Citation

Bernstein EE, Bentley KH, Nock MK, Stein MB, Beck S, Kleiman EM. Behav. Ther. 2022; 53(2): 267-280.

Copyright

(Copyright © 2022, Association for Behavioral and Cognitive Therapies, Publisher Elsevier Publishing)

DOI

10.1016/j.beth.2021.09.001

PMID

35227403

PMCID

PMC8891654

Abstract

The practice of therapeutic skills outside of sessions in which they are learned is one presumed key component of cognitive behavioral therapy (CBT). Yet, our understanding of how skills practice relates to clinical outcomes remains limited. Here, we explored patients' emotional responses to CBT skills practice in a pilot study pairing smartphone-app-delivered skills reminders and guided practice (ecological momentary intervention [EMI]) using ecological momentary assessment (EMA). Participants (n = 25) were adults recently hospitalized for a suicide attempt or severe suicidal thinking. They received brief inpatient CBT (1 to 3 sessions covering core CBT skills from the Unified Protocol), followed by 1 month of EMI and EMA after discharge. On average, participants reported modest reductions in negative affect after skills use (i.e., immediate responses; median time elapsed = 4.30 minutes). Additionally, participants tended to report less negative affect when the timepoint preceding the current assessment included EMI skills practice, rather than EMA alone (i.e., delayed responses; median time elapsed between prompts = 2.17 hours). Immediate effects were unrelated to longer-term clinical outcomes, whereas greater delayed effects were associated with lower symptom severity at follow-up. Future studies should further examine how CBT skills use in daily life may alleviate symptoms.

Language: en

Keywords

Humans; Emotions; Pilot Projects; cognitive behavioral therapy; mHealth; Smartphone; ecological momentary assessment; ecological momentary intervention; skills; Cognitive Behavioral Therapy; Mobile Applications; Ecological Momentary Assessment