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Cognitive Modification versus Therapeutic Support for Internalizing Distress and Positive Thinking: A Randomized Technique Evaluation Trial

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Abstract

It is important to evaluate not only comprehensive treatment packages, but also specific procedures to determine their contribution to the change process. The current study examined the efficacy of cognitive modification (CM) techniques compared to supportive therapy (ST) for university students reporting significant internalizing distress. CM consisted of three sessions of Fluency Training (FT) to increase positive self-statements and three sessions of Thought Record (TR) training in challenging negative thoughts. Participants (N = 57) were randomized to CM or ST and assessed at pre-, mid-, post-treatment, 1- and 3-month follow-ups. Intent-to-treat analyses suggested that CM produced greater changes in internalizing distress and positive thinking, which was especially apparent at midtreatment with small-to-medium differences consistently favoring CM at post-treatment and follow-up. These data suggest that change in CM was beyond that attributable to time spent with an engaged therapist who provided a treatment rationale, subsequent intervention and homework assignment.

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Notes

  1. Analyses of the STFA total number of positive and negative thoughts revealed that the ratio of positive to negative self-thoughts was driven by a significant time*treatment interaction with respect to increased positive thoughts, F(2, 54) = 8.60, p = 0.001, rather than decreased negative thoughts, F(2, 54) = 0.15, p = 0.86.

  2. On the general therapy subscale there was a significant interaction between the rater and condition variables, F(1, 47) = 5.20, p = 0.03, which indicated that therapists rated themselves lower in CM (M = 4.70) compared ST (M = 5.24) and the coder ratings (M = 5.02). However, all the means were well above the “considerable” adherence threshold (i.e., above 4). On the ST subscale there was a significant interaction between the rater and condition variables, F(1, 47) = 28.67, p < 0.001, which indicated that the coders (M = 2.23) saw more ST techniques occurring in the CM condition than the therapists (M = 1.32). Again, however, the means for all raters were in the “minimal” to “not at all” range (i.e., 1–2).

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  1. Advanced Behavioral Health, Peoria, IL, 61615, USA

    Jean L. Clore

  2. Department of Psychology, Western Michigan University, Kalamazoo, MI, 49008, USA

    Scott T. Gaynor

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  1. Jean L. Clore
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Correspondence to Jean L. Clore.

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Clore, J.L., Gaynor, S.T. Cognitive Modification versus Therapeutic Support for Internalizing Distress and Positive Thinking: A Randomized Technique Evaluation Trial. Cogn Ther Res 36, 58–71 (2012). https://doi.org/10.1007/s10608-010-9344-9

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