Client Motivation and Engagement in Transdiagnostic Group Cognitive Behavioral Therapy for Anxiety Disorders: Predictors and Outcomes

摘要

Client motivation is regarded as a key factor in cognitive behavioral therapy (CBT) for anxiety disorders. To date, client motivation has only been measured during individual-CBT, with little known about the predictive capacity of motivation in group settings. The current study aimed to explore the role of client motivation in group-CBT. Measuring motivation during individual-CBT has proven somewhat difficult with many self-report measures providing weak and inconsistent results. For this reason observational measures of motivation, such as rating client change (CT) language during CBT, have been trialled with some success. The current study aimed to measure motivation using an observational coding system of CT and counter change talk (CCT) during two components of group CBT: cognitive restructuring and exposure sessions. The study explored the predictive capacity of CT and CCT in determining treatment outcomes, and baseline characteristics that predicted in session CT and CCT. Results indicated that CT and CCT predicted different treatment outcomes depending on the stage of therapy. CT and CCT predicted symptom severity at post-treatment and slope of improvement in cognitive restructuring sessions. During exposure sessions only CCT was predictive of poorer treatment outcomes but CT determined client attendance and treatment drop out. Furthermore, baseline characteristics including symptom severity, education, and age were predictive of CT and CCT throughout treatment. These findings are discussed and comparisons are drawn to the role of motivation in individual-CBT. Limitations and implications of this research are explored, specifically the utility of coding motivational language using observational methods in group settings.