The Effect of a Motivational Interviewing Style in Cognitive Therapy for Depression

Persistent Link:
http://hdl.handle.net/10150/145363
Title:
The Effect of a Motivational Interviewing Style in Cognitive Therapy for Depression
Author:
Carlin, Erica
Issue Date:
2010
Publisher:
The University of Arizona.
Rights:
Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
Abstract:
While cognitive therapy (CT) is one of the most well-validated and widely used treatments for patients with Major Depressive Disorder (MDD), many individuals remain symptomatic at the end of treatment or drop out prematurely (Cuijpers, van Straten, Anderson, & van Oppen, 2008; Vittengl, Clark, Dunn, & Jarrett, 2007). Evidence suggests that certain types of therapist relational styles, such as one characterized by empathy and support, are facilitative of better therapeutic outcomes (Keijsers, Schaap, & Hoogduin, 1997) and motivational interviewing (MI; Miller & Rollnick, 2002) is a therapeutic approach which emphasizes this type of relational stance. The present study examined whether cognitive therapists exhibit a relational stance that is emphasized in motivational interviewing and whether this relational stance is associated with greater symptomatic improvement in cognitive therapy for depression. The Motivational Interviewing Treatment Integrity Skills Code (MITI; Moyers, Martin, Manuel, Miller, & Ernst, 2007), an observational coding system originated for assessing fidelity to MI, was used to assess three aspect of MI relational stance (MI Spirit, MI Adherent behaviors, and MI Nonadherent behaviors) among cognitive therapists in a randomized-controlled of CT for individuals with moderate to severe depression. Multilevel modeling was employed to examine the effect of MI relational stance on overall symptom trajectories throughout treatment and subsequent symptom reduction immediately after the use of MI relational stance. In order to rule out early symptom reduction as a potential confound, shared variance between MI relational stance and early symptom reduction was removed. The hypothesis that MI relational stance would be associated with more rapid symptom reduction was confirmed for MI Adherent behaviors but not for MI Spirit or MI Nonadherent behaviors. The prediction that initial depression severity would moderate the effect of MI relational stance on symptomatic improvement was not confirmed; however, a three-way interaction between initial depression severity, MI Adherence, and session number revealed that patients with high initial depression severity did not significantly improve through the course of therapy unless they received high MI Adherence. The hypothesis that MI relational stance in a given session would be associated with a reduction in depressive symptoms in the following sessions across the first four sessions was not confirmed. As predicted, early clinical improvement was not associated with MI relational stance in a later session, suggesting that MI relational stance was not merely an artifact of early clinical improvement. There was no support for the prediction that MI relational stance would be associated with subsequent retention in therapy or the therapeutic alliance. Overall, these findings suggest that a specific type of MI relational stance, MI Adherent behaviors, contribute to more symptomatic improvement. Implications of the role of MI relational stance in cognitive therapy are discussed.
Type:
Electronic Dissertation; text
Keywords:
Cognitive Behavioral Therapy; Cognitive Therapy; Depression; MI; Motivational Interviewing; Therapist style
Degree Name:
Ph.D.
Degree Level:
doctoral
Degree Program:
Graduate College; Psychology
Degree Grantor:
University of Arizona
Advisor:
Arkowitz, Harold S.

Full metadata record

DC FieldValue Language
dc.language.isoenen_US
dc.titleThe Effect of a Motivational Interviewing Style in Cognitive Therapy for Depressionen_US
dc.creatorCarlin, Ericaen_US
dc.contributor.authorCarlin, Ericaen_US
dc.date.issued2010en
dc.publisherThe University of Arizona.en_US
dc.rightsCopyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.en_US
dc.description.abstractWhile cognitive therapy (CT) is one of the most well-validated and widely used treatments for patients with Major Depressive Disorder (MDD), many individuals remain symptomatic at the end of treatment or drop out prematurely (Cuijpers, van Straten, Anderson, & van Oppen, 2008; Vittengl, Clark, Dunn, & Jarrett, 2007). Evidence suggests that certain types of therapist relational styles, such as one characterized by empathy and support, are facilitative of better therapeutic outcomes (Keijsers, Schaap, & Hoogduin, 1997) and motivational interviewing (MI; Miller & Rollnick, 2002) is a therapeutic approach which emphasizes this type of relational stance. The present study examined whether cognitive therapists exhibit a relational stance that is emphasized in motivational interviewing and whether this relational stance is associated with greater symptomatic improvement in cognitive therapy for depression. The Motivational Interviewing Treatment Integrity Skills Code (MITI; Moyers, Martin, Manuel, Miller, & Ernst, 2007), an observational coding system originated for assessing fidelity to MI, was used to assess three aspect of MI relational stance (MI Spirit, MI Adherent behaviors, and MI Nonadherent behaviors) among cognitive therapists in a randomized-controlled of CT for individuals with moderate to severe depression. Multilevel modeling was employed to examine the effect of MI relational stance on overall symptom trajectories throughout treatment and subsequent symptom reduction immediately after the use of MI relational stance. In order to rule out early symptom reduction as a potential confound, shared variance between MI relational stance and early symptom reduction was removed. The hypothesis that MI relational stance would be associated with more rapid symptom reduction was confirmed for MI Adherent behaviors but not for MI Spirit or MI Nonadherent behaviors. The prediction that initial depression severity would moderate the effect of MI relational stance on symptomatic improvement was not confirmed; however, a three-way interaction between initial depression severity, MI Adherence, and session number revealed that patients with high initial depression severity did not significantly improve through the course of therapy unless they received high MI Adherence. The hypothesis that MI relational stance in a given session would be associated with a reduction in depressive symptoms in the following sessions across the first four sessions was not confirmed. As predicted, early clinical improvement was not associated with MI relational stance in a later session, suggesting that MI relational stance was not merely an artifact of early clinical improvement. There was no support for the prediction that MI relational stance would be associated with subsequent retention in therapy or the therapeutic alliance. Overall, these findings suggest that a specific type of MI relational stance, MI Adherent behaviors, contribute to more symptomatic improvement. Implications of the role of MI relational stance in cognitive therapy are discussed.en_US
dc.typeElectronic Dissertationen_US
dc.typetexten_US
dc.subjectCognitive Behavioral Therapyen_US
dc.subjectCognitive Therapyen_US
dc.subjectDepressionen_US
dc.subjectMIen_US
dc.subjectMotivational Interviewingen_US
dc.subjectTherapist styleen_US
thesis.degree.namePh.D.en_US
thesis.degree.leveldoctoralen_US
thesis.degree.disciplineGraduate Collegeen_US
thesis.degree.disciplinePsychologyen_US
thesis.degree.grantorUniversity of Arizonaen_US
dc.contributor.advisorArkowitz, Harold S.en_US
dc.contributor.committeememberShoham, Vardaen_US
dc.contributor.committeememberSbarra, Daviden_US
dc.contributor.committeememberSilverberg Koerner, Sueen_US
dc.identifier.proquest11254en
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