Skip to main content
SpringerLink
Log in

The Role of Motivation in Cognitive Behavioural Psychotherapy for Anxiety Disorders

  • Chapter
  • First Online:
Increasing Psychological Well-being in Clinical and Educational Settings

Part of the book series: Cross-Cultural Advancements in Positive Psychology ((CAPP,volume 8))

  • 2699 Accesses

Abstract

Anxiety disorders are considered a chronic condition, associated to worse and impaired quality of life. Despite the efficacy of Cognitive-behavioral therapy (CBT) for anxiety disorders, some patients do not have enough motivation for treatment. Patient’s motivation is evaluated as a state of readiness for change prior to the treatment that is subject to high fluctuations influenced by interactions between patient characteristics and psychotherapeutic process. Then, motivation could be considered a way of directing attention to elicit the patients’ desire for their behavior changes in the best interest of their health and well-being. Strategies like Motivational Interviewing (MI), Thought Mapping (TM) and psychoeducation were developed to make the individuals understand their own motivations and to reduce ambivalence about changing a particular behavior.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Almeida, A. C. (2007). Corrupção: com jeitinho parece que vai. In E. Record (Ed.), A cabeça do brasileiro. Rio de Janeiro.

    Google Scholar 

  • Anand, N., Sudhir, P. M., Math, S. B., et al. (2011). Cognitive behavior therapy in medication non-responders with obsessive-compulsive disorder: A prospective 1-year follow-up study. Journal of Anxiety Disorders, 25, 939–945. doi:10.1016/j.janxdis.2011.05.007.

    Article  PubMed  Google Scholar 

  • Anonymous. (1995). The World Health Organization Quality of Life assessment (WHOQOL): Position paper from the World Health Organization. Social Science & Medicine, 41, 1403–1409. doi:10.1016/0277-9536(95)00112-K.

    Article  Google Scholar 

  • APA. (2002). Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM-IV-TR). Porto Alegre: Artmed.

    Google Scholar 

  • Barlow, J. H., Ellard, D. R., Hainsworth, J. M., et al. (2005). A review of self-management interventions for panic disorders, phobias and obsessive-compulsive disorders. Acta Psychiatrica Scandinavica, 111, 272–285. doi:10.1111/j.1600-0447.2005.00499.X.

    Article  PubMed  Google Scholar 

  • Beesdo, K., Knappe, S., & Pine, D. S. (2009). Anxiety and anxiety disorders in children and adolescents: Developmental issues and implications for DSM-V. The Psychiatric Clinics of North America, 32, 483–524. doi:10.1016/j.psc.2009.06.002.

    Article  PubMed Central  PubMed  Google Scholar 

  • Beidas, R. S., Benjamin, C. L., Puleo, C. M., et al. (2010). Flexible applications of the coping cat program for anxious youth. Cognitive and Behavioral Practice, 17, 142–153. doi:10.1016/j.cbpra.2009.11.002.

    Article  PubMed Central  PubMed  Google Scholar 

  • Buckner, J. D., & Schmidt, N. B. (2009). A randomized pilot study of motivation enhancement therapy to increase utilization of cognitive-behavioral therapy for social anxiety. Behaviour Research and Therapy, 47, 710–715. doi:10.1016/j.brat.2009.04.009.

    Article  PubMed  Google Scholar 

  • Buckner, J. D., Cromer, K. R., Merrill, K. A., et al. (2009). Pretreatment intervention increases treatment outcomes for patients with anxiety disorders. Cognitive Therapy and Research, 33, 126–137. doi:10.1007/s10608-007-9154-x.

    Article  PubMed Central  PubMed  Google Scholar 

  • Candilis, P. J., Mclean, R. Y., Otto, M. W., et al. (1999). Quality of life in patients with panic disorder. Journal of Nervous and Mental Disease, 187, 429–434.

    Article  PubMed  Google Scholar 

  • Chavira, D. A., Stein, M. B., Golinelli, D., et al. (2009). Predictors of clinical improvement in a randomized effectiveness trial for primary care patients with panic disorder. Journal of Nervous and Mental Disease, 197, 715–721. doi:10.1097/NMD.0b013e3181b97d4d.

    Article  PubMed Central  PubMed  Google Scholar 

  • Chen, C. S., & Stevenson, H. W. (1989). Homework: A cross-cultural examination. Child Development, 60, 551–561.

    Article  PubMed  Google Scholar 

  • Cloninger, C. R. (2004). Feeling good: The science of well-being. New York: Oxford University Press.

    Google Scholar 

  • Cloninger, C. R., Zohar, A. H., Hirschmann, S., et al. (2012). The psychological costs and benefits of being highly persistent: Personality profiles distinguish mood disorders from anxiety disorders. Journal of Affective Disorders, 136, 758–766. doi:10.1016/j.jad.2011.09.046.

    Article  PubMed  Google Scholar 

  • Colman, I., Ploubidis, G. B., Wadsworth, M. E., et al. (2007). A longitudinal typology of symptoms of depression and anxiety over the life course. Biological Psychiatry, 62, 1265–1271. doi:10.1016/j.biopsych.2007.05.012.

    Article  PubMed  Google Scholar 

  • Conway, K. P., Compton, W., Stinson, F. S., et al. (2006). Lifetime comorbidity of DSM-IV mood and anxiety disorders and specific drug use disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 67, 247–257.

    Article  PubMed  Google Scholar 

  • Cordioli, A. V., Heldt, E., Bochi, D. B., et al. (2003). Cognitive-behavioral group therapy in obsessive-compulsive disorder: A randomized clinical trial. Psychotherapy and Psychosomatics, 72, 211–216. doi:10.1159/000070785.

    Article  Google Scholar 

  • Cougle, J. R., Timpano, K. R., Sachs-Ericsson, N., et al. (2010). Examining the unique relationships between anxiety disorders and childhood physical and sexual abuse in the National Comorbidity Survey-Replication. Psychiatry Research, 177, 150–155. doi:10.1016/j.psychres.2009.03.008.

    Article  PubMed  Google Scholar 

  • Cummins, R. A., Lau, A. L., & Stokes, M. (2004). HRQOL and subjective well-being: Noncomplementary forms of outcome measurement. Expert Review of Pharmacoeconomics & Outcomes Research, 4, 413–420. doi:10.1586/14737167.4.4.413.

    Article  Google Scholar 

  • De Araujo, L. A., Ito, L. M., & Marks, I. M. (1996). Early compliance and other factors predicting outcome of exposure for obsessive-compulsive disorder. British Journal of Psychiatry, 169, 747–752.

    Article  PubMed  Google Scholar 

  • Denys, D., Van Megen, H., & Westenberg, H. (2002). The adequacy of pharmacotherapy in outpatients with obsessive-compulsive disorder. International Clinical Psychopharmacology, 17, 109–114.

    Article  PubMed  Google Scholar 

  • Dozois, D. J., Westra, H. A., Collins, K. A., et al. (2004). Stages of change in anxiety: Psychometric properties of the University of Rhode Island Change Assessment (URICA) scale. Behaviour Research and Therapy, 42, 711–729. doi:10.1016/S0005-7967.

    Article  PubMed  Google Scholar 

  • Fava, G. A., Rafanelli, C., Ottolini, F., et al. (2001). Psychological well-being and residual symptoms in remitted patients with panic disorder and agoraphobia. Journal of Affective Disorders, 65, 185–190. PII: S0165-0327(00)00267-6.

    Article  PubMed  Google Scholar 

  • Fava, G. A., Ruini, C., Rafanelli, C., et al. (2005). Well-being therapy of generalized anxiety disorder. Psychotherapy and Psychosomatics, 74, 26–30. doi:10.1159/000082023.

    Article  PubMed  Google Scholar 

  • Gaynor, S. T., Lawrence, P. S., & Nelson-Gray, R. O. (2006). Measuring homework compliance in cognitive-behavioral therapy for adolescent depression: Review, preliminary findings, and implications for theory and practice. Behavior Modification, 30, 647–672. doi:10.1177/0145445504272979.

    Article  PubMed  Google Scholar 

  • Heldt, E., Manfro, G. G., Kipper, L., et al. (2003). Treating medication-resistant panic disorder: Predictors and outcome of cognitive-behavior therapy in a Brazilian public hospital. Psychotherapy and Psychosomatics, 72, 43–48. doi:10.1159/000067188.

    Article  PubMed  Google Scholar 

  • Heldt, E., Blaya, C., Isolan, L., et al. (2006). Quality of life and treatment outcome in panic disorder: Cognitive behavior group therapy effects in patients refractory to medication treatment. Psychotherapy and Psychosomatics, 75, 183–186. doi:10.1159/000091776.

    Article  PubMed  Google Scholar 

  • Heldt, E., Kipper, L., Blaya, C., et al. (2011). Predictors of relapse in the second follow-up year post cognitive-behavior therapy for panic disorder. Revista Brasileira de Psiquiatria, 33, 23–29. doi:10.1590/S1516-44462010005000005.

    Article  PubMed  Google Scholar 

  • Keithly, L. J., Samples, S. J., & Strupp, H. H. (1980). Patient motivation as a predictor of process and outcome in psychotherapy. Psychotherapy and Psychosomatics, 33, 87–97.

    Article  PubMed  Google Scholar 

  • Kendall, P. C., & Hedtke, K. A. (2006). The coping cat workbook. Ardmore: Workbook Publishing.

    Google Scholar 

  • Kipper, L., Wachleski, C., Salum, G. A., et al. (2009). Can psychopharmacological treatment change personality traits in patients with panic disorder? Revista Brasileira de Psiquiatria, 31, 307–313. doi:10.1590/S1516-44462009000400005.

    Article  PubMed  Google Scholar 

  • Leukefeld, C., Brown, C., Clark, J., et al. (2000). Behavioral therapy for rural substance abusers. Lexington: University of Kentucky Press.

    Google Scholar 

  • Lewis-Fernandez, R., Hinton, D. E., Laria, A. J., et al. (2010). Culture and the anxiety disorders: Recommendations for DSM-V. Depression and Anxiety, 27, 212–229. doi:10.1002/da.20647.

    Article  PubMed  Google Scholar 

  • Mancebo, M. C., Eisen, J. L., Sibrava, N. J., et al. (2011). Patient utilization of cognitive-behavioral therapy for OCD. Behavior Therapy, 42, 399–412. doi:10.1016/j.beth.2010.10.002.

    Article  PubMed  Google Scholar 

  • Manfro, G. G., Heldt, E., Cordioli, A. V., et al. (2008). Cognitive-behavioral therapy in panic disorder. Revista Brasileira de Psiquiatria, 30(Suppl 2), s81–87. doi:10.1590/S1516-44462008000600005.

    Article  PubMed  Google Scholar 

  • Marques, L., Robinaugh, D. J., Leblanc, N. J., et al. (2011). Cross-cultural variations in the prevalence and presentation of anxiety disorders. Expert Review of Neurotherapeutics, 11, 313–322. doi:10.1586/ern.10.122.

    Article  PubMed  Google Scholar 

  • Mcmanus, F., Sacadura, C., & Clark, D. M. (2008). Why social anxiety persists: An experimental investigation of the role of safety behaviours as a maintaining factor. Journal of Behavior Therapy and Experimental Psychiatry, 39, 147–161. doi:10.1016/j.jbtep.2006.12.002.

    Article  PubMed  Google Scholar 

  • Meyer, E., Shavitt, R. G., Leukefeld, C., et al. (2010). Adding motivational interviewing and thought mapping to cognitive-behavioral group therapy: Results from a randomized clinical trial. Revista Brasileira de Psiquiatria, 32, 20–29. doi:10.1590/S1516-44462010000100006.

    Article  PubMed  Google Scholar 

  • Mooney, A. (2006). Quality of life: Questionnaires and questions. Journal of Health Communication, 11, 327–341. doi:10.1080/10810730600614094.

    Article  PubMed  Google Scholar 

  • Moons, P., Budts, W., & De Geest, S. (2006). Critique on the conceptualisation of quality of life: A review and evaluation of different conceptual approaches. International Journal of Nursing Studies, 43, 891–901. doi:10.1016/j.ijnurstu.2006.03.015.

    Article  PubMed  Google Scholar 

  • Nock, M. K., Hwang, I., Sampson, N. A., et al. (2010). Mental disorders, comorbidity and suicidal behavior: Results from the National Comorbidity Survey Replication. Molecular Psychiatry, 15, 868–876. doi:10.1038/mp.2009.29.

    Article  PubMed Central  PubMed  Google Scholar 

  • Otto, M. W., Pollack, M. H., Penava, S. J., et al. (1999). Group cognitive-behavior therapy for patients failing to respond to pharmacotherapy for panic disorder: A clinical case series. Behaviour Research and Therapy, 37, 763–770. doi:10.1016/S0005-7967(98)00176-4.

    Article  PubMed  Google Scholar 

  • Otto, M. W., Hinton, D., Korbly, N. B., et al. (2003). Treatment of pharmacotherapy-refractory posttraumatic stress disorder among Cambodian refugees: A pilot study of combination treatment with cognitive-behavior therapy vs sertraline alone. Behaviour Research and Therapy, 41, 1271–1276. doi:10.1016/S0005-7967(03)00032-9.

    Article  PubMed  Google Scholar 

  • Pollack, M. H., Otto, M. W., Kaspi, S. P., et al. (1994). Cognitive behavior therapy for treatment-refractory panic disorder. Journal of Clinical Psychiatry, 55, 200–205.

    PubMed  Google Scholar 

  • Quilty, L. C., Van Ameringen, M., Mancini, C., et al. (2003). Quality of life and the anxiety disorders. Journal of Anxiety Disorders, 17, 405–426. doi:10.1016/S0887-6185(02)00225-6.

    Article  PubMed  Google Scholar 

  • Rollnick, S., Miller, W. R., & Butler, C. C. (2008). Motivational interviewing in health care: Helping patients change behavior (Applications of motivational interviewing). New York: The Guilford Press.

    Google Scholar 

  • Rosenbaum, R. L., & Horowitz, M. J. (1983). Motivation for psychotherapy: A factorial and concept analysis. Psychotherapy: Theory, Research and Practice, 20, 346–354.

    Article  Google Scholar 

  • Roy-Byrne, P. P. (1996). Generalized anxiety and mixed anxiety-depression: Association with disability and health care utilization. Journal of Clinical Psychiatry, 57(Suppl 7), 86–91.

    PubMed  Google Scholar 

  • Russell, J. G. (1989). Anxiety disorders in Japan: A review of the Japanese literature on shinkeishitsu and taijinkyofusho. Culture, Medicine and Psychiatry, 13, 391–403.

    Article  PubMed  Google Scholar 

  • Ryff, C. D., & Keyes, C. L. M. (1995). The structure of psychological well-being revisited. Journal of Personality and Social Psychology, 69, 719–727.

    Article  PubMed  Google Scholar 

  • Smoller, J. W., Block, S. R., & Young, M. M. (2009). Genetics of anxiety disorders: The complex road from DSM to DNA. Depression and Anxiety, 26, 965–975. doi:10.1002/da.20623.

    Article  PubMed  Google Scholar 

  • Snyder, C. R., Stephen, S. I., Cheavens, J., et al. (2000). The role of hope in cognitive-behaviour therapies. Cognitive Therapy and Research, 24, 747–762.

    Article  Google Scholar 

  • Somers, J. M., Goldner, E. M., Waraich, P., et al. (2006). Prevalence and incidence studies of anxiety disorders: A systematic review of the literature. Canadian Journal of Psychiatry, 51, 100–113.

    Google Scholar 

  • Starcevic, V., Berle, D., Brakoulias, V., et al. (2011). The nature and correlates of avoidance in obsessive-compulsive disorder. The Australian and New Zealand Journal of Psychiatry, 45, 871–879. doi:10.3109/00048674.2011.607632.

    Article  PubMed  Google Scholar 

  • Tarricone, I., Stivanello, E., Poggi, F., et al. (2012). Ethnic variation in the prevalence of depression and anxiety in primary care: A systematic review and meta-analysis. Psychiatry Research, 195, 91–106. doi:10.1016/j.psychres.2011.05.020.

  • Watanabe, N., Furukawa, T. A., Chen, J., et al. (2010). Change in quality of life and their predictors in the long-term follow-up after group cognitive behavioral therapy for social anxiety disorder: A prospective cohort study. BMC Psychiatry, 10, 81. doi:10.1186/1471-244X-10-81.

    Article  PubMed Central  PubMed  Google Scholar 

  • Watson, H. J., Swan, A., & Nathan, P. R. (2011). Psychiatric diagnosis and quality of life: The additional burden of psychiatric comorbidity. Comprehensive Psychiatry, 52, 265–272. doi:10.1016/j.comppsych.2010.07.006.

    Article  PubMed  Google Scholar 

  • Westra, H. A. (2011). Comparing the predictive capacity of observed in-session resistance to self-reported motivation in cognitive behavioral therapy. Behaviour Research and Therapy, 49, 106–113. doi:10.1016/j.brat.2010.11.007.

    Article  PubMed Central  PubMed  Google Scholar 

  • Westra, H. A., & Dozois, D. J. (2006). Preparing clients for cognitive behavioral therapy: A randomized pilot study of motivational interviewing for anxiety. Cognitive Therapy and Research, 30, 481–498.

    Article  Google Scholar 

  • Westra, H. A., Arkowitz, H., & Dozois, D. J. (2009). Adding a motivational interviewing pretreatment to cognitive behavioral therapy for generalized anxiety disorder: A preliminary randomized controlled trial. Journal of Anxiety Disorders, 23, 1106–1117. doi:10.1016/j.janxdis.2009.07.014.

    Article  PubMed Central  PubMed  Google Scholar 

  • Wittchen, H. U., Kessler, R. C., Beesdo, K., et al. (2002). Generalized anxiety and depression in primary care: Prevalence, recognition, and management. Journal of Clinical Psychiatry, 63(Suppl 8), 24–34.

    PubMed  Google Scholar 

  • Zhou, X., Dere, J., Zhu, X., et al. (2011). Anxiety symptom presentations in Han Chinese and Euro-Canadian outpatients: Is distress always somatized in China? Journal of Affective Disorders, 135, 111–114. doi:10.1016/j.jad.2011.06.049.

    Article  PubMed  Google Scholar 

  • Zubaran, C., Foresti, K., Thorell, M. R., et al. (2009). Portuguese version of the Quality of Life Enjoyment and Satisfaction Questionnaire: A validation study. Revista Panamericana de Salud Pública, 25, 443–448. doi:10.1590/S1020-49892009000500010.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Psychiatry Service – Hospital de Clinicas de Porto Alegre, Rua Ramiro Barcelos, 2350 – Room 400N, 90035-903, Porto Alegre, RS, Brazil

    Elizeth Heldt, Carolina Blaya & Gisele Gus Manfro

  2. Universidade Federal do Rio Grande do Sul., Rua Ramiro Barcelos, 2350 – Room 400N, 90035-903, Porto Alegre, RS, Brazil

    Elizeth Heldt, Carolina Blaya & Gisele Gus Manfro

Authors
  1. Elizeth Heldt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carolina Blaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gisele Gus Manfro
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elizeth Heldt .

Editor information

Editors and Affiliations

  1. Department of Psychology, University of Bologna, Bologna, Italy

    Giovanni Andrea Fava

  2. Department of Psychology, University of Bologna, Bologna, Italy

    Chiara Ruini

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media Dordrecht

About this chapter

Cite this chapter

Heldt, E., Blaya, C., Manfro, G.G. (2014). The Role of Motivation in Cognitive Behavioural Psychotherapy for Anxiety Disorders. In: Fava, G., Ruini, C. (eds) Increasing Psychological Well-being in Clinical and Educational Settings. Cross-Cultural Advancements in Positive Psychology, vol 8. Springer, Dordrecht. https://doi.org/10.1007/978-94-017-8669-0_7

Download citation

Publish with us

Policies and ethics

Search

Navigation