5 - (SYM 71) Do Client Adherence, Skills, and Outcomes Improve When Memory Support Strategies Are Used with Cognitive Therapy?

Client memory for treatment recommendations is poor. In turn, poor memory for treatment predicts worse treatment outcomes. The Memory Support Intervention (MSI) was designed to improve treatment outcomes by enhancing client memory for treatment. This intervention consists of eight memory support strategies that therapists integrate into treatment-as-usual. Theoretically, if clients are better able to remember treatment recommendations, they may be more adherent during treatment and utilize treatment skills more frequently and with greater competency after treatment ends. Together, this may in turn predict better treatment outcomes. The present study evaluated these possible mechanisms of memory support strategies when used with treatment-as-usual. Specifically, we tested whether therapist use of memory support strategies indirectly predicts improved client outcomes via serial improvements in (a) client adherence throughout treatment and (b) client utilization and competency of treatment skills.

Adults with major depressive disorder (N=178, mean age=37.93, 63% female, 17% Hispanic or Latino) were randomized to Cognitive Therapy plus MSI or Cognitive Therapy-as-usual. Because therapists from both treatment groups used memory support strategies, data from conditions were combined. Blind assessments of depression severity and overall impairment were conducted before treatment, immediately post-treatment (POST), at six-month follow-up (6FU), and at 12-month follow-up (12FU). Client adherence to treatment was rated by therapists at each session and averaged across treatment sessions. Clients completed measures of utilization and competency in cognitive therapy skills at POST, 6FU, and 12FU.

Results of serial mediation models indicated that more therapist use of memory support strategies predicted lower depression severity at POST, 6FU, and 12FU indirectly and sequentially through (a) increased client adherence during treatment and (b) more utilization and competency of Cognitive Therapy skills at POST, 6FU, and 12FU. The same patterns were found for serial mediation models predicting lower overall impairment at POST, 6FU, and 12FU.  

In sum, memory support strategies may represent a promising means to enhance client adherence to treatment as well as client utilization and competence of treatment skills. Together, this sequential chain may improve treatment outcomes. Limitations and future research directions – such as applications to other client populations and evidence-based treatments – will be discussed.