Knowledge Bank

Cognitive behavioral therapy (CBT) is a first-line treatment for depression, but it would still benefit from improved efficacy. One potential method of increasing its efficacy is through adding memory support strategies to enhance patients’ memory for the content of treatment. Another potential way to increase the efficacy of CBT may be through greater efforts to increase patients’ CBT skills, which may improve the quality of patients’ CBT skills and the outcomes they achieve. In this study, I considered the role of memory for treatment content and skill development while drawing data from a randomized trial comparing CBT and skill-enhanced CBT among 150 adults with major depressive disorder. Averaged across assessments at three sessions (session 3, 6, and 10), patients in skill-enhanced CBT recalled more treatment points than those in the CBT condition. Memory for treatment points at session 3 did not predict subsequent change in depressive symptoms. Similarly, the average treatment points recalled across the sessions examined were not related to change in depressive symptoms from pre- to post-treatment. Finally, patients in the skill-enhanced CBT condition exhibited higher CBT skill quality at posttreatment than the CBT condition, controlling for pretreatment skill quality. This difference remained significant after controlling for memory for treatment points at session 10, but the difference was reduced to a non-significant trend when controlling for memory for treatment points averaged across all timepoints. Taken together, the findings suggest that memory for treatment is enhanced by the use of skill-enhancing strategies in CBT. However, our findings largely failed to support the view that memory enhancement added to or explained the therapeutic benefits of a skill-enhanced treatment.