Change talk and sustain talk in treatment of generalized anxiety disorder: A secondary analysis of cognitive behavioral therapy and metacognitive therapy in adult outpatients

Abstract

Background and objectives: Measures of patient motivation have proven elusive, showing inconsistent results in relation to psychotherapy outcome. How patients talk about change is an alternative measure of motivation, with potential value in predicting treatment outcome. This study had two aims: (1) to examine if change talk and sustain talk (including its subcategories) predicted reduction in worry levels at post-treatment and 2-year follow-up, and (2) if there were differences between the cognitive behavioral therapy (CBT) and metacognitive therapy (MCT) conditions with respect to change talk.

Methods: This study investigated 24 patients receiving CBT and 27 patients receiving MCT for generalized anxiety disorder (GAD), and coded patients' utterances in sessions 1 and 4.

Results: Change talk was significantly associated with lower worry levels at post-treatment and 2-year follow-up, beyond initial worry severity and treatment condition. Change talk in session 4, and reduction in sustain talk from session 1 to 4, was positively associated with improvement, whilst sustain talk in session 4 showed a negative relationship. More specifically, commitment statements in session 1 and expressing signs of taking steps at session 4 were associated with reduction in worry levels. Moreover, patients in the MCT condition argued more both for and against change during session 1, but not session 4.

Limitations: The sample size was relatively small.

Conclusions: These results indicate that change talk sustain talk could be important in the treatment of GAD.

Keywords: Cognitive behavioral therapy; Generalized anxiety disorder; Metacognitive therapy; Motivation; Worry.