Innovative moments in low-intensity, telephone-based cognitive-behavioral therapy for depression

Marie Drüge; Robert Staeck; Elisa Haller; Cara Seiler; Valentin Rohner; Birgit Watzke

doi:10.3389/fpsyg.2023.1165899

Innovative moments in low-intensity, telephone-based cognitive-behavioral therapy for depression

Front Psychol. 2023 Jul 25:14:1165899. doi: 10.3389/fpsyg.2023.1165899. eCollection 2023.

Authors

Marie Drüge¹, Robert Staeck², Elisa Haller³, Cara Seiler¹, Valentin Rohner¹, Birgit Watzke¹

Affiliations

¹ Department of Psychology, Clinical Psychology with Focus on Psychotherapy Research, University of Zurich, Zurich, Switzerland.
² Faculty of Medicine, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
³ Faculty of Psychology, Clinical Psychology and Intervention Science, University of Basel, Basel, Switzerland.

Abstract

Background: Innovative moments (IMs), defined as moments in psychotherapy when patients' problematic patterns change toward more elaborated and adaptive patterns, have been shown to be associated with a clinical change in patients with depression. Thus, far IMs have been studied in face-to-face settings but not in telephone-based cognitive-behavioral therapy (t-CBT). This study investigates whether IMs occur in t-CBT and examines the association between IMs and symptom improvement, and reconceptualization and symptom improvement.

Methods: The therapy transcripts of n = 10 patients with mild to moderate depression (range: 7-11 sessions, in total 94 sessions) undergoing t-CBT were qualitatively and quantitatively analyzed. Symptom severity (Patient Health Questionnaire-9) and IMs (levels and proportions) were assessed for each therapy session. Hierarchical linear models were used to test the prediction models.

Results: The rating of IMs was shown to be feasible and reliable using the Innovative Moments Coding System (IMCS) (84.04% agreement in words coded), which is indicative of the applicability of the concept of IMs in t-CBT. Only reconceptualization IMs were shown to have a predictive value for treatment success (R² = 0.05, p = 0.01).

Discussion: The results should be interpreted with caution due to the exploratory nature of this study. Due to the telephone setting, it was necessary to adapt the IMCS. Nonetheless, the extent of IMs identified in the low-intensity t-CBT investigated was comparable to IMs in face-to-face therapy. Further studies are needed to clarify the association between IMs and treatment success as a change process, especially for low-intensity treatments.

Keywords: change process; depression; digital psychotherapy; innovative moments; reconceptualization; telephone-based cognitive-behavioral therapy.