Development of a motivational interviewing programme as a prelude to CBT for anxiety following traumatic brain injury

Abstract

A brief preparatory programme, based on the principles of motivational interviewing (MI), was developed as a way of engaging clients with traumatic brain injury (TBI) and preparing them for a cognitive behaviour therapy (CBT) programme for anxiety. The MI + CBT programme was delivered to a male client in his early 40s with severe TBI at four months post-injury, using a single-subject design with repeated measures pre- and post-treatment. The client received three sessions of manualised MI, followed by nine sessions of CBT. The MI sessions focused on helping the client to develop more realistic goals and supporting his self-efficacy about his ability to cope with anxiety. Specific strategies were used to accommodate the client's cognitive limitations, such as the use of personally meaningful metaphors and role plays. Re-assessments were conducted at the end of MI, CBT and nine weeks post-treatment, using a semi-structured clinical interview and self-report measures of anxiety, mood and change expectancy. The client showed significant improvement in anxiety following treatment and a significant reduction in subjective units of distress (SUDS) between the MI and CBT phases. The results suggest the potential utility of MI in people with TBI, and the need to evaluate treatment protocols in a controlled trial.

Keywords:

• Anxiety
• Motivational interviewing
• Cognitive behaviour therapy
• Traumatic brain injury

Acknowledgments

This study was supported by a grant from Monash University, and a scholarship from the Victorian Brain Injury Recovery Association. The funding sources had no role in study design, data collection or analysis. The authors alone were responsible for the content and writing of the paper. A portion of the preliminary findings of this paper was presented at the Australian Association of Cognitive and Behaviour Therapy conference in Melbourne, April 2010. The data reported herein are from the first author's doctoral thesis, which was supervised by the second, third and fourth authors. The authors would like to thank all participants who helped to make this work possible. Special thanks to the staff members at the Monash-Epworth Rehabilitation Research Unit, Epworth Hospital and The Victorian Rehabilitation Centre. We gratefully acknowledge Dr Henny Westra and Dr David Dozois, who generously provided us with their MI treatment manual for adaptation.

Notes

¹The client's name and details have been anonymised to protect confidentiality.