Dataset Information

Do patients' cognitive therapy skills predict personality change during treatment of depression?

ABSTRACT:

Background

Psychological interventions can change personality, including increasing positive temperament (extraversion) and decreasing negative temperament (neuroticism), but why these changes occur is unclear. The current study tested the extent to which patients' acquisition and use of skills taught in cognitive therapy (CT) correlated with changes in positive and negative temperament during treatment of depression.

Method

Outpatients (N = 351) with recurrent major depressive disorder (MDD) were enrolled in a 12-week CT protocol. Temperament (early and late in CT), patient skills (mid and late in CT), and depressive symptoms (early, mid, and late in CT) were measured repeatedly.

Results

Patients with greater acquisition and use of CT skills showed significantly larger increases in positive temperament and larger decreases in negative temperament in path analyses. Effect sizes were small, median standardized |beta| = 0.13. Models controlled depressive symptom levels and changes.

Conclusions

Skills taught in CT for recurrent depression correlate with personality change during this efficacious treatment. The absence of measures of CT skills at baseline and personality mid-CT allows several interpretations of the current findings. Future research is needed to clarify whether patients' use of CT skills facilitates adaptive changes in personality during CT.

SUBMITTER: Vittengl JR

PROVIDER: S-EPMC7855535 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:A strong and growing body of evidence has demonstrated the effectiveness of cognitive behavioral therapy (CBT), either face-to-face, in person, or as self-help via the Internet, for depression. However, CBT is a complex intervention consisting of several putatively effective components, and how each component may or may not contribute to the overall effectiveness of CBT is poorly understood.The aim of this study was to investigate how the users of smartphone CBT use and benefit from various components of the program.This is a secondary analysis from a 9-week, single-blind, randomized controlled trial that has demonstrated the effectiveness of adjunctive use of smartphone CBT (Kokoro-App) over antidepressant pharmacotherapy alone among patients with drug-resistant major depressive disorder (total n=164, standardized mean difference in depression severity at week 9=0.40, J Med Internet Res). Kokoro-App consists of three cognitive behavioral skills of self-monitoring, behavioral activation, and cognitive restructuring, with corresponding worksheets to fill in. All activities of the participants learning each session of the program and completing each worksheet were uploaded onto Kokoro-Web, which each patient could use for self-check. We examined what use characteristics differentiated the more successful users of the CBT app from the less successful ones, split at the median of change in depression severity.A total of 81 patients with major depression were allocated to the smartphone CBT. On average, they completed 7.0 (standard deviation [SD] 1.4) out of 8 sessions of the program; it took them 10.8 (SD 4.2) days to complete one session, during which they spent 62 min (SD 96) on the app. There were no statistically significant differences in the number of sessions completed, time spent for the program, or the number of completed self-monitoring worksheets between the beneficiaries and the nonbeneficiaries. However, the former completed more behavioral activation tasks, engaged in different types of activities, and also filled in more cognitive restructuring worksheets than the latter. Activities such as "test-drive a new car," "go to a coffee shop after lunch," or "call up an old friend" were found to be particularly rewarding. All cognitive restructuring strategies were found to significantly decrease the distress level, with "What would be your advice to a friend who has a similar problem?" found more helpful than some other strategies.The CBT program offered via smartphone and connected to the remote server is not only effective in alleviating depression but also opens a new avenue in gathering information of what and how each participant may utilize the program. The activities and strategies found useful in this analysis will provide valuable information in brush-ups of the program itself and of mobile health (mHealth) in general.Japanese Clinical Trials Registry UMIN CTR 000013693; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ ctr_view.cgi?recptno=R000015984 (Archived by WebCite at http://www.webcitation.org/6u6pxVwik).