CBT Model

MI as a pre-treatment to CBT. In the transtheoretical model of change (Prochaska & DiClemente, 2005), MI is understood to be relevant at certain stages of a clients’ change process. In this framework, MI might seem particularly relevant during early stages of therapy, even before committing to treatment. MI applied in these phases may contribute to increased engagement in therapy by dealing with issues of ambivalence that would not have been adequately addressed in standard CBT (Westra, 2012). Such issues may include low expectations about therapy, conflicting motivations, or fear of treatment procedures (Constantino et al., 2013). MI as a marker-based intervention in CBT. However, the founders of MI have argued that it should not be restricted
More specifically, clinicians can shift out of an action-oriented approach towards MI in the face of motivational impasses at any point in therapy (Westra, 2012). This view is consistent with context-responsive psychotherapy integration (Constantino et al., 2013; Constantino, DeGeorge, Dadlani, & Overtree, 2009). This framework “proposes an if-then structure for therapists to respond to clients’ personal characteristics and emerging clinical scenarios with context-relevant, evidence-based therapeutic strategies” (Constantino et al., 2013, p. 1). It advocates elucidating empirically derived markers in therapeutic processes, and developing evidence-based strategies to address these. In context-responsive psychotherapy integration, change ambivalence is regarded as one such marker and MI as its adequate intervention (Constantino et al., 2009). Notably, in her textbook on CBT, Beck (2011) adviced therapists to evaluate whether there are issues in terms of alliance or goal agreements with the client when facing “stuck points” before addressing issues
A critical review by Randall and McNeil (in press) covered 17 articles on this topic published between 2005 and 2012, and concluded that this combination is both feasible and promising. Furthermore, a meta-analysis of quantitative studies by Romano and Peters (2015) suggested that MI can, indeed, increase engagement in treatment among clients with mental health problems such as anxiety, depression and psychosis. To date, however, no systematic review has provided an extensive overview of all the published literature on this field.
In sum, motivation and ambivalence about therapy may be relevant to understand why some patients have suboptimal responses to CBT for anxiety disorders, such as drop-out or lack of improvement. Furthermore, there are several potential ways of accomplishing a combination of MI and CBT that may address these issues. Importantly, there are principles in CBT that seem to align with MI (Beck, 2011), meaning that this may be a question of expanding existing ideas rather than fundamentally altering