Temporal and specific pathways of change in cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) for depression.

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Publisher: Elsevier Science Publishers
Document Type: Report
Length: 444 words

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Keywords Depression; Mechanisms of change; Cognitive-behavioral therapy; Interpersonal psychotherapy; Therapy skills; Cognitive change Highlights * Latent difference score models were used to investigate temporal relations and mediation in CBT and IPT for depression. * CBT skills was a mechanism of change specific to CBT. * IPT skills seem a non-specific mechanism of change. * Decrease in depression led to an improvement in therapeutic alliance and a decrease in autonomous motivation. * The role of cognitive change and behavioral activation in CBT and IPT for depression remains unclear. Abstract Background The present study investigated the specific and temporal role of putative mechanisms of change in cognitive-behavioral therapy (CBT) and interpersonal psychotherapy (IPT) for major depressive disorder (MDD). Method 200 patients were randomized to CBT weekly, CBT twice weekly, IPT weekly or IPT twice weekly. Outcome and putative mechanisms of change (i.e., dysfunctional thinking, behavioral activation, CBT skills, IPT skills, therapeutic alliance, compliance, motivation) were measured multiple times up to six months after the start of treatment. Latent change score models were used to investigate temporal relations and test mediation. Explorative analyses tested whether baseline working memory moderated the effect of mechanism change on outcome change. Results CBT skills and dysfunctional thinking mediated the relation between treatment modality and changes in depression. In both treatments, IPT skills and behavioral activation were related to subsequent change in depression while a decrease in depression led to subsequent improvement in therapeutic alliance and a decrease in autonomous motivation. Change in compliance was unrelated to change in depression. Baseline working memory was related to therapy skill improvement. Conclusion CBT skill improvement seems a specific mechanism of change leading to subsequent decrease in depression in CBT. Changes in IPT skills acted as a non-specific mechanism, subsequently reducing depression regardless of treatment modality. The specific role of cognitive change and behavioral activation remains unclear. Future studies should investigate the specificity and direction of the potential mechanisms of change throughout the course of therapy and investigate whether these mechanistic pathways differ between individuals. Author Affiliation: (a) Department of Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany (b) Vrije Universiteit Amsterdam, LEARN! Research Institute, Amsterdam, Netherlands (c) Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands (d) Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands (e) Department of Psychology, University of Pennsylvania, Philadelphia, United States * Corresponding author. University of Freiburg, Engelbergerstrasse 41, 79106, Freiburg, Germany. Article History: Received 5 July 2021; Revised 18 November 2021; Accepted 22 November 2021 Byline: Sanne J.E. Bruijniks [sanne.bruijniks@psychologie.uni-freiburg.de] (a,*), Martijn Meeter (b), Lotte H.J.M. Lemmens (c), Frenk Peeters (c), Pim Cuijpers (d), Marcus J.H. Huibers (d,e)

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Gale Document Number: GALE|A696275034