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Remmerswaal KC, Batelaan NM, van Oppen P, Scholten WD, van Balkom AJ. Multifaceted, Brief Intensive Home-Based Exposure Treatment in Patients with Obsessive-Compulsive Disorder Who are Nonresponsive to Regular Cognitive Behavior Therapy: An Uncontrolled Pilot Study. J Psychiatr Pract 2024; 30:297-307. [PMID: 39058530 PMCID: PMC11280449 DOI: 10.1097/pra.0000000000000796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
OBJECTIVE To test a multifaceted treatment program for patients with obsessive-compulsive disorder (OCD) who did not respond to regular cognitive behavior therapy (CBT). The treatment addresses several factors that may play a role in maintaining OCD. METHODS We designed a treatment consisting of a 6-day intensive, individual exposure in vivo with response prevention (ERP) format, with 24 therapist-assisted treatment hours at the patient's home and 12 self-controlled ERP hours, including behavioral activation and family interventions. Next, we investigated the effect (obsessive-compulsive symptoms, comorbidity, functioning, quality of life, OCD-related interaction patterns) and feasibility (dropout, treatment satisfaction, and organization) of this program using pre-post-tests, pre-follow-up tests, and qualitative data from patients, family members, and therapists. RESULTS In a sample of 22 participants, obsessive-compulsive symptoms (Y-BOCS pre: 28.7, post: 15.9; Wilcoxon S-R tests P<0.01) improved significantly, as did most other effect measures. Results were largely, but not completely, preserved at 3-month follow-up. There was only 1 dropout. Patients, family members, and therapists were satisfied with the treatment. Implementation of the treatment did not pose difficulties. CONCLUSIONS In nonresponders with OCD, a multifaceted, brief, intensive home-based ERP program targeting factors maintaining OCD is promising and feasible. Extra care is needed to maintain improvement.
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Mallott MA, Stryker JST, Schmidt NB. Paranoia and Social Anxiety: Predicting Aggressive Behavior. Behav Ther 2024; 55:825-838. [PMID: 38937053 DOI: 10.1016/j.beth.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 12/06/2023] [Accepted: 12/12/2023] [Indexed: 06/29/2024]
Abstract
Aggression is a transdiagnostic behavior that is associated with poor clinical outcomes. As such, it is important to understand factors that contribute to various manifestations of aggressive behavior. Recent research has revealed a subtype of individuals with social anxiety disorder (SAD) who tend to display relatively high amounts of aggression and experience more severe social anxiety and dysfunction compared to individuals in the prototypical SAD group. The current study used a status threat manipulation along with behavioral indices of aggression to examine the impact of paranoia and social anxiety symptom severity on aggression in a sample of undergraduates with social anxiety (N = 220). Analyses indicated that paranoia uniquely predicted indirect aggression whereas an interaction between social status threat, paranoia, and social anxiety severity uniquely predicted direct aggression. These findings suggest that paranoia may be a particularly important contributor to aggression among individuals with social anxiety.
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Ragnarsson EH, Reinebo G, Ingvarsson S, Lindgren A, Beckman M, Alfonsson S, Hedman-Lagerlöf M, Rahm C, Sahlin H, Stenfors T, Sörman K, Jansson-Fröjmark M, Lundgren T. Effects of Training in Cognitive Behavioural Therapy and Motivational Interviewing on Mental Health Practitioner Behaviour: A Systematic Review and Meta-Analysis. Clin Psychol Psychother 2024; 31:e3003. [PMID: 38855846 DOI: 10.1002/cpp.3003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 06/11/2024]
Abstract
Effective training of mental health professionals is crucial for bridging the gap between research and practice when delivering cognitive behavioural therapy (CBT) and motivational interviewing (MI) within community settings. However, previous research has provided inconclusive evidence regarding the impact of training efforts. The current study aimed to systematically search, review and synthesize the literature on CBT and MI training to assess its effect on practitioner behavioural outcomes. Following prospective registration, a literature search was conducted for studies where mental health practitioners were exposed to training in face-to-face CBT or MI, reporting on at least one quantitative practitioner behavioural outcome. A total of 116 studies were eligible for the systematic review, and 20 studies were included in four meta-analyses. The systematic review highlights the need to establish psychometrically valid outcome measures for practitioner behaviour. Results of the meta-analyses suggest that training has a greater effect on practitioner behaviour change compared to receiving no training or reading a treatment manual. Training combined with consultation/supervision was found to be more effective than training alone, and no differences were found between face-to-face and online training. Results should be interpreted with caution due to methodological limitations in the primary studies, large heterogeneity, and small samples in the meta-analyses. Future directions are discussed.
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Affiliation(s)
- Emma Högberg Ragnarsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
| | - Gustaf Reinebo
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
| | - Sara Ingvarsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
| | - Annika Lindgren
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
| | - Maria Beckman
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
| | - Sven Alfonsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
| | - Maria Hedman-Lagerlöf
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
| | - Christoffer Rahm
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
| | - Hanna Sahlin
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
| | - Terese Stenfors
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Karolina Sörman
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
| | - Markus Jansson-Fröjmark
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
| | - Tobias Lundgren
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
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Abstract
This review traces the development of motivational interviewing (MI) from its happenstance beginnings and the first description published in this journal in 1983, to its continuing evolution as a method that is now in widespread practice in many professions, nations and languages. The efficacy of MI has been documented in hundreds of controlled clinical trials, and extensive process research sheds light on why and how it works. Developing proficiency in MI is facilitated by feedback and coaching based on observed practice after initial training. The author reflects on parallels between MI core processes and the characteristics found in 70 years of psychotherapy research to distinguish more effective therapists. This suggests that MI offers an evidence-based therapeutic style for delivering other treatments more effectively. The most common use of MI now is indeed in combination with other treatment methods such as cognitive behaviour therapies.
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Affiliation(s)
- William R Miller
- Department of Psychology, The University of New Mexico, Albuquerque, NM, USA
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Hovmand OR, Reinholt N, Dichmann K, Borisov R, Arnfred S. Social phobia and evasiveness: trial protocol for a randomized controlled feasibility and superiority trial of the effect of Modified Collaborative Assessment vs. standard assessment on patients' readiness for psychotherapy (CO-ASSM-RCT). Pilot Feasibility Stud 2023; 9:102. [PMID: 37340450 DOI: 10.1186/s40814-023-01332-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 05/26/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Evasive personality disorder (AvPD) and social phobia (SP) have substantial costs for patients and their families and great economic costs to the society. While psychotherapy can be an efficacious treatment, many patients drop out during treatment. Increased knowledge on how to decrease dropout from psychotherapy is warranted, including how to increase a patient's readiness for psychotherapy. METHODS We describe a randomized controlled feasibility and superiority trial of 42 individuals with a clinical diagnosis of either SP or AvPD, who are to initiate psychotherapeutic treatment in Danish outpatient mental health services. They will be randomized in a 1:1 ratio to either assessment-as-usual and receive no further assessment or to a Modified Collaborative Assessment (MCA) provided as a pre-treatment intervention before psychotherapy initiation. MCA will include a battery of psychological tests designed to thoroughly assess the patients' psychopathology. The tests are administered in collaboration with the patient, including detailed oral and written feedback. We hypothesize that the intervention is feasible regarding patient's acceptance and adherence. We further hypothesize that patients randomized to MCA will reach higher levels of readiness for psychotherapy as assessed with the University of Rhode Island Change Assessment Scale (URICA). DISCUSSION This protocol assesses the feasibility, efficacy, acceptability, and safety of an intervention aimed at changing the readiness for participation in psychotherapy of patients with SP and AvPD. Results from this feasibility study could guide the development of future large-scale trials of MCA and procedures for MCA treatment fidelity assessment. TRIAL REGISTRATION NCT2021001.
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Affiliation(s)
- Oliver Rumle Hovmand
- Department of Clinical Medicine, Faculty of Health, University of Copenhagen, Copenhagen, Denmark.
- Psychiatric Research Unit, Region Zealand Mental Health Service, Fælledvej 6, 4200, Slagelse, Denmark.
| | - Nina Reinholt
- Psychiatric Research Unit, Region Zealand Mental Health Service, Fælledvej 6, 4200, Slagelse, Denmark
| | - Kirstine Dichmann
- Department of Clinical Medicine, Faculty of Health, University of Copenhagen, Copenhagen, Denmark
- Research Unit for Psychotherapy and Psychopathology, Region Zealand Mental Health Service, Fælledvej 6, 4200, Slagelse, Denmark
- Department of Forensic Psychiatry, Region Zealand Mental Health Service, Slagelse, Denmark
| | - Radoslav Borisov
- Psychiatry South, Region Zealand Mental Health Service, Ramsherred 1, 1. Sal, 4700, Naestved, Denmark
| | - Sidse Arnfred
- Department of Clinical Medicine, Faculty of Health, University of Copenhagen, Copenhagen, Denmark
- Psychiatric Research Unit, Region Zealand Mental Health Service, Fælledvej 6, 4200, Slagelse, Denmark
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Del Mauro L, Vergallito A, Gattavara G, Juris L, Gallucci A, Vedani A, Cappelletti L, Farneti PM, Romero Lauro LJ. Betting on Non-Invasive Brain Stimulation to Treat Gambling Disorder: A Systematic Review and Meta-Analysis. Brain Sci 2023; 13:698. [PMID: 37190663 PMCID: PMC10136786 DOI: 10.3390/brainsci13040698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
Gambling disorder (GD) is a behavioral addiction that severely impacts individuals' functioning, leading to high socioeconomic costs. Non-invasive brain stimulation (NiBS) has received attention for treating psychiatric and neurological conditions in recent decades, but there is no recommendation for its use for GD. Therefore, this study aimed to systematically review and analyze the available literature to determine the effectiveness of NiBS in treating GD. Following the PRISMA guidelines, we screened four electronic databases up to July 2022 and selected relevant English-written original articles. We included ten papers in the systematic review and seven in the meta-analysis. As only two studies employed a sham-controlled design, the pre-post standardized mean change (SMCC) was computed as effect size only for real stimulation. The results showed a significant effect of NiBS in reducing craving scores (SMCC = -0.69; 95% CI = [-1.2, -0.2], p = 0.010). Moreover, considering the GD's frequent comorbidity with mood disorders, we ran an exploratory analysis of the effects of NiBS on depressive symptoms, which showed significant decreases in post-treatment scores (SMCC = -0.71; 95% CI = [-1.1, -0.3], p < 0.001). These results provide initial evidence for developing NiBS as a feasible therapy for GD symptoms but further comprehensive research is needed to validate these findings. The limitations of the available literature are critically discussed.
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Affiliation(s)
- Lilia Del Mauro
- Department of Psychology, University of Milano-Bicocca, 20126 Milano, Italy
- Fondazione Eris Onlus, 20134 Milano, Italy
| | - Alessandra Vergallito
- Department of Psychology & Neuromi, University of Milano-Bicocca, 20126 Milano, Italy
| | - Gaia Gattavara
- Department of Psychology, University of Milano-Bicocca, 20126 Milano, Italy
| | | | - Alessia Gallucci
- Ph.D. Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Anna Vedani
- Department of Psychology, University of Milano-Bicocca, 20126 Milano, Italy
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Bernardsdóttir B, Sandahl H, Carlsson J, Mortensen EL, Palic S. Psychotherapy readiness domains as predictors of psychotherapy outcome in trauma-affected refugees. J Affect Disord 2023; 325:248-255. [PMID: 36586606 DOI: 10.1016/j.jad.2022.12.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Little is known about predictors of psychotherapy outcome in trauma-affected refugees. Knowledge on outcome predictors can help clinicians identify patients prior to treatment who are not likely to benefit from standardized psychotherapy and take additional measures to adjust treatment to the individual patient. Given the dynamic nature of psychotherapy readiness domains, they represent potential targets to be worked with in therapy in order to improve outcomes. METHODS Psychotherapy readiness domains (locus of control, cognitive functioning, motivation for therapy, and personality functioning) were examined as potential predictors of psychotherapy outcome in trauma-affected refugees. Secondary analyses were conducted on data from a pragmatic randomized controlled trial. Study participants (N = 190) were refugees with PTSD who received flexible manual-based Cognitive Behavioral Therapy (CBT) at a psychiatric outpatient clinic in Denmark. Psychotherapy readiness domains were assessed via semi-structured interviews at the beginning of psychotherapy. Outcome variables were pre-post change in PTSD symptomology and global level of functioning. RESULTS Multiple regression analyses revealed that higher motivation for psychotherapy predicted improvement in PTSD symptomology and global level of functioning. Moreover, higher cognitive functioning predicted improvement in global level of functioning. LIMITATIONS The predictor rating scales need further psychometric evaluations in cross-cultural contexts. CONCLUSIONS These findings highlight the importance of considering motivation in psychotherapy offered to trauma-affected refugees. Further research is needed to identify potential barriers to motivation in this diverse patient population and to determine whether motivational interventions can lead to improved treatment outcomes.
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Affiliation(s)
- Berglind Bernardsdóttir
- Competence Center for Transcultural Psychiatry, Mental Health Center Ballerup, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark.
| | - Hinuga Sandahl
- Competence Center for Transcultural Psychiatry, Mental Health Center Ballerup, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark
| | - Jessica Carlsson
- Competence Center for Transcultural Psychiatry, Mental Health Center Ballerup, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Sabina Palic
- Competence Center for Transcultural Psychiatry, Mental Health Center Ballerup, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark
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Ong CW, Hayes SC, Hofmann SG. A process-based approach to cognitive behavioral therapy: A theory-based case illustration. Front Psychol 2022; 13:1002849. [PMID: 36389539 PMCID: PMC9642026 DOI: 10.3389/fpsyg.2022.1002849] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/10/2022] [Indexed: 09/14/2023] Open
Abstract
Despite the significant contribution of cognitive-behavioral therapy to effective treatment options for specific syndromes, treatment progress has been stagnating, with response rates plateauing over the past several years. This stagnation has led clinical researchers to call for an approach that instead focuses on processes of change and the individual in their particular context. Process-based therapy (PBT) is a general approach representing a model of models, grounded in evolution science, with an emphasis on idiographic methods, network models of case conceptualization, and enhancing wellbeing. In this paper, we describe the theory underlying PBT and present a case study for how to apply PBT tools and principles to deliver process-informed and person-centered evidence-based treatment. In addition, we discuss lessons learned from our case and provide suggestions for future considerations when implementing PBT in clinical settings.
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Affiliation(s)
- Clarissa W. Ong
- Department of Psychology, University of Toledo, Toledo, OH, United States
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, United States
| | - Steven C. Hayes
- Department of Psychology, University of Nevada, Reno, Reno, NV, United States
| | - Stefan G. Hofmann
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, United States
- Department of Psychology, Philipps-Universität Marburg, Marburg, Germany
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Uzun S, Özmaya E. The effect of motivational interview conducted by nurses on quality of life: Meta-analysis. Perspect Psychiatr Care 2022; 58:2449-2459. [PMID: 35383938 DOI: 10.1111/ppc.13080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/12/2022] [Accepted: 03/23/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The aim of the study is to examine the effect of the motivational interviewing method conducted by nurses on the quality of life of patients with chronic diseases. DESIGN AND METHODS The studies examined in this meta-analysis study were obtained by scanning the PubMed, Web of Science, EBSCOhost, Google Scholar, and YÖK thesis databases between January and May 2021 without any year limitation. After the elimination, 16 studies were included in the study. The data were synthesized with meta-analysis and narrative methods. The total sample size of the studies was 14,425. FINDINGS This meta-analysis demonstrated that the motivational interviewing method applied by nurses in individuals with chronic diseases changed their quality of life (SMD: 0.258, 95% confidence interval: 0.076-0.441; Z = 2.775, p = 0.006, I2 = 89.97%). The variance between studies was statistically significant (p < 0.05) for the moderator of the measurement tools, the duration of the motivational interviews, and the country/continent of the studies were conducted (p < 0.05), suggesting that the measurement tools, the duration of the motivational interview, and the country/continent of the studies changed the effect size of the motivational interview method on the quality of life. PRACTICE IMPLICATIONS It has been concluded that the motivational interview method applied by nurses who are in a critical position in the protection and development of health improves the quality of life of individuals with chronic diseases.
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Affiliation(s)
- Sevda Uzun
- Department of Nursing, Faculty of Health Sciences, Gümüşhane University, Gümüşhane, Turkey
| | - Esma Özmaya
- Department of Health Care, Vocational School of Health Services, Karamanoğlu Mehmetbey University, Karaman, Turkey
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Newman MG, Basterfield C, Erickson TM, Caulley E, Przeworski A, Llera SJ. Psychotherapeutic treatments for generalized anxiety disorder: cognitive and behavioral therapies, enhancement strategies, and emerging efforts. Expert Rev Neurother 2022; 22:751-770. [PMID: 36107159 PMCID: PMC9754763 DOI: 10.1080/14737175.2022.2125800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 09/14/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Generalized anxiety disorder (GAD) is common and disabling. Different versions of cognitive behavioral therapy (CBT) have been tested, but no treatment works for everyone. Therefore, researchers have attempted approaches to enhance CBT. AREAS COVERED The current narrative review examines meta-analyses and individual trials of CBT-based treatments for GAD. We focus on CBT and its cognitive and behavioral components as well as efforts to enhance CBT and its dissemination and generalizability. Enhancement efforts included interpersonal and emotional processing therapy, mindfulness-based CBT, emotion regulation therapy, intolerance of uncertainty therapy, the unified protocol, metacognitive therapy, motivational interviewing, and contrast avoidance targeted treatment. Emerging strategies to enhance dissemination have focused on technologically based treatments. Attempts at generalizability have included examination of efficacy within diverse racial and ethnic groups. EXPERT OPINION We conclude that CBT is efficacious, and a number of enhancement efforts have shown some promise in improving upon CBT in single trials. However, more research is needed, particularly efforts to determine which enhancements work best for which individuals and what are the mechanisms of change. Furthermore, few technological interventions have been compared to active treatments. Finally, much more attention needs to be paid to ethnic and racial diversity in randomized controlled trials.
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Affiliation(s)
- Michelle G Newman
- Department of Psychology, The Pennsylvania State University, Park, PA, USA
| | | | - Thane M Erickson
- Department of Psychology, Seattle Pacific University, Seattle, Washington, USA
| | - Evan Caulley
- Department of Psychology, Seattle Pacific University, Seattle, Washington, USA
| | - Amy Przeworski
- Department of Psychology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sandra J Llera
- Department of Psychology, Towson University, Baltimore, Maryland, USA
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Jardine J, Bowman R, Doherty G. Digital Interventions to Enhance Readiness for Psychological Therapy: Scoping Review. J Med Internet Res 2022; 24:e37851. [PMID: 36040782 PMCID: PMC9472056 DOI: 10.2196/37851] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/02/2022] [Accepted: 07/31/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Psychological therapy is an effective treatment method for mental illness; however, many people with mental illness do not seek treatment or drop out of treatment early. Increasing client uptake and engagement in therapy is key to addressing the escalating global problem of mental illness. Attitudinal barriers, such as a lack of motivation, are a leading cause of low engagement in therapy. Digital interventions to increase motivation and readiness for change hold promise as accessible and scalable solutions; however, little is known about the range of interventions being used and their feasibility as a means to increase engagement with therapy. OBJECTIVE This review aimed to define the emerging field of digital interventions to enhance readiness for psychological therapy and detect gaps in the literature. METHODS A literature search was conducted in PubMed, PsycINFO, PsycARTICLES, Scopus, Embase, ACM Guide to Computing Literature, and IEEE Xplore Digital Library from January 1, 2006, to November 30, 2021. The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) methodology was applied. Publications were included when they concerned a digitally delivered intervention, a specific target of which was enhancing engagement with further psychological treatment, and when this intervention occurred before the target psychological treatment. RESULTS A total of 45 publications met the inclusion criteria. The conditions included depression, unspecified general mental health, comorbid anxiety and depression, smoking, eating disorders, suicide, social anxiety, substance use, gambling, and psychosis. Almost half of the interventions (22/48, 46%) were web-based programs; the other formats included screening tools, videos, apps, and websites. The components of the interventions included psychoeducation, symptom assessment and feedback, information on treatment options and referrals, client testimonials, expectation management, and pro-con lists. Regarding feasibility, of the 16 controlled studies, 7 (44%) measuring actual behavior or action showed evidence of intervention effectiveness compared with controls, 7 (44%) found no differences, and 2 (12%) indicated worse behavioral outcomes. In general, the outcomes were mixed and inconclusive owing to variations in trial designs, control types, and outcome measures. CONCLUSIONS Digital interventions to enhance readiness for psychological therapy are broad and varied. Although these easily accessible digital approaches show potential as a means of preparing people for therapy, they are not without risks. The complex nature of stigma, motivation, and individual emotional responses toward engaging in treatment for mental health difficulties suggests that a careful approach is needed when developing and evaluating digital readiness interventions. Further qualitative, naturalistic, and longitudinal research is needed to deepen our knowledge in this area.
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Affiliation(s)
- Jacinta Jardine
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Robert Bowman
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Gavin Doherty
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
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Peynenburg V, Hadjistavropoulos H, Thiessen D, Titov N, Dear B. A Randomized Factorial Trial of Internet-Delivered Cognitive Behaviour Therapy for Post-Secondary Students: Examining Motivational Interviewing and Booster Lessons (Preprint). J Med Internet Res 2022; 24:e40637. [PMID: 36069785 PMCID: PMC9494224 DOI: 10.2196/40637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/28/2022] [Accepted: 08/12/2022] [Indexed: 12/05/2022] Open
Abstract
Background Internet-delivered cognitive behavioral therapy (ICBT) can improve access to mental health care for students, although high attrition rates are concerning and little is known about long-term outcomes. Motivational interviewing (MI) exercises and booster lessons can improve engagement and outcomes in face-to-face cognitive behavioral therapy. Objective This study aimed to examine the use of pretreatment MI exercises and booster lessons in ICBT for postsecondary students. Methods In this factorial trial (factor 1: web-based MI before treatment; factor 2: self-guided booster lesson 1 month after treatment), 308 clients were randomized to 1 of 4 treatment conditions, with 277 (89.9%) clients starting treatment. All clients received a 5-week transdiagnostic ICBT course (the UniWellbeing course). Primary outcomes included changes in depression, anxiety, and perceived academic functioning from before treatment to after treatment and at the 1-month and 3-month follow-ups. Results Overall, 54% (150/277) of students completed treatment and reported large improvements in symptoms of depression and anxiety and small improvements in academic functioning after treatment, which were maintained at the 1-month and 3-month follow-ups. Pretreatment MI did not contribute to better treatment completion or engagement, although small between-group effects favored MI for reductions in depression (Cohen d=0.23) and anxiety (Cohen d=0.25) after treatment. Only 30.9% (43/139) of students randomized to one of the booster conditions accessed the booster. Overall, no main effects were found for the booster. Subanalyses revealed that clients who accessed the booster had larger decreases in depressive symptoms (Cohen d=0.31) at the 3-month follow-up. No interactions were found between MI and the booster. Conclusions Rather than offering MI before treatment, clients may experience more benefits from MI exercises later in ICBT when motivation wanes. The low uptake of the self-guided booster limited our conclusions regarding its effectiveness. Future research should examine offering a booster for a longer duration after treatment, with therapist support and a longer follow-up period. Trial Registration ClinicalTrials.gov NCT04264585; https://clinicaltrials.gov/ct2/show/NCT04264585
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Affiliation(s)
| | | | - David Thiessen
- Department of Psychology, University of Regina, Regina, SK, Canada
| | - Nickolai Titov
- eCentre Clinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Blake Dear
- eCentre Clinic, Department of Psychology, Macquarie University, Sydney, Australia
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Serio C, Gabarda A, Uyar-Morency F, Silfee V, Ludwig J, Szigethy E, Butterworth S. Strengthening the Impact of Digital Cognitive Behavioral Interventions through a Dual Intervention: Proficient Motivational Interviewing-based Health Coaching Plus In-Application Techniques (Preprint). JMIR Form Res 2021; 6:e34552. [PMID: 35544323 PMCID: PMC9133992 DOI: 10.2196/34552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/10/2022] [Accepted: 02/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background The COVID-19 pandemic has accelerated the adoption of digital tools to support individuals struggling with their mental health. The use of a digital intervention plus human coaching (“dual” intervention) is gaining momentum in increasing overall engagement in digital cognitive behavioral interventions (dCBIs). However, there is limited insight into the methodologies and coaching models used by those deploying dual interventions. To achieve a deeper understanding, we need to identify and promote effective engagement that leads to clinical outcomes versus simply monitoring engagement metrics. Motivational interviewing (MI) is a collaborative, goal-oriented communication approach that pays particular attention to the language of change and is an effective engagement approach to help people manage mental health issues. However, this approach has been traditionally used for in-person or telephonic interventions, and less is known about the application of MI to digital interventions. Objective We sought to provide a dual intervention approach and address multiple factors across two levels of engagement to operationalize a dCBI that combined cognitive behavioral therapy–based techniques and MI-based interactions between the digital health coach (DHC) and user. Methods We reviewed hundreds of digital exchanges between DHCs and users to identify and improve training and quality assurance activities for digital interventions. Results We tested five hypotheses and found that: (1) users of a dual digital behavioral health intervention had greater engagement levels than users of a noncoached intervention (P<.001); (2) DHCs with a demonstrated competency in applying MI to digital messages had more engaged users, as measured by the DHC-to-user message exchange ratio (P<.001); (3) the DHC-to-user message exchange ratio was correlated with more engagement in app activities (r=0.28, 95% CI 0.23-0.33); (4) DHCs with demonstrated MI proficiency elicited a greater amount of “change talk” from users than did DHCs without MI proficiency (H=25.12, P<.001); and (5) users who were engaged by DHCs with MI proficiency had better clinical outcomes compared to users engaged by DHCs without MI proficiency (P=.02). Conclusions To our knowledge, this pilot was the first of its kind to test the application of MI to digital coaching protocols, and it demonstrated the value of MI proficiency in digital health coaching for enhanced engagement and health improvement. Further research is needed to establish coaching models in dCBIs that incorporate MI to promote effective engagement and optimize positive behavioral outcomes.
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Affiliation(s)
- Catherine Serio
- UPMC Health Plan, Pittsburgh, PA, United States
- Happify Health, New York, NY, United States
| | | | | | | | | | - Eva Szigethy
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
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Ellis AE, Martino S, Simiola V, Mackintosh MA, Bellamy C, Cook JM. Study design and interventions for a peer-delivered motivational interviewing group treatment for sexual and gender minority male sexual trauma survivors. Contemp Clin Trials 2021; 111:106597. [PMID: 34653650 DOI: 10.1016/j.cct.2021.106597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Abstract
Sexual abuse of boys and men is a public health problem that has received relatively little attention from clinical scholars and researchers. Given unique pathways for development of and recovery from trauma-related emotional distress, sexual abuse survivors who identify as men may require distinct psychosocial interventions to engage in formal mental health care and assist in symptom reduction. This paper describes the rationale for and methodology of a randomized controlled trial comparing the effectiveness of Motivational Interviewing (MI) versus MI with affirmative care (MI-AC) for sexual and gender minority men who have been sexually traumatized. This study is designed to randomly assign 356 participants to either condition of six online group sessions delivered by two trained peers with lived experience of sexual trauma. Assessments will be conducted at baseline, post-treatment, 60- and 120-day follow-up. The primary hypotheses are that participants assigned to MI-AC, compared to those in MI only, will report reduced symptoms of depression and increased levels of engagement in formal mental health treatment. Additional hypotheses relate to secondary outcome variables, including post-traumatic stress disorder, suicidality, and substance use.
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Affiliation(s)
- Amy E Ellis
- Nova Southeastern University, Fort Lauderdale, FL, United States of America.
| | - Steve Martino
- Yale School of Medicine, New Haven, CT, United States of America; VA Connecticut Healthcare System, West Haven, CT, United States of America
| | - Vanessa Simiola
- Kaiser Permanente, Center for Health Care Research, Honolulu, HI, United States of America
| | | | - Chyrell Bellamy
- Yale School of Medicine, New Haven, CT, United States of America
| | - Joan M Cook
- Yale School of Medicine, New Haven, CT, United States of America
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Reinauer C, Platzbecker AL, Viermann R, Domhardt M, Baumeister H, Foertsch K, Linderskamp H, Krassuski L, Staab D, Minden K, Kilian R, Holl RW, Warschburger P, Meißner T. Efficacy of Motivational Interviewing to Improve Utilization of Mental Health Services Among Youths With Chronic Medical Conditions: A Cluster Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2127622. [PMID: 34596672 PMCID: PMC8486984 DOI: 10.1001/jamanetworkopen.2021.27622] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE Despite the high prevalence of anxiety and depression in youths with chronic medical conditions (CMCs), physicians encounter substantial barriers in motivating these patients to access mental health care services. OBJECTIVE To determine the efficacy of motivational interviewing (MI) training for pediatricians in increasing youths' use of mental health care. DESIGN, SETTING, AND PARTICIPANTS The COACH-MI (Chronic Conditions in Adolescents: Implementation and Evaluation of Patient-Centered Collaborative Healthcare-Motivational Interviewing) study was a single-center cluster randomized clinical trial at the University Children's Hospital specialized outpatient clinics in Düsseldorf, Germany. Treating pediatricians were cluster randomized to a 2-day MI workshop or treatment as usual (TAU). Patient recruitment and MI conversations occurred between April 2018 and May 2020 with 6-month follow-up and 1-year rescreening. Participants were youths aged 12 to 20 years with CMCs and comorbid symptoms of anxiety and depression; they were advised by their MI-trained or untrained physicians to access psychological counseling services. Statistical analysis was performed from October 2020 to April 2021. INTERVENTIONS MI physicians were trained through a 2-day, certified MI training course; they recommended use of mental health care services during routine clinical appointments. MAIN OUTCOMES AND MEASURES The primary outcome of uptake of mental health care services within the 6-month follow-up was analyzed using a logistic mixed model, adjusted for the data's cluster structure. Uptake of mental health services was defined as making at least 1 appointment by the 6-month follow-up. RESULTS Among 164 youths with CMCs and conspicuous anxiety or depression screening, 97 (59%) were female, 94 (57%) had MI, and 70 (43%) had TAU; the mean (SD) age was 15.2 (1.9) years. Compared with patients receiving TAU, the difference in mental health care use at 6 months among patients whose physicians had undergone MI training was not statistically significant (odds ratio [OR], 1.96; 95% CI, 0.98-3.92; P = .06). The effect was moderated by the subjective burden of disease (F2,158 = 3.42; P = .04). Counseling with an MI-trained physician also led to lower anxiety symptom scores at 1-year rescreening (F1,130 = 4.11; P = .045). MI training was associated with longer conversations between patients and physicians (30.3 [16.7] minutes vs 16.8 [12.5] minutes; P < .001), and conversation length significantly influenced uptake rates across conditions (OR, 1.03; 95% CI, 1.01-1.06; P = .005). CONCLUSIONS AND RELEVANCE In this study, use of MI in specialized pediatric consultations did not increase the use of mental health care services among youths with CMCs but did lead to longer patient-physician conversations and lower anxiety scores at 1 year. Additional research is required to determine whether varying scope and duration of MI training for physicians could encourage youths with CMCs to seek counseling and thus improve integrated care models. TRIAL REGISTRATION German Trials Registry: DRKS00014043.
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Affiliation(s)
- Christina Reinauer
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Anna Lena Platzbecker
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Rabea Viermann
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Matthias Domhardt
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Katharina Foertsch
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Hannah Linderskamp
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Lisa Krassuski
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Doris Staab
- Department of Pediatric Pneumology and Immunology, University Children's Hospital Charité of Humboldt University, Berlin, Germany
| | - Kirsten Minden
- German Rheumatism Research Centre Berlin, and Charité, University Medicine, Berlin, Germany
| | - Reinhold Kilian
- Department of Psychiatry and Psychotherapy II, University of Ulm and BKH Günzburg, Günzburg, Germany
| | - Reinhard W. Holl
- Institute for Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| | - Petra Warschburger
- Department of Psychology, Counseling Psychology, University of Potsdam, Potsdam, Germany
| | - Thomas Meißner
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University, Düsseldorf, Germany
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16
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Integrating motivational interviewing with cognitive behavioural therapy for anxiety disorders, depression and co-morbid unhealthy lifestyle behaviours: a randomised controlled pilot trial. Behav Cogn Psychother 2021; 50:74-88. [PMID: 34409931 DOI: 10.1017/s1352465821000345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND A substantial proportion of patients receiving cognitive behavioural therapy (CBT) do not achieve remission, and drop-out is considerable. Motivational interviewing (MI) may influence non-response and drop-out. Previous research shows that MI as a pre-treatment to CBT produces moderate effects compared with CBT alone. Studies integrating MI with CBT (MI-CBT) are scarce. AIMS To test the feasibility of MI-CBT in terms of therapist competence in MI and various participant measures, including recruitment and retention. In addition, separate preliminary evaluations were conducted, exploring the effects of CBT alone for anxiety disorders and depression, and of MI-CBT for anxiety disorders, depression and unhealthy lifestyle behaviours. METHOD Using a randomised controlled parallel trial design, participants were recruited in routine psychiatric care and allocated to CBT alone or MI-CBT. Means in feasibility measures and within-condition Hedges' g effect sizes in treatment outcome measures were calculated. Authors were not blind to treatment allocation, while independent raters were blind. RESULTS Seventy-three patients were assessed for eligibility, and 49 were included. Participant perceptions of treatment credibility, expectancy for improvement, and working alliance were similar for both conditions. Overall, effect sizes were large across outcome measures for both conditions, including anxiety and depressive symptoms and functional impairment. However, therapists did not acquire sufficient competence in MI and the drop-out rate was high. CONCLUSIONS MI-CBT proved feasible in some respects, but the present study did not support the progression to a randomised controlled trial designed to assess the effectiveness of MI-CBT. Additional pilot studies are needed.
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Atkinson C, Kenneally O. A model for therapeutic educational psychology practice. EDUCATIONAL PSYCHOLOGY IN PRACTICE 2021. [DOI: 10.1080/02667363.2021.1933393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Cathy Atkinson
- Manchester Institute of Education, Ellen Wilkinson Building, University of Manchester, Manchester, UK
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18
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Lück S, Kienle R, Langenbeck S, Sehy V, Freytag J. Motivierende Gesprächsführung mit Simulationspatient_innen lehren und prüfen. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2021. [DOI: 10.1026/1616-3443/a000637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Simulationspatient_innen (SP) werden in der medizinischen Ausbildung zum Erlernen und Prüfen kommunikativer Kompetenzen eingesetzt. Fragestellung: Wie wird Motivierende Gesprächsführung (MI) mit SP an der Charité Berlin gelehrt und geprüft? Methode: MI wird im Modellstudiengang Medizin im 4. Semester gelehrt und im Rahmen einer Objective Structured Clinical Examination (OSCE) geprüft. Es wurden Lehr- und Prüfungsevaluationen und die Beobachtungsübereinstimmung erhoben. Die Komplexität von MI erfordert spezielle Methoden für das SP-Training. Ergebnisse: In der Lehrveranstaltungsevaluation gaben 74,5 % der Studierenden und 90 % der Dozierenden an, dass MI-Kompetenzen erworben wurden, in der Prüfungsstation erreichten Studierende einen Leistungsmittelwert von 78 % ( SD = 2.1 %). Die Beobachtungsübereinstimmung lag bei r = .74 ( p = .009), r = .88 ( p < .001) und r = .47 ( p = .091). Die Prüfenden bewerteten die MI-Prüfungsstation überwiegend (sehr) gut. Schlussfolgerungen: MI kann mit SP gelehrt und geprüft werden, birgt aber Herausforderungen für SP-Training und Testkonstruktion.
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Affiliation(s)
- Susanne Lück
- Prodekanat für Studium und Lehre, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Rolf Kienle
- Prodekanat für Studium und Lehre, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Sylke Langenbeck
- Prodekanat für Studium und Lehre, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Victoria Sehy
- Prodekanat für Studium und Lehre, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Julia Freytag
- Prodekanat für Studium und Lehre, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin
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19
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Whittall H, Kahn M, Pillion M, Gradisar M. Parents matter: barriers and solutions when implementing behavioural sleep interventions for infant sleep problems. Sleep Med 2021; 84:244-252. [PMID: 34182352 DOI: 10.1016/j.sleep.2021.05.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/26/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
Behavioural sleep interventions (eg, extinction-based methods) are among the most efficacious evidence-based techniques in the treatment of infant sleep problems. However, behavioural sleep interventions can be challenging for families to successfully implement. This review aims to summarise current research surrounding the potential barriers that arise when clinicians attempt to implement extinction-based methods with parents of infants. We provide a model that summarises 3 types of contextual-barriers; socio-cultural barriers, parent barriers, and infant barriers. Based on the current evidence, we propose that adopting a stepped care approach, planning ahead, increasing support, motivational interviewing, and/or emotional regulation may serve as useful tools for parents when implementing extinction-based methods. By considering these techniques, more families may receive the benefits of improved infant sleep.
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Affiliation(s)
- Hannah Whittall
- Flinders University, College of Education, Psychology and Social Work, Adelaide, South Australia, Australia.
| | - Michal Kahn
- Flinders University, College of Education, Psychology and Social Work, Adelaide, South Australia, Australia
| | - Meg Pillion
- Flinders University, College of Education, Psychology and Social Work, Adelaide, South Australia, Australia
| | - Michael Gradisar
- Flinders University, College of Education, Psychology and Social Work, Adelaide, South Australia, Australia
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20
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Richter J, Pané-Farré CA, Gerlach AL, Gloster AT, Wittchen HU, Lang T, Alpers GW, Helbig-Lang S, Deckert J, Fydrich T, Fehm L, Ströhle A, Kircher T, Arolt V, Hamm AO. Transfer of exposure therapy effects to a threat context not considered during treatment in patients with panic disorder and agoraphobia: Implications for potential mechanisms of change. Behav Res Ther 2021; 142:103886. [PMID: 34023593 DOI: 10.1016/j.brat.2021.103886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/14/2021] [Accepted: 05/04/2021] [Indexed: 01/07/2023]
Abstract
Further developments of exposure-based therapy (EBT) require more knowledge about transfer of treatment to non-trained everyday contexts. However, little is known about transfer effects of EBT. Using a standardized EBT protocol in 275 patients with panic disorder and agoraphobia we investigated the transfer of EBT to a highly standardized context during a Behavioral Avoidance Test (BAT; being entrapped in a small and dark test chamber) and not part of the exposure sessions. Patients of a treatment group underwent the BATs before treatment (t1), after a preparatory treatment phase (t2), and after an agoraphobic exposure phase (t3) and were compared with wait-list control patients, who repeated BAT assessments across the same time period. We found stronger reductions in avoidance behavior, reported fear, and autonomic arousal during the BAT from t1 to t3 in the treatment group patients who were anxious during t1 relative to the anxious but untreated patients. Fear reduction was related to treatment outcome indicating the contribution of transfer effects to successful EBT. Interestingly, reduction varied for different fear response systems suggesting different processes to may be involved in transfer effects. Importantly, final BAT assessment still evoked residual fear in the treatment group as compared to BAT non-anxious control patients, suggesting limited transfer effects - one possible reason for the return of symptoms in new situations.
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Affiliation(s)
- Jan Richter
- Department of Biological and Clinical Psychology/Psychotherapy, University of Greifswald, Greifswald, Germany.
| | - Christiane A Pané-Farré
- Department of Biological and Clinical Psychology/Psychotherapy, University of Greifswald, Greifswald, Germany; Department of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
| | - Alexander L Gerlach
- Clinical Psychology and Psychotherapy, University of Cologne, Cologne, Germany
| | - Andrew T Gloster
- Department of Psychology, Division of Clinical Psychology and Intervention Science, University of Basel, Basel, Switzerland
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Thomas Lang
- Christoph-Dornier-Foundation for Clinical Psychology, Institute for Clinical Psychology Bremen, Bremen, Germany; Department for Psychology & Methods, Jacobs University Bremen, Bremen, Germany
| | - Georg W Alpers
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Sylvia Helbig-Lang
- Department of Psychology and Psychotherapy, University of Hamburg, Hamburg, Germany
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Thomas Fydrich
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lydia Fehm
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Volker Arolt
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany
| | - Alfons O Hamm
- Department of Biological and Clinical Psychology/Psychotherapy, University of Greifswald, Greifswald, Germany
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21
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A Review of Motivational Interviewing in Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder. J Cogn Psychother 2021; 35:116-132. [PMID: 33990444 DOI: 10.1891/jcpsy-d-20-00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although cognitive behavioral therapy (CBT) is a highly effective treatment for individuals with obsessive-compulsive disorder (OCD), a portion people with OCD do not benefit fully from CBT due to ambivalence about participating in treatment, nonadherence to exposure exercises, and dropout. This paper reviews the promising evidence for motivational interviewing (MI) as a therapeutic approach that is well suited to address these issues and potentially improve treatment outcomes. It will also provide a discussion of MI processes that may enhance CBT for OCD which can foster a collaborative relationship that integrates a patient's own goals and values into exposure planning, helps resolve ambivalence or reluctance to engage in exposure exercises and builds and supports patients' intrinsic motivation to participate in treatment. The review will conclude with a case report describing the use of pre-CBT MI for an individual with OCD.
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22
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Strodl E, Yang J. Motivational Interviewing Enhances Group Cognitive Behavioral Therapy for Anxiety Disorders. J Cogn Psychother 2021; 35:JCPSY-D-20-00025. [PMID: 33833090 DOI: 10.1891/jcpsy-d-20-00025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This pilot study tested whether the addition of motivational interviewing (MI) prior to group cognitive behavioral therapy (CBT) for anxiety may improve the effectiveness of the treatment. Prior to group CBT, 40 individuals with a principal diagnosis of an anxiety disorder (40% panic disorder, 25% generalized anxiety disorder, 22.5% social phobia, and 12.5% others) were randomly assigned to receive either three individual sessions of MI or were assigned to a control group that did not receive MI. The pretreatment MI group, compared to the control group, experienced significantly greater reduction in anxiety symptoms post-CBT. These results suggest that brief MI pretreatment enhances the efficacy of CBT on anxiety. A combination of MI and CBT may be particularly promising for the treatment of anxiety, with MI directed at increasing motivation and commitment to change, and CBT directed at helping the client achieve the desired changes.
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Affiliation(s)
- Esben Strodl
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Joel Yang
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Queensland, Australia
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23
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Billingsley BE, Steinberg ML. Motivational Interviewing Produces Change Talk in Smokers with Serious Mental Illness. J Dual Diagn 2021; 17:151-158. [PMID: 33725471 PMCID: PMC9514377 DOI: 10.1080/15504263.2021.1896826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Change talk, or client language that is consistent with making a behavioral change, has been found to improve the efficacy of motivational interviewing (MI). It is not known, however, if change talk helps to explain MI's effect on instigating a quit attempt in smokers with serious mental illness. Methods: We measured change talk in smokers with a serious mental illness (SMI) randomized to receive either a single session adaptation of motivational interviewing or an interactive education intervention. We evaluated relationships between treatment condition, proportion of change talk, and study outcomes of quit attempts and willingness to follow up on treatment provider referrals. Results: Participants receiving the adaptation of motivational interviewing had higher proportions of change talk than participants in the interactive education condition. However, total proportion of change talk did not mediate the relationship between treatment and outcome, nor did it predict making a quit attempt or following up on a referral to contact a treatment provider. Conclusions: Our study found that motivational interviewing has the same change talk augmenting effect in individuals with SMI as those without SMI. Given that anhedonia, negative affect, and depressive symptoms are a major part of serious mental illnesses, it is encouraging that MI can generate change talk in this population. Future smoking cessation intervention trials with larger samples should investigate whether greater amounts of change talk lead to increased quit attempts in this population.
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Affiliation(s)
- Benjamin E Billingsley
- Department of Psychology, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Marc L Steinberg
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
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24
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Romano M, Peters L. The effect of motivational interviewing on ambivalence in social anxiety disorder. Behav Cogn Psychother 2021; 49:1-12. [PMID: 33736745 DOI: 10.1017/s1352465821000138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND One reason that motivational interviewing (MI) is thought to translate well to a variety of treatment domains is due to the focus on client ambivalence. AIMS Therefore, the current study aimed to explore the construct of ambivalence in the context of MI and cognitive behavioural therapy (CBT) for social anxiety disorder (SAD). METHOD Participants were 147 individuals diagnosed with SAD who were randomised to receive either MI or supportive counselling prior to receiving group CBT for SAD. RESULTS The results suggested that MI was not related to decreases in general ambivalence or treatment ambivalence, although an indicator of treatment ambivalence was found to predict worse treatment outcome. CONCLUSIONS The findings suggest that three sessions of MI prior to CBT may not decrease ambivalence in participants with SAD, which may underscore the potential importance of tackling ambivalence as it arises during CBT.
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Affiliation(s)
- Mia Romano
- Centre for Emotional Health, Department of Psychology, Macquarie University, NSW 2109, Australia
| | - Lorna Peters
- Centre for Emotional Health, Department of Psychology, Macquarie University, NSW 2109, Australia
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25
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Moonen AJH, Mulders AEP, Defebvre L, Duits A, Flinois B, Köhler S, Kuijf ML, Leterme AC, Servant D, de Vugt M, Dujardin K, Leentjens AFG. Cognitive Behavioral Therapy for Anxiety in Parkinson's Disease: A Randomized Controlled Trial. Mov Disord 2021; 36:2539-2548. [PMID: 33617699 PMCID: PMC9290129 DOI: 10.1002/mds.28533] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/13/2021] [Accepted: 01/22/2021] [Indexed: 12/14/2022] Open
Abstract
Background Anxiety disorders are among the most prevalent and disabling neuropsychiatric syndromes in patients with Parkinsonʼs disease (PD), but no randomized controlled treatment trials of anxiety have been published to date. Objective The aim of this study was to assess the effectiveness of cognitive behavioral therapy (CBT) in the treatment of anxiety in patients with PD. Methods Forty‐eight patients with PD with anxiety were randomized 1:1 between CBT and clinical monitoring only (CMO). The CBT program was developed to specifically address anxiety symptoms in PD and consisted of 10 weekly sessions. Assessments were conducted by blinded assessors at baseline, at the end of the intervention, after 3 months, and after 6 months (CBT group only). Main outcome measures were the Hamilton Anxiety Rating Scale (HARS) and the Parkinson Anxiety Scale (PAS). Results Both the CBT and CMO groups showed clinically relevant improvement. Although there was no between‐group difference in outcome on the Hamilton Anxiety Rating Scale (6.7‐point reduction in the CBT group versus 3.9‐point reduction in the CMO group; P = 0.15), there was both a statistically significant and a clinically relevant between‐group difference on the total PAS in favor of CBT (9.9‐point reduction in the CBT group versus 5.2‐point reduction in the CMO group; P = 0.012), which was due to improvement on the PAS subscales for episodic (situational) anxiety and avoidance behavior. This greater improvement was maintained at 3‐ and 6‐month follow‐ups. Conclusion CBT is an effective treatment for anxiety in patients with PD and reduces situational and social anxiety, as well as avoidance behavior. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
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Affiliation(s)
- Anja J H Moonen
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, the Netherlands.,Research School of Mental Health and Neuroscience (Mhens), Maastricht University, Maastricht, the Netherlands
| | - Anne E P Mulders
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, the Netherlands.,Research School of Mental Health and Neuroscience (Mhens), Maastricht University, Maastricht, the Netherlands
| | - Luc Defebvre
- Neurology and Movement Disorders Department, Centre Hospitalier Universitaire, Lille, France
| | - Annelien Duits
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, the Netherlands.,Research School of Mental Health and Neuroscience (Mhens), Maastricht University, Maastricht, the Netherlands
| | - Bérengère Flinois
- Neurology and Movement Disorders Department, Centre Hospitalier Universitaire, Lille, France
| | - Sebastian Köhler
- Research School of Mental Health and Neuroscience (Mhens), Maastricht University, Maastricht, the Netherlands
| | - Mark L Kuijf
- Research School of Mental Health and Neuroscience (Mhens), Maastricht University, Maastricht, the Netherlands.,Department of Neurology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Anne-Claire Leterme
- Neurology and Movement Disorders Department, Centre Hospitalier Universitaire, Lille, France
| | - Dominique Servant
- Neurology and Movement Disorders Department, Centre Hospitalier Universitaire, Lille, France
| | - Marjolein de Vugt
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, the Netherlands.,Research School of Mental Health and Neuroscience (Mhens), Maastricht University, Maastricht, the Netherlands
| | - Kathy Dujardin
- Neurology and Movement Disorders Department, Centre Hospitalier Universitaire, Lille, France.,Degenerative & Vascular Cognitive Disorders, University of Lille, Lille, France
| | - Albert F G Leentjens
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, the Netherlands.,Research School of Mental Health and Neuroscience (Mhens), Maastricht University, Maastricht, the Netherlands
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26
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Ziser K, Rheindorf N, Keifenheim K, Becker S, Resmark G, Giel KE, Skoda EM, Teufel M, Zipfel S, Junne F. Motivation-Enhancing Psychotherapy for Inpatients With Anorexia Nervosa (MANNA): A Randomized Controlled Pilot Study. Front Psychiatry 2021; 12:632660. [PMID: 33597901 PMCID: PMC7882628 DOI: 10.3389/fpsyt.2021.632660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/08/2021] [Indexed: 11/13/2022] Open
Abstract
Patients with anorexia nervosa (AN) are frequently characterized by an unstable readiness to change and high ambivalence toward treatment. Enhancing readiness to behavioral change therefore plays an essential role for adherence to treatment especially for severely ill patients treated in inpatient settings. Therefore, a novel 10 week program for the individual psychotherapy sessions was designed using elements from motivational interviewing to be applied within the multidisciplinary inpatient treatment for patients with AN. In a randomized controlled pilot trial, N = 22 patients with AN received either the new intervention or treatment as usual in one of two recruiting university hospitals. Readiness to change, eating disorder pathology, therapeutic alliance as well as acceptance and feasibility of the new intervention were measured from patients and therapists in week 1, 5, and 10 of inpatient treatment. Results confirm acceptance and feasibility of the MANNA intervention as evaluated by patients as well as therapists. Patients receiving the new intervention completed their inpatient treatment significantly more often on regular terms than patients receiving treatment as usual. No differences between the groups could be found concerning therapeutic alliance during and at the end of treatment and readiness to change. Absolute numbers of BMI increase indicate a larger increase in the intervention group albeit not significant in this pilot study sample. Limitations of the study such as the small sample size as well as possible adaptions and advancements of the intervention that need to be examined in a larger clinical trial of efficacy are discussed. This phase II study is registered with the German Clinical Trials Register (DRKS) under the trial number DRKS00015639.
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Affiliation(s)
- Katrin Ziser
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Nadine Rheindorf
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University Duisburg-Essen, Essen, Germany
| | - Katharina Keifenheim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Sandra Becker
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Gaby Resmark
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany.,Centre of Excellence for Eating Disorders, University of Tuebingen, Tuebingen, Germany
| | - Katrin E Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany.,Centre of Excellence for Eating Disorders, University of Tuebingen, Tuebingen, Germany
| | - Eva-Maria Skoda
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University Duisburg-Essen, Essen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University Duisburg-Essen, Essen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany.,Centre of Excellence for Eating Disorders, University of Tuebingen, Tuebingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany.,Centre of Excellence for Eating Disorders, University of Tuebingen, Tuebingen, Germany
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27
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Tester-Jones M, White MP, Elliott LR, Weinstein N, Grellier J, Economou T, Bratman GN, Cleary A, Gascon M, Korpela KM, Nieuwenhuijsen M, O'Connor A, Ojala A, van den Bosch M, Fleming LE. Results from an 18 country cross-sectional study examining experiences of nature for people with common mental health disorders. Sci Rep 2020; 10:19408. [PMID: 33159132 PMCID: PMC7648621 DOI: 10.1038/s41598-020-75825-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/07/2020] [Indexed: 02/06/2023] Open
Abstract
Exposure to natural environments is associated with a lower risk of common mental health disorders (CMDs), such as depression and anxiety, but we know little about nature-related motivations, practices and experiences of those already experiencing CMDs. We used data from an 18-country survey to explore these issues (n = 18,838), taking self-reported doctor-prescribed medication for depression and/or anxiety as an indicator of a CMD (n = 2698, 14%). Intrinsic motivation for visiting nature was high for all, though slightly lower for those with CMDs. Most individuals with a CMD reported visiting nature ≥ once a week. Although perceived social pressure to visit nature was associated with higher visit likelihood, it was also associated with lower intrinsic motivation, lower visit happiness and higher visit anxiety. Individuals with CMDs seem to be using nature for self-management, but ‘green prescription’ programmes need to be sensitive, and avoid undermining intrinsic motivation and nature-based experiences.
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Affiliation(s)
- Michelle Tester-Jones
- European Centre for Environment and Human Health, University of Exeter Medical School, c/o Knowledge Spa, Royal Cornwall Hospital, Truro, TR1 3HD, Cornwall, UK
| | - Mathew P White
- European Centre for Environment and Human Health, University of Exeter Medical School, c/o Knowledge Spa, Royal Cornwall Hospital, Truro, TR1 3HD, Cornwall, UK. .,Cognitive Science Hub, Department of Psychology, Univerity of Vienna, Liebiggassse 5, 1010, Vienna, Austria.
| | - Lewis R Elliott
- European Centre for Environment and Human Health, University of Exeter Medical School, c/o Knowledge Spa, Royal Cornwall Hospital, Truro, TR1 3HD, Cornwall, UK
| | | | - James Grellier
- European Centre for Environment and Human Health, University of Exeter Medical School, c/o Knowledge Spa, Royal Cornwall Hospital, Truro, TR1 3HD, Cornwall, UK
| | - Theo Economou
- College of Engineering, Mathematics, and Physical Sciences, University of Exeter, Exeter, UK
| | - Gregory N Bratman
- School of Environmental and Forest Sciences, University of Washington, Washington, USA
| | | | - Mireia Gascon
- Barcelona Institute for Global Health, Barcelona, Spain
| | - Kalevi M Korpela
- Faculty of Social Sciences/ Psychology, Tampere University, Tampere, Finland
| | | | | | - Ann Ojala
- Natural Resources Institute Finland, Helsinki, Finland
| | - Matilda van den Bosch
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Lora E Fleming
- European Centre for Environment and Human Health, University of Exeter Medical School, c/o Knowledge Spa, Royal Cornwall Hospital, Truro, TR1 3HD, Cornwall, UK
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28
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Marker I, Corbett BE, Drummond SPA, Norton PJ. Intermittent Motivational Interviewing and Transdiagnostic CBT for Anxiety: A Randomized Controlled Trial. J Anxiety Disord 2020; 75:102276. [PMID: 32768874 DOI: 10.1016/j.janxdis.2020.102276] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 06/15/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
Recent meta-analytic findings suggest that Motivational Interviewing (MI) used as an adjunct to Cognitive Behavior Therapy (CBT) for anxiety disorders improves overall treatment outcomes (Marker & Norton, 2018). However, when used as a prelude to CBT, MI significantly increases the length of treatment and numerous studies note that the effectiveness of pre-treatment MI subsides over time. The current study adapted an already established 12-session transdiagnostic CBT protocol (tCBT, Norton, 2012) to include one hour of MI spread across four sessions of tCBT (sessions 1, 3, 8, and 10) at 15 minutes each, with the option of including additional MI if resistance arose in therapy. Thirty-six treatment seeking adults with principal anxiety disorder diagnosis were randomly assigned to receive intermittent MI and tCBT (iMI + tCBT) or tCBT and psychoeducation. Results indicated that the iMI + tCBT condition significantly outperformed the tCBT condition on several primary outcome variables. While no significant difference was found between the two groups on clinician rated scores of participant principal anxiety disorder, differences were found on a composite index of participants' self-report measures of symptom improvement, and on clinician rated scores of global psychiatric functioning. These effects were not moderated by baseline motivation or baseline ambivalence. The study also found that the iMI + tCBT condition showed significantly greater improvement to comorbid conditions and greater reduction in self-report depressive symptoms. The inclusion of MI did not impact participant drop out. This study provides further support for integrating MI and tCBT and highlights that even small doses of MI can improve treatment outcomes, without increasing length of usual therapy. Limitations and future research options are also discussed.
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29
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Tobon JI, Zipursky RB, Streiner DL, Colvin E, Bahl N, Ouimet AJ, Burckell L, Jeffs L, Bieling PJ. Motivational Enhancement as a Pretreatment to a Transdiagnostic Intervention for Emerging Adults with Emotion Dysregulation: A Pilot Randomized Controlled Trial. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2020; 29:132-148. [PMID: 32774397 PMCID: PMC7391867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 02/07/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE New approaches are needed to help the large number of emerging adults (EA) presenting with early-stage mental health problems. The goal of this pilot study was to carry out a randomized controlled trial to investigate whether motivational enhancement therapy (MET) improved the treatment effects of a 12-week psychological intervention, Dialectical Behaviour Therapy Skills Training (DBT-ST), for EA presenting in the early stages of mental health difficulties. Participants were recruited from the Youth Wellness Centre at St. Joseph's Healthcare Hamilton and McMaster University's Student Wellness Centre in Hamilton, Canada. METHODS Seventy-five participants were randomized to receive MET followed by DBT-ST or to DBT-ST alone. We assessed psychological distress, emotion dysregulation, and depression and anxiety symptoms as outcomes. RESULTS We found that both treatment groups had significant reductions in emotional dysregulation, psychological distress, depression, and anxiety at post-treatment and at the three-month follow-up. Participants assigned to MET pre-treatment experienced greater improvement in psychological distress at the end of treatment. CONCLUSION This pilot study provides preliminary evidence of the potential augmentation of DBT-ST using MET in a real-world setting. Future studies should examine whether MET uniquely augments DBT-ST through the use of a comparable pre-treatment control group.
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Affiliation(s)
- Juliana I Tobon
- Youth Wellness Centre, St. Joseph's Healthcare Hamilton, Hamilton, Ontario
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, Ontario
| | - Robert B Zipursky
- Youth Wellness Centre, St. Joseph's Healthcare Hamilton, Hamilton, Ontario
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
- Centre for Addiction and Mental Health, Toronto, Ontario
| | - David L Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
- Centre for Addiction and Mental Health, Toronto, Ontario
| | - Eamon Colvin
- School of Psychology, University of Ottawa, Ottawa, Ontario
| | - Nancy Bahl
- School of Psychology, University of Ottawa, Ottawa, Ontario
| | | | - Lisa Burckell
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, Ontario
- Borderline Personality Disorder Service, St. Joseph's Healthcare Hamilton, Hamilton, Ontario
| | - Lisa Jeffs
- Youth Wellness Centre, St. Joseph's Healthcare Hamilton, Hamilton, Ontario
| | - Peter J Bieling
- Youth Wellness Centre, St. Joseph's Healthcare Hamilton, Hamilton, Ontario
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, Ontario
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30
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Romano M, Arambasic J, Peters L. Motivational interviewing for social anxiety disorder: An examination of the technical hypothesis. Psychother Res 2020; 31:224-235. [PMID: 32308153 DOI: 10.1080/10503307.2020.1751892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
ABSTRACT Background and objective: Motivational interviewing (MI) was originally developed to treat problematic drinking but is increasingly integrated into treatment for anxiety disorders. A causal model has been proposed which suggests technical and relational factors may account for the efficacy of MI. The technical hypothesis suggests that therapist MI-consistent behaviours are related to client change talk, and change talk is linked to treatment outcome. Research examining the technical hypothesis has typically been conducted in MI for substance use; therefore, the current study aimed to explore the technical hypothesis in MI for social anxiety disorder (SAD). Method: Participants diagnosed with SAD (n = 85) each received MI prior to receiving group cognitive-behavioural therapy (CBT). MI sessions were coded for behaviours relevant to the MI technical hypothesis. Results: The proportion of MI-consistent therapist behaviours and reflections of change language significantly predicted the proportion of change talk by the client during MI sessions; however, therapist and client behaviours did not predict treatment outcome. Conclusion: The findings support one path of the MI causal model in the context of social anxiety, though indicate that the occurrence of these behaviours during an MI pre-treatment may not extend to predict treatment outcome following CBT.
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Affiliation(s)
- Mia Romano
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Jelena Arambasic
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Lorna Peters
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
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31
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Nolet K, Corno G, Bouchard S. The Adoption of New Treatment Modalities by Health Professionals and the Relative Weight of Empirical Evidence in Favor of Virtual Reality Exposure Versus Mindfulness in the Treatment of Anxiety Disorders. Front Hum Neurosci 2020; 14:86. [PMID: 32269517 PMCID: PMC7109262 DOI: 10.3389/fnhum.2020.00086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 02/27/2020] [Indexed: 12/19/2022] Open
Abstract
Anxiety disorders are among the most prevalent mental disorders, and cognitive-behavioral therapy (CBT) with exposure exercises is considered as the gold-standard psychological intervention. New psychotherapeutic modalities have emerged in the last decade and, among them, mindfulness has been rapidly adopted by therapists. The adoption rate is slower for the use of virtual reality (VR) to conduct exposure. The goal of the present position paper is to contrast, for the treatment of anxiety disorders, the weight of empirical evidences supporting the use of exposure in VR with the use of mindfulness-based therapy (MBT). Based on the most recent meta-analyses, we found that CBT with exposure conducted in VR was more thoroughly researched and supported than MBT, receiving validation from roughly twice as many studies with high control (i.e., randomized, active controls with clinical samples). However, this conclusion is nuanced by reviewing gaps in the literature for both therapies. Potential factors influencing clinicians' choice of treatment and suggestions for future research directions are proposed.
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Affiliation(s)
- Kevin Nolet
- Cyberpsychology Laboratory of UQO, Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Giulia Corno
- Cyberpsychology Laboratory of UQO, Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, QC, Canada
- LabPsiTec, Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universitat de València, Valencia, Spain
| | - Stéphane Bouchard
- Cyberpsychology Laboratory of UQO, Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, QC, Canada
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32
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Beck CD, Soucy JN, Hadjistavropoulos HD. Mixed-method evaluation of an online motivational intervention as a pre-treatment to internet-delivered cognitive behaviour therapy: Immediate benefits and user feedback. Internet Interv 2020; 20:100311. [PMID: 32154118 PMCID: PMC7052510 DOI: 10.1016/j.invent.2020.100311] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/13/2020] [Accepted: 02/19/2020] [Indexed: 11/19/2022] Open
Abstract
•An online MI intervention was recently developed to complement ICBT.•Intervention consists of videos, exercises, feedback to better simulate face-to-face MI.•Study evaluated intervention impact on motivation and perceptions of MI.•Ratings of motivation and MI perceptions significantly increased from pre- to post-MI.•Future research should explore longer term impact of online MI on ICBT.
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Affiliation(s)
- Cynthia D. Beck
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
| | - Joelle N. Soucy
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
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33
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Li D, Kong J, Yang Y, Wang S, Wu J, Chao J. Group cognitive behavioural therapy of physical and psychological menopausal symptoms of Chinese women, delivered via Internet and mobile phone versus face to face: A protocol for a randomized non-inferiority trial. Maturitas 2019; 129:23-29. [PMID: 31547909 DOI: 10.1016/j.maturitas.2019.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 06/05/2019] [Accepted: 08/12/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Menopause syndrome generally includes psychological problems. Group treatment delivered via the Internet and mobile phone (imGT) may improve women's physiological and psychological conditions. OBJECTIVE To investigate the efficacy of group cognitive behavioural therapy of menopause-related mood swings and quality of life, delivered face to face or via the Internet and mobile phone. METHODS This protocol is for a randomized controlled clinical trial with a sample of 140 menopausal women divided into 2 groups: imGT and face-to-face group treatment (ffGT). The primary outcome will be the improvement in the menopausal symptoms of the two groups, as assessed by the Greene Climacteric Scale. The secondary outcomes will be: quality of life, assessed by the Short Form 36 Health Survey Questionnaire; insomnia, assessed by the Pittsburgh Sleep Quality Inventory; anxiety, assessed by the Hamilton Anxiety Rating Scale; and therapeutic alliance, assessed by the Working Alliance Inventory-Short Revised and Client Sat-is-fac-tion Qes-tion-naire-8. imGT will be performed once a week for 1.5 h for 10 weeks with a daily 'Punched-in' on the WeChat app; ffGT will be performed once a week for 1.5 h for 10 weeks. All outcomes will be assessed at baseline, at a post-intervention evaluation (week 10), and at a follow-up evaluation (week 22). DISCUSSION This study will be the first clinical trial to examine the effects of imGT on menopausal women in China. If imGT is found to be non-inferior to ffGT, it will facilitate access to menopausal health services.
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Affiliation(s)
- Dan Li
- Southeast University, China
| | - Jing Kong
- Nanjing Maternity and Child Health Care Hospital, China
| | - Ying Yang
- Nanjing Maternity and Child Health Care Hospital, China
| | - Suli Wang
- Nanjing Maternity and Child Health Care Hospital, China
| | - Jiangping Wu
- Nanjing Maternity and Child Health Care Hospital, China
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Peters L, Romano M, Byrow Y, Gregory B, McLellan LF, Brockveld K, Baillie A, Gaston J, Rapee RM. Motivational interviewing prior to cognitive behavioural treatment for social anxiety disorder: A randomised controlled trial. J Affect Disord 2019; 256:70-78. [PMID: 31158718 DOI: 10.1016/j.jad.2019.05.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/28/2019] [Accepted: 05/24/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND We examined whether providing three sessions of treatment based on motivational interviewing (MI) prior to Cognitive Behavioral Therapy (CBT) for Social Anxiety Disorder (SAD) improved outcomes. METHODS Participants diagnosed with SAD (N = 186) were randomly allocated to receive three sessions of MI (MI+CBT; n = 85) or supportive counselling (SC+CBT; n = 101) prior to a 12-week group CBT program. Assessments occurred at baseline, after preparatory treatment, after CBT, and at 6-months follow-up. Outcomes were expectations for change, number of CBT sessions attended, self- and clinician-rated CBT homework completion, and self- and clinician-rated social anxiety severity. RESULTS Conditions did not differ significantly on expectations for change, number of CBT sessions attended, or clinician-rated homework completion. Self-rated homework completion was greater in MI+CBT than in SC+CBT. Change over time in social anxiety severity did not differ between conditions overall, however, this outcome was significantly moderated by two variables; those in MI+CBT, as compared to SC+CBT, showed significantly poorer outcomes on self-reported social anxiety severity if they were higher in change readiness and significantly better outcomes on clinician-rated social anxiety severity if they were higher in functional impairment. LIMITATIONS Although therapists in MI sessions were rated as behaving more consistently with MI than therapists in SC sessions, some MI consistent behaviors occurred in the SC sessions. CONCLUSIONS Addition of a MI-based discussion prior to evidence-based CBT appears to benefit people with SAD who have high functional impairment but may interfere with outcomes for those higher in readiness for change.
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Affiliation(s)
- Lorna Peters
- Centre for Emotional Health, Department of Psychology, Macquarie University, NSW 2109, Australia.
| | - Mia Romano
- Centre for Emotional Health, Department of Psychology, Macquarie University, NSW 2109, Australia
| | - Yulisha Byrow
- Centre for Emotional Health, Department of Psychology, Macquarie University, NSW 2109, Australia
| | - Bree Gregory
- Centre for Emotional Health, Department of Psychology, Macquarie University, NSW 2109, Australia
| | - Lauren F McLellan
- Centre for Emotional Health, Department of Psychology, Macquarie University, NSW 2109, Australia
| | - Keila Brockveld
- Centre for Emotional Health, Department of Psychology, Macquarie University, NSW 2109, Australia
| | - Andrew Baillie
- Centre for Emotional Health, Department of Psychology, Macquarie University, NSW 2109, Australia
| | - Jonathan Gaston
- Centre for Emotional Health, Department of Psychology, Macquarie University, NSW 2109, Australia
| | - Ronald M Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, NSW 2109, Australia
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35
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Kramer Schmidt L, Moyers TB, Nielsen AS, Andersen K. Is fidelity to motivational interviewing associated with alcohol outcomes in treatment-seeking 60+ year-old citizens? J Subst Abuse Treat 2019; 101:1-11. [PMID: 31174708 DOI: 10.1016/j.jsat.2019.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/07/2019] [Accepted: 03/12/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Part of the variability in treatment outcomes for Motivational Interviewing (MI) may be explained by differences in the fidelity to MI. The Motivational Interviewing Treatment Integrity manual version 4 (MITI 4) is an improved measure of fidelity to elements of MI. It is not known whether the fidelity to MI, as measured by the MITI 4, is related to treatment outcome. OBJECTIVES To examine whether fidelity to MI is associated with alcohol use outcomes - predictive validity of the MITI 4. METHOD Twenty percent of the recorded sessions at the Danish sites of the Elderly Study were randomly drawn and coded for fidelity to MI with the MITI 4. The Elderly Study was an international, randomized controlled trial, in which people 60 years or older with Alcohol Use Disorders received either four weeks of Motivational Enhancement Therapy (MET) or four weeks of MET combined with up to eight additional sessions of the Community Reinforcement Approach- Senior (MET+CRA-S). Elements of MI and summary scores of the MITI 4 were used as predictors in a mixed effects regression analysis. Treatment outcomes were use of alcohol and consequences of drinking at 26-weeks follow-up. RESULTS In total, 423 sessions representing 238 participants were randomly drawn and coded for fidelity to MI. Mean values of the treatment elements indicated high fidelity to MI, with higher fidelity to MI in the MET sessions, as compared to CRA-S sessions. None of the predictors in the multilevel model analyses were associated with outcome at follow-up. Exploratory analysis indicated reverse associations between one measure of MI-fidelity and drinking outcomes in the combined treatment (CRAS). CONCLUSION The fidelity of the MI intervention, received by participants in this study, did not predict better treatment outcomes. MI may be less effective in populations which are already committed to change behavior. As expected and validating for the MITI 4, fidelity to MI-elements was lower in the combination of MI with other treatment approaches. Additionally, the timing of MI in these combined settings might be important for effectiveness.
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Affiliation(s)
- Lotte Kramer Schmidt
- Unit of Clinical Alcohol Research, University of Southern Denmark, J.B. Winsløwsvej 18, entrance 220B, 5000 Odense C, Denmark.
| | - Theresa B Moyers
- Center on Alcoholism, Substance Abuse, and Addictions, MSC11 6280, 1 University of New Mexico, Albuquerque, NM 87131, United States.
| | - Anette Søgaard Nielsen
- Unit of Clinical Alcohol Research, University of Southern Denmark, J.B. Winsløwsvej 18, entrance 220B, 5000 Odense C, Denmark; OPEN Odense Patient data Explorative Network, Denmark.
| | - Kjeld Andersen
- Unit of Clinical Alcohol Research, University of Southern Denmark, J.B. Winsløwsvej 18, entrance 220B, 5000 Odense C, Denmark; Department of Mental Health, Region of Southern Denmark, Denmark.
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Marker I, Norton PJ. Intermittent Motivational Interviewing and Transdiagnostic CBT for Anxiety: A Case Study. Clin Case Stud 2019. [DOI: 10.1177/1534650119849104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Client Motivation and Engagement in Transdiagnostic Group Cognitive Behavioral Therapy for Anxiety Disorders: Predictors and Outcomes. COGNITIVE THERAPY AND RESEARCH 2019. [DOI: 10.1007/s10608-019-10014-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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