Resistance and Outcome Expectations in Cognitive-Behavioural Therapy for Generalized Anxiety Disorder
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Higher levels of resistance have been consistently found to be negatively associated with outcome in psychotherapy. However, the pathways through which resistance impacts therapy outcomes are underexplored. Given that outcome expectations have been identified as an important common factor influencing therapy outcomes, the goals of the present study were to: (1) examine impact of resistance on client and therapist outcome expectations (COE & TOE respectively) (2) explore whether the impact of resistance on these expectations mediates the relationship between resistance and therapy outcome. These relationships were tested among 44 clients with severe generalized anxiety disorder treated with Cognitive Behavioral Therapy for severe generalized anxiety in the context of a randomized controlled trial (Westra, Constantino, & Antony, 2016). Resistance was measured for a midtreatment session and COE and TOE were assessed at baseline and immediately after the session at which resistance was measured. Treatment outcome was measured via client-rated worry severity at posttreatment. As predicted, higher resistance was associated with lower subsequent COE and TOE (B = - 0.73, p < .001 and B = - 0.46, p < .001, respectively). COE post resistance in turn predicted higher posttreatment worry (B = - 0.5, p < .001) indicating mediation; TOE in contrast was not found to mediate the relationship between resistance and outcome (B = - 0.02, p = .876). These results suggest that resistance is potentially demoralizing to both clients and therapists. But it is the lower morale of clients associated with resistance that is detrimental to therapy outcome. This study makes a contribution to understanding the influences on outcome expectations. The discussion will consider the importance of managing resistance as one strategy for maintaining positive expectations for therapy.