Abstract
Background
Initial evidence suggests Socratic questioning predicts session-to-session symptom change in cognitive behavioral therapy (CBT) for depression, but little is known about which clients are most likely to benefit from this approach. We examined pretreatment client characteristics as potential moderators of the relation between Socratic questioning and symptom improvement.
Methods
Participants were 55 adults who met criteria for major depressive disorder and participated in CBT. Clients on antidepressant medication were required to be on a stable dose during the study. Therapist use of Socratic questioning was rated by trained observers at sessions 1–3 and depressive symptoms were assessed at each session. We examined four potential pre-treatment moderators of the relation of within-client Socratic questioning and session-to-session symptom change: cognitive bias, medication use, presence of a personality disorder, and dysfunctional attitudes.
Results
Pessimistic bias in predicting future life events and concurrent use of antidepressant medication emerged as significant moderators with small effects. Among clients with a greater pessimistic bias and those not on antidepressant medication, Socratic questioning more strongly predicted symptom improvement.
Conclusions
Findings are consistent with the view that Socratic questioning promotes session-to-session symptom improvements for some clients but plays a less important role for others.
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Notes
We modified the instructions for the BDI-II to inquire about the past week, instead of the past 2 weeks, to assess degree of symptom change on a session-to-session basis (see Dimidjian et al., 2006 for a similar modification).
We modified the time period to one week so that clients responding at intake would be making predictions about events prior to their first session. Had we kept a one-month period, we were concerned that bias would be influenced by clients’ ability or inability to anticipate the degree to which treatment would influence the occurrence of desirable and undesirable events.
While not a primary focus, to be comprehensive we also tested interactions of Socratic-between and each of the moderators of interest in predicting next session symptom change. Again, we used separate models for each moderator. From these models, being on medication emerged as the only significant moderator of the relation of Socratic-between and next session symptom change (b* = 1.71, b = 2.88, SE = 1.40, t(51) = 2.05, p = .045), such that greater therapist use of Socratic questioning (i.e., Socratic-between) significantly predicted greater symptom improvement for those not on antidepressant medication (b = -1.18, SE = .57, t = -2.07, p = .046), but was not significant for those on medication (b = 2.22, SE = 1.31, t = 1.70, p = .11).
Bias was also collected at post-treatment. Bias scores at intake and post-treatment were significantly correlated (r = .33, p = .03). For more details, see Ezawa et al. (2020).
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This study was funded by the National Center for Research Resources [Award Number TL1RR025753].
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Lisa N. Vittorio, Justin D. Braun, Jennifer S. Cheavens and Daniel R. Strunk declare that they have no conflict of interest.
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Vittorio, L.N., Braun, J.D., Cheavens, J.S. et al. Cognitive Bias and Medication Use Moderate the Relation of Socratic Questioning and Symptom Change in Cognitive Behavioral Therapy of Depression. Cogn Ther Res 45, 1235–1245 (2021). https://doi.org/10.1007/s10608-021-10224-6
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DOI: https://doi.org/10.1007/s10608-021-10224-6