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Motivation and Changes in Depression

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Abstract

This study evaluated the capacity of the Willingness Scale (WS) to predict changes in depression over the course of a brief inpatient admission. Two cohorts (N = 160) of adult inpatients completed the Willingness Scale along with a measure of depression following admission. Depression severity was assessed approximately 4 days later, prior to discharge. Data were evaluated using structural equation modeling. Higher WS scores predicted greater reductions in depression in both cohorts, and the magnitude of this effect was large. The fits of the models were outstanding, with no significant differences in any parameter estimates across the two cohorts. The WS predicts changes in depression, even within a brief inpatient admission where the treatment is predominantly biological. These results replicate results of previous studies in outpatient populations where CBT was the primary treatment and suggest motivational factors may play an important role in causation and recovery from depression.

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Notes

  1. All the analyses reported in this paper were repeated using the full BDC, and the results were virtually identical to those reported here.

  2. In addition, this scoring system facilitates a rough comparison with other comparable tests. For example, the 21-item beck depression inventory (BDI) ranges from 0 to 63. A score of 70 % on the BDC would correspond approximately to a score of 43 on the BDI.

  3. We do not have any empirical data on the extent of participation in the CBT groups.

  4. This method provides efficient and consistent estimates for missing data, even when the data are not missing completely at random. Three alternative methods of estimating models with missing data include mean substitution, listwise deletion, and pairwise deletion. These methods provide efficient and consistent estimates only under the stronger assumption that the data are missing completely at random.

  5. A nested test is a powerful and flexible method for comparing any group of parameter estimates within groups or across groups. For example, an investigator might wish to compare factor structures in two independent samples by declaring the parameter estimates to be identical. A statistically significant increase in the Chi-square for the nested model indicates that the hypothesis can be rejected, and that the factor structures are not the same. In contrast, a negligible increase in the Chi-square indicates the hypothesis can be accepted.

  6. These values represent the sum of the Chi-squares values and degrees of freedom in both groups, which were estimated simultaneously.

  7. A tau-equivalent factor has identical unstandardized factor loadings. A parallel factor also has identical error terms for all the indicators. In a super parallel factor, all the indicators also have identical intercept terms.

References

  • Arbuckle, J. (1994). Analysis of moment structures. Psychometrika, 59, 135–137.

    Article  Google Scholar 

  • Arbuckle, J. (1996). Full information estimation in the presence of incomplete data. In G. A. Marcoulides & R. E. Schumacker (Eds.), Advanced structural equation modeling: Issues and techniques. Mahwah, NJ: Lawrence Erlbaum Associates.

    Google Scholar 

  • Arkowitz, H., Westra, H. A., Miller, W. R., & Rollnick, S. (2008). Motivational interviewing in the treatment of psychological problems. New York: Guilford Press.

    Google Scholar 

  • Bandura, A. (1997). Self-efficacy: The exercise of control. New York: W. H. Freeman and Company.

    Google Scholar 

  • Barrett, P. (2007). Structural equation modeling: Adjusting model fit. Personality and Individual Differences, 42(5), 815–824.

    Article  Google Scholar 

  • Beutler, L. E., Rocco, F., Moleiro, C. M., & Talebi, H. (2001). Resistance. Psychotherapy, 38, 431–436.

    Article  Google Scholar 

  • Brogan, M. M., Prochaska, M. O., & Prochaska, J. M. (1999). Predicting termination and continuation status in psychotherapy using the transtheoretical model. Psychotherapy, 36, 105–113.

    Article  Google Scholar 

  • Brown, C., Battista, D. R., Sereika, S. M., Bruehlman, R. D., Dunbar-Jacob, J., & Thase, M. E. (2007). Primary care patients’ personal illness models for depression: Relationship to coping behavior and functional disability. General Hospital Psychiatry, 29, 492–500.

    Article  PubMed  Google Scholar 

  • Burnett, D. M. (2008). The psychometric properties of the EASY diagnostic system for the diagnosis of major depressive disorder and bipolar disorder: A pilot study. Dissertation presented to the faculty of the PGSP-Stanford Consortium in partial fulfillment for the degree of Doctor of Psychology. Palo Alto, CA: author.

  • Burns, D. D. (1997, 2006). Therapist’s toolkit: 1997 upgrade; 2006 upgrade. Los Altos Hills: Author.

  • Burns, D. D. (2005a). Strategies for therapeutic success. Los Altos Hills: Author.

    Google Scholar 

  • Burns, D. D. (2005b). The EASY diagnostic system. Los Altos Hills: Author.

    Google Scholar 

  • Burns, D. D. (2007). The revised EASY diagnostic system. Los Altos Hills: Author.

    Google Scholar 

  • Burns, D. D., & Nolen-Hoeksema, S. (1991). Coping styles, homework compliance and the effectiveness of cognitive-behavioral therapy. Journal of Consulting and Clinical Psychology, 59(2), 305–311.

    Article  PubMed  CAS  Google Scholar 

  • Burns, D. D., Shaw, B. F., & Crocker, W. (1987). Thinking styles and coping strategies of depressed women: An empirical investigation. Behavior Research and Therapy, 25(3), 223–225.

    Article  CAS  Google Scholar 

  • Burns, D. D., & Spangler, D. (2000). Does psychotherapy homework lead to changes in depression in cognitive behavioral therapy? Or does clinical improvement lead to homework compliance? Journal of Consulting and Clinical Psychology, 68(1), 46–59.

    Article  PubMed  CAS  Google Scholar 

  • Burns, D. D., & Spangler, D. (2001). Can we confirm our theories? Can we measure causal effects? A reply to Kazantzis et al. (2001). Journal of Consulting and Clinical Psychology, 69(6), 1084–1086.

    Article  Google Scholar 

  • De Haan, E., Van Oppen, P., Balkom, A. J. L. M., Spinhoven, P., Hoogduin, K. A. L., & Van Dyck, R. (1997). Prediction of outcome and early vs. late improvement in OCD patients treated with cognitive behaviour therapy and pharmacotherapy. Acta Psychiatrica Scandinavica, 96, 354–361.

    Article  PubMed  Google Scholar 

  • Dozois, D. J. A., Westra, H. A., Collins, K. A., Fung, T. S., & Garry, J. K. F. (2004). Stages of change in anxiety: Psychometric properties of the University of Rhode Island Change Assessment (URICA) scale. Behaviour Research and Therapy, 42, 711–729.

    Article  PubMed  Google Scholar 

  • Engle, D. E., & Arkowitz, H. (2006). Ambivalence in psychotherapy: Facilitating readiness to change. New York: Guilford Press.

    Google Scholar 

  • First, M. B., Gibbon, M., Spitzer, R. L., Williams, J. B. W., & Benjamin, L. S. (1997). The structured clinical interview for DSM-III-R personality disorders (SCID-II). Washington, DC: American psychiatric Press, Inc.

    Google Scholar 

  • First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2002). Structured clinical interview for DSM-IV-TR Axis I disorders—Patient edition. New York: Biometrics Research Department, New York State Psychiatric Institute.

    Google Scholar 

  • Frank, J. D., & Frank, J. B. (1991). Persuasion and healing: A comparative study of psychotherapy. Baltimore: Johns Hopkins University Press.

    Google Scholar 

  • Geisner, I. M., Neighbors, C., & Larimer, M. E. (2006). A randomized clinical trial of a brief, mailed intervention for symptoms of depression. Journal of Consulting and Clinical Psychology, 74(2), 393–399.

    Article  PubMed  Google Scholar 

  • Hargrave, T. D., & Sells, J. N. (1997). The development of a forgiveness scale. Journal of Marital and Family Therapy, 23(1), 41–63.

    Article  PubMed  CAS  Google Scholar 

  • Helbig, S., & Fehm, L. (2004). Problems with homework in CBT: Rare exception or rather frequent? Behavioral and Cognitive Psychotherapy, 32(3), 291–301.

    Article  Google Scholar 

  • Hettema, J., Steele, J., & Miller, W. R. (2005). Motivational interviewing. Annual Review of Clinical Psychology, 1(1), 91–111.

    Article  PubMed  Google Scholar 

  • Jöreskog, K. G., & Sörbom, D. (2006). LISREL 8.80 for windows [computer software]. Lincolnwood, IL: Scientific Software International, Inc.

    Google Scholar 

  • Judd, L. L., Akiskal, H. S., Zeller, P. J., Paulus, M., Andrew, C., Maser, J. D., et al. (2000). Psychosocial disability during the long-term course of unipolar major depressive disorder. Archives of General Psychiatry, 57, 375–380.

    Article  PubMed  CAS  Google Scholar 

  • Kampman, M., Keijsers, G. P. J., Hoogduin, C. A. L., & Hendriks, G. J. (2008). Outcome prediction of cognitive behaviour therapy for panic disorder: Initial symptom severity is predictive for treatment outcome, comorbid anxiety or depressive disorder, cluster C personality disorders and initial motivation are not. Behavioural and Cognitive Psychotherapy, 36, 99–112.

    Article  Google Scholar 

  • Kazantzis, N., Deane, F. P., & Ronan, K. R. (2000). Homework assignments in cognitive and behavioral therapy: A meta-analysis. Clinical Psychology: Science and Practice, 7, 189–202.

    Article  Google Scholar 

  • Kazantzis, N., Deane, F. P., Ronan, K. R., & L’Abate, L. (2005). Using homework assignments in cognitive behavior therapy. New York: Routledge/Taylor.

    Google Scholar 

  • Kazantzis, N., & Ronan, K. R. (2006). Can between-session homework activities be considered a common factor in psychotherapy? Journal of Psychotherapy Integration, 16(2), 115–127.

    Article  Google Scholar 

  • Keene, M. S. (2005). Confusion and complaints: The true cost of noncompliance in antidepressant therapy. Medscape Psychiatry and Mental Health, 10(2). Retrieved on December 21, 2005 from http://www.medscape.com/viewarticle/518273.

  • Keijsers, G. P. J., Hoogduin, C. A. L., & Schaap, C. P. D. R. (1994a). Prognostic factors in the behavioral treatment of panic disorder with and without agoraphobia. Behavior Therapy, 25, 689–708.

    Article  Google Scholar 

  • Keijsers, G. P. J., Hoogduin, C. A. L., & Schaap, C. P. D. R. (1994b). Predictors of treatment outcome in the behavioural treatment of obsessive-compulsive disorder. British Journal of Psychiatry, 165, 781–786.

    Article  PubMed  CAS  Google Scholar 

  • Keijsers, G. P. J., Kampman, M., & Hoogduin, C. A. L. (2001). Dropout prediction in cognitive behavior therapy for panic disorder. Behavior Therapy, 32, 739–749.

    Article  Google Scholar 

  • Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33, 159–174.

    Article  PubMed  CAS  Google Scholar 

  • Leamer, E. (1985). Sensitivity analyses would help. American Economic Review, 75, 308–313.

    Google Scholar 

  • Leventhal, H., Diefenbach, M., & Leventhal, E. A. (1992). Illness cognition: Using common sense to understand treatment adherence and affect cognition interactions. Cognitive Therapy and Research, 16, 143–163.

    Article  Google Scholar 

  • Marr, I. B. (May, 2000). Concurrent validation of the burns depression inventory (burns-D). Submitted to the Graduate School of Eastern Kentucky University in partial fulfillment of the requirements for the degree of Master of Science.

  • Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change (2nd ed.). New York: Guilford Press.

    Google Scholar 

  • Neimeyer, R. A., Kazantzis, M., Kassler, D. M., Baker, K. D., & Fletcher, R. (2008). Group cognitive behavioural therapy for depression outcomes predicted by willingness to engage in homework, compliance with homework, and cognitive restructuring skill acquisition. Cognitive Behaviour Therapy, 37(4), 199–215.

    Article  PubMed  Google Scholar 

  • Orlinsky, D. E., Grawe, K., & Parks, B. K. (1994). Process and outcome in psychotherapy: Noch einmal. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change (4th ed., pp. 270–376). Oxford: Wiley.

    Google Scholar 

  • Sekirnjak, G. C., & Beal, D. (1999). Concurrent validation of the burns depression checklist. Presented at the annual meeting of the association for the advancement of behavior therapy, Toronto, Canada.

  • Soler, J., Trujols, J., Pascual, J. C., Portella, M. J., Barrachina, J., Campins, J., et al. (2008). Stages of change in dialectical behaviour therapy for borderline personality disorder. British Journal of Clinical Psychology, 47, 417–426.

    Article  PubMed  Google Scholar 

  • Svarstad, B. L., Shireman, T. I., & Sweeney, J. K. (2001). Using drug claims data to assess the relationship of medication adherence with hospitalization and costs. Psychiatric Services, 52, 805–811.

    Article  PubMed  CAS  Google Scholar 

  • Tang, T. Z., DeRubeis, R. J., Beberman, R., & Pham, T. (2005). Cognitive changes, critical sessions, and sudden gains in cognitive-behavioral therapy for depression. Journal of Consulting and Clinical Psychology, 73, 168–172.

    Article  PubMed  Google Scholar 

  • Vogel, P. A., Hansen, B., Stiles, T. C., & Gotestam, K. G. (2006). Treatment motivation, treatment expectancy, and helping alliance as predictors of outcome in cognitive behavioral treatment of OCD. Journal of Behavior Therapy and Experimental Psychiatry, 37, 247–255.

    Article  PubMed  Google Scholar 

  • Weiden, P. J., Kozma, C., Grogg, A., & Locklear, J. (2004). Partial compliance and risk of rehospitalization among California medicaid patients with schizophrenia. Psychiatric Services, 55(8), 886–891.

    Article  PubMed  Google Scholar 

  • 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, 23, 1106–1117.

    Article  PubMed  Google Scholar 

  • Westra, H. A., & Dozois, D. J. A. (2006). Preparing clients for cognitive behavioral therapy: A randomized pilot study of motivational interviewing for anxiety. Cognitive Therapy and Research, 30(4), 481–498.

    Article  Google Scholar 

  • Westra, H. A., Dozois, D. J. A., & Boardman, C. (2002). Correlates of treatment change and engagement in cognitive behavioural group therapy for depression. Journal of Cognitive Psychotherapy: An International Quarterly, 16, 227–241.

    Article  Google Scholar 

  • Wothke, W. (2000). Longitudinal and multigroup modeling with missing data. In T. D. Little, K. U. Schnabel, & J. Baumert (Eds.), Modeling longitudinal and multilevel data: Practical issues, applied approaches and specific examples (pp. 219–240). Mahwah, NJ: Erlbaum Associates.

    Google Scholar 

  • Zuroff, D. C., Koestner, R., Moskowitz, D. S., McBride, C., Marshall, M., & Bagby, R. M. (2007). Autonomous motivation for therapy: A new common factor in brief treatments for depression. Psychotherapy Research, 17(2), 137–147.

    Article  Google Scholar 

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Acknowledgments

This authors wish to thank the following individuals who provided help or collaboration in the EASY Diagnostic Research Study: Britney Blair, Debra Burnett, Psy.D., Kim Chu, Jennifer Coughlin, Katherine Claypool, Leigh Harrington, M.D., Chris Hayward, M.D., Neda Kharrazi, Anthony Mascola, M.D., Wendy O’Connor, Psy.D., Jonah Paquette, Psy.D., Lindsay Paquette, Psy.D, and Debra Safer, M.D.

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Authors and Affiliations

  1. Department of Psychiatry and Behavior Sciences, Stanford University, 401 Quarry Road, Stanford, CA, 94305, USA

    David Burns & Mickey Trockel

  2. Department of Psychology, York University, Toronto, ON, Canada

    Henny Westra

  3. Department of Psychology, The Pennsylvania State University, University Park, PA, USA

    Aaron Fisher

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  1. David Burns
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  2. Henny Westra
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Correspondence to Mickey Trockel.

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Burns, D., Westra, H., Trockel, M. et al. Motivation and Changes in Depression. Cogn Ther Res 37, 368–379 (2013). https://doi.org/10.1007/s10608-012-9458-3

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