Creating New Perspectives: An Investigation of Therapist Strategies and the Promotion of Cognitive Change
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Date
2019-05
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The Ohio State University
Abstract
Introduction: Little is known about the means by which cognitive therapy (CT), an empirically supported treatment for depression, achieves its effects. In a recent study, within-patient cognitive change (CC) was found to predict session-to-session symptom change in CT (Schmidt, Pfeifer, & Strunk, in press). Drawing from that same study, I selected two consecutive sessions for which patients reported dramatically different amounts of CC from a group of 62 patients undergoing CT for depression. Observers rated these sessions for therapists’ use of cognitive methods intended to promote CC, as well as other psychotherapy process variables.
Methods: A sample of 126 patients participating in a study of CT for depression rated their CC at the conclusion of each therapy session. For each patient, I identified successive sessions with the largest difference in the amount of CC reported. The 62 patients with the largest of these differences were selected for further study. These high and low CC sessions were coded by observers (blind to session type) for therapists’ use of cognitive methods, as well as Socratic questioning, behavioral methods, and the therapeutic alliance.
Results: Raters’ judgments of cognitive methods were moderately reliable (Intraclass Correlation Coefficient (ICC) = .61). Reliability for judgments of the three other process measures ranged from moderate to good (ICCs = .61 to .79). Therapists’ use of cognitive methods differentiated the high and low CC sessions. There were no significant effects of severity of symptoms at intake, session number within the course of CT, and whether the high or low CC session occurred first. No other observer rating exhibited this relation.
Conclusion: These findings are consistent with the idea that cognitive methods promote CC in CT. I discuss my finding in light of the mixed literature on the role of CC in CT. I suggest distinguishing between treatment procedures (e.g., cognitive methods) and potential therapeutic mechanisms (e.g., CC) may be key to resolving the mixed findings in the literature.
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cognitive change, cognitive therapy, depression, psychotherapy process