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Lassen ER, Lia SA, Hjertaas I, Hjemdal O, Kennair LEO, Hagen R, Solem S. Patient motivation and adherence in metacognitive therapy for major depressive disorder: an observational study. Cogn Behav Ther 2024; 53:220-234. [PMID: 38047723 DOI: 10.1080/16506073.2023.2289863] [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: 07/06/2023] [Accepted: 11/24/2023] [Indexed: 12/05/2023]
Abstract
The aim of this observational study was to examine the predictive and discriminant validity of patient motivation and adherence in metacognitive therapy (MCT) for depression. Motivational development for recovered- and non-recovered patients was also investigated. Motivation in sessions 1, 4, and 7 was measured using the Motivational Interviewing Skill Code 2.5 (MISC) in a 10-session trial of MCT for depression (N = 37). Adherence was assessed with the CBT compliance measure in session 7. The Beck Depression Inventory measured treatment outcome at 3-year follow-up. Recovered patients developed significantly more change talk and taking steps, and less sustain talk, as therapy progressed, compared to non-recovered patients. Evidence of the predictive validity of motivation in sessions 1 and 4 was limited. Higher sustain talk and taking steps in session 7 were significant predictors of more and less depressive symptoms, respectively. There was a moderate-strong correlation between motivation and adherence. The results confirm the predictive value of MISC in sessions 7 of MCT for depression, and establish differential motivational development between recovered and non-recovered patients. Subsequent research should clarify the discriminant validity and temporal relationships between motivation, adherence, and other clinical variables.
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Affiliation(s)
- Espen R Lassen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Susanne Aabel Lia
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ingrid Hjertaas
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Odin Hjemdal
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Roger Hagen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
- Research Institute, Modum Bad, Vikersund, Norway
| | - Stian Solem
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
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Olson DA, Westra HA, Shukla S, Di Bartolomeo AA. Therapist responsivity during disagreement in psychotherapy. COUNSELLING & PSYCHOTHERAPY RESEARCH 2022. [DOI: 10.1002/capr.12583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- David A. Olson
- Department of PsychologyYork UniversityTorontoOntarioCanada
| | | | - Serena Shukla
- Centre for Addictions and Mental HealthYork UniversityTorontoOntarioCanada
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Lassen ER, Touil M, Svendsen TL, Haseth S, Solem S. Patient motivation in group metacognitive therapy for generalized anxiety disorder. Psychother Res 2021; 32:585-597. [PMID: 34789063 DOI: 10.1080/10503307.2021.2001068] [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: 10/19/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the predictive value of motivational language (change talk [CT] and sustain talk [ST]) on treatment outcome of group metacognitive therapy (g-MCT) for generalized anxiety disorder (GAD). METHOD Video recordings of the first, fourth, and seventh therapy sessions (55 patients) were encoded using the Motivational Interviewing Skill Code (MISC) manual. The strength of the patients' motivational utterances was encoded as CT or ST with seven subcategories. RESULTS The strength of CT-utterances and ST-utterances differed significantly between treatment responders and non-responders as therapy progressed. The strength of ST-utterances increased significantly more among non-responders than responders, whereas CT and positive taking steps utterances increased more among treatment responders than non-responders. CT and ST in session 1 were not associated with treatment outcome. CT and ST in sessions 4 and 7 significantly predicted lower and higher worry-scores at post-treatment, respectively. This effect was particularly evident for taking steps utterances in session 7. CONCLUSION These findings confirm the predictive value of MISC in sessions 4 and 7 of g-MCT for GAD and highlight the importance of therapists addressing patient motivation.
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Affiliation(s)
- Espen R Lassen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mourad Touil
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tone L Svendsen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Svein Haseth
- Nidaros DPS, St. Olavs Hospital, Trondheim, Norway
| | - Stian Solem
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Hara KM, Westra HA, Coyne AE, Di Bartolomeo AA, Constantino MJ, Antony MM. Therapist affiliation and hostility in cognitive-behavioral therapy with and without motivational interviewing for severe generalized anxiety disorder. Psychother Res 2021; 32:598-610. [PMID: 34789067 DOI: 10.1080/10503307.2021.2001069] [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] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Although therapist supportive, rather than directive, strategies have been particularly indicated during client resistance, little systematic research has examined how therapists responsively navigate resistance in different therapy approaches and how this responsiveness is related to outcome. METHOD In the context of disagreement episodes in cognitive-behavioral therapy (CBT) for generalized anxiety disorder (GAD; Westra, H. A., Constantino, M. J., & Antony, M. M. Integrating motivational interviewing with cognitive-behavioral therapy for severe generalized anxiety disorder: An allegiance-controlled randomized clinical trial. Journal of Consulting and Clinical Psychology, 84(9), 768-782. https://doi.org/10.1037/ccp0000098, 2016), the present study examined (1) the degree to which therapist management of resistance differed between therapists trained in CBT integrated with motivational interviewing (MI-CBT; i.e., training centered on the responsive management of resistance) and therapists trained in CBT-alone, and (2) the impact of specific therapist behaviors during disagreement on client worry outcomes immediately posttreatment and 1-year posttreatment. Episodes of disagreement were rated used the Structural Analysis of Social Behavior (Benjamin, L. S. Structural analysis of social behavior. Psychological Review, 81(5), 392-425. https://doi.org/10.1037/h0037024, 1974). RESULTS Therapists trained in MI-CBT were found to exhibit significantly more affiliative and fewer hostile behaviors during disagreement compared to those trained in CBT-alone; both of these, in turn, were found to mediate client 1-year posttreatment outcomes, such that increased affiliation during disagreement was associated with improved outcomes. CONCLUSION This study highlights the value of training therapists in the responsive detection and management of resistance, as well as the systematic integration of MI into CBT.
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Affiliation(s)
| | - Henny A Westra
- Department of Psychology, York University, Toronto, Canada
| | - Alice E Coyne
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | | | - Michael J Constantino
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Martin M Antony
- Department of Psychology, Ryerson University, Toronto, Canada
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Malins S, Moghaddam N, Morriss R, Schröder T, Brown P, Boycott N. The predictive value of patient, therapist, and in-session ratings of motivational factors early in remote cognitive behavioural therapy for severe health anxiety. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 61:364-384. [PMID: 34514604 DOI: 10.1111/bjc.12328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/24/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Remote psychotherapy and the prevalence of Severe Health Anxiety (SHA) are both growing as a result of the COVID-19 pandemic. Remotely delivered Cognitive Behavioural Therapy (rCBT) for SHA is evidenced as effective, but many who seek help do not benefit. Motivational processes can influence outcomes, but it is unclear what assessment methods offer the best clinical utility in rCBT for SHA. DESIGN This study compared the predictive validity of patient, therapist and in-session ratings of motivational factors taken at session two of rCBT for SHA among high healthcare users experiencing multimorbidity. METHODS Motivational factors were assessed for 56 participants who attended at least two sessions of CBT for SHA delivered via video-conferencing or telephone. Following session two, therapists and patients completed online assessments of patient motivation. Two trained observers also rated motivational factors and therapeutic alliance from in-session interactions using session two recordings and transcripts. Multilevel modelling was used to predict health anxiety and a range of secondary health outcomes from motivation assessments. RESULTS Where patients were more actively engaged in discussion of positive changes during session two, greater outcome improvements ensued in health anxiety and all secondary outcomes. Conversely, larger proportions of session two spent describing problems predicted poorer outcomes. Therapist and patient assessments of motivation did not predict health anxiety, but therapist assessments of client confidence and motivation predicted all secondary outcomes. CONCLUSIONS Motivation remains an important process in CBT when delivered remotely, and motivational factors may predict outcomes more consistently from in-session interactions, compared to self-reports.
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Affiliation(s)
- Sam Malins
- Division of Psychiatry and Applied Psychology, University of Nottingham, UK.,Nottinghamshire Healthcare NHS Foundation Trust, UK
| | | | - Richard Morriss
- Division of Psychiatry and Applied Psychology, University of Nottingham, UK.,Nottinghamshire Healthcare NHS Foundation Trust, UK
| | - Thomas Schröder
- Division of Psychiatry and Applied Psychology, University of Nottingham, UK
| | - Paula Brown
- Division of Psychiatry and Applied Psychology, University of Nottingham, UK
| | - Naomi Boycott
- Division of Psychiatry and Applied Psychology, University of Nottingham, UK
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Norouzian N, Westra HA, Button ML, Constantino MJ, Antony MM. Ambivalence and the working alliance in variants of cognitive‐behavioural therapy for generalised anxiety disorder. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | | | | | - Michael J. Constantino
- Department of Psychological and Brain Sciences University of Massachusetts Amherst Amherst MA USA
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Joramo I, Solem S, Romundstad B, Nordahl HM. Change talk and sustain talk in treatment of generalized anxiety disorder: A secondary analysis of cognitive behavioral therapy and metacognitive therapy in adult outpatients. J Behav Ther Exp Psychiatry 2021; 72:101650. [PMID: 33667828 DOI: 10.1016/j.jbtep.2021.101650] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 12/17/2020] [Accepted: 02/12/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND OBJECTIVES Measures of patient motivation have proven elusive, showing inconsistent results in relation to psychotherapy outcome. How patients talk about change is an alternative measure of motivation, with potential value in predicting treatment outcome. This study had two aims: (1) to examine if change talk and sustain talk (including its subcategories) predicted reduction in worry levels at post-treatment and 2-year follow-up, and (2) if there were differences between the cognitive behavioral therapy (CBT) and metacognitive therapy (MCT) conditions with respect to change talk. METHODS This study investigated 24 patients receiving CBT and 27 patients receiving MCT for generalized anxiety disorder (GAD), and coded patients' utterances in sessions 1 and 4. RESULTS Change talk was significantly associated with lower worry levels at post-treatment and 2-year follow-up, beyond initial worry severity and treatment condition. Change talk in session 4, and reduction in sustain talk from session 1 to 4, was positively associated with improvement, whilst sustain talk in session 4 showed a negative relationship. More specifically, commitment statements in session 1 and expressing signs of taking steps at session 4 were associated with reduction in worry levels. Moreover, patients in the MCT condition argued more both for and against change during session 1, but not session 4. LIMITATIONS The sample size was relatively small. CONCLUSIONS These results indicate that change talk sustain talk could be important in the treatment of GAD.
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Affiliation(s)
- Isak Joramo
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Solem
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Bendik Romundstad
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hans M Nordahl
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
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Di Bartolomeo AA, Shukla S, Westra HA, Shekarak Ghashghaei N, Olson DA. Rolling with resistance: A client language analysis of deliberate practice in continuing education for psychotherapists. COUNSELLING & PSYCHOTHERAPY RESEARCH 2020. [DOI: 10.1002/capr.12335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
| | - Serena Shukla
- Department of Psychology York University Toronto ON Canada
| | | | | | - David A. Olson
- Department of Psychology York University Toronto ON Canada
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Ewbank MP, Cummins R, Tablan V, Catarino A, Buchholz S, Blackwell AD. Understanding the relationship between patient language and outcomes in internet-enabled cognitive behavioural therapy: A deep learning approach to automatic coding of session transcripts. Psychother Res 2020; 31:326-338. [PMID: 32619163 DOI: 10.1080/10503307.2020.1788740] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Objective: Understanding patient responses to psychotherapy is important in developing effective interventions. However, coding patient language is a resource-intensive exercise and difficult to perform at scale. Our aim was to develop a deep learning model to automatically identify patient utterances during text-based internet-enabled Cognitive Behavioural Therapy and to determine the association between utterances and clinical outcomes. Method: Using 340 manually annotated transcripts we trained a deep learning model to categorize patient utterances into one or more of five categories. The model was used to automatically code patient utterances from our entire data set of transcripts (∼34,000 patients), and logistic regression analyses used to determine the association between both reliable improvement and engagement, and patient responses. Results: Our model reached human-level agreement on three of the five patient categories. Regression analyses revealed that increased counter change-talk (movement away from change) was associated with lower odds of both reliable improvement and engagement, while increased change-talk (movement towards change or self-exploration) was associated with increased odds of improvement and engagement. Conclusions: Deep learning provides an effective means of automatically coding patient utterances at scale. This approach enables the development of a data-driven understanding of the relationship between therapist and patient during therapy.
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Affiliation(s)
- M P Ewbank
- Clinical Science Laboratory at Ieso, Ieso Digital Health, Cambridge, United Kingdom
| | - R Cummins
- Clinical Science Laboratory at Ieso, Ieso Digital Health, Cambridge, United Kingdom
| | - V Tablan
- Clinical Science Laboratory at Ieso, Ieso Digital Health, Cambridge, United Kingdom
| | - A Catarino
- Clinical Science Laboratory at Ieso, Ieso Digital Health, Cambridge, United Kingdom
| | - S Buchholz
- Clinical Science Laboratory at Ieso, Ieso Digital Health, Cambridge, United Kingdom
| | - A D Blackwell
- Clinical Science Laboratory at Ieso, Ieso Digital Health, Cambridge, United Kingdom
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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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Can Self-Report Measures of Readiness for Change and Treatment Ambivalence Predict Outcomes in Cognitive Behavioral Therapy for Generalized Anxiety Disorder? J Cogn Psychother 2019; 33:301-319. [PMID: 32746393 DOI: 10.1891/0889-8391.33.4.301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Clients with generalized anxiety disorder (GAD) that demonstrate observer-coded treatment ambivalence benefit from the addition of motivational interviewing (MI) to cognitive behavioral therapy (CBT; Button, Westra, Constantino, & Antony, 2016). While observer-coded assessment of ambivalence and readiness for change is resource-intensive, the present study investigates the use of more efficient self-report measures to predict treatment outcomes. Participants (N = 85) with GAD received CBT or MI-CBT and completed self-report measures of readiness for change (Change Questionnaire, Miller & Johnson, 2008) and ambivalence (Treatment Ambivalence Questionnaire, Purdon, Rowa, Gifford, McCabe, & Antony, 2012). Greater self-reported baseline readiness for change was associated with lower posttreatment worry and symptom severity and faster reduction in worry. Self-reported ambivalence was not associated with outcomes. Patients with less concern about adverse consequences of treatment who received CBT experienced greater increases in readiness for change than those receiving MI-CBT. We discuss implications for using these measures in clinical settings.
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