While the efficacy of therapist-guided internet-delivered cognitive behaviour therapy (iCBT) for anxiety and depression is well-established, a significant proportion of clients show little to no improvement with this approach. Given that motivational interviewing (MI) is found to enhance face-to-face treatment of anxiety, the current trial examined potential benefits of a brief online MI intervention prior to therapist-guided iCBT. Clients applying to transdiagnostic therapist-guided iCBT in routine care were randomly assigned to receive iCBT with (n = 231) or without (n = 249) the online MI pre-treatment. Clients rated motivation at screening and pre-iCBT and anxiety and depression at pre- and post-treatment and at 13- and 25-week follow-up after enrollment. Clients in the MI plus iCBT group made more motivational statements in their emails and were enrolled in the course for a greater number of days compared to clients who received iCBT only, but did not demonstrate higher motivation after completing the MI intervention or have higher course completion. Clients in both groups, at screening and pre-iCBT, reported high levels of motivation. No statistically significant group differences were found in the rate of primary symptom change over time, with both groups reporting large reductions in anxiety and depression pre- to post-treatment (Hedges' g range = 0.96–1.11). During follow-up, clients in the iCBT only group reported additional small reductions in anxiety, whereas clients in the MI plus iCBT group did not. The MI plus iCBT group also showed small increases in depression during follow-up, whereas improvement was sustained for the iCBT only group. It is concluded that online MI does not appear to enhance client outcomes when motivation at pre-treatment is high.

尽管由治疗师指导的互联网提供的认知行为疗法（iCBT）对焦虑和抑郁的疗效已得到公认，但相当一部分客户对此方法的改善甚微甚至没有改善。鉴于发现动机访谈（MI）可以增强面对面焦虑症的治疗能力，因此本试验研究了在治疗师指导下进行iCBT之前进行简短的在线MI干预的潜在益处。在常规护理中申请经诊断医生指导的iCBT的患者被随机分配为接受（n  = 231）或不接受（n = 249）在线MI预处理。客户对入选后iCBT筛查和iCBT之前的动机，治疗前和后以及在13周和25周的随访中的焦虑和抑郁程度进行了评估。与仅接受iCBT的客户相比，MI plus iCBT组中的客户在电子邮件中表达了更多的动机声明，并且在课程中的入学时间更长，但仅在完成MI干预或完成较高的课程后没有表现出更高的动机。两组的客户在筛查和iCBT之前都表现出很高的积极性。无统计学随着时间的推移主要症状的变化率被发现显著的组间差异，这两个组织报告了焦虑和抑郁之前到之后的处理大量减少（套期摹范围= 0.96-1.11）。在随访期间，仅iCBT组的客户报告说焦虑有所减轻，而MI加iCBT组的客户则没有。MI加iCBT组在随访过程中也显示出抑郁的轻微增加，而仅iCBT组则持续改善。可以得出结论，当预处理的动机很高时，在线MI似乎并不能提高客户的治疗效果。