The goal of this paper was to examine theoretically important mechanisms of change in psychotherapy outcome across different types of treatment. Specifically, the role of gains in selfunderstanding, acquisition of compensatory skills, and improvements in views of the self were examined. The University of Pennsylvania Center for Psychotherapy Research database that includes studies conducted from 1995 to 2002 evaluating the efficacy of cognitive and psychodynamic therapies for a variety of disorders was used. Patient samples included major depressive disorder, generalized anxiety disorder, panic disorder, borderline personality disorder, and adolescent anxiety disorders. A common assessment battery of mechanism and outcome measures was given at treatment intake, termination, and 6-month follow-up for all 184 patients. Improvements in self-understanding, compensatory skills, and views of the self were all associated with symptom change across the diverse psychotherapies. Changes in self-understanding and compensatory skills across treatment were predictive of follow-up symptom course. Changes in self-understanding demonstrated specificity of change to dynamic psychotherapy. KeywordsMechanism; Cognitive therapy; Dynamic therapy; Psychotherapy outcome The major models of psychotherapy propose specific mechanisms of change responsible for the effects of the treatment packages. Despite these well-articulated models of psychotherapeutic change within the psychotherapeutic treatments widely practiced today, there are few empirical studies demonstrating clearly that the proposed mechanisms actually account for the effects of treatment. Further, there is very little evidence that effective mechanisms of psychotherapeutic change are unique to specific treatment modalities rather than common to diverse psychotherapeutic approaches and techniques aiming to achieve symptom reduction.As the field moves toward identifying empirically supported treatments for mental disorders, it is important to not only identify specific treatment packages that are effective for specific disorders, but also validate the theoretically relevant mechanisms of change of these efficacious treatments. Although knowledge of which therapeutic packages are most effective in the treatment of specific disorders is important for making decisions about the best treatment choice today, a better understanding of the important mechanisms of therapeutic change provides the best opportunity for further improving the effects of treatments currently available.

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In Cognitive Therapy (CT), therapists work to help patients develop skills to cope with negative affect. Most current methods of assessing patients’ skills are cumbersome and impractical for clinical use. To address this issue, we developed and conducted an initial psychometric evaluation of self and therapist reported versions of a new measure of CT skills: the Competencies of Cognitive Therapy Scale (CCTS). We evaluated the CCTS at intake and post-treatment in a sample of 67 patients participating in CT. The CCTS correlated with a preexisting measure of CT skills (the Ways of Responding Questionnaire) and was also related to concurrent depressive symptoms. Across CT, self-reported improvements in CT competencies were associated with greater changes in depressive symptoms. These findings offer initial evidence for the validity of the CCTS. We discuss the CCTS in comparison with other measures of CT skills and suggest future research directions.

This initial study suggests that IE is an innovative approach to treating veterans with symptoms of PTSD that reduces symptoms of posttraumatic stress and improves psychological quality of life. This approach to recovery may expand the reach of PTSD treatment into non-traditional settings and to veterans who may prefer a familiar activity, such as exercise, over medication or psychotherapy.