Comparing skill enhanced and standard cognitive behavioral therapy for depression: a protocol for a randomized trial

Abstract

<p class="abstract"><strong>Background:</strong> Cognitive behavioral therapy (CBT) features prominently among the first-line treatments for depression. The development of CBT skills is associated with both symptom reductions and reduced risk for relapse, suggesting that improvements in CBT skills might be important to the benefits of CBT. Nonetheless, standard CBT places modest emphasis on the development of these skills.</p><p class="abstract"><strong>Methods:</strong> In this paper, we describe a randomized clinical trial testing the benefits of a variation of CBT that places greater emphasis on teaching patients CBT skills and makes patients' independent use of these skills a central therapeutic goal. Patients in this study (75 per condition) are being randomized to 12 weeks of standard or skill enhanced CBT for depression. The primary outcomes are change in symptoms and change in CBT skills. We will also evaluate the process of change in the treatments.</p><p class="abstract"><strong>Conclusions: </strong>This study has the potential to suggest an approach to enhancing CBT outcomes through greater focus on patients developing and independently using CBT skills. It will also provide an important context for understanding the role that CBT skills play in the therapeutic outcomes of CBT.</p><p class="abstract"><strong>Trial registration:</strong> The trial has been registered in ClinicalTrials.gov. Registration number: NCT04673513; registered on 17 December 2020.</p>

Promoting skill use in skill enhanced cognitive behavioral therapy: A case example

“…Additionally, we encourage further research on methods used to foster CBT skills and the benefits of a treatment that makes skills development its central focus. Findings from our ongoing clinical trial (Murphy, Bailey, et al, 2021) will soon be available to provide initial evidence regarding the therapeutic benefits of CBT-SE relative to standard CBT.…”

“…In an effort to test the benefits of placing a greater emphasis on CBT skill development, our group recently developed and tested a skill-enhanced version of CBT (CBT-SE; Murphy, Bailey, et al, 2021). Over the course of treatment, CBT-SE therapists provide scaffolding as clients learn to utilize skills with more independence and proficiency.…”

Between‐session homework and processes of change

“…Fourth, Murphy et al (2023) provided an illustration of the use of skill‐enhanced CBT with a male client presenting with MDD and comorbid social anxiety disorder. The authors demonstrate how brief videos demonstrating CBT skills may be used as BSH at the outset of treatment to reinforce the treatment rationale, and further how the development of CBT skills may be facilitated by engaging systematically in BSH with the use of thought records to identify and challenge negative automatic thoughts and beliefs, as well as activity logs to increase pleasure and mastery experiences.…”

“…Further, any specific BSH should be framed as an opportunity to learn something new, even if the task does not go exactly as planned, and the clients' experience of engaging with BSH is always “grist for the therapeutic mill.” Perfectionism is not the goal. As emphasized in the case studies, therapists need to be attuned to the client's experience and the therapeutic process and progress, to propose BSH that is within the client's experiential and developmental grasp (e.g., Warwar, 2023) or tolerable level of anxiety (e.g., Church et al, 2023), through a scaffolding process that over time facilitates increased independence on the client (e.g., Murphy et al, 2023) and progressive internalization of new skills (Wachen, 2023). Hammersmark and colleagues (2023) also demonstrate how clients in group therapy may aid and facilitate each other in designing BSH.…”

“…Several authors commented on potential barriers and obstacles to client engagement with BSH. For example, lack of engagement could be due to limited socialization to the treatment model and frustration, especially in the early phase of treatment (e.g., Hammersmark et al, 2023; Murphy et al, 2023), which highlight the need to have a continuous emphasis on the rationale for the treatment and BSH specifically (Callan et al, 2019). Emotional barriers, such as worry and distress (Hammersmark et al, 2023; Magistrale et al, 2023; Warwar, 2023), or difficulties with identifying emotions and anxiety levels (Church et al, 2023) were other potential barriers.…”