Questioning the distinction between active elements and mechanisms: Evidence from a reanalysis in cognitive...

A new theoretical measurement framework for assessing active elements in cognitive behavioral therapies (CBT) emphasizes distinguishing various aspects of therapeutic components, and differentiating processes occurring within and between sessions. In this article, we apply the framework to data analyzed prior to its introduction.

In Study 1, a panel of CBT experts evaluated items from the Cognitive Change scales (immediate and sustained) to determine whether they assess CBT skills (active elements) or cognitive change (mechanisms). In Study 2, we applied the framework to data from 125 CBT clients undergoing treatment for depression. Using disaggregated within- and between-patient components, we tested mediation models using framework-informed scores.

In Study 1, experts achieved high interrater reliability and identified skill and cognitive change items using the framework. In Study 2, findings revealed that cognitive change mediated the relationship between skill use and symptom improvement. Results were similar using different subscales, consistent with the subscales being driven by a single underlying factor.

Our results suggest that the pattern of findings was similar whether a distinction between skills and cognitive change was made or not. Considering previous factor analytic results and the present findings, we call into question whether the distinction between active elements and mechanisms is as essential or important as the framework suggests. (PsycInfo Database Record (c) 2025 APA, all rights reserved).