Comparing the predictive capacity of observed in-session resistance to self-reported motivation in cognitive behavioral therapy

May combine two claims.

In the Westra et al. (2009) study, the CMOTS did not predict outcome, but clients with high baseline worry reported larger increases in intrinsic motivation from pre- to post-MI than those with moderate worry.

“And while the CMOTS failed to predict outcome in the Westra et al. (2009) study, those of high worry severity at baseline reported greater increases in intrinsic motivation from change from pre to post MI, compared to those of moderate worry severity.”

• cites Westra et al. (2009) sourcePartly supported

  The Results report a significant treatment-by-worry-severity interaction in intrinsic motivation after pretreatment (p = .013), supporting the greater increase among high-severity clients who received MI. The paper does not establish the broader assertion that the CMOTS failed to predict outcome: it reports a marginally significant interaction between baseline intrinsic motivation and treatment group for post-CBT worry (p = .080). (LLM, conf=0.82)

  Experimental — accuracy not yet measured

May combine two claims.

In CBT for generalized anxiety disorder, observed in-session resistance during session 1 predicted all three outcomes well, while the two self-report motivation measures were weaker and inconsistent.

“Observed in-session resistance performed very well on each index, compared to the performance of self-reported motivation which was inconsistent and weaker relative to observed resistance.”

May combine two claims.

Observed early resistance explained at least three times as much variance in client-rated homework compliance as CQ scores, which explained 11%.

“observed early resistance accounted for at least three times the amount of variance in client rated homework compliance compared with CQ scores (11%).”

May combine two claims.

For one-year post-treatment worry, lower early resistance (t=1.91, p=.068, beta=.33) and higher CQ scores (t=1.81, p=.083, beta=-.34) were marginally significant predictors.

“both lower early resistance, t = 1.91, p=.068, beta=.33 and higher CQ scores, t = 1.81, p=.083, beta = −.34 were significantly predictive, albeit at a marginal level of significance.”

May combine two claims.

Higher scores on the CQ predicted greater client-rated homework compliance, but did not predict therapist-rated homework compliance.

“Higher scores on the CQ were also predictive of higher levels of client rated homework compliance but not therapist rated homework compliance.”

May combine two claims.

Higher observed early resistance in the first CBT session predicted lower subsequent homework compliance as rated by both therapists and clients, explaining 36% and 39% of the variance respectively.

“higher observed early resistance was a consistent and substantive predictor of subsequent lower client homework compliance as rated by both therapists and clients, accounting for 36% and 39% of the variance, respectively.”

May combine two claims.

Higher observed early resistance significantly predicted poorer worry reduction at post-CBT and one-year follow-up, explaining 32% and 23% of the variance respectively.

“Higher observed early resistance was a significant and substantive predictor of both poorer post-CBT and one-year post-treatment worry reduction, accounting for 32% and 23% of the variance in worry outcome respectively.”

May combine two claims.

A marginally significant time by treatment group effect occurred for the CMOTS index of more self-determined motivation, with a moderate effect size d=.73 (CI: .05 to 1.38); those who received MI reported greater increases in more self-determined motivation than those who received no pretreatment.

“A marginally significant time by treatment group effect was obtained for the CMOTS index of more self-determined motivation, with a moderate effect size of d=.73 (CI: .05 to 1.38). Those who received MI reported greater increases in more self-determined motivation compared to those who received no pretreatment.”

May combine two claims.

When individual CMOTS subscales were examined, no significant time by treatment group interactions occurred for any subscale, although change in intrinsic motivation approached significance (p=.094).

“when the individual subscales of the CMOTS were examined, there were no significant time by treatment group interactions for any of the subscale; although change in intrinsic motivation approached significance, p=.094.”

May combine two claims.

In simultaneous regressions, self-report measures together explained 22% of post-treatment worry variance, while resistance explained an additional 21% beyond self-report.

“Collectively, the self-report measures of motivation accounted for 22% of the variance in post-treatment worry, while resistance accounted for 21% of the variance beyond the self-report measures.”

May combine two claims.

In simultaneous regressions for one-year worry, self-report measures together explained 23% of variance, while resistance explained an additional 8% beyond self-report.

“Collectively, the self-report measures accounted for 23% of the variance in worry scores at one-year follow-up, while resistance accounted for an additional 8% of the variance beyond the self-report scales.”

May combine two claims.

Neither CMOTS index nor its individual subscales was related to worry outcome.

“both CMOTS indices, as well as individual CMOTS subscales, were unrelated to outcome.”

May combine two claims.

In simultaneous regressions, observed resistance explained an additional 30% of therapist-rated and 31% of client-rated homework compliance variance beyond the other motivation measures.

“observed resistance accounted for 30% and 31% of the variance beyond the other measures of motivation in therapist rated and client rated homework compliance, respectively.”

May combine two claims.

Existing self-report motivation measures reliably predict dropout from CBT for anxiety but do not reliably predict treatment outcome.

“Existing measures reliably predict treatment dropout (e.g., Brogan, Prochaska, & Prochaska, 1999; Dozois, Westra, Collins, Fung, & Garry, 2004; Keijsers, Kampman, & Hoogduin, 2001) but not treatment outcome.”

• cites Brogan, Prochaska, & Prochaska, 1999 sourceNot checked — no full text of the source
• cites Dozois, Westra, Collins, Fung, & Garry, 2004 sourceNot checked — no full text of the source
• cites Keijsers, Kampman, & Hoogduin, 2001 sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

In the motivation literature, resistance and noncompliance in therapy are commonly viewed as signs of low motivation or ambivalence about change.

“In fact, in the literature on motivation, resistance and noncompliance in therapy are commonly regarded as manifestations of low motivation or ambivalence about change (Engle & Arkowitz, 2006; Miller & Rollnick, 2002; Westra & Arkowitz, 2010)”

• cites Engle & Arkowitz, 2006Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Miller & Rollnick, 2002Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Westra & Arkowitz, 2010Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Classified as probably not a substantial claim.

The study's results support clinicians paying attention to client resistance in actual therapy sessions as early as the first session.

“These findings strongly support both clinician sensitivity to moments of client resistance in actual therapy sessions as early as session 1, and the inclusion of observational process measures in CBT research.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Therapist directiveness or demands for change reliably trigger resistance.

“that are reliably triggered by therapist directiveness or demands for change (e.g., Beutler, Harwood, Michelson, Song, & Holman, in press; Miller, Benefield, & Tonigan, 1993; Patterson & Forgatch, 1985).”

• cites Beutler, Harwood, Michelson, Song, & Holman, in pressNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Miller, Benefield, & Tonigan, 1993 sourceNot checked — no full text of the source
• cites Patterson & Forgatch, 1985 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The CQ can be adapted to a 3-item version suitable for clinical practice.

“The CQ can even be adapted to a 3-item version amenable for administration in clinical practice (Miller & Johnson, 2008).”

• cites Miller & Johnson, 2008 sourceNot checked — no full text of the source

May combine two claims.

Higher early resistance significantly distinguished patients who continued to meet GAD criteria at one year from those who did not, and those who received no pretreatment before CBT from those who received MI.

“Higher levels of early resistance also significantly distinguished both those who continued to meet diagnostic criteria for GAD one-year post-treatment compared to those who did not, as well as those who did not receive a pretreatment prior to CBT compared to those who received MI.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Higher HCS scores have been linked to more positive CBT outcomes.

“Higher scores on the HCS have been associated with more positive outcome in CBT (Bryant, Simons, & Thase, 1999; Taft, Murphy, King, Musser, & DeDeyn, 2003).”

• cites Bryant, Simons, & Thase, 1999 sourceNot checked — no full text of the source
• cites Taft, Murphy, King, Musser, & DeDeyn, 2003 sourceNot checked — no full text of the source

May combine two claims.

The CRC has good construct and predictive validity, as well as face and content validity.

“The CRC has been shown to possess good construct and predictive validity (Chamberlain Patterson, Reid, Kavanagh, & Forgatch, 1984; Patterson & Forgatch, 1985) as well as face and content validity (Bischoff & Tracey, 1995).”

• cites Chamberlain Patterson, Reid, Kavanagh, & Forgatch, 1984Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Patterson & Forgatch, 1985 sourceNot checked — no full text of the source
• cites Bischoff & Tracey, 1995 sourceNot checked — no full text of the source

May combine two claims.

Observed resistance in actual therapy sessions is a very sensitive index of MI's impact, with MI recipients showing substantially more co-operation early in CBT than non-recipients.

“These findings strongly suggest that observed resistance in actual therapy sessions is a very sensitive index of the impact of having received MI, with those receiving MI exhibiting substantially higher levels of co-operation early in CBT than those who did not receive MI.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Resistance to therapist direction is conceptualized as a behavioral expression of ambivalence about change or treatment, signaling that the therapist is pushing for changes the client is not ready for.

“In this context, resistance to therapist direction is conceptualized as a behavioral expression of ambivalence about change or treatment; it represents a signal that the therapist is pushing the client to make changes or move in directions for which they are not yet ready (Miller & Rollnick, 2002; Moyers & Rollnick, 2002).”

• cites Miller & Rollnick, 2002Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Moyers & Rollnick, 2002 sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

All participants had a principal GAD diagnosis established with the ADIS-IV.

“All participants had a principal diagnosis of GAD based on the administration of the Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV: Brown, DiNardo, & Barlow, 1994).”

• cites Brown, DiNardo, & Barlow, 1994Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Early resistance explained between 36% and 39% of variance in homework compliance and between 23% and 32% of variance in outcome.

“the variance accounted for by early resistance was consistently impressive, accounting for between 36% to 39% of the variance in homework compliance, and between 23% to 32% of the variance in outcome.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In CBT, resistance can appear in many forms, such as refusing homework, acting against in-session agreements, expressing high emotion toward the therapist, avoiding in session through silence or 'I don't know', debating gratuitously, and misinterpreting therapist comments.

“Newman (1994) outlines various forms that resistance can take in CBT including refusal to follow through with homework, taking actions that run counter to what was agreed upon in session, high levels of expressed emotion toward the therapist, in-session avoidance such as silence or frequent use of “I don’t know”, gratuitous debates with the therapist, and misinterpretation of the therapist’s comm”

• cites Newman (1994) sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The Change Questionnaire has good internal consistency and test-retest reliability.

“The CQ has good internal consistency and test-retest reliability (Miller & Johnson, 2008).”

• cites Miller & Johnson, 2008 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Interrater reliability for ADIS-IV diagnoses, based on a random 20% of audiotaped interviews, was good: overall kappa .75 and 1.0 for GAD; GAD severity rater correlation was r = .79, p < .001.

“Inter-rater reliability based on a random sample of 20% of audiotaped interviews for those who were successfully enrolled in the study was good, with an overall kappa for all diagnoses of .75, and 1.0 for GAD. The correlation between raters for GAD severity was r = .79, p<.001.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Resistance in CBT has been observed to indicate misalliances, poor collaboration on tasks and goals, and opposition to the therapist's formulation of the client's problems.

“Expressions of resistance in CBT have also been observed to indicate misalliances, lack of collaboration on tasks and goals and clients’ opposition to therapist formulation of the clients’ problems (Watson & McCullen, 2005).”

• cites Watson & McCullen, 2005Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The CMOTS has good internal consistency, fits its theoretically derived factor structure, and has good convergent and discriminant validity.

“They found that the scale had good internal consistency, conformed to the theoretically-derived factor structure and possessed good convergent and discriminant validity.”

• cites Pelletier et al., 1997 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The PSWQ has high internal consistency and temporal stability, good convergent and discriminant validity, and distinguishes GAD from other anxiety disorders.

“The PSWQ possesses high internal consistency and temporal stability, as well as good convergent and discriminant validity (Brown, Antony, & Barlow, 1992; Meyer et al.). It also differentiates individuals with GAD from those with other anxiety disorders (Brown et al.).”

• cites Brown, Antony, & Barlow, 1992 sourceNot checked — no full text of the source
• cites Meyer et al.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Classified as probably not a substantial claim.

Self-report measures of motivation may be sensitive to response or self-presentation bias.

“any self-report measure of motivation may be sensitive to response or self-presentation bias.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Higher CMOTS scores were associated with greater short- and long-term improvement in three psychotherapy types for depression.

“Zuroff et al. (2007) reported that higher scores on the CMOTS were associated with increased rates of short- and long-term improvement in three different types of psychotherapy for depression.”

• cites Zuroff et al. (2007) sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

ADIS-IV interviews were conducted by advanced clinical psychology graduate students trained to criterion.

“ADIS-IV interviews were conducted by advanced clinical psychology graduate students who were trained to criterion in the administration of this diagnostic instrument.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The resistance coding team comprised four clinical psychology graduate students trained for one year until reliability was reached.

“The team of coders consisted of four graduate students in clinical psychology who were trained over a period of one year by reviewing, coding, and discussing samples of videotape in bi-weekly meetings until reliability was achieved.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The present sample consisted only of patients with GAD.

“the present sample included only those with GAD.”

Probably not a substantial claim: may not pass S2 (checkable).

The ability to detect and effectively manage resistance is a key clinical skill.

“a number of investigators have suggested that the ability to detect and effectively mange resistance is a key clinical skill (Binder & Strupp, 1997; Burns & Auerbach, 1996; Safran & Muran, 1996; Westra & Dozois, 2008; Westra, in press).”

• cites Binder & Strupp, 1997 sourceNot checked — no full text of the source
• cites Burns & Auerbach, 1996Not checked — no full text of the source
• cites Safran & Muran, 1996 sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

To evaluate each measure's ability to predict homework compliance and outcome, the study used the CBT-alone group (N=38) so that receiving MI would not influence these measures.

“For the evaluation of the capacity of each measure to predict homework compliance and outcome, the CBT alone group (no pre-treatment; N=38) was used in order to avoid any influence of having received MI on these measures.”

Classified as probably not a substantial claim. May combine two claims.

Coders were blind to client outcome and pretreatment status and coded sessions independently.

“Coders were blind to client outcome or pretreatment status and coded sessions independently.”

May combine two claims.

Among the three motivation measures, higher observed resistance in CBT session 1 was the most consistent and strongest predictor of both proximal (lower homework compliance) and distal (less worry reduction post-CBT and at one-year follow-up) outcomes in CBT.

“higher observed resistance in CBT session 1 was the most consistent and strongest predictor of both proximal (lower homework compliance) and distal (less worry reduction post-CBT and at one-year follow-up) outcomes in CBT.”

May combine two claims.

The two self-report motivation measures were inconsistently related to homework compliance and short- and long-term outcome, and did not consistently differentiate patients who received MI before CBT from those who did not.

“the two self-report measures of motivation were inconsistently related to homework compliance, short and long term outcome, and failed to consistently differentiate those who received MI prior to CBT from those who did not.”

May combine two claims.

In depressed adolescents, observed resistance in CBT session 1 was low overall, but higher resistance significantly predicted the total number of sessions completed.

“For example, Jungbluth and Shirk (2009) noted that even though observed resistance levels in CBT session 1 for a group of depressed adolescents were quite low, higher resistance significantly predicted the total number of sessions completed.”

• cites Jungbluth and Shirk (2009) sourceNot checked — no full text of the source

May combine two claims.

A highly face-valid direct self-report questionnaire can perform as well as, and possibly better than, indirect or complex self-report measures of motivation.

“a highly face-valid direct self-report questionnaire can fare as well and possibly better than indirect or complex self-report measures of motivation (Miller & Johnson, 2008).”

• cites Miller & Johnson, 2008 sourceNot checked — no full text of the source