Consultation Interactions Coding Scheme: Comparison with self-reported motivation

Client motivation can have an important influence on the outcome of Cognitive Behaviour Therapy (CBT) for anxiety disorders. However, it is unclear what assessment method offers the best clinical utility in CBT for Severe Health Anxiety (SHA). This study compared the predictive validity of client, therapist and observer-ratings of client motivation taken at the second session of remotely delivered CBT for SHA. In a secondary analysis of randomised controlled trial data, client motivation was assessed for 56 participants who attended at least two sessions of CBT for SHA delivered via videoconferencing or telephone. Following session two, therapists and clients completed online assessments of client motivation. Trained observers also rated client motivation from in-session motivational interactions using session two recordings and transcripts. Multilevel modelling was used to predict health anxiety outcome from motivation assessments. There was weak-to-no correlation between therapist, client and observer-rated motivation at session two. Only observer-rated motivational interactions predicted health anxiety in multilevel models, controlling for baseline severity, therapist-rated confidence and change across 12-month follow-up. Observer-rated client motivation is superior to client and therapist-reported motivation early in CBT for SHA. Specifically, interactions where clients identify positive changes they have noticed may be an early indicator of improved prognosis.