What is motivational interviewing?

Motivational interviewing is a counseling style that helps people explore their own mixed feelings about change. In Westra and colleagues' 2009 trial, it was given as four weekly 50-minute sessions before CBT, focused on ambivalence and motivation to change worry.

Does motivational interviewing help anxiety on its own?

In the same trial, after four sessions of motivational interviewing and before any CBT, 21% of the MI group (8 people) met recovery criteria on worry, against 3% (1 person) of the group that waited. It was a small, early finding.

Does doing therapy homework help?

In this trial, CBT therapists rated the group that started with motivational interviewing as doing more homework, 4.59 against 4.19 on a 0 to 6 scale, and that extra practice helped explain why their worry dropped further.

Intention

Does it help to talk through mixed feelings before therapy?

Short answer

It may help. In a 2009 trial of 76 adults with generalized anxiety, people who spent four sessions exploring their mixed feelings about change before starting CBT did more of their between-session practice and had more treatment responders. The gains were clearest when worry was severe, and the authors called the trial preliminary.

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The research

Westra, H. A., Arkowitz, H., & Dozois, D. J. A. (2009). Adding a motivational interviewing pretreatment to cognitive behavioral therapy for generalized anxiety disorder: A preliminary randomized controlled trial. Journal of Anxiety Disorders, volume 23, issue 8, pages 1106 to 1117.

Sample 76 adults with a principal diagnosis of generalized anxiety disorder, recruited in the Toronto area and randomly assigned to two groups before both groups received individual CBT.

Published 2009

Journal Journal of Anxiety Disorders

Henny Westra and colleagues randomly assigned 76 adults with generalized anxiety disorder to one of two starts. One group had four weekly 50-minute sessions of motivational interviewing (MI), a conversation style that explores mixed feelings about change. The other group waited four weeks with no pretreatment. Then everyone received cognitive behavioral therapy (CBT). On the main worry measure, 92% of the MI group (35 people) were treatment responders, against 71% (27 people) of the group with no pretreatment, and the MI group had no nonresponders, against 21% (8 people). CBT therapists rated the MI group as doing more of their homework, 4.59 against 4.19 on a 0 to 6 scale, a moderate effect (d of 0.59), and that homework difference helped explain the extra drop in worry. People's own ratings of their homework did not differ between groups. The benefit was concentrated in people with high worry at the start. That group showed some relapse at 6 months, and the advantage appeared again at 12 months. The authors described the results as preliminary, pending replication.

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What does this mean for you?

Most people come to therapy with two minds about change. Part of you wants things to be different. Another part is tired, wary, or attached to how things are. That push and pull is called ambivalence, and it is normal. This trial asked a simple question: does it help to talk that through before the skills work begins?

For the people in this study, it seemed to. The group that started with four sessions on their mixed feelings did more of the practice their CBT therapist assigned between sessions. That matters, because CBT asks people to try new things in daily life, not just in the room. The extra practice was part of why their worry dropped further.

The conversation itself was not a lecture or a pep talk. Motivational interviewing works by listening. A therapist helps you say out loud what you want, what worries you about changing, and what matters to you. The aim is for your own reasons to become clearer, so the work that follows feels like your choice.

The clearest benefit showed up for people whose worry was most severe at the start. For people with milder worry, the two groups ended up closer together. So this is not a rule that everyone needs a warm up. It is a signal that when change feels heavy or stuck, making room for the mixed feelings first may be worth it.

Be careful about reading too far. This was one small trial with 76 people, focused on generalized anxiety, and the authors called it preliminary. The high worry group showed some slipping at 6 months before doing better again at 12 months. Therapists rated homework higher in the MI group, but the patients' own ratings did not differ. A single study like this points in a direction. It does not settle the question.

What you can take from it is practical. If you notice that part of you does not want to change, you do not have to hide it from your therapist. Saying it out loud is part of the work, and it may make the practice between sessions easier to do.

The takeaway

Mixed feelings about change are normal. You can bring them to your first sessions instead of hiding them.
In this trial, talking them through first went with more practice between sessions and more people responding to CBT.
The evidence is early and came from one small study, so treat it as a useful idea to raise with your therapist, not a rule.

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Intention setting Between-session support

This is the work Asendar™ was built for: helping you notice how you are really feeling about the work between sessions, mixed feelings included, so you and your therapist can see them clearly. It sits alongside your care and supports the plan you set together, rather than replacing it.

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