Results of a five-year, randomized clinical trial of a new combined treatment approach for severe generalized anxiety disorder (GAD) led by Henny Westra at York University, Toronto, with Michael Constantino at the University of Massachusetts Amherst and Martin Antony at Ryerson University, Toronto, suggest that integrating motivational interviewing (MI) with cognitive behavioral therapy (CBT) improves long-term patient improvement rates than CBT alone.

As psychotherapy researcher Constantino explains, “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. We wanted to do something about improving mental health treatment outcomes for this very commonly encountered disorder.” Details appear in an early online issue of the Journal of Consulting and Clinical Psychology.

Westra, Constantino and Antony tested an idea based on preliminary research suggesting that therapists might improve CBT by addressing the observation that patients are very often ambivalent about giving up their worry and anxiety. Constantino says, “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.”

Patients talking with a therapist during CBT may reach a place where they have internal ambivalence and begin to more actively resist the therapist’s suggestions about ways to change…

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