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Problem mastery and motivational clarification as mechanisms of change in cognitive-behavioral therapy for
Juan Martín Gómez-Penedo1, Anna Babl2, Agnete Dyresen3
1Psychology Department, Universidad de Buenos Aires, Lavalle 2353, 1052, Buenos Aires, Argentina; Department of Psychology, University of Zürich, 8 Binzmühlestr. 14, 8050, Zürich, Switzerland.
Objective:
In process-outcome research, there is a growing body of literature investigating the therapeutic mechanisms underlying the promotion of positive change. This study investigated the between- and within-patient effects of problem mastery and motivational clarification on outcome in patients receiving two variations of cognitive therapies for depression.
Methods:
This study drew on data of a randomized controlled trial conducted at an outpatient clinic and included 140 patients randomly assigned to 22 sessions of either cognitive-behavioral therapy or exposure-based cognitive therapy. To address the nested structure of the data and analyze mechanism effects, we used multilevel dynamic structural equations models.
Results:
We found significant within-patient effects of both problem mastery and motivational clarification on subsequent outcome.
Conclusion:
The results suggest that changes in problem mastery and motivational clarification precede symptom improvement during cognitive therapy for depressed patients and thus there may be benefit in fostering these putative mechanisms during psychotherapy.
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