The Predictive Value of Patient, 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COVID-19疫情影响，远程心理治疗与重度健康焦虑（Severe Health Anxiety, SHA）的患病率均呈上升趋势。针对重度健康焦虑的远程认知行为疗法（remote Cognitive Behavioural Therapy, rCBT）已被证实有效，但诸多寻求帮助的人群并未从中获益。动机过程可影响治疗结局，但目前尚不明确何种评估方式在重度健康焦虑的远程认知行为疗法中具备最佳临床应用价值。
研究设计：本研究针对共病且为高频医疗服务使用者的群体，对比了在重度健康焦虑的远程认知行为疗法第2次会谈时采集的患者、治疗师及会谈现场评分的动机因素的预测效度。
研究方法：本研究共纳入56名至少完成2次视频会议或电话形式的重度健康焦虑认知行为疗法会谈的参与者，并对其动机因素进行评估。在第2次会谈结束后，治疗师与患者完成了关于患者动机的线上评估。另有2名经过培训的观察员，通过第2次会谈的录像与转录文本，对会谈中的动机因素与治疗联盟（therapeutic alliance）进行评分。本研究采用多层建模（Multilevel modelling）方法，基于动机评估结果预测健康焦虑及一系列次要健康结局。
研究结果：若参与者在第2次会谈中更积极地参与正向改变相关的讨论，则其健康焦虑及所有次要健康结局的改善程度更为显著。反之，会谈中用于描述问题的时长占比越高，则治疗结局越差。治疗师与患者对动机的评估均无法预测健康焦虑，但治疗师对来访者信心与动机的评估可预测所有次要健康结局。
研究结论：远程实施认知行为疗法时，动机仍是一项重要的作用过程；相较于自我报告，基于会谈现场互动的动机因素或能更稳定地预测治疗结局。