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Document Type

Campus-Only Access for Five (5) Years

Embargo Period

5-10-2020

Degree Program

Psychology

Degree Type

Master of Science (M.S.)

Year Degree Awarded

2019

Month Degree Awarded

May

Abstract

Aim: A randomized clinical trial demonstrated that responsively adding motivational interviewing (MI) to cognitive-behavioral therapy (CBT) for generalized anxiety disorder (GAD) outperformed CBT alone on long-term worry reduction (Westra et al., 2016). Consistent with MI’s additive aim, this effect was mediated by less patient midtreatment resistance in the integrative treatment (Constantino et al., 2019). Insofar as GAD is marked by interpersonal styles of excessive nonassertiveness and over accommodation, I tested here whether MI-CBT also outperformed CBT, across acute treatment and long-term follow up, on reducing these characteristic interpersonal problems. Moreover, as patient resistance is an interpersonal event for which person-centered MI should, according to theory, be more helpful than directive CBT, I tested if resistance also mediated the expected effect of treatment on the long-term interpersonal outcomes. Method: Eighty-five patients with severe GAD were randomly assigned to 15 sessions of MI-CBT or CBT. Patients completed a measure of interpersonal problems repeatedly through treatment and 12 months of follow up. Independent observers rated patient resistance at a midtreatment session. Results: As expected, structural equation models revealed comparable reductions in nonassertiveness and over accommodation across acute MI-CBT and CBT. Also as predicted, MI-CBT vs. CBT promoted significantly greater reduction in over accommodation problems over long-term follow up; however, this differential effect was only marginally significant for nonassertiveness problems. Finally, as predicted, the treatment effect on the level of both interpersonal problems at 12-month follow up was mediated by less midtreatment resistance in MI-CBT vs. CBT. Discussion: Results support that the benefit of adding MI to CBT for GAD extends to long-term interpersonal change, and they implicate resistance management as a candidate mechanism of this additive effect.

First Advisor

Michael J. Constantino

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