Research paperPatients' comprehension and skill usage as a putative mediator of change or an engaged target in cognitive therapy: Preliminary findings

- The cognitive behavioral skills that patients learn and use may mediate depressive outcomes.
- This hypothesis, drawn from human learning, likely applies to other psychotherapies.
- We offer a model ripe for replication and methods to use in target identification.

BackgroundThe skills that patients learn in cognitive therapy (CT) and use thereafter may mediate improvement in depression during and after intervention.MethodWe used a sequential, three-stage design: acute phase (523 outpatients received 12-14 weeks of CT); 8-month experimental phase (responders at higher risk were randomized to continuation phases: C-CT, C-fluoxetine or C-pill placebo); and 24 months of longitudinal, post-treatment follow-up. Path analyses estimated mediation by skill measured by the Skills of Cognitive Therapy (SoCT: Patient and Observer [Therapist] versions).ResultsBetter SoCT scores predicted lower depressive symptoms both in CT and C-CT. In CT depressive symptoms did not predict subsequent changes in skills. During CT and C-CT, when averaged across patients and therapists, skills predicted subsequent decreases in depressive symptoms.LimitationsGeneralization of findings may be limited by the trial's methodology.ConclusionFurther rigorous investigation of the role of patient CT skills stands to increase understanding of mediators of change or engaged targets in psychosocial intervention.