General change mechanisms in the early treatment phase and their associations with the outcome of cognitive behavioural therapy in patients with different levels of motivational incongruence.

Early general change mechanisms (GCMs) have been shown to be associated with psychotherapy outcome but it remains unclear which specific patients benefit from which GCM. This study explored whether the patients' characteristic motivational incongruence moderates the effect of GCMs in the early treatment phase on the outcome. Three early GCMs (interpersonal experiences, intrapersonal experiences, and problem actuation) were evaluated after five therapy-preparing sessions by patients and therapists. On the basis of previous work, we assumed that the association between intrapersonal experiences and outcome is moderated by incongruence. A total of 524 patients completing outpatient cognitive behavioural therapy (CBT) were investigated. The patient-reported outcome measure was psychological symptom severity. The patients' motivational incongruence was assessed with the incongruence questionnaire short form at baseline. Results showed that therapists' ratings of all three early GCMs and patients' ratings of early problem actuation were not associated with CBT outcome. By contrast, positive patients' ratings of early interpersonal and early intrapersonal experiences were beneficial for CBT outcome (both p < .05). Only the association between patients' ratings of early intrapersonal experiences and CBT outcome was moderated by incongruence (p < .05). The higher the patients' baseline incongruence was, the more beneficial early intrapersonal experiences in the patients' perspective were for a good outcome. These findings entail that increasing early intrapersonal experiences from the patients' perspective is particularly important in patients with motivational incongruence but working on early interpersonal experiences in the patients' perspective is important in patients with all levels of incongruence to reach a good CBT outcome.