Phase-sensitive integration of motivational interviewing and cognitive behavioral therapy for anxiety disorders: a scoping review

Cognitive behavioral therapy (CBT) is an effective treatment for anxiety disorders; however, treatment engagement, adherence, and premature dropout remain persistent clinical challenges. Motivational interviewing (MI) has increasingly been integrated with CBT to address ambivalence, enhance treatment readiness, and support treatment engagement across different phases of therapy. This scoping review mapped and synthesized existing models of MI-CBT integration and their reported clinical and methodological characteristics.

This scoping review followed Joanna Briggs Institute methodology and PRISMA-ScR guidelines. Searches were conducted in PubMed, CINAHL, PsycINFO, and Web of Science for studies published between January 2005 and December 2025. Eligible studies examined integrated MI-CBT interventions for anxiety disorders. Data were synthesized descriptively. Based on recurrent implementation patterns identified across the included studies, a preliminary conceptual synthesis was developed to organize MI-CBT integration according to treatment sequencing, phase-specific engagement functions, delivery formats, and implementation characteristics.

Nine empirical studies met the inclusion criteria. Three broad MI-CBT integration approaches were identified: pretreatment MI, concurrent/embedded MI, and intermittent/responsive MI. Considerable heterogeneity was observed across studies in treatment sequencing, MI content, dosage, therapist training, fidelity monitoring, and implementation procedures. Across studies, MI was primarily implemented with the reported aim of enhancing and address motivational challenges, with several studies reported improved in treatment readiness, adherence, attendance, therapeutic alliance, and resistance management. Evidence for incremental symptom improvement beyond standard CBT remained inconsistent.

Based on recurrent descriptive patterns identified across the included studies, a preliminary conceptual framework was developed to organize the observed MI-CBT integration approaches. The reviewed literature suggests that MI may have potential value for addressing ambivalence, strengthening the therapeutic alliance, managing resistance, and supporting engagement during clinically challenging phases of CBT. However, the current evidence base remains limited and heterogeneous. Future research should evaluate this preliminary conceptual framework across diverse clinical populations and implementation settings while clarifying optimal sequencing strategies, fidelity procedures, dosage parameters, and the role of therapist-supported and asynchronous digital CBT interventions.