Perceived costs and benefits of behavioral change: reconsidering the value of ambivalence for psychotherapy outcomes.

This study examined the measurement of ambivalence toward change, and the predictive utility of ambivalence in terms of psychotherapy outcomes. Ambivalent individuals were defined as those acknowledging both costs and benefits to change. Two competing hypotheses were tested. The first, based on the transtheoretical model (C. C. DiClemente & J. O. Prochaska, 1998), predicted that ambivalent individuals would experience less symptom change than those who predominantly acknowledge benefits to change. The second, based on evidence that acknowledging the costs of change is associated with better outcomes, predicted that ambivalence would be associated with more change. Patients (n = 173) with anxiety and affective disorders completed unitary and multidimensional measures of perceived costs and benefits to change, with a subset (n = 115) completing a course of cognitive-behavioral therapy. Results suggested that ambivalence was best measured within a multidimensional framework. Patients who acknowledged both costs and benefits to change (i.e., ambivalent) achieved better outcomes than those acknowledging predominantly benefits, or few costs and benefits, to change.