Knowing and Doing: Patient CBT Skill Use and Quality as Predictors of Outcomes
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Date
2024-05
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The Ohio State University
Abstract
Introduction: Cognitive behavioral therapy (CBT) has been established as an effective treatment for depression. The set of skills taught in CBT has been studied as an important aspect of the treatment. Nonetheless, studies of the role of CBT skills have been mostly naturalistic. Drawing data from a recent trial comparing CBT and a variant of CBT intended to enhance skills more fully, I examine variables characterizing skills: skill quality in a standardized assessment, self-report use of skills, and observer assessed use of skills from session recordings. I examine whether skill enhanced treatment resulted in differences in these skill variables and test these variables as predictors of outcomes following acute treatment.
Methods: A total of 150 participants were randomly assigned to either a CBT or CBT-SE (skill enhanced) treatment condition. Acute treatment was provided for 12 weeks, after which participants were asked to complete monthly surveys over a 6-month follow-up period.
Results: At the post-treatment evaluation, there were treatment differences with greater skill quality (assessed via the Ways of Responding Inventory) and observer-rated skill use in the second last session (assessed with the Performance of Cognitive Therapy Strategies scale) in the CBT-SE than the CBT condition. Differences in patient-reported skill use (assessed via the Competencies of Cognitive Therapy – Self Report Scale) were not significant. In predicting outcome over the follow-up period, WOR-assessed skill quality significantly predicted lower overall symptom severity, but not risk of relapse following treatment. Neither observer-rated skill use nor patient-reported skill use were significant predictors of overall symptom severity or risk of relapse.
Discussion: These findings suggest patient CBT skill quality is important to consider as a predictor for overall depressive symptom severity. Results also suggest that although observer rated skill use alone may not be enough to provide benefits in CBT, therapists should emphasize the development of patient's skill quality within treatment.
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Keywords
Cognitive Therapy, Depression, Outcomes, Psychotherapy, Skills