(PS9-78) Cognitive Behavioral Therapy Is Associated with Enhanced Social Cognition

Background: Although many efficacious psychotherapeutic treatments have been identified, we are at an early stage of understanding how treatments achieve therapeutic change. Identifying change processes allows for optimization of treatment and clinical flexibility that can enhance therapeutic efficacy, particularly as treatments transition from research to real-world practice. In this project, we begin to test the longstanding assumption that mentalization—the ability to accurately identify thoughts and feelings—is a mechanism of therapeutic change.

Method: Our sample contains 157 diagnostically diverse patients enrolled in a cognitive behavioral therapy-based partial hospital program (Mage = 34.48, SD = 13.45; 65.8% female; 78.3% White; 46.7% unemployed). Patients met criteria for a variety of mood, anxiety, personality, and psychotic spectrum disorders. Approximately one third (34.2%) of the sample had been hospitalized in an inpatient psychiatric program in the six months preceding their partial hospitalization. Participants completed the following measures of mentalization at admission and discharge: Reading the Mind in the Eyes Task, Penn Emotion Recognition Test (ER-40), Hinting Task, Interpersonal Reactivity Index (IRI), and Perth Alexithymia Questionnaire (PAQ).

Results: Participants demonstrated significant improvements in emotion recognition on the ER-40 from admission to discharge (t[126] = 2.25, p = .03, d = .20). There were no other significant improvements across other mentalization tasks (ts < 1.46, ps > .15). On self-reported questionnaires, participants reported significantly more frequent perspective taking (IRI perspective taking subscale: t[137] = 5.56, p < .001, d = .47) and ability to identify their own emotions (PAQ: t[138] = 5.05, p < .001, d = .43) at discharge relative to admission. Follow-up analyses indicated significant improvements in participants self-reported ability to detect negative emotions (PAQ difficulty appraising negative feelings subscale: t[138] = 7.01, p < .001, d = .60) but not positive emotions (PAQ difficulty appraising positive feelings subscale: t[138] = 1.23, p = .11, d = .11).

Discussion: Our results suggest that the longstanding assumption that psychotherapy enhances patient mentalization is partially supported. Participants demonstrated significant improvements in emotion identification and self-reported perspective-taking, but did not improve in accurately recognizing more complex mental states. These findings highlight an active ingredient in therapy that is commonly overlooked in practice and can be used to inform targeted personalized treatment approaches. Future research with multiple time-points and a waitlist control group is underway to add to this emerging work on mentalization as a mechanism of therapeutic change.