OBJECTIVE This study aimed to identify differential patient change processes and mechanisms associated with long-term outcome in exposure-based cognitive therapy (EBCT) and cognitive-behavioral therapy (CBT) for depression. METHOD We drew on a randomized controlled trial in which 149 patients were randomly assigned to either EBCT or CBT, with the treatments showing comparable efficacy at 12-month follow-up (grosse Holtforth et al., 2019). Based on Doss's (2004) 4-step model of psychotherapy change and using sequential multilevel structural equation models, we tested putative theory-based change processes and mechanisms for both treatments. Specifically, we examined emotional processing and cognitive restructuring during treatment as hypothesized change processes of EBCT and CBT, respectively. Furthermore, as potential change mechanisms during follow-up, we examined theory-relevant mechanisms for each treatment, preselected via multilevel models. RESULTS Although the full serial mediational pathways were not supported, EBCT fostered greater during-treatment increases in emotional processing and higher self-efficacy during follow-up than CBT, both of which associated with better long-term depression outcome. Unexpectedly, cognitive restructuring change did not differ between EBCT and CBT. Across both CBT and EBCT, greater during-treatment increases in cognitive restructuring related to lower cognitive-behavioral avoidance and greater self-efficacy across follow-up, which associated with lower long-term depression. CONCLUSIONS Results suggest that therapists might improve long-term depression outcome by fostering both emotional processing (via emotion-focused techniques as included in EBCT) and cognitive restructuring (by using general CBT techniques included in both treatments), which operate either directly or through varied treatment-common mechanisms (e.g., greater self-efficacy and reduced cognitive-behavioral avoidance). (PsycInfo Database Record (c) 2020 APA, all rights reserved).

中文翻译：

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不同抑郁症认知疗法中针对特定理论的患者变化过程和机制。

目的本研究旨在确定与抑郁症基于暴露的认知疗法（EBCT）和认知行为疗法（CBT）的长期结果相关的差异患者变化过程和机制。方法我们进行了一项随机对照试验，其中149名患者被随机分配至EBCT或CBT，治疗在12个月的随访中显示出可比的疗效（Grosse Holtforth等，2019）。基于Doss（2004）的心理治疗变更四步模型，并使用顺序多级结构方程模型，我们测试了两种治疗均基于推定理论的变更过程和机制。具体来说，我们分别以EBCT和CBT的假设变化过程检查了治疗过程中的情绪加工和认知重构。此外，作为随访过程中潜在的变化机制，我们研究了每种治疗的与理论相关的机制，这些机制是通过多层模型预先选择的。结果尽管不支持全系列的中介途径，但EBCT与CBT相比，在治疗过程中促进了情绪处理过程中更大的情感增长和更高的自我效能感，两者均与长期抑郁症的改善相关。出乎意料的是，EBCT和CBT之间的认知结构改变没有差异。在CBT和EBCT中，治疗过程中更大的认知重建与较低的认知行为回避和较高的自我效能感相关，这与较低的长期抑郁症相关。结论结果表明，治疗师可能通过促进情绪处理（通过包括在EBCT中的以情绪为中心的技术）和认知重构（通过使用两种治疗中包括的通用CBT技术）两者来改善长期抑郁症的结果，这些方法可以直接或通过多种方式进行操作常见的治疗机制（例如，更高的自我效能感和减少的认知行为规避）。（PsycInfo数据库记录（c）2020 APA，保留所有权利）。