Sample Size And Power
On the basis of our earlier study,10 we estimated that 60% of the control group would either die or be admitted to hospital during the follow-up period, and we allowed for 10% attrition owing to inadequate or unavailable case notes. A sample size of 180 patients in each group would have about 95% power to detect a difference between the two groups with a significance level of 0.05, assuming that the rate of admission or death would be reduced from 60% to 40% in the treatment arm. Thus we aimed to recruit 400 patients.
We revised this sample size to 320 in February 2006 because recruitment was slower than anticipated. This number of patients would provide primary outcome data on 140 participants per group, with about 90% power to detect a reduction in the rate of admission or death from 60% to 40%. We estimated that we would also have secondary outcome data on 130 participants per arm and thus have 80% power to detect an effect size of 0.35 with a two sided significance level of 0.05.
Clinical And Scientific Implications
The case studies and small, uncontrolled studies reviewed here provide rich and insightful accounts of how MI can be utilized along with CBT for anxiety disorders. Further, the RCTs presented demonstrate promise that adding MI may be beneficial for a range of clients and across a range of anxiety diagnoses. Still, given the low-powered studies and sometimes neutral findings, it is too early to confidently suggest that therapists should routinely incorporate MI into CBT regimens for clients with anxiety disorders. That said, the current literature is trending in such a way that skilled clinicians who are well-trained in MI principles and processes, as well as expert in the delivery of CBT, may find the marrying of the two approaches useful for improving utilization of treatment, and outcomes for certain clients with anxiety disorders. Clinically, clients who seem reluctant, uncertain, or resistant about certain aspects of interventions, or treatment generally, may be the best candidates for inclusion of MI in CBT.
Acceptance And Commitment Therapy
Acceptance and commitment therapy is a form of psychotherapy and has been described as the fourth wave in therapy following cognitive behavioural therapy . Conceptually, ACT is based on the idea that psychological suffering occurs as a result of ongoing experiential avoidance, leading to psychological ridigity that prevents an individual from behaving in accord with their own core values. Rather than focusing on changing or challenging thoughts and emotions, ACT includes acceptance, mindfulness, cognitive defusion, values and committed action as the focus of treatment.
ACT incorporates traditional behaviour therapy techniques, including cognitive therapy and behavioural analysis. In addition, ACT introduces other techniques described as cognitive defusion, acceptance, mindfulness, values, and commitment methods. ACT differs from CBT in that the emphasis is not on thoughts, but on altering ones relationship to ones private experiences to become disentangled from them.
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Academic Insight: Can Incorporating Motivational Interviewing To Cognitive Behavioral Therapy Be Beneficial
Experiencing Anxiety, whether its related to ones job, personal relationships, or other factors, is a reality of life for most people. However, at times anxiety can become so problematic and debilitating it becomes a clinical mental health disorder. In fact, Anxiety Disorders are one of the most prevalent types of psychological disorders that afflict individuals. In the US alone, anxiety disorders are twice as prevalent than mood disorders, and five times higher than the number of people with substance disorders. These disorders affect many areas of functioning.
Cognitive behavioral therapy is a form of psychotherapy that gives people the encouragement and skills needed to change destructive behaviors or thought patterns. It is widely regarded as an effective treatment for anxiety disorders, regardless of the specific diagnosis. Despite its success, cognitive behavioral therapy does have its limitations. Between 15 and 50 percent of those who engage in cognitive behavioral therapy as a treatment for anxiety do not respond to treatment, and approximately 23% drop out of treatment.
OConnor Professional Group provides private mental health care coordination and support services for individuals and families impacted by mental illness. Contact us online or call 617.910.3940 for more information and to schedule a consultation with a member of our caring team.
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Training And Monitoring Trial Therapists
The trial therapists were two clinical psychologists, two nurse therapists, and one social worker, who all had training and experience in conducting cognitive behavioural therapy with people who have psychosis. During a three month period before seeing trial participants, therapists undertook training in motivational interviewing, cognitive behavioural therapy for substance misuse, and integrated motivational interviewing and cognitive behavioural therapy, with all therapists practising the integrated therapy with volunteer patients under supervision. Weekly group and individual supervision were provided while the therapists were treating trial participants.
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Integrating Motivational Interviewing With Cognitive
|The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.|
|First Posted : February 5, 2020Last Update Posted : September 5, 2021|
|Anxiety Disorders and SymptomsDepressionLife Style||Behavioral: Cognitive-behavioral therapyBehavioral: Integrated motivational interviewing and cognitive-behavioral therapy||Not Applicable|
|Study Type :|
|Official Title:||Integrating Motivational Interviewing With Cognitive-behavioral Therapy for Anxiety Disorders, Depression, and Unhealthy Lifestyle Behaviors: a Feasibility Study|
|Actual Study Start Date :|
|Active Comparator: Cognitive-behavioral therapy||Behavioral: Cognitive-behavioral therapyPsychological treatment focusing on changing cognitions and behaviors using information processing theory and learning theory approaches.|
|Experimental: Integrated motivational interviewing and CBT||Behavioral: Integrated motivational interviewing and cognitive-behavioral therapyMotivational interviewing is a psychological treatment approach focusing on increasing motivation by eliciting patient talk favoring behavior change and resolving patient ambivalence about change.|
Comparison With Other Studies
A Cochrane review identified three studies that compared cognitive behavioural therapy and motivational interviewing with standard care in people with psychosis and substance misuse.6 Edwards and colleagues found no effect of intervention in a sample of patients who had experienced a recent episode of psychosis and who also used cannabis.44 Baker et al found no effect of integrated motivational interviewing and cognitive behavioural therapy on substance misuse or symptoms but a significant improvement in functioning, as assessed on the global assessment of functioning.45
Our previous study demonstrated significant benefits of cognitive behavioural therapy and motivational interviewing in terms of negative symptoms, functioning, and relapse rate at 12 month follow-up.1019 One factor that might explain these superior outcomes relative to the study reported here is that relapse rates in the control group in the earlier study were much higher . Similarly, the frequency of substance use in the control group showed relatively little change from baseline in the earlier study, but there were large decreases in the control group in the current study. These better outcomes with standard care in the study reported here might reflect the widespread policy driven improvements in care for dual diagnosis patients that have occurred in the UK since 2001.7
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What Is Dialectical Behaviour Therapy
Dialectical behaviour therapy is an evidenced-based approach derived from cognitive behavioural therapy . Intended to balance both acceptance and change in therapy, DBT focuses on helping individuals learn a variety of skills to cope with their psychological distress. DBT skills are especially helpful for individuals who are experiencing difficulties with emotional regulation , impulsive behaviours, distress tolerance and acting ineffectively in interpersonal relationships.
DBT facilitates the use of cognitive behavioural, acceptance and emotion-focused skills both in daily life and crisis situations. Although originally developed to treat borderline personality disorder , DBT skills can also be applied to a variety of other psychological difficulties, including depression, anxiety, eating disorders, substance use disorders, and for individuals experiencing heightened levels of intra- and interpersonal life stressors.
Underlying Mental Health Conditions
Patients with an underlying mental illness present one such limitation to motivational interviewing. In a case where the patient suffers from an underlying mental illness such as depression, anxiety, bipolar disease, schizophrenia or other psychosis, more intensive therapy may be required to induce a change. In these instances, the use of motivational interviewing as a technique to treat outward-facing symptoms, such as not brushing teeth, may be ineffective where the root cause of the problem stems from the mental illness. Some of the patients may act like listening to the interviewer just to veil their underlying mental health issue. It is so important to dig more in a subtle way. When working with these patients, it is important to recognize that only so much can be done at certain levels. The treating therapists should, therefore, ensure the patient is referred to the correct medical professional to treat the cause of the behavior, and not simply one of the symptoms.
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Finding An Addiction Therapy Thats Right For You
Though there are many different types of addiction therapies available, not every plan was discussed here. Every person is different and because of this, there is no one-size-fits-all approach to therapy. Each therapy offers a different approach to dealing with addiction and there is bound to be one that can help you or your loved one. If you have tried to overcome your addiction and failed, it wasnt your fault. There is a way for you to overcome your addiction, you just have to find the right path.
Safety Of Treatment And Adverse Events
There were seven participant deaths during the course of the trial: two in the therapy group and five in the control group. The causes were recorded as suicide, non-dependent use of drugs, stroke, cancer, genetic disorder, heart attack, and multiple physical conditions. Four participants were admitted to a secure unit during the trial, three of whom were receiving the intervention and one who was receiving treatment as usual. Our independent data monitoring committee was informed of all the above events and considered them unrelated to the trial treatments.
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Case Studies And Uncontrolled Trials
Mixed Anxiety and Depression
McKay and Bouman described three cases in which monosymptomatic hypochondriasis was treated with CBT, following a series of between 5 and 8 MI sessions. Each of the clients previously had received extensive psychotherapy . For all three cases presented, once-weekly therapy sessions lasted 50 minutes each and the entire course of treatment ranged from 12 to 31 sessions. According to the authors, MI was intended to âweaken the strength of the belief in the presence of illness or diseaseâ . Immediately following MI and CBT, scores on anxiety and depression measures were decreased for all three clients, and these reductions were maintained at 6-month follow-up. The authors concluded that âMI is promising as an adjunct to treatment for monosymptomatic hypochondriasisâ . Of clinical importance is that in each of the presented cases, there was one âcriticalâ session in which MI facilitated lowered belief conviction about health concerns, then allowing more intensive CBT.
Social Anxiety Disorder
Critique Of The Literature
For the RCTs, the control group treatment is another critical experimental design consideration. Several of the RCTs included in this review utilized double-blind, nonspecific or standard treatment control groups in order to experimentally control for amount of therapist/treatment contact, limiting threats to internal and construct validity . Two other studies utilized nonspecific treatment control groups however, these groups did not receive the same amount of therapist contact as experimental treatment groups. Four studies utilized only a waiting-list control, reducing construct validity.
A final experimental design issue that is intimately related to external validity and the generalizability of study findings involves therapist assignment to study cases. Clinical outcome studies that involve only one therapist may have reduced external validity, as therapist variables, not treatment variables, may account for much of the variance observed in study findings . Reviewed studies that utilized multiple MI and CBT therapists are considered to have appropriately addressed this experimental design concern . All studies included in this review apparently occurred at a single study site, which limits external validity and generalizability.
Measurement and Data Analytic Issues
Data Analytic and Statistical Considerations
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Technology Assisted Motivational Interview
Technology Assisted Motivational Interview is “used to define adaptations of MI delivered via technology and various types of media”. This may include technological devices and creations such as computers, mobile phones, telephones, videos and animations. A review of multiple studies shows the potential effectiveness of the use of technology in delivering motivational interviewing consultations to encourage behavior change. However, some limitations include: the lack of empathy that may be expressed through the use of technology and the lack of face-to-face interaction may either produce a positive or negative effect on the patient. Further studies are required to determine whether face-to-face consultations to deliver MI is more effective in comparison to those delivered via technology.
Exploratory Analyses Of Alcohol Subgroup
To explore whether the lack of effect of the therapy was consistent for all substance use groups we examined the largest subgroupindividuals who met only alcohol dependence or abuse criteria at baselineand compared it to the remaining participants. There was a statistically significant treatment by subgroup interaction on the percentage of days abstinent from the main substance : the difference in means between the therapy group and the control group for those individuals using alcohol only was 10.72% and that for the remaining individuals was 7.42% , the difference between the treatment effects being 18.13% . No treatment by subgroup interactions were found either on the primary outcome or on any other secondary outcome.
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Is Motivational Interviewing A Modality
Motivational Interviewing Outcomes. Research suggests that MI is an effective treatment modality for substance use disorder. Its applications as a treatment philosophy provide a set of methods that can be used to generate a spirit of motivation and positive change alongside a wide variety of modalities.
Eye Movement Desensitization And Reprocessing
Eye movement desensitization and reprocessing developed during the 1980s after a key discovery showed the potential of using eye movement to lessen the intensity of disturbing thoughts. For several years following the discovery, researchers focused on how to effectively utilize eye movement in the treatment of trauma victims. EMDR is now used in the treatment of various disorders ranging from addiction to PTSD. What exactly is EMDR? Patients move their eyes rapidly from side to side while simultaneously recalling a traumatic experience together with the counselor. The basis for this idea is that by the conclusion of the therapy sessions, the patient will have desensitized themselves from both the rapid movement of the eyes and the traumatic experience they are recalling. By having the individual move their eyes, the counselor is creating a physical stimulus with which to identify. This stimulus can also come in the form of pulsating lights, tapping of the knees, or other various physical motions that can be used to the same effect. Traumatic experiences such as the death of a loved one, rape, child abuse, or domestic violence are often the catalyst for addiction. Individuals become unable to cope with their traumatic experience normally and reach for other methods such as substance abuse and other addictive behaviors. How is EMDR implemented? A comprehensive EMDR treatment plan includes eight phases:
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Behaviour Change Counselling Scale
The Behaviour Change Counselling Scale is a tool used to assess lifestyle counselling using BCC, focusing on feedback on the skill achieved. “Items of BCCS were scored on 1-7 Likert scales and items were tallied into 4 sub-scales, reflecting the 3 skill-sets: MI and readiness assessment, behavior modification, and emotion management”. The data obtained is then presented on: item characteristics, sub-scale characteristics, interrater reliability, test-retest reliability and construct validity. Based on a study conducted by Vallis, the results suggest that BCCS is a potentially useful tool in assessing BCC and aid to training practitioners as well as assessing training outcomes.
Strengths And Limitations Of Study
This is the largest randomised controlled trial to evaluate an individual level treatment for psychosis and substance misuse. We had high rates of follow-up and low refusal and dropout rates. These rates compare very favourably with dropout rates from other treatment programmes for psychosis and substance misuse, which report in excess of 50% of patients failing to engage.46 The large sample was drawn from both urban and rural populations, and the sample characteristics seem representative of patients with substance misuse and psychosis presenting to mental health services,24 who often have longstanding substance use, with frequent misuse at moderate or severe levels, in the context of low levels functioning and significant psychopathology.
For all the above reasons, we can have confidence that the trial results give a reliable indication of the outcomes from delivering integrated motivational interviewing and cognitive behavioural therapy by trained therapists to people with a diagnosis of psychosis and moderate to heavy use of alcohol, illicit drugs, or both.
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Components Of Comprehensive Addiction Treatment
Research in addiction therapy has undergone immense changes since a boom in research that started in the 1970s. Several therapies have developed due to successful studies and others have evolved out of those studies in recent years. What governs whether or not an addiction therapy is effective in treatment? Researchers have identified key principles that they use in developing and assessing the effectiveness of newly developed therapies:
Each of the following addiction treatments has been proven to be effective and follow the components listed above. Within these principles, there are usually about five key steps that all addiction treatment programs follow. First, the patient must remove the addiction through detoxification. Next, behavioral counseling is used to determine various aspects of causation. From here, therapists can prescribe medication should it be necessary as well as proceed with the appropriate method of addiction therapy. Long-term follow-ups are necessary to monitor patients for relapse as well.