Grant: Doctoral Award - Frederick Banting and Charles Best Canada Graduate Scholarships

Generalized anxiety disorder (GAD), characterized by excessive uncontrollable worry, reduces quality of life for approximately 6% of adult Canadians, and places a substantial burden on public health care resources. Cognitive Behavioral Therapy (CBT) and Motivational Interviewing are often effective, but fail to help some people seeking treatment for GAD. Just as biochemists study pharmaceutical ingredients to make better medications, psychotherapy researchers study in-session behavior to make therapy more effective. We do not yet understand how GAD treatment works, and my project examines possible active ingredients in GAD treatment. I will use a standardized coding system to measure minute-by-minute behavior in videotaped sessions from a recent clinical trial of CBT and Motivational Interviewing for GAD. I chose this coding system because it can measure several patient behaviors thought to underlie recovery from GAD: ambivalent beliefs about worry; emotion avoidance; and emotion processing. I will track the frequency of these behaviors at early, middle, and late-stage therapy, and compare recovered versus unchanged patients. I have four main predictions: Emotion avoidance will decrease more for recovered versus unchanged patients; Emotion processing will increase more for recovered vs. unchanged patients; Ambivalence about worry will differentiate patients receiving Motivational Interviewing from those receiving CBT (because Motivational Interviewing is designed to resolve ambivalence); Early-stage ambivalence will predict recovery. To optimize treatment effectiveness, we must first understand the processes associated with recovery, and then clinically apply these active ingredients. This study will help clarify how CBT and Motivational Interviewing actually work to promote recovery in individuals with severe GAD, enabling clinicians to provide more effective, efficient treatments to improve the health and quality of life of GAD-sufferers.