MI and CBT
Combination, Integration
Synergy
Paul Earnshaw
Psychological Therapist
/Social Worker
Sylvie Naar King
Associate Professor
Clinical Psychologist
Explore combination
Integration Synergy in MI CBT
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Use an extract from training developed with
Rory Allott-thanks.
MI enhances CBT nearly all MINTIES agree
No definitive research to back that up
My clinical experience in a Beckian CT world
and in MIDAS trial - MICBT integration
suggests that is does.
We are more interested in what you think
Combining/Integrating MI and
CBT; Some Questions
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Why integrate?
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What are similarities and differences between MI
and CBT?
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How to integrate (prelude, combination, integration)?
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Why bother? Is there a synergistic effect?
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What are the challenges presented to therapist,
clients, and trainer around integration?
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Other questions?
CBT & MI: What separates them
and brings them together?
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Take the cards in front of you and distribute them around your
group
Elect three people to collect the cards
 One person collects cards that apply to MI and CBT
 One person collects cards that apply more to MI
 One person collects cards that apply more to CBT
Elect a fourth person to guide the conversation
Consider each card and discuss the placement
Obviously, there are no right or wrong answers or expectations
about the size of piles
We will give you 20 mins
Move about
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Place your cards on the continuum on the wall
All cards will go on the wall so we can discuss
consensus
While you are doing this notice where the cards are
going
Debrief
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What themes emerged from your group’s discussion
What were the challenges of this activity
Combining/Integrating MI and
CBT; Some Questions

Why integrate?

What are similarities and differences between MI
and CBT?

How to integrate (prelude, combination, integration)?

Why bother? Is there a synergistic effect?

What are the challenges presented to therapist,
clients, and trainer around integration?
MI and CBT
“ sort of like cousins ” Peter
Prescott
“some kinds of Cognitive
therapy look a lot like MI” List
serve discussions.
But what is different?
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Origins
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Many ‘kinds’ of cognitive behaviour therapy
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Beckian, Padesky, Metacognitive, REBT, CBT for
substance use, DBT, ACT, Schema focussed,
Compassionate Mind CBT, Method of Levels
Makes comparisons difficult
Only one Motivational Interviewing
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Miller and Rollnick
Though many variations: MET, DDMI, AMI’s,
Compliance therapy ?
What other differences?
Traditional Cognitive-Behavioral
Therapy
Motivational Interviewing
Problem Focused
Strengths Focused
Formulation led
Target-behaviour led
Schema
Values
Expert-led
Expert-trap
How?
Why?
Thoughts-Feelings-Behaviour
Values-Dissonance-Behaviour
Change as a function of the individual
Change as a function of the
relationship
Psychological-Medical
Humanistic- Psychological
But what is similar?
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Origins
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Neither grounded in theory
Emerged from detailed phenomenological
research
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Beck: Dreams
Miller: Client utterances and values
Cognitive-Behavioural journals
Strong evidence-base and culture of evaluation
What else is similar?
Cognitive-behaviour Therapy & Motivational Interviewing
Collaborative, Directive
Empathic, Positive Regard
Guided Discovery, Evocative
Summaries, Questions, Reframe
Self-monitoring, Relapse prevention, Normalising
What to integrate from CBT?
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Agendas
Formulation / Case conceptualisation
Identifying Beliefs
Problem solving
Behavioural experiments
Skills training
Emphasis on self-monitoring
What to integrate from MI?
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Listening for & responding to readiness to change
Identifying core values
Working with ambivalence
Developing discrepancy
Autonomy – client as agent of change NOT the
therapy
Supporting self-efficacy
Reflective listening
Affirmation
How to integrate?
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Combination approaches
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MI as a prelude to CBT (Arkowitz et al 2008)
Switching to MI during CBT to explore specific
issues around ambivalence
Integrative approaches
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Seamless joining together of CBT and MI
“assimilative integration”an ‘Integrative
Framework’
Stages of Readiness &
Therapy Style
Style of Therapy
l
na
io g
at i n
iv w
ot vie
M ter
In
e l
tiv ra
ni i ou
og v
C ha apy
Be er
Th
Client’s Stage of Change
Precontemplation
Contemplation
Determination
Action
Maintenance
Relapse
Training issues
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Is it easier to train a CBT therapist to do MI or
an MI therapist to do CBT?
Why
If you could teach both to a naïve counselor,
would you do it sequentially or
simultaneously.
How would you integrate MI and CBT training
In research trials use an MICT fidelity scale?
Other Challenges
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CBT not necessary to be in the Spirit of MI
Irrational thinking that needs to be corrected
MI can result in a cognitive shift is this CBT
CBT experts don’t see the need to integrate
MI
CBT models tend to be expert not client led
Switching from one to the other is confusing
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Combining/Integrating MI and CBT