Background: The memory support intervention (MSI), derived from basic science in cognitive psychology and education, was developed in response to evidence showing that patient memory for psychological treatment is poor and that poor memory for such treatment is associated with both poorer adherence and poorer outcomes. The present study aimed to assess differences in specific factors impacting behavior change (domains) described in the Theoretical Domains Framework (TDF) among participants who received the MSI compared to those who received psychotherapeutic treatment-as-usual. This study also investigated whether these memory for these domains facilitate behavior change. The “platform” for this research was cognitive therapy (CT) for depression.
Methods: Participants were 64 consecutively randomized participants from a “parent study” in which adults with Major Depressive Disorder (MDD) (n = 178) were randomly allocated to CT + Memory Support (MS) or CT-as-usual. In the parent study, participants were assessed at baseline, post-treatment and at 6 and 12-month follow-up. To ascertain whether CT+MS better improves expertise in domains of behavior change, the Cognitive Behavior Change Interview was administered at the 12-month follow-up of the parent study. This is a qualitative and quantitative interview, grounded in the TDF. It includes ratings of potential facilitators of behavior change from the TDF, coded from audio recordings of the Cognitive Behavior Change Interview. Regression analyses were used to determine relations between memory support, these facilitators, and behavior change.
Results: On average, participants who received CT+MS scored better on overall engagement with domains of change compared to participants who received CT-as-usual. Also, improved memory for treatment was positively associated with overall engagement and the number of domains engaged. In turn, overall engagement and the total number of domains engaged were each associated with multiple outcomes at 12 months post-treatment, including utilization of skills learned in CT and better impairment and depression scores.
Conclusions: This research helps facilitates understanding of the potential role of memory for what occurred in psychological treatment in improving long-term behavior change among recipients of an evidence-based psychological treatments as well, exploratory analyses highlight specific (a) domains that may be driving factors for changes in behavior as a result of CT and (b) reductions in depression and functional disability.