Motivational Enhancement Therapy in Two Cases of Anxiety Disorder

Abstract

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.

Preparing Clients for Cognitive Behavioral Therapy: A Randomized Pilot Study of Motivational Interviewing for Anxiety

“…This adaptation of MI has undergone extensive development and revision from initial inception with treatment development steps including: r consultation with individuals having expertise in motivational therapies and anxiety r extensive training of the first author in MI r a series of case studies for piloting the procedures and further refining the protocol in CBT nonresponders or refusers (e.g., Arkowitz & Westra, 2004;Westra, 2004;Westra & Phoenix, 2003) r further protocol refinement in early cases seen by the research therapist in this study There was a single research therapist in this study who was a Ph.D. level Clinical Psychologist trained intensively in MI and MI for Anxiety and supervised closely by the first author. Training was conducted over a 6-month period (5 hours per week) and involved readings and discussion, co-therapy cases with the first author, and direct observation of each videotaped MI session for the first 15 cases, with random as well as therapist-driven selection of videotaped segments on later cases to ensure protocol adherence (e.g., the therapist would select segments of more challenging sessions for supervisory input on proper application of the protocol).…”

“…The motivational intervention was developed through generalizing MI (Miller & Rollnick, 2002) to be specifically applicable to anxiety. Treatment development steps included expert consultation, numerous case studies to refine and adapt the protocol (Westra, 2004;Westra & Phoenix, 2003), and development of a treatment manual (Westra & Dozois, 2003).…”

Motivation enhancement therapy can increase utilization of cognitive‐behavioral therapy: the case of social anxiety disorder

“…This timeframe was used given evidence that two to four sessions of MI can effect behavioral change among patients with anxiety (Buckner et al, 2008;Westra & Dozois, 2006;Westra & Phoenix, 2003). She received eight specific MET techniques (described below) conducted within the spirit of MI (Miller & Rollnick, 2002).…”

Limited Motivation, Patient-Therapist Mismatch, and the Therapeutic Alliance

“…With regard to its application in anxiety, MI fi rst appeared in the research literature in the form of case series (Westra, 2004 ;Westra & Phoenix, 2003 ) . Subsequently, MI was applied as a part of a pilot trial by Westra and Dozois ( 2006 ) involving 55 patients whose principal diagnoses consisted of panic disorder (45%), social phobia (31%), and GAD (24%), where patients were randomized to CBT with or without a pretreatment MI intervention.…”