Therapist affiliation and hostility in cognitive–behavioral therapy with and without motivational interviewing for severe generalized anxiety disorder
Abstract
Objective Although therapist supportive, rather than directive, strategies have been particularly indicated during client resistance, little systematic research has examined how therapists responsively navigate resistance in different therapy approaches and how this responsiveness is related to outcome. Method In the context of disagreement episodes in cognitive-behavioral therapy (CBT) for generalized anxiety disorder (GAD; Westra, H. A., Constantino, M. J., & Antony, M. M. Integrating motivational interviewing with cognitive-behavioral therapy for severe generalized anxiety disorder: An allegiance-controlled randomized clinical trial. Journal of Consulting and Clinical Psychology , 84 (9), 768-782. https://doi.org/10.1037/ccp0000098, 2016), the present study examined (1) the degree to which therapist management of resistance differed between therapists trained in CBT integrated with motivational interviewing (MI-CBT; i.e., training centered on the responsive management of resistance) and therapists trained in CBT-alone, and (2) the impact of specific therapist behaviors during disagreement on client worry outcomes immediately posttreatment and 1-year posttreatment. Episodes of disagreement were rated used the Structural Analysis of Social Behavior (Benjamin, L. S. Structural analysis of social behavior. Psychological Review , 81 (5), 392-425. https://doi.org/10.1037/h0037024, 1974). Results Therapists trained in MI-CBT were found to exhibit significantly more affiliative an…
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Increased affiliative therapist behavior during disagreement is implicated as a mechanism of motivational interviewing plus cognitive behavioral therapy for generalized anxiety disorder.
“Investigations into the mechanisms of MI plus CBT for GAD have implicated lower resistance to treatment [85,87,88] and increased affiliative therapist behavior during disagreement [89], but not higher homework compliance or client-therapist alliance [87], suggesting that MI may improve outcomes primarily through clients’ greater receptivity to change.”
From Psychotherapeutic treatments for generalized anxiety disorder: cognitive and behavioral therapies, enhancement strategies, and emerging efforts (2022) · cites this paper as [89]
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- Authors
- Hara, K. M., Westra, H. A., Coyne, A. E., Di Bartolomeo, A. A., Constantino, M. J., & Antony, M. M.
- Affiliations
- York University (CA)
- University of Massachusetts Amherst (US)
- Department of Psychology, York University, Toronto, Canada
- Toronto Metropolitan University (CA)
- Corresponding author
- Westra, Henny A.
- Venue
- Psychotherapy Research
- Publisher
- Informa UK Limited
- Published
- 2021-11-18
- Volume
- 32
- Issue
- 5
- Pages
- 598-610
- ISSN
- 1050-3307 (ISSN-L)
- 1468-4381
- OpenAlex
- W3211350279
- Cited by
- 10
- References
- 53
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 1 · 2022: 4
- FWCI
- 1.20
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychotherapy Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institute of Health Research (MOP-114909)
- Frederick Banting and Charles Best Canada Graduate Scholarship (336457)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- client resistance, motivational interviewing, cognitive behavioral therapy, generalized anxiety disorder, therapist training
- MeSH terms
- Anxiety, Anxiety Disorders, Hostility, Humans, Cognitive Behavioral Therapy, Treatment Outcome, Motivational Interviewing
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