The predictive capacity of patients' change- and counter-change talk: Results from a randomized controlled trial of cognitive behavioral therapy vs. metacognitive therapy for generalized anxiety disorder

Abstract

Patient motivation for change is thought to be an important factor for psychotherapy outcome. However, accurate measures of patient motivation have proven elusive, with self-report measures showing inconsistent results in relation to treatment success. How patients initially talk about change has been found to be a more accurate measure of their motivation, with subsequent value in predicting treatment outcome. This study investigated 24 patients receiving cognitive behavioral therapy (CBT) and 27 patients receiving metacognitive therapy (MCT) for generalized anxiety disorder (GAD), and included data from session 1 and 4. There were two aims: (1) to examine if patient language about change could predict worry reduction at post-treatment and 2-year follow-up, and (2) if there were differences between the CBT and MCT conditions on observed motivational language. Motivational language was found to be a strong predictor of worry scores at post-treatment and 2-year follow-up, beyond initial worry severity and treatment condition. For instance, both commitments to change at session 1, taking steps at session 4, and Change Talk along with Counter Change Talk at session 4 showed good predictive value, as did changes in observed Counter Change Talk. Moreover, CBT and MCT differed in their frequency of patient language during session 1, with patients in the MCT condition arguing more both for and against change, as well as being more vocal overall. These results support the importance of attending to patient motivational language in CBT and MCT for GAD with regard to psychotherapy outcome.