One of the most widely diagnosed conditions, Generalized Anxiety Disorder, affects about 3% of Americans. If you’re a mental health practitioner, it’s likely that this is one of the most common diagnoses in your practice. What does the latest research tell us about GAD? Spoiler alert: CBT combined with Motivational Interviewing results in better outcomes than CBT alone.



Criteria for Generalized Anxiety Disorder DSM-5 300.02 F41.1

First, let’s review the DSM-V criteria for GAD:

  • Extreme anxiousness and worrying that occurs for at least one-half year and is present for a greater amount of days than it is not. The worrying is about several things.
  • The person is not able to manage the worrying.
  • The anxiousness and worrying are related to a minimum of three of the symptoms below. In youngsters, only one symptom is necessary.
  • Feels irritable and unsettled.
  • Tires tired quickly.
  • Tension in muscles.
  • Sleep is difficult, including waking up, being able to fall asleep and not feeling refreshed after a night of sleep.
  • The worrying and other symptoms have resulted in extreme anxiety and an inability to be able to perform tasks on the job, at school and in everyday life.
  • The symptoms are not caused by a different type of disorder.

These criteria must all be present in order for a client to be diagnosed with the disorder.

Integrating motivational interviewing with CBT for severe GAD

Henny A. Westra, Michael J. Constantino, and Martin M. Antony’s paper in the Journal of Consulting and Clinical Psychology found that assimilating motivational interviewing strategies into Cognitive Behavioral Therapy resulted in better long term outcomes than CBT alone. What is most interesting is that the odds of no longer meeting GAD diagnostic criteria were ∼5 times higher at 12-months for clients receiving MI-CBT compared with CBT alone. There were also twice as many dropouts in CBT alone compared with MI-CBT (23% vs. 10%).

That’s a significant finding! Motivational interviewing with CBT seems to have a five-times greater benefit than CBT alone. Science Daily has a more detailed review of the study, be sure to check it out here!

What is Motivational Interviewing?

For those not familiar with the technique, motivational interviewing is a technique in which the practitioner becomes a helper in the change process and expresses acceptance of the client. Motivational interviewing builds on Carl Rogers’ optimistic and humanistic theories about people’s capabilities for exercising free choice and changing through a process of self-actualization.

Motivational interviewing is a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. Compared with nondirective counseling, it is more focused and goal-directed. The examination and resolution of ambivalence is its central purpose, and the counselor is intentionally directive in pursuing this goal.

Behavioral and Cognitive Psychotherapy, 23, 325-334

iCouch cofounder Jessica Dear is a big advocate of this technique. “When I become a trusted partner in the journey of my clients, they are more inspired to change. Setting goals, assigning ‘homework’ and getting my client engaged in their own success seems to result in a better outcome than just using standard CBT.”

If you’re interested in learning more about Motivational Interviewing, William R. Miller and Theresa B. Moyers have a great paper summarizing the eight stages in learning motivational interviewing in the Journal of Teaching in the Addictions, Vol. 5(1) 2006. Be sure to check it out!

Published by Brian Dear

Brian is the cofounder and CEO of iCouch, Inc. He has an extensive background in software engineering, inbound marketing and mental health practice management.

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