Joel Yager, MD reviewing Aviram A et al. J Consult Clin Psychol 2016 Sep.

Patients with generalized anxiety disorders whose CBT therapists directly and supportively addressed their resistance showed better outcomes.

Although cognitive-behavioral therapy (CBT) is recognized as a “gold standard” treatment for generalized anxiety disorder (GAD), many patients fail to respond or they drop out, with many exhibiting noncompliance and negative attitudes toward or disagreements with therapists. Investigators used data on 30 patients with severe GAD (28 women; mean age, 35) from a 15-week CBT study to examine patients' resistance, their therapists' responses, and the effects on outcomes.

Independent coders watching videotaped sessions rated patients for displays of resistance (specifically, disagreements with the therapist, including behaviors that oppose, impede, or divert the therapist's directions) and rated therapists for CBT competence and for behaviors consistent with motivational interviewing (MI). At baseline, after each session, and after completing CBT, patients self-rated their intensity of worrying.

After adjustment for patients' earlier worry scores and therapists' CBT competence, patients whose therapists showed more disagreement-specific MI responses reported lower worry scores at the end of treatment. Use of MI accounted for 14.5% of the variance in posttreatment worry scores. Therapists' MI behaviors at other points were not correlated with improved worry scores. In various analyses, therapists' higher MI context-specific responses were associated with lower patients' resistance scores in the next session and were responsible for 19% to 31% of the variance in later resistance.

CITATION(S):

Aviram A et al. Responsive management of early resistance in cognitive–behavioral therapy for generalized anxiety disorder. J Consult Clin Psychol 2016 Sep; 84:783. 

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