The predictive value of patient, therapist, and in‐session ratings of motivational factors early in remote cognitive behavioural therapy for severe health anxiety

Malins, Sam; Moghaddam, Nima; Morriss, Richard; Schröder, Thomas; Brown, Paula; Boycott, Naomi

Abstract

Objectives. Remote psychotherapy and the prevalence of Severe Health Anxiety (SHA) are both growing as a result of the COVID-19 pandemic. Remotely delivered Cognitive Behavioural Therapy (rCBT) for SHA is evidenced as effective, but many who seek help do not benefit. Motivational processes can influence outcomes, but it is unclear what assessment methods offer the best clinical utility in rCBT for SHA.

Design. This study compared the predictive validity of patient, therapist and in-session ratings of motivational factors taken at session two of rCBT for SHA among high healthcare users experiencing multimorbidity.

Methods. Motivational factors were assessed for 56 participants who attended at least two sessions of CBT for SHA delivered via video-conferencing or telephone. Following session two, therapists and patients completed online assessments of patient motivation. Two trained observers also rated motivational factors and therapeutic alliance from in-session interactions using session two recordings and transcripts. Multilevel modelling was used to predict health anxiety and a range of secondary health outcomes from motivation assessments.

Results. Where patients were more actively engaged in discussion of positive changes during session two, greater outcome improvements ensued in health anxiety and all secondary outcomes. Conversely, larger proportions of session two spent describing problems predicted poorer outcomes. Therapist and patient assessments of motivation did not predict health anxiety, but therapist assessments of client confidence and motivation predicted all secondary outcomes.

Conclusions. Motivation remains an important process in CBT when delivered remotely, and motivational factors may predict outcomes more consistently from in-session interactions, compared to self-reports.

Citation

Malins, S., Moghaddam, N., Morriss, R., Schröder, T., Brown, P., & Boycott, N. (2022). The predictive value of patient, therapist, and in‐session ratings of motivational factors early in remote cognitive behavioural therapy for severe health anxiety. British Journal of Clinical Psychology, 61(2), 364-384. https://doi.org/10.1111/bjc.12328

• Journal Article Type: Article
• Acceptance Date: Aug 24, 2021
• Online Publication Date: Sep 12, 2021
• Publication Date: Jun 1, 2022
• Deposit Date: Sep 13, 2021
• Publicly Available Date: Sep 13, 2022
• Journal: British Journal of Clinical Psychology
• Print ISSN: 0144-6657
• Electronic ISSN: 2044-8260
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 61
• Issue: 2
• Pages: 364-384
• DOI: https://doi.org/10.1111/bjc.12328
• Keywords: Clinical Psychology; General Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/6237911
• Publisher URL: https://bpspsychub.onlinelibrary.wiley.com/doi/full/10.1111/bjc.12328
• Additional Information: This is the peer reviewed version of the following article: Malins, S., Moghaddam, N., Morriss, R., Schröder, T., Brown, P. and Boycott, N. (2021), The predictive value of patient, therapist, and in-session ratings of motivational factors early in remote cognitive behavioural therapy for severe health anxiety. Br J Clin Psychol, which has been published in final form at https://doi.org/10.1111/bjc.12328. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.