational interviewing?Poster session presented at the 34th Annual Meeting of the Research Society on Alcoholism. Atlanta, GA. Retrieved from http://www.unm.edu/~jhouck/Houck_RSA_2011.pdf
26.
NortonP. J. (2012). Group cognitive-behavioral therapy of anxiety: A transdiagnostic treatment manual. New York, NY: Guilford Press.
27.
NortonP. J.BarreraT. L. (2012). Transdiagnostic versus diagnosis-specific CBT for anxiety disorders: A preliminary randomized controlled non-inferiority trial. Depression and Anxiety, 29, 874-882.
28.
NortonP. J.BarreraT. L.MathewA. R.ChamberlainL. D.SzafranskiD. D.ReddyR.SmithA. H. (2013). Effect of transdiagnostic CBT for anxiety disorders on comorbid diagnoses. Depression and Anxiety, 30, 168-173.
29.
NortonP. J.RobinsonC. M. (2010). Development and evaluation of the anxiety disorder diagnostic questionnaire. Cognitive Behavior Therapy, 39, 137-149.
30.
RiccardiC. J.TimpanoK. R.SchmidtN. B. (2010). A case study perspective on the importance of motivation in the treatment of obsessive compulsive disorder. Clinical Case Studies, 9, 273-284.
31.
RowaK.GiffordS.McCabeR.MilosevicI.AntonyM. M.PurdonC. (2014). Treatment fears in anxiety disorders: Development and validation of the treatment ambivalence questionnaire. Journal of Clinical Psychology, 70, 979-993.
32.
SijercicI.ButtonM. L.WestraH. A.HaraK. M. (2016). The interpersonal context of client motivational language in cognitive-behavioral therapy. Psychotherapy, 53(1), 13-21.
33.
SimpsonH. B.ZuckoffA. M.MaherM. J.PageJ. R.FranklinM. E.FoaE. B.WangY. (2010). Challenges using motivational interviewing as an adjunct to exposure therapy for obsessive-compulsive disorder. Behaviour Research and Therapy, 48, 941-948.
34.
SpringerK. S.LevyH. C.TolinD. F. (2018). Remission in CBT for adult anxiety disorders: A meta-analysis. Clinical Psychology Review, 61, 1-8.
35.
WestenD.MorrisonK. (2001). A multidimensional meta-analysis of treatments for depression, panic, and generalized anxiety disorder: An empirical examination of the status of empirically supported therapies. Journal of Consulting and Clinical Psychology, 69, 875-899.
36.
WestraH. A. (2011). Comparing the predictive capacity of observed in-session resistance to self-reported motivation in cognitive behavioral therapy. Behaviour Research and Therapy, 49, 106-113.
37.
WestraH. A.ArkowitzH. (2011). Integrating motivational interviewing with cognitive behavioural therapy for a range of mental health problems. Cognitive and Behavioral Practice, 18, 1-4.
38.
WestraH. A.ConstantinoM. J.AntonyM. M. (2016). Integrating motivational interviewing with cognitive-behavioral therapy for severe generalized anxiety disorder: An allegiance-controlled randomized clinical trial. Journal of Consulting and Clinical Psychology, 84, 768-782.
39.
WestraH. A.DozoisD. J. A. (2003). Motivational interviewing adapted for anxiety. Unpublished treatment manual, Department of Psychology, York University, Toronto, Ontario, Canada.
40.
WestraH. A.PhoenixE. (2003). Motivational enhancement therapy in two cases of anxiety disorder: New responses to treatment refractoriness. Clinical Case Studies, 2, 306-322.
41.
WoottonB. M.BragdonL. B.SteinmanS. A.TolinD. F. (2015). Three-year outcomes of adults with anxiety and related disorders following cognitive-behavioral therapy in a non-research clinical setting. Journal of Anxiety Disorders, 31, 28-31.
42.
YangW.StrodlE. (2011). Motivational interviewing changes the treatment trajectory of group cognitive-behavioural therapy for anxiety. In BoagS.TiliopoulosN. (Eds.), Personality and individual differences: Theory, assessment, & application (pp. 237-248). New York, NY: Nova Science Publishers.
43.
ZuckoffA.SwartzH. A.GroteN. K. (2008). Motivational interviewing as a prelude to psychotherapy of depression. In ArkowitzH.WestraH. A.MillerW. R.RollnickS. (Eds.), Motivational interviewing in the treatment of psychological problems. New York, NY: Guilford Press.
