Readiness to change and therapy outcomes of an innovative psychotherapy program for surgical patients: results from a randomized controlled trial

Abstract

Background: Readiness to change is a pivotal construct for psychotherapy research and a major target of motivational interventions. Our primary objective was to examine whether pre-treatment readiness to change moderated therapy effects of Bridging Intervention in Anesthesiology (BRIA), an innovative psychotherapy approach for surgical patients. This stepped care program aims at motivating and supporting surgical patients with mental disorders to engage in psychosocial mental health care.

Methods: The major steps of BRIA are two motivational interventions with different intensity. The first step of the program consists of preoperative computer-assisted psychosocial self-assessment including screening for psychological distress and automatically composed computerized brief written advice (BWA). In the second step, patients participate in postoperative psychotherapy sessions combining motivational interviewing with cognitive behavioural therapy (BRIA psychotherapy sessions). We performed regression-based moderator analyses on data from a recent randomized controlled trial published by our research group. The sample comprised 220 surgical patients with diverse comorbid mental disorders according to ICD-10. The most frequent disorders were mood, anxiety, substance use and adjustment disorders. The patients had a mean age of 43.31 years, and 60.90% were women. In a regression model adjusted for pre-treatment psychological distress, we investigated whether readiness to change moderated outcome differences between (1) the BRIA psychotherapy sessions and (2) no psychotherapy / BWA only.

Results: Multiple regression analyses showed that readiness to change moderated treatment effects regarding the primary outcomes "Participation in psychosocial mental health care options at month 6" (p = 0.03) and "Having approached psychosocial mental health care options at month 6" (p = 0.048) but not regarding the secondary outcome "Change of general psychological distress between baseline assessment and month 6" (p = 0.329). Probing the moderation effect with the Johnson-Neyman technique revealed that BRIA psychotherapy sessions were superior to BWA in patients with low to moderate readiness, but not in those with high readiness.

Conclusions: Readiness to change may act as moderator of the efficacy of psychosocial therapy. Combinations of motivational interviewing and cognitive behavioural therapy may be effective particularly in patients with a variety of mental disorders and low readiness to change.

Trial registration: clinicaltrials.gov Identifier: NCT01357694.

Keywords: Bridging Intervention in Anesthesiology (BRIA); Cognitive behavioural therapy (CBT); Motivational interviewing (MI); Surgical patients; University of Rhode Island Change Assessment (URICA).

Fig. 1

Flow of participants through the trial. ⁺ Numbers in brackets refer to patients lost to follow-up and drop outs concerning the secondary outcome. Numbers of patients lost to follow-up differ between primary and secondary outcomes because the primary outcome was assessed via a telephone interview, and the secondary outcome as a postal questionnaire. Kerper et al., Effects of an innovative psychotherapy program for surgical patients - Bridging Intervention in Anesthesiology: A randomized controlled trial. Anesthesiology 2015;123:148-59 [6]

Fig. 2

Johnson-Neyman plots of the interaction between treatment allocation (BRIA psychotherapy sessions vs. BWA, N = 220) and readiness to change. a Participation in psychosocial mental health care options at month 6; b Having approached psychosocial mental health care options at month 6. The black continuous lines show the conditional effects of BRIA psychotherapy sessions for all values of readiness to change, and the dotted lines above and below indicate the corresponding 95% confidence intervals (CI). The gray vertical dashed lines identify the regions of significance, reaching from the lowest score until the score of readiness to change at which the lower 95% CI of the slope crosses the zero point. For all readiness values below, the effect of BRIA psychotherapy sessions is statistically significant