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Putting the "Cognitive" Back in Cognitive Therapy: Sustained Cognitive Change as a Mediator of In-Session Insights and Depressive Symptom Improvement

Schmidt, Iony D ; Pfeifer, Benjamin J ; Strunk, Daniel R Davila, Joanne

Journal of consulting and clinical psychology, 2019-05, Vol.87 (5), p.446-456 [Periódico revisado por pares]

United States: American Psychological Association

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  • Título:
    Putting the "Cognitive" Back in Cognitive Therapy: Sustained Cognitive Change as a Mediator of In-Session Insights and Depressive Symptom Improvement
  • Autor: Schmidt, Iony D ; Pfeifer, Benjamin J ; Strunk, Daniel R
  • Davila, Joanne
  • Assuntos: Cognitive change ; Cognitive Therapy ; Female ; Human ; Major Depression ; Male ; Mental depression ; Psychotherapists ; Psychotherapy ; Symptoms ; Therapeutic Alliance ; Therapeutic alliances ; Therapeutic Processes ; Therapists ; Treatment Compliance
  • É parte de: Journal of consulting and clinical psychology, 2019-05, Vol.87 (5), p.446-456
  • Notas: ObjectType-Article-1
    SourceType-Scholarly Journals-1
    ObjectType-Feature-2
    content type line 23
  • Descrição: Objective: Although cognitive change has long been posited to drive symptom improvements in cognitive therapy (CT) of depression, whether it does so remains controversial. Methodological challenges have contributed heavily to the lack of resolution on this issue. Using a patient-reported measure of cognitive change, we tested the role of cognitive change in contributing to symptom change in CT. In addition, we tested whether therapists' use of cognitive methods intended to promote cognitive changes predicted these changes. We also tested the specificity of the relation of cognitive methods and cognitive change by examining other psychotherapy process variables. Method: In a sample of 126 patients who participated in CT of depression, patients rated immediate cognitive change (CC-Immediate) at the end of each session and sustained cognitive change (CC-Sustained) at the start of each subsequent session. Observers rated therapist adherence and alliance for the first five sessions. Depressive symptoms were assessed at each session. For all predictors, we disaggregated within- and between-patient effects. Results: Focusing on within-patient predictors, CC-Sustained mediated the relation of CC-Immediate and subsequent symptom change. In addition, both CC-Immediate and CC-Sustained predicted symptom change. Therapist adherence to cognitive methods was the only within-patient variable to predict CC-Immediate. Conclusions: These findings are consistent with the view that cognitive change contributes to symptom reductions in CT, and that therapists' use of cognitive methods contributes to cognitive changes during sessions. What is the public health significance of this article? This study provides evidence that cognitive change achieved during sessions predicts subsequent symptom change in CT of depression via sustained cognitive change following sessions. Findings also suggest that therapists' use of cognitive strategies in session may promote patients' experience of immediate cognitive change.
  • Editor: United States: American Psychological Association
  • Idioma: Inglês
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  • Realização: ABCD-USP USP   Logos de Redes Sociais: Freepik

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