Fostering Cognitive Change in Cognitive Therapy of Depression: An Investigation of Therapeutic Strategies
There is little evidence regarding which therapist strategies promote cognitive change in cognitive therapy (CT) of depression. Drawing from a sample of CT patients, we selected two consecutive sessions for which patients reported markedly different amounts of cognitive change (CC; i.e., a low and high cognitive change session). We then investigated whether four observer-rated psychotherapy process variables differentiated high and low CC sessions. Our analyses focused on 62 patients with large session-to-session differences in self-reported CC. Results from single predictor models showed the therapeutic alliance and therapists’ use of cognitive methods predicted high versus low CC session type. In a model including multiple predictors, only cognitive methods remained significant. These findings are consistent with the view that cognitive methods promote CC in CT.
KeywordsCognitive change Cognitive therapy Depression Psychotherapy process
Compliance with Ethical Standards
Conflict of interest
Suzannah J. Stone and Daniel R. Strunk declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional and/or National Research Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
This article does not contain any studies with animals performed by any of the authors.
- Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford Press.Google Scholar
- Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory (2nd ed.). San Antonio, TX: The Psychological Corporation.Google Scholar
- Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). New York: Guilford.Google Scholar
- Braun, J. D., Strunk, D. R., Sasso, K. E., & Cooper, A. A. (2015). Therapist use of Socratic questioning predicts session-to-session symptom change in cognitive therapy for depression. Behaviour Research and Therapy,70, 32–37. https://doi.org/10.1016/j.brat.2015.05.004.CrossRefPubMedPubMedCentralGoogle Scholar
- Bruijniks, S. J., Los, S. A., & Huibers, M. J. (2019). Direct effects of cognitive therapy skill acquisition on cognitive therapy skill use, idiosyncratic dysfunctional beliefs and emotions in distressed individuals: An experimental study. Journal of Behavior Therapy and Experimental Psychiatry. https://doi.org/10.1016/j.jbtep.2019.02.005.CrossRefPubMedGoogle Scholar
- Darchuk, A. J., Wang, V., Weibel, D. T., Fende, J. M., Anderson, T., & Horvath, A. O. (2000). Manual for the working alliance inventory: Observer form (WAI-O): Revision IV (Unpublished manuscript). Athens, OH: Ohio University.Google Scholar
- DeRubeis, R. J., Evans, M. D., Hollon, S. D., Garvey, M. J., Grove, W. M., & Tuason, V. B. (1990). How does cognitive therapy work? Cognitive change and symptom change in cognitive therapy and pharmacotherapy for depression. Journal of Consulting and Clinical Psychology,58, 862–869. https://doi.org/10.1037/0022-006X.58.6.862.CrossRefPubMedGoogle Scholar
- First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2002). Structured clinical interview for DSM-IV axis I disorders, research version, non-patient edition (SCID/I/NP). New York: Biometrics Research, New York State Psychiatric Institute.Google Scholar
- Hollon, S. D., Evans, M. D., Auerbach, A., DeRubeis, R. J., Elkin, I., Lowery, A., … Piasecki, J. M. (1988). Development of a system for rating therapies for depression: Differentiating cognitive therapy, inter-personal psychotherapy and clinical management pharmacotherapy (Unpublished manuscript). Nashville, TN: Vanderbilt University.Google Scholar
- IAPT Programme. (2007). The competencies required to deliver effective cognitive and behavioural therapy for people with depression and with anxiety disorders. London: Department of Health.Google Scholar
- Jacobson, N. S., Dobson, K. S., Truax, P. A., Addis, M. E., Koerner, K., Gollan, J. K., ... Prince, S. E. (1996). A component analysis of cognitive–behavioral treatment for depression. Journal of Consulting and Clinical Psychology,64, 295–304. https://doi.org/10.1037/0022-006X.64.2.295.CrossRefGoogle Scholar
- Jarrett, R. B., Vittengl, J. R., Doyle, K., & Clark, L. A. (2007). Changes in cognitive content during and following cognitive therapy for recurrent depression: Substantial and enduring, but not predictive of change in depressive symptoms. Journal of Consulting and Clinical Psychology,75, 432–446. https://doi.org/10.1037/0022-006X.75.3.432.CrossRefPubMedPubMedCentralGoogle Scholar
- Lemmens, L. H., Galindo-Garre, F., Arntz, A., Peeters, F., Hollon, S. D., DeRubeis, R. J., & Huibers, M. J. H. (2017). Exploring mechanisms of change in cognitive therapy and interpersonal psychotherapy for adult depression. Behaviour Research and Therapy,94, 81–92. https://doi.org/10.1016/j.brat.2017.05.005.CrossRefPubMedGoogle Scholar
- Lorenzo-Luaces, L., German, R. E., & DeRubeis, R. J. (2015). It's complicated: The relation between cognitive change procedures, cognitive change, and symptom change in cognitive therapy for depression. Clinical Psychology Review,41, 3–15. https://doi.org/10.1016/j.cpr.2014.12.003.CrossRefPubMedGoogle Scholar
- Schmidt, I. D., Pfeifer, B. J., & Strunk, D. R. (2019). Putting the “cognitive” back in cognitive therapy: Sustained cognitive change as a mediator of in-session insights and depressive symptom improvement. Journal of Consulting and Clinical Psychology,87, 446–456. https://doi.org/10.1037/ccp0000392.CrossRefPubMedGoogle Scholar
- Strunk, D. R., Adler, A. D., & Hollon, S. D. (2017). Cognitive therapy of depression. In R. J. DeRubeis & D. R. Strunk (Eds.), The Oxford handbook of mood disorders (pp. 411–422). New York: Oxford University Press.Google Scholar
- Strunk, D. R., Cooper, A. A., Ryan, E. T., DeRubeis, R. J., & Hollon, S. D. (2012). The process of change in cognitive therapy for depression when combined with antidepressant medication: Predictors of early intersession symptom gains. Journal of Consulting and Clinical Psychology,80, 730–738. https://doi.org/10.1037/a0029281.CrossRefPubMedPubMedCentralGoogle Scholar
- Webb, C. A., Stanton, C. H., Bondy, E., Singleton, P., Pizzagalli, D. A., & Auerbach, R. P. (2019). Cognitive versus behavioral skills in CBT for depressed adolescents: Disaggregating within-patient versus between-patient effects on symptom change. Journal of Consulting and Clinical Psychology,87, 484–490. https://doi.org/10.1037/ccp0000393484.CrossRefPubMedGoogle Scholar