Understanding the mechanisms: How cognitive-behavioral therapy components impact mental health

By Tarun Sai LomteReviewed by Lily Ramsey, LLMApr 4 2024

In a recent study published in Science Advances, researchers tested the effects of cognitive-behavioral therapy components on cognitive mechanisms.

Study: Different components of cognitive-behavioral therapy affect specific cognitive mechanisms. Image Credit: Microgen/Shutterstock.com

Background

Psychotherapy programs are complex, multicomponent interventions that can effectively treat common mental health problems. However, there is a lack of understanding about how the different components of these programs work.

Gaining insights into these programs is vital as delineating mechanisms can help achieve mental health research goals, such as improved efficacy, engagement, and treatment personalization.

The study and findings

In the present study, researchers investigated the mechanisms by which specific components of cognitive and behavioral therapies work. First, each set of measures and tasks underwent analytic and design optimizations.

Next, various studies were performed to test whether interventions derived from distinct components of cognitive restructuring and behavioral activation therapies impact their proposed mechanisms.

Participants completed task-based assessments twice, with their assignment to an active or a matched control intervention in between (the two).

After these initial discovery experiments, replication tests were performed to examine the reliability of the results. After each study, participants provided clinical and demographic information.

The team developed a short, gamified task to investigate how a goal-setting intervention affects reward-effort decision-making.

This intervention was based on exercises from a behavioral activation therapy for low mood and comprised texts describing the significance of setting realistic goals. Participants had to select between two options that varied in effort and reward.

The option with a higher reward required more effort. Subjects had to exert the required efforts to gain the reward within a limited time. Participants rated their sense of achievement, pleasure, and boredom after each block of trials.

During the second time (i.e., post-intervention), the goal-setting group had to set a goal (e.g., the number of coins to be earned) before each block.

Linear mixed-effect modeling indicated significant interactions between the intervention condition and time point (pre- and post-intervention) when choosing higher-effort and reward options.

Moreover, there was a greater choice of higher-effort options the second time in the goal-setting group due to a reduction in effort sensitivity.

Further, participants in the goal-setting intervention had a greater sense of achievement upon successful efforts, greater pleasure in gaining rewards, and lower boredom during the second time.

Next, the team developed and used a causal attribution task to investigate the effects of cognitive restructuring. This intervention was based on materials from cognitive therapy for low mood.

Subjects were presented with brief descriptions of events and instructed to select which of the four listed causal explanations they thought most likely.

The four explanations varied in terms of describing global and internal causes. Consistently, linear mixed-effects modeling showed significant interactions between intervention and time point, i.e., pre- and post-intervention, on the choice of internal attributions for negative events.

There was a lower choice of internal attributions for negative events during the second time in the intervention group, and this was due to a declined tendency to attribute negative events to internal (or self-related) causes.

Further, a crossover design study was performed to test whether intervention effects were specific to their proposed mechanisms.

To this end, individuals were randomized to intervention and task conditions to examine the effects of 1) goal setting on reward-effort decision-making relative to cognitive restructuring and 2) cognitive restructuring on causal attribution relative to goal setting.

The team found that goal setting decreased effort sensitivity and not cognitive restructuring for participants randomized to the reward-effort decision-making task.

Likewise, cognitive restructuring reduced internal attribution for negative events and not goal setting for those randomized to the causal attribution task. Besides, cognitive restructuring was associated with higher internal attribution for positive events.

Finally, the researchers performed an exploratory analysis to examine whether individual (psychological) symptom profile differences might moderate intervention effects.

As such, they merged the discovery and replication samples for each task and tested whether the effects in this combined sample were replicated in the crossover data.

There was evidence of moderate variation in change in the mean effort sensitivity (after goal-setting) and a tendency to attribute positive events to internal causes (after cognitive restructuring).

Conclusions

In sum, the researchers found that a goal-setting intervention reliably increased the choice of higher-effort and -reward actions due to a selective decrease in sensitivity to required efforts when deciding how to act.

Moreover, this was accompanied by a higher sense of achievement for efforts and pleasure for rewards. In addition, a cognitive restructuring intervention reliably reduced the tendency to attribute negative events to internal causes.