Insight as a Mechanism of Change in CBT for Depression: A Longitudinal Multilevel Approach

Despite the evidence for the efficacy of psychotherapy for treating mental disorders, there is a lack of knowledge about the mechanisms that facilitate change as people go through psychotherapy. Mechanisms of change are defined as the steps that are responsible for a therapeutic outcome, and they explain how change occurred (Bosqui & Marshoud, 2018). A mechanism of growing interest is insight, which is the process by which clients gain understanding of their internal states, patterns, and behaviors. Since empirical research on the insight-outcome relationship is rare, this study aimed to understand how insights gained during psychotherapy are related to depressive symptoms over time within CBT treatment. Hypothesis 1 predicted that greater variations of patient insights in a therapy session would be associated with lower depressive symptoms compared to those with lower levels of insights (within-patient effect), and hypothesis 2 predicted that higher levels of insights across the...Show moreDespite the evidence for the efficacy of psychotherapy for treating mental disorders, there is a lack of knowledge about the mechanisms that facilitate change as people go through psychotherapy. Mechanisms of change are defined as the steps that are responsible for a therapeutic outcome, and they explain how change occurred (Bosqui & Marshoud, 2018). A mechanism of growing interest is insight, which is the process by which clients gain understanding of their internal states, patterns, and behaviors. Since empirical research on the insight-outcome relationship is rare, this study aimed to understand how insights gained during psychotherapy are related to depressive symptoms over time within CBT treatment. Hypothesis 1 predicted that greater variations of patient insights in a therapy session would be associated with lower depressive symptoms compared to those with lower levels of insights (within-patient effect), and hypothesis 2 predicted that higher levels of insights across the treatment period would be associated with lower levels of depressive symptoms (between-patient effect). The study is a secondary analysis based on a randomized controlled trial, uses a multilevel analysis, and employs a within- and between-patient approach. The results revealed that higher levels of insight in a session as well as across sessions are associated with lower levels of depression, supporting both hypotheses. The findings of this study provide valuable insights to improve the effectiveness of psychological treatments in the future, as they highlight the importance of insights. The current study also acknowledges its limitations, and future research suggestions are discussed.Show less

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Insight as a Mechanism of Change in CBT for Depression: A Longitudinal Multilevel Approach