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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

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


Authors

Sam Malins

Nima Moghaddam

RICHARD MORRISS richard.morriss@nottingham.ac.uk
Professor of Psychiatry and Community Mental Health

THOMAS SCHRODER THOMAS.SCHRODER@NOTTINGHAM.AC.UK
Professor of Clinical Psychology and Psychological Therapies

Paula Brown

Naomi Boycott



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.

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.

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