Motivational Enhancement Therapy: How to increase treatment use and engagement for persons with social anxiety disorder

VIDEO SUMMARY:

Article summary provided by Hillary Greene

THE MAIN POINT:

Despite high levels of distress and impairment, individuals with social anxiety disorder often do not seek available treatment options or may struggle to engage if in treatment. Therefore, it is imperative for clinicians to know how to increase individuals’ motivation for change and willingness to pursue treatment. Motivational Enhancement Therapy, which draws heavily from Motivational Interviewing principles, may provide clinicians with a method to increase treatment utilization for those with social anxiety disorder. See details below for more information about this method and examples of its use.

THE DETAILS:

What is Motivational Enhancement Therapy (MET)?

Motivational Enhancement Therapy (MET) incorporates principles of Motivational Interviewing (MI) with direct feedback about the disorder-specific behavior and symptoms (e.g., alcohol use, social anxiety) to help individuals work through ambivalence about change and seeking treatment (Buckner, 2009). Motivational Interviewing (MI) is a therapeutic approach that is a “client-centered, directive style for enhancing intrinsic motivation to change by exploring and resolving ambivalence regarding change” (Miller & Rollnick, 2002). The MI approach involves fostering a collaborative relationship with the patient and working to elicit their motivation for behavior change, in part through eliciting change talk (Miller & Rollnick, 2002).

How might MET be helpful for working with individuals with social anxiety disorder?

Although viable treatment options exist, most individuals with social anxiety disorder (SAD) do not pursue treatment or do so after a long period of distress and impairment (Grant et al., 2005). Treatment underutilization among this population may relate in part to ambivalence about seeking treatment or about engaging in treatment once started (Buckner, 2009). Motivational Enhancement Therapy (MET) provides a powerful option for clinicians to help individuals with SAD work through their fears and uncertainties about treatment and anticipated judgment of others, which might improve treatment utilization and engagement in this vulnerable population (Buckner, 2009).

What does the research in general say about MET and MI for treating anxiety?

A recent review of four meta-analyses examining the effectiveness of Motivational Interviewing found strong support for the benefits of MI compared to control groups (e.g., no treatment) and compared to other treatments (e.g., cognitive-behavioral therapy; CBT) (Lundahl & Burke, 2009). These authors concluded that MI consistently results in positive treatment outcomes, although the magnitude of benefit varies based on factors such as the disorder treated (e.g., alcohol use, anxiety) and the comparison group (Lundahl & Burke, 2009). Empirical studies also have shown MI to be effective with anxiety disorders, including social anxiety disorder, as a pre-treatment additive to traditional approaches, such as CBT, especially for those who are highly distressed (Westra, Arkowitz, & Dozois, 2009; Westra & Dozois, 2006). Additionally, recent research using MET among individuals with SAD has shown promising effects for increasing treatment seeking among these individuals (Buckner & Schmidt, 2009).

How MET might work in real practice:  a case example from a recent article. 

Clinicians interested in using Motivational Enhancement Therapy (MET) to increase treatment motivation and engagement for patients with social anxiety might find Buckner’s detailed case description useful, which includes transcript portions of actual MET sessions (2009). This article describes treatment progression with a young woman suffering from social anxiety disorder (SAD) who had mixed feelings about seeking treatment prior to MET intervention despite suffering from social anxiety most of her life (Buckner & Schmidt, 2009). This case provides clear examples of how to implement MET techniques with a patient with SAD, particularly emphasizing how to use a Motivational Interviewing approach with ambivalent or resistant patients.

Where can I learn more about MET and MI? 

Clinicians interested in learning more about the theory, clinical application, and training available for Motivational Interviewing and Motivational Enhancement Therapy might explore the following resources:

http://www.motivationalinterviewing.org

http://www.motivationalinterview.org

http://integratedrecovery.org/wp-content/uploads/2012/07/MET-and-CBT-for-Social-Anxiety.pdf  (Buckner & Schmidt, 2009 pilot study article available free)

http://www.ncbi.nlm.nih.gov/pubmed/19739204 (Buckner, 2009 case study article preview)

 

REFERENCES

Buckner, J. D. (2009). Motivation Enhancement Therapy Can Increase Utilization of Cognitive-Behavioral Therapy: The Case of Social Anxiety Disorder. Journal of Clinical Psychology, 65(11), 1195-1206.

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(8), 710-715.

Grant, B. F., Hasin, D. S., Blanco, C., Stinson, F. S., Chou, S. P., Goldstein, R. B., . . . Huang, B. (2005). The epidemiology of social anxiety disorder in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 66(11), 1351-1361.

Lundahl, B., & Burke, B. L. (2009). The Effectiveness and Applicability of Motivational Interviewing: A Practice-Friendly Review of Four Meta-Analyses. Journal of Clinical Psychology, 65(11), 1232-1245.

Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change (2nd ed.). New York: Guildford Press.

Westra, H. A., Arkowitz, H., & Dozois, D. J. A. (2009). Adding a motivational interviewing pretreatment to cognitive behavioral therapy for generalized anxiety disorder: A preminary randomized controlled trial. Journal of Anxiety Disorders, 23, 1106-1117.

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