The Predictive Value of Client, Therapist and In-Session Ratings Of Motivational Factors Early in Remote Cognitive Behavioral Therapy for Severe Health Anxiety

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.<br>

研究目标。受新冠疫情影响，远程心理治疗与严重健康焦虑（Severe Health Anxiety, SHA）的患病率均呈上升趋势。针对SHA的远程认知行为疗法（remotely delivered Cognitive Behavioural Therapy, rCBT）已被证实有效，但诸多寻求治疗的人群并未从中获益。动机过程可对治疗结局产生影响，但目前尚不明确哪种评估方法在SHA的远程CBT中具备最优临床应用价值。
研究设计。本研究针对合并多种疾病的高频医疗服务使用者群体，对比了在SHA远程CBT第二次会谈时采集的患者、治疗师及会谈内动机因素评分的预测效度。
研究方法。本研究纳入56名至少完成两次以视频会议或电话形式开展的SHA针对性CBT会谈的参与者，对其动机因素进行评估。第二次会谈结束后，治疗师与患者完成关于患者动机的线上评估。两名经过培训的评估者借助第二次会谈的录音与转录文本，对会谈过程中的动机因素与治疗同盟（therapeutic alliance）进行评分。本研究采用多层模型（multilevel modelling），基于动机评估结果预测健康焦虑及一系列次级健康结局。
研究结果。当参与者在第二次会谈中更积极地参与正向改变相关的讨论时，其健康焦虑及所有次级健康结局的改善程度更为显著。反之，第二次会谈中花费更多时间描述问题则预示着更差的治疗结局。治疗师与患者对动机的评估无法预测健康焦虑，但治疗师对来访者信心与动机的评估能够预测所有次级健康结局。
研究结论。在远程实施的认知行为疗法中，动机仍是一项关键过程；与自我报告相比，基于会谈互动的动机因素或许能更一致地预测治疗结局。