(PS9-94) The effect of skills-enhanced cognitive behavioral therapy for depression on cognitive and behavioral skill development

Abstract Text: In cognitive behavioral therapy, therapists aim to teach their clients cognitive and behavioral skills to address maladaptive thoughts and patterns of behavior. These skills are considered one potential mechanism of treatment in CBT for depression (Lorenzo-Luaces et al., 2015) and have been found to increase over the course of treatment (Hundt et al., 2016; Jarret et al., 2011). In a recent trial of skills-enhanced CBT for depression, we examined whether CBT-SE would lead to greater changes in cognitive and behavioral skills. Initial analyses from this sample confirmed that individuals in the CBT-SE condition achieved greater improvements in skill quality over the course of treatment and that the magnitude of this effect was stronger among patients who were more severely depressed (d = .79). Additionally, analyses also suggested that CBT-SE led to greater reductions in depressive symptoms among those with higher severity depressive symptoms (d = .45). However, it may also be important to understand whether specific skill domains (i.e., cognitive versus behavioral skills) are targeted to the same degree in skills-enhanced CBT. Using hierarchical linear models, we assessed whether CBT-SE led to greater changes in cognitive and behavioral skills compared to standard CBT using an observer-rated measure of skills, the Ways of Responding Questionnaire. We also examined whether these findings were stronger among those who were more severely depressed. Results from these analyses suggest that CBT-SE did lead to greater changes in cognitive skills (F = 4.63, p = .03, d = 0.43). For behavioral skill scores, there was a non-significant trend for CBT-SE to yield higher scores than CBT (F = 3.30, p = .07, d = 0.37). Among those with higher initial severity depression, we observed a similar pattern of results. These findings suggest that CBT-SE has an additive benefit over standard CBT for cognitive skill development with some evidence for behavioral skill development, especially among those with high initial depressive symptom severity.