Researcher finds clues to enhance therapy for worriers

Preparing worriers for psychotherapy before it starts may help them stick with the treatment and learn how to manage their anxiety, says York Professor Henny Westra.

Westra, a clinical psychologist and professor of psychology in the Faculty of Arts, is studying how “motivational interviewing” prior to cognitive behavioural therapy (CBT) may increase treatment effectiveness. Anxiety disorders are rampant, affecting one in four North Americans in their lifetimes, according to Westra, and anxiety is the single most common mental health problem.

CBT is a practical treatment for anxiety that focuses on finding ways to manage anxious thoughts and reduce avoidance behaviours. However, the therapy assumes that people are ready to change. In fact, almost two-thirds of people who begin psychotherapy are ambivalent about change, says Westra.

“This is not the exception. It’s the rule. Change brings up conflicting feelings in people. Although it makes good sense to reduce worry because it impairs concentration, at the same time worrying can feel motivating. So one might be concerned that if they didn’t worry, they might become lazy,” explains Westra.

Westra has recently begun a three-year study to determine if talking to people with generalized anxiety disorder (i.e. non-stop worriers) before CBT treatment will increase the success rate of the therapy. In motivational interviewing, or pre-treatment, a therapist discusses the pros and cons of change in a way that allows the client to explore and resolve his or her feelings about it.

About half of patients who use CBT treatment respond well to it. In a pilot study in 2003, however, Westra found that exploring the patient’s feelings about the treatment prior to starting it actually increased the success rate to 75 per cent of patients. Those who received the pre-treatment got more actively involved in the treatment and were more confident they could make a change, says Westra.

The current study, which is now enrolling participants, repeats the earlier study with tighter controls. Participants will be screened by phone, interviewed and then take part in 18 individual therapy sessions. To inquire about participating, call ext. 55120.

The end goal of Westra’s research is to enhance people’s engagement with existing effective treatments for anxiety. “We have good treatments for anxiety. What we need now is to engage people with those treatments – people that would otherwise not use therapy or would not stay in it,” says Westra.

Some effective ways to deal with worry, according to Westra:

  • Do not try to avoid the worrisome thoughts. People often tell themselves not to worry and this, in fact, increases worry. It’s like trying not to think about your nose. Relinquish things like distraction, reassurance-seeking and checking and see what happens to your worry.
  • Practise becoming aware of and identifying your feelings. Worry can be a way of avoiding feelings, especially negative feelings, since these feel frightening. Get to know your feelings instead of running from them.
  • Take a more compassionate view toward your worry. What are the good things about worry? Ask what it is trying to help you achieve – for example, is it trying to give you a feeling of control, of preventing bad things from happening or being prepared in case something bad happens?