Therapist affiliation and hostility in cognitive-behavioral therapy with and without motivational interviewing for severe generalized anxiety disorder

Development and evaluation of an online intervention for reducing hostile interpretation bias: A randomized controlled trial

Hostility is a trait-level construct characterized by a generally suspicious and cynical view of other people that results in a tendency to interpret ambiguous social situations in hostile or threatening ways. Cognitive behavioral treatments for hostility have high dropout rates, which may be due to hostile beliefs interfering with treatment engagement. As such, there is a need for an alternative approach to prevent dropout and enhance engagement. The current study therefore developed and tested a 1-session, 40-minute online intervention targeting hostility. It was hypothesized that the hostility intervention would be rated as acceptable as indexed by self-report and completion rates. It was also hypothesized that the hostility intervention would be associated with greater reductions in hostility as compared to a control intervention. Finally, it was hypothesized there would be indirect effects of intervention condition on anger and aggression via changes in hostility. Undergraduates (N = 101) who reported elevated hostility and hazardous alcohol use were randomized to complete either the hostility intervention or a control condition targeting physical health habits. Results showed that individuals randomized to the hostility intervention found the intervention to be highly acceptable and all participants completed the intervention in its entirety. The hostility intervention was associated with significantly faster reductions in hostile interpretations than the control condition with medium to large effects. There were significant indirect effects of intervention condition on month one follow-up anger and aggression via changes in hostile cognitions. This proof-of-concept study provides initial evidence that a brief, single-session intervention may be a promising approach for reducing hostility and its correlates.

Psychotherapeutic treatments for generalized anxiety disorder: cognitive and behavioral therapies, enhancement strategies, and emerging efforts

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.

The Resistance Vignette Task: Validating a rapid measure of therapist skill at managing resistance

BACKGROUND

Therapist appropriate responsivity to client ambivalence and resistance is considered an important interpersonal skill to avoid disengagement and ensure a continued collaborative, productive process. The present study examined the predictive validity of the newly developed Resistance Vignette Task (RVT), a 10-item rapidly administered measure of therapist ability to appropriately respond to various presentations of client resistance.

METHODS

Following a resistance management workshop, the concurrent and prospective predictive capacity of RVT scores were examined through test interviews with ambivalent simulators and volunteers.

RESULTS

Prospectively, in test interviews with ambivalent interviewees, higher RVT scores immediately postworkshop were associated with significantly greater responsivity (appropriate responsivity and fewer responsivity errors) at 4-month follow-up. RVT scores at the 4-month follow-up point were also concurrently associated with significantly greater therapist responsivity and lower levels of interviewee resistance.

CONCLUSIONS

These findings provide further validation for the RVT as a measure of therapist responsivity in vivo, in actual interviews by predicting and being concurrently associated with therapist performance in response to client resistance. Thus, the RVT holds promise in advancing therapist training, as well as research on resistance as it represents an efficient measure of this key therapist skill.