Mechanisms Of Change In Cognitive Behavioral Therapy Research Articles

Potential mechanisms of change in cognitive behavioral therapy for childhood anxiety: A meta-analysis.

Cognitive-behavioral therapy (CBT) is regarded as an effective treatment for anxiety disorders in childhood. Researchers have begun to investigate potential mechanisms of change that drive these positive outcomes, including shifts in cognitions, behavior, and affect. However, few studies have established the mediational effects of these factors as a proxy for establishing mechanistic change. This meta-analysis attempts to synthesize the literature on potential mechanisms of change in CBT for childhood anxiety and investigates the mediational effects of these factors on treatment outcomes. Seventeen studies met the inclusion criteria. Across studies, five potential mediators were identified: externalizing difficulties, negative self-talk, coping, fear, and depression. Results indicated that CBT was effective in improving outcomes on all potential mediators, except for fear. Mediational analyses showed that externalizing difficulties, negative self-talk, coping, and depression mediated anxiety following treatment. Fear did not mediate the relationship. Implications for future mechanisms of change research are proposed.

The role of expressive suppression and cognitive reappraisal in cognitive behavioral therapy for social anxiety disorder: A study of self-report, subjective, and electrocortical measures

BackgroundContemporary models of cognitive behavioral therapy (CBT) for social anxiety disorder (SAD) emphasize emotion dysregulation as a core impairment whose reduction may play a causal role in psychotherapy. The current study examined changes in use of emotion regulation strategies as possible mechanisms of change in CBT for SAD. Specifically, we examined changes in expressive suppression and cognitive reappraisal during CBT and whether these changes predict treatment outcome. MethodsPatients (n = 34; 13 females; Mean age = 28.36 (6.97)) were allocated to 16-20 sessions of CBT. An electrocortical measure of emotion regulation and a clinician-rated measure of SAD were administered monthly. Self-report measures of emotion regulation and social anxiety were administered weekly. Multilevel models were used to examine changes in emotion regulation during treatment and cross-lagged associations between emotion regulation and anxiety. ResultsCBT led to decreased suppression frequency, increased reappraisal self-efficacy, and decreased unpleasantness for SAD-related pictures (ps < .05). At post-treatment, patients were equivalent to healthy controls in terms of suppression frequency and subjective reactivity to SAD-related stimuli. Gains were maintained at 3-months follow-up. Decreases in suppression frequency and electrocortical reactivity to SAD-related pictures predicted lower subsequent anxiety but not the other way around (ps < .05). Lower anxiety predicted greater subsequent increases in reappraisal self-efficacy. LimitationsThe lack of a control group precludes conclusions regarding mechanisms specificity. ConclusionsDecreased frequency of suppression is a potential mechanism of change in CBT for SAD.

Deconstructing the process of change in cognitive behavioral therapy: An alternative approach focusing on the episodic retrieval mode.

Lane et al. view the process of memory reconsolidation as a main ingredient of psychotherapeutic change. They ascertain that in cognitive behavioral therapy (CBT) high priority is given to the "semantic structure." We argue that memory-related mechanisms of change in CBT are more nuanced than the target article presents. Furthermore, we propose to partially shift the focus from the process of reconsolidation to the retrieval operations.

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

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 ...