Hal Arkowitz

The efficacy of motivational interviewing: A meta-analysis of controlled clinical trials.

A meta-analysis was conducted on controlled clinical trials investigating adaptations of motivational interviewing (AMIs), a promising approach to treating problem behaviors. AMIs were equivalent to other active treatments and yielded moderate effects (from .25 to .57) compared with no treatment and/or placebo for problems involving alcohol, drugs, and diet and exercise. Results did not support the efficacy of AMIs for smoking or HIV-risk behaviors. AMIs showed clinical impact, with 51% improvement rates, a 56% reduction in client drinking, and moderate effect sizes on social impact measures (d=0.47). Potential moderators (comparative dose, AMI format, and problem area) were identified using both homogeneity analyses and exploratory multiple regression. Results are compared with other review results and suggestions for future research are offered.

Comprehensive Handbook of Cognitive Therapy

Theory and Research: The History of Cognition in Psychotherapy (A. Ellis). Cognitive Therapy (A.T. Beck & M. Weishaar). The Measurement of Cognition in Psychopathology: Clinical and Research Applications (J.O. Goldberg & B.F. Shaw). rocess and Outcome in Cognitive Therapy (E.E. Beckham & J.T. Watkins). Cognitive Therapy and Cognitive Science (D. Tataryn et al.). Constructs of the Mind in Mental Health and Psychotherapy (R.S. Lazarus). The Role of Cognitive Change in Psychotherapy (L.E. Beutler & P.D. Guest). Clinical Applications of Cognitive Therapy: Clinical Assessment in Cognitive Therapy (T. Merluzzi). Combined Cognitive Therapy and Pharmacology (J. Wright & R. Schrodt). Cognitive Restructuring through Guided Imagery: Lessons from Gestalt Therapy (D. Edwards). Cognitive Therapy with the Adult Depressed Patient (C. Perris). The Treatment of Suicidal Behavior (A. Freeman & D. White). Cognitive Therapy of Anxiety (A. Freeman & K.M. Simon). Cognitive and Behavioral Approaches to the Treatment of Anorexia Nervosa (S. Edgette & M. Prout). Treatment of Obesity (M. Cramer). 16 additional articles. Index.

Adding a motivational interviewing pretreatment to cognitive behavioral therapy for generalized anxiety disorder: a preliminary randomized controlled trial.

Seventy-six individuals with a principal diagnosis of generalized anxiety disorder (GAD) were randomly assigned to receive either an MI pretreatment or no pretreatment (NPT), prior to receiving CBT. Significant group differences favoring the MI-CBT group were observed on the hallmark GAD symptom of worry and on therapist-rated homework compliance, which mediated the impact of treatment group on worry reduction. Adding MI pretreatment to CBT was specifically and substantively beneficial for individuals with high worry severity at baseline. There was evidence of relapse at 6-month follow-up for high severity individuals who received MI-CBT, but significant moderator effects favoring the high severity MI-CBT group were again apparent at 12-months post-treatment. Pending replication in a more controlled test, these findings suggest that MI may be a promising adjunct to CBT for GAD for those of high severity, a group which has been less responsive to CBT in past research.

Integrating Motivational Interviewing and Cognitive Behavioral Therapy in the Treatment of Depression and Anxiety

Many clients engaging in Cognitive Behavioral Therapy (CBT) for depression and anxiety are ambivalent about change, and about taking necessary actions to bring about change such as exposure or behavioral activation exercises. Given the focus of motivational interviewing (MI) on enhancing readiness for change, it is of great interest to investigate applications of MI to prevalent disorders such as depression and anxiety. After exploring the rationale for integrating MI with CBT for these disorders, we outline unique features of MI that may render it a useful complement to CBT, such as its focus on resolving ambivalence for change and specific strategies for responding to resistance. We suggest several possible ways in which MI may be combined with CBT. Finally, we discuss our clinical experience with adapting MI to the treatment of depression and anxiety, including case illustrations of each, and discuss some of the unique issues arising in generalizing MI for use with these populations.

A Pilot Investigation of Emotion‐Focused Two‐Chair Dialogue Intervention for Self‐Criticism

UNLABELLED Self-criticism plays a key role in many psychological disorders and predicts poor outcome in psychotherapy. Yet, psychotherapy research directly targeting self-critical processes is limited. In this pilot study, we examined the efficacy of an emotion-focused intervention, the two-chair dialogue task, on self-criticism, self-compassion and the ability to self-reassure in times of stress, as well as on depressive and anxiety symptoms among nine self-critical clients. Results showed that the intervention was associated with significant increases in self-compassion and self-reassuring, and significant reductions in self-criticism, depressive symptoms and anxiety symptoms. Effect sizes were medium to large, with most clients exhibiting low and non-clinical levels of symptomatology at the end of therapy, and maintaining gains over a 6-month follow-up period. Although preliminary, these finding suggest that emotion-focused chair work might be a promising intervention addressing self-criticism. KEY PRACTITIONER MESSAGE Self-criticism is an important process in a variety of clinical disorders and predicts poor outcome in brief therapy for depression. Yet, little is known about how self-criticism can be effectively addressed in psychological treatment. Practitioners can benefit from increasing their awareness of self-critical processes in their clinical work, and from directly working with emotions in addressing self-criticisim. Emotion-focused two-chair dialogue intervention can be effective in reducing self-criticism, increasing self-compassion, and decreasing depressive and anxiety symptoms, and these improvements are largely maintained six months after therapy.

Viewing Resistance as Ambivalence: Integrative Strategies for Working With Resistant Ambivalence

Resistance to change is a problem that has long evaded easy solutions. In this article, the authors suggest the value of understanding and working with some forms of resistance as ambivalence. They describe resistant ambivalence in the context of an integrative and multivoiced understanding. A person who is ambivalent possesses a voice that moves toward change and a voice that struggles against change. The authors sought therapy methods that were consistent with the multivoiced integrative understanding of ambivalence and that could be useful in its resolution. Motivational interviewing and the two-chair method are described in this article, along with illustrative case material. These methods share a common spirit and therapist style that is accepting of the clients worldview and creates a strong partnership between the therapist and client. These methods can be used in conjunction with other therapy approaches and have a research base supporting their use.

Efficacy of Self-Administered Treatments for Depression and Anxiety

Self-administered treatments (SATs) are widely used by the general public and mental health professionals. Previous reviews of the efficacy of SATs have included under this category interventions for nonclinical problems, group interventions, and interventions involving significant amounts of therapist contact. The efficacy of SATs for clinical levels of depression and anxiety with minimal therapeutic contact was examined by meta-analyzing 24 studies. The results show large effects for SATs when compared with no-treatment control groups (d 1.00). However, unlike previous meta-analyses that found nonsignificant differences between SATs and therapist-administered treatments, in this sample SATs resulted in significantly poorer outcomes (d –0.31). Some differences in effect size were observed between the clinical targets of depression and anxiety. However, there were high correlations between clinical target, methodological quality of the study, and amount of contact. This makes it impossible to determine whether the observed differences could be explained by the nature of the disorders, methodological quality, or the amount of contact with a member of the research team. The implications of the findings for the clinical use of SATs and for future research are discussed.

Therapist differences in cognitive-behavioral psychotherapy for generalized anxiety disorder: a pilot study.

Little is known about factors differentiating more and less effective therapists or the mechanisms through which therapists influence outcome. In the present study, the performance of a small sample of 4 therapists was compared in the context of delivering cognitive-behavioral psychotherapy (CBT) to 32 clients with generalized anxiety disorder. More effective therapists were characterized by higher observer-rated CBT competence, higher client outcome expectations and client treatment credibility assessments, and higher early treatment client ratings of therapeutic alliance quality. Higher early CBT competence was associated with higher client midtreatment outcome expectations, which in turn were associated with better posttreatment outcomes. Although these findings are preliminary given the small sample of therapists and clients, they suggest that the common factor of outcome expectations might be a mechanism through which the specific factor of psychotherapist competence exerts its influence on treatment outcome. The implications of these findings and directions for future research are discussed.

The assessment of mother-child interactions in physically abusive and nonabusive families

Physically abusive mothers and their children were compared with matched nonabusive mothers and their children in a laboratory playroom setting. Parenting skills, as well as mother-child interaction patterns, were assessed using three different tasks designed to create varying levels of parental stress and child frustration. Mother-child interactions were observed and coded. Questionnaire measures of knowledge of child behavior and a measure of social desirability were also administered. Discriminant function analyses revealed that 10 of the 11 abusive mothers and 10 of the 12 control mothers could be correctly identified, representing an 87% classification rate. The main difference between the two groups was in the overall rate of activity. Abusive mothers engaged in significantly less behavior toward their children than control mothers; behavior rates were essentially similar for both groups of children. Abusive mothers contingently praised appropriate behavior significantly less often than controls, and abused children complied significantly less often to requests. The implications of these findings for the understanding and treatment of abusive parent-child interactions were discussed.

Minimal dating and its relationship to other social problems and general adjustment

This study was designed to answer the question of whether low-dating men and women have difficulties in same-sex friendship interactions and in general psychological adjustment. Anxious minimal daters were compared with active relaxed daters on self-report, self-monitoring, behavioral, and peer-rating measures of social anxiety, social skill, and social activity. In addition, all subjects were given the Eysenck Personality Inventory (EPI) as a measure of general adjustment. For men, our prediction that low-daters would show difficulties in samesex friendship interactions was confirmed, as was the prediction that they would be less well adjusted than high-daters on the EPI. However, the predictions were not confirmed for women. Low-dating women did not show any difficulties in same-sex friendship interactions, nor were they any less well adjusted in general than high-dating women. These results point to the importance of sex, differences in understanding and treating minimal dating and suggest that broader based interventions may be needed for low-dating men.