Neurology Central

Promising new approach to therapy for generalized anxiety disorder

A recent study led by Henry Westra at York University (Toronto, Canada), in collaboration with Michael Constantino (University of Massachusetts Amherst, MA, USA) and Martin Antony (Ryerson University, Toronto, Canada), has suggested that integrating motivational interviewing (MI) with cognitive behavioral therapy (CBT) in the treatment of generalized anxiety disorder, compared to CBT alone, may have a higher long-term success rate for patients. A combined treatment approach has long been recommended for treating anxiety, but prior to this research few well-controlled tests of integrating treatments existed.

The study, published recently in the Journal of Consulting and Clinical Psychology, recruited 85 participants in Toronto (Canada) and compared the efficacy of 15 sessions of CBT alone in 43 randomly assigned patients with 15 sessions of integrated therapy in the other 42 patients.

The results demonstrated that there was a significant decline in both general stress and the rate of worry over a 1 year post-treatment follow-up period for patients receiving the integrated treatment compared to those treated with just CBT.

“Interestingly, for the main outcomes of worry and of global distress, when assessed immediately after treatment ended, there was no significant effect of treatment condition… So it was a sleeper effect, they got better but we didn’t see it until later,” further explained Michael Constantino.

The study tested the use of MI in addition to CBT to explore the idea addressed in previous research that patients are often ambivalent about giving up their worry. Constantino commented: “People can come into therapy both wanting to change and being reluctant to change. They may be reluctant to let go of something that is so familiar, something that serves as an adaptive tool. That is, the worry is useful to them if they feel it helps keep them on track and functioning responsibly, for example.”

Consequently, researchers believe that patients may begin to resist cognitive behavioral therapy at a certain point. “This may be what happens in people with generalized anxiety disorder to keep treatment from being successful. Our idea is to add MI at the stage to help people to address their ambivalence and any resistances to the therapist or intervention.”

Constantino continued: “Generalized anxiety disorder is a very stubborn condition, and even with a full course of CBT, which is the long-time gold standard of treatment, less than half of patients respond.”

The follow-up participation rate was 97% among this study’s subjects, meaning the researchers are now conducting several secondary studies to explore the results further.

Constantino noted: “Psychotherapy works…it is definitely better than nothing, but it doesn’t work the same for everybody. We also know that it can always be improved. Ideally, this new knowledge will turn into workshops and enter the mainstream in new teaching methods and as we train next-generation psychology students. As a field, we keep trying to get better at this.”

Sources: University of Massachusetts Amherst press release; Westra HA, Constantino MJ, and Antony MM. Integrating Motivational Interviewing With Cognitive-Behavioral Therapy for Severe Generalized Anxiety Disorder: An Allegiance-Controlled Randomized Clinical Trial. Journal of consulting and clinical psychology (2016) (Epub ahead of print).