Robin B Jarrett1, Jeffrey R Vittengl2, Lee Anna Clark3, Michael E Thase4. 1. Department of Psychiatry,The University of Texas Southwestern Medical Center, United States. Electronic address: Robin.Jarrett@UTSouthwestern.edu. 2. Truman State University, United States. Electronic address: vittengl@truman.edu. 3. Norte Dame University, United States. 4. Departments of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia Veterans Affairs Medical Center, United States.
Abstract
BACKGROUND: The skills that patients learn in cognitive therapy (CT) and use thereafter may mediate improvement in depression during and after intervention. METHOD: We used a sequential, three-stage design: acute phase (523 outpatients received 12-14 weeks of CT); 8-month experimental phase (responders at higher risk were randomized to continuation phases: C-CT, C-fluoxetine or C-pill placebo); and 24 months of longitudinal, post-treatment follow-up. Path analyses estimated mediation by skill measured by the Skills of Cognitive Therapy (SoCT: Patient and Observer [Therapist] versions). RESULTS: Better SoCT scores predicted lower depressive symptoms both in CT and C-CT. In CT depressive symptoms did not predict subsequent changes in skills. During CT and C-CT, when averaged across patients and therapists, skills predicted subsequent decreases in depressive symptoms. LIMITATIONS: Generalization of findings may be limited by the trial's methodology. CONCLUSION: Further rigorous investigation of the role of patient CT skills stands to increase understanding of mediators of change or engaged targets in psychosocial intervention.
RCT Entities:
BACKGROUND: The skills that patients learn in cognitive therapy (CT) and use thereafter may mediate improvement in depression during and after intervention. METHOD: We used a sequential, three-stage design: acute phase (523 outpatients received 12-14 weeks of CT); 8-month experimental phase (responders at higher risk were randomized to continuation phases: C-CT, C-fluoxetine or C-pill placebo); and 24 months of longitudinal, post-treatment follow-up. Path analyses estimated mediation by skill measured by the Skills of Cognitive Therapy (SoCT: Patient and Observer [Therapist] versions). RESULTS: Better SoCT scores predicted lower depressive symptoms both in CT and C-CT. In CT depressive symptoms did not predict subsequent changes in skills. During CT and C-CT, when averaged across patients and therapists, skills predicted subsequent decreases in depressive symptoms. LIMITATIONS: Generalization of findings may be limited by the trial's methodology. CONCLUSION: Further rigorous investigation of the role of patient CT skills stands to increase understanding of mediators of change or engaged targets in psychosocial intervention.