Patients' comprehension and skill usage as a putative mediator of change or an engaged target in cognitive therapy: Preliminary findings.

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.