5 - (SYM 111) Promoting Cognitive Change and Cognitive Behavioral Therapy Skills: Examining the Process of Change in CBT and Skill Enhanced CBT

Clients’ experience of cognitive change and their use of cognitive behavioral coping strategies have been identified as potential mechanisms of change in cognitive behavioral therapy (CBT). In one study, variables reflecting these mechanisms predicted subsequent, session-to-session changes in depressive symptoms over the course of CBT (Schmidt et al., 2019). We sought to replicate and extend this finding by modeling potential reciprocal, within-person relationships in session-to-session cognitive change / CBT skills and depressive symptoms over the course of treatment in an independent sample. We drew data from a recent clinical trial comparing CBT and a treatment focused on developing patients’ cognitive behavioral coping strategies (Skill Enhanced CBT; CBT-SE). A total of 150 eligible adults (Mage = 31.3, SDage = 10.4, nfemale = 91, nnon-Hispanic white = 108, nheterosexual = 103) were randomized to one of the two study conditions. We assessed cognitive change / CBT skills using two measures: Cognitive Change Immediate (CC-I; reflecting cognitive change and skill use in session) and Cognitive Change Sustained (CC-S; reflecting cognitive change and skill use between sessions). Depressive symptoms were assessed with the Quick Inventory of Depressive Symptomatology (QIDS). We utilized random intercept cross-lagged panel models (RI-CLPM), which parse within and between person variation, appropriately model auto-regressive effects, and model reciprocal relationships between two variables. CBT-SE and CBT produced similar levels of in-session cognitive change, but CBT-SE led to greater between session cognitive change and skill use. In RI-CLPMs, CC-S had a significant within-person effect on depressive symptoms (median standard estimate = -0.12), with no evidence of a reciprocal relationship. In a separate model, CC-I had a significant within-person effect on depressive symptoms (median standard estimate = -0.08), with evidence for reciprocal relationship of symptoms on CC-I (median standard estimate = -0.07). Therapist adherence to CBT predicted CC-S (median standard estimate = 0.05), without evidence for a reciprocal relationship. These findings are consistent with the view that cognitive change and CBT skills promote symptom reductions in CBT and CBT-SE. Our results further highlight therapist strategies that serve to promote clients between session CBT skills use.