Cognitive Mechanisms of Change in CBT for Adolescent Depression: Associations among Client Involvement, Cognitive Distortions, and Treatment Outcome

Abstract

A substantial body of evidence has supported the efficacy of cognitive-behavioral therapy (CBT) for adolescent depression. Fewer studies have addressed mechanisms that contribute to positive youth CBT outcomes. The CBT model holds that adolescents acquire skills through active involvement in sessions and completion of homework assignments between sessions. Skill acquisition including cognitive modification is assumed to contribute to reductions in depressive symptoms. This study examined hypothesized associations among client involvement in cognitive therapy tasks, change in cognitive distortions, and reductions in depressive symptoms with a sample of 44 clinically depressed adolescents. Results partially supported the CBT model. Specifically, change in cognitive distortions prospectively predicted reductions in depressive symptoms, whereas change in depressive symptoms did not predict change in cognitive distortions. Neither in-session involvement nor between-session homework adherence predicted changes ...