Markers for context-responsiveness: Client baseline interpersonal problems moderate the efficacy of two psychotherapies for generalized anxiety disorder

Abstract

Objective: To follow-up a randomized clinical trial that compared the acute and long-term efficacy of 15 sessions of cognitive-behavioral therapy (CBT) versus CBT integrated with motivational interviewing (MI) for severe generalized anxiety disorder (GAD; Westra, Constantino, & Antony, 2016), we (a) characterized the sample's baseline interpersonal problems, and (b) analyzed the role of several theory-relevant problems as moderators of the comparative treatment effects on outcome. Method: We first compared clients' (N = 85) baseline interpersonal problems profile to a general clinical sample. We next conducted piecewise, 2-level growth models to analyze the interactive effects of treatment condition and the hypothesized interpersonal problem indices of nonassertiveness (ranging from low to high), exploitability (ranging from low to high on this specific combination of nonassertiveness and friendliness), and overall agency (ranging from more problems of being too submissive to more problems of being too domineering, including friendly or hostile variants) on acute and follow-up worry reduction. Finally, we conducted hierarchical generalized linear models to examine these interactive effects on the likelihood of achieving clinically meaningful worry reduction across follow-up. Results: As expected, the GAD clients evidenced more nonassertive and exploitable interpersonal problems than the general clinical sample. Also as predicted, clients with more problematic nonassertiveness and low overall agency in their relationships had greater follow-up worry reduction in MI-CBT versus CBT, including to a clinically significant degree for the agency by treatment interaction. Conclusions: GAD-specific interpersonal problems can serve as contextual markers for integrative treatment selection and planning.