The Relationship Between Use of CBT Skills and Depression Treatment Outcome: A Theoretical and Methodological Review of the Literature

Do mental health patients learn what their cognitive-behaviour therapists think they do? A short report on qualitative interviews comparing perspectives

“…Accordingly, we focused not only on depression (Barnes et al, 2013; French et al, 2017; Hundt et al, 2013) but included different diagnoses, which also implied heterogeneity. Study limitations refer to the small accidental sample size, reactivity due to an awareness of being interviewed, self-assessment bias (Walfish, McAlister, O’Donnell, & Lambert, 2012), patient selection by therapists (which is why it remains unclear whether prototypical or especially cooperative patients were included), of therapies mainly in the early stages, and the restriction to a university treatment setting.…”

“…Although even in 1961, Bandura stated that it is “customary to conceptualize psychotherapy as a learning process” (p. 143) aiming at behaviour change, there is relatively little research on what skills are addressed by psychotherapy in general and interestingly, by cognitive-behavioural therapy (CBT) in particular (Hundt, Mignogna, Underhill, & Cully, 2013). A narrative review identified preliminary support for skills as mediators between CBT and outcome (Hundt et al, 2013).…”

“…A narrative review identified preliminary support for skills as mediators between CBT and outcome (Hundt et al, 2013). Yet, they focused on depression only, found that skill use was frequently confounded with outcome assessments, that the efficacy of skill use and its everyday practice were often neglected, and they thus emphasized the need for further psychometric testing of skill measures (Hundt et al, 2013).…”

“…Yet, they focused on depression only, found that skill use was frequently confounded with outcome assessments, that the efficacy of skill use and its everyday practice were often neglected, and they thus emphasized the need for further psychometric testing of skill measures (Hundt et al, 2013). Methods used for the evaluation of skill use include patient questionnaires, interviews, knowledge tests, thought-listing procedures and daily records with subsequent rater codings, or observational codings of session recordings (Hofmann, Fehlinger, Stenzel, & Rief, 2015; Hundt et al, 2013). Studies have investigated the level of agreement between patients and therapists on outcomes like alliance or functioning (e.g., Bar-Kalifa et al, 2016).…”

“…Studies have investigated the level of agreement between patients and therapists on outcomes like alliance or functioning (e.g., Bar-Kalifa et al, 2016). Others were conducted with therapists rating their patient’s skill use, which again may introduce bias (Hundt et al, 2013). Nonetheless, the reliable and valid measurement of skills is fundamental to the research of skill use, the differentiation of frequency, quality or efficacy of use, and the comparison of patient and therapist perspectives (Hundt et al, 2013).…”