Motivational interviews help patients with anxiety benefit from psychotherapy

People who suffer from severe anxiety respond much better to psychotherapy for anxiety if they receive motivational interviewing first to prepare them for change, a study led by York University has shown.

The study, published online in the Journal of Anxiety Disorders, offers hope for people who suffer from the most severe level of generalized anxiety disorder, a chronic condition characterized by excessive and uncontrollable worry.

Anxiety disorders are the most common mental health problem in North America, and chronic severe anxiety is the most difficult form to treat. The recommended treatment – cognitive behavioural therapy – focuses on finding ways to manage anxious thoughts and to reduce avoidance behaviours. However, it produces good results in only about half of patients and is least effective for the most severe type of anxiety, says clinical psychologist Henny Westra, a professor of psychology in York’s Faculty of Health and lead author of the study.

"People who worry all day every day are ambivalent about worry and may be reluctant to stop worrying. Worry severely interferes with their lives, but they also see it as something positive that motivates them, shows they care or prevents bad things from happening," says Westra. "We used brief motivational interviewing prior to cognitive behavioural therapy to see if we could increase the success rate of therapy by helping clients to explore their ambivalence about worry and prepare themselves for change."

The first controlled study or clinical trial of its kind, it randomly divided 76 people with a principal diagnosis of generalized anxiety disorder into two groups: those who would receive four weekly 50-minute sessions of motivational interviewing prior to eight weeks of cognitive behavioural therapy (14 hours), and those who would receive only the cognitive behavioural therapy.

The study found that 92 per cent of the group that had motivational interviewing prior to cognitive behavioural therapy responded very well, with normal worry scores following treatment, and everyone in the group improved to some extent. In the group that did not have motivational interviewing prior to treatment, 71 per cent responded well, but 21 per cent did not respond at all to therapy.

The effects were greatest for those patients with severe anxiety, where adding the brief course of motivational interviewing was "like doubling the effect of therapy", Westra says. For those with the most severe symptoms, one year after treatment, 81 per cent of the patients who had received motivational interviewing sessions before cognitive behavioural therapy no longer met the criteria for generalized anxiety disorder. In contrast, 56 per cent of those who received only cognitive behavioural therapy were free from generalized anxiety disorder, which is consistent with response rates in previous studies for cognitive behavioral therapy alone. 

The study, "Adding a motivational interviewing pretreatment to cognitive behavioural therapy for generalized anxiety disorder: A preliminary randomized controlled trial", was co-authored by Professors David Dozois of the University of Western Ontario and Hal Arkowitz of the University of Arizona.