a Department of Psychological and Brain Sciences , University of Massachusetts Amherst , Amherst , MA , USA.
b Department of Psychology , York University , Toronto , Ontario , Canada.
Psychother Res. 2019 Feb;29(2):213-225. doi: 10.1080/10503307.2017.1332794. Epub 2017 Jun 5.
A trial of psychotherapy for generalized anxiety disorder (GAD) demonstrated that motivational interviewing (MI) integrated with cognitive-behavioral therapy (CBT) outperformed CBT alone on clients' worry reduction across a 12-month follow-up. In the present study, we hypothesized and tested that less client resistance and greater client-perceived therapist empathy (specific foci of MI) would account for MI's additive effect. Exploratory analyses assessed whether the common processes of homework completion and therapeutic alliance quality mediated the treatment effect.
Clients with GAD were randomized to 15 sessions of MI-CBT (n = 42) or CBT alone (n = 43). Worry was assessed throughout treatment and follow-up. Observers rated resistance at midtreatment, and clients reported on perceived therapist empathy, alliance, and homework completion throughout treatment. Mediation was tested with bootstrapping methods.
Expectedly, MI-CBT clients evidenced less resistance and perceived greater therapist empathy, each of which related to lower 12-month worry. However, when both variables were tested simultaneously, only resistance remained a significant mediator of treatment. No indirect effects through homework completion or alliance emerged.
Reducing client resistance may be a theory-consistent mechanism through which integrative MI-CBT promotes superior long-term improvement than traditional CBT when treating GAD. Clinical or methodological significance of this article: This study further supports the long-term clinical benefit of integrating MI into CBT when treating the highly prevalent and historically difficult-to-treat condition of GAD. In particular, it points to the theory-specific mechanism of MI (helping to reduce/resolve patients' in-treatment resistance) as accounting for the integrative treatment's additive effect on worry reduction across a follow-up period. Therapists using CBT to treat patients with GAD should be trained to incorporate MI principles (e.g., empathy, collaboration, autonomy support) in general and in response to explicit markers of resistance.
一项针对广泛性焦虑障碍（GAD）的心理治疗试验表明，动机性访谈（MI）与认知行为疗法（CBT）相结合的效果优于单独的 CBT，在 12 个月的随访中，患者的担忧程度降低。在本研究中，我们假设并测试了较少的患者抵触情绪和更大的患者感知到的治疗师同理心（MI 的具体焦点）将解释 MI 的附加效果。探索性分析评估了家庭作业完成和治疗联盟质量等共同过程是否在治疗效果中起中介作用。
将 GAD 患者随机分为 15 节 MI-CBT（n=42）或单独 CBT（n=43）组。在整个治疗和随访过程中评估担忧。在治疗中期，观察者评估阻力，患者报告对治疗师同理心、联盟和家庭作业完成情况的感知。使用自举法检验中介作用。
意料之中的是，MI-CBT 组的患者表现出较低的抵触情绪和更高的感知同理心，两者都与 12 个月时的担忧程度降低有关。然而，当同时测试这两个变量时，只有阻力仍然是治疗的一个显著中介变量。没有通过家庭作业完成或联盟出现间接影响。
减少患者的抵触情绪可能是一种理论一致的机制，通过这种机制，整合 MI 的 CBT 比传统的 CBT 更能促进 GAD 的长期改善。本文的临床或方法学意义：这项研究进一步支持了在治疗高度流行且历史上难以治疗的 GAD 时，将 MI 整合到 CBT 中的长期临床益处。特别是，它指出了 MI 的特定理论机制（帮助减少/解决患者在治疗中的抵触情绪），这解释了在随访期间整合治疗对减轻担忧的附加效果。使用 CBT 治疗 GAD 患者的治疗师应接受培训，将 MI 原则（例如，同理心、合作、自主支持）纳入一般治疗，并针对明确的抵触情绪标志物做出回应。
