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The effort to limit the spread of the coronavirus (COVID‐19) has relied heavily on the general public's compliance with health guidelines limiting social contact and mitigating risk when contact occurs. The aim of this study was to identify latent variables underlying adherence to COVID‐19 guidelines and to examine demographic and psychological predictors of adherence. A sample of US adults ( N = 1,200) were surveyed in late April to mid‐May 2020. The factor structure of adherence was examined using exploratory factor analysis. Machine learning regression models using elastic net regularization were used to examine predictors of adherence. Two factors characterized adherence: avoidance and cleaning. Elastic net models identified differential demographic and psychological predictors of these two forms of adherence. Religious affiliation, denial coping, full‐time employment, substance use coping, and being 60 or older predicted lower avoidance adherence. Behavioral and mindfulness emotion regulation skills, agreeableness, and Democrat political affiliation predicted greater avoidance adherence. For cleaning adherence, interpersonal and behavioral emotion regulation skills and conscientiousness emerged as strong predictors of greater cleaning. Efforts to promote compliance with COVID‐19 health guidelines may benefit from distinguishing avoidance and cleaning adherence and considering predictors of each of these aspects of adherence.

Objective: Research suggests that decreases in negative cognitions coincide with symptom improvements over the course of cognitive therapy (CT) of depression, but the role cognitive change (CC) plays in reducing symptoms remains controversial. Method: A total of 126 adults (mean age = 31.7, SD = 13.35; 60% female; 83% Caucasian) participated in CT for depression. Patients completed the Beck Depression Inventory–II and the Immediate Cognitive Change Scale at each session. At intake evaluation, maladaptive personality traits (Personality Inventory for DSM–5, Brief Form) and interpersonal problems (Inventory of Interpersonal Problems, Short Version) were assessed via self-report, and social skills were assessed through patients’ evaluation of their performance following a series of behavioral role-plays (standardized interaction task). To rule out between-patient differences as potential confounds, our model disaggregated within- and between-patient components of CC and depression scores. Results: Within-patient CC significantly predicted within-patient change in depressive symptoms. This relation was moderated by patients’ evaluations of their social skills and patients’ level of interpersonal problems, with CC predicting symptoms more robustly for patients with fewer perceived social skills and for those with greater interpersonal problems. Maladaptive personality traits did not emerge as a moderator. Additional analyses showed the relation of CC and symptom change was particularly strong among those with social anxiety disorder and among those observers rated as having lower social skills. Conclusions: CC in CT sessions appears to foster subsequent depressive symptom reduction, especially among patients with lower levels of self-evaluated social skills and greater interpersonal problems.

<p class="abstract"><strong>Background:</strong> Cognitive behavioral therapy (CBT) features prominently among the first-line treatments for depression. The development of CBT skills is associated with both symptom reductions and reduced risk for relapse, suggesting that improvements in CBT skills might be important to the benefits of CBT. Nonetheless, standard CBT places modest emphasis on the development of these skills.</p><p class="abstract"><strong>Methods:</strong> In this paper, we describe a randomized clinical trial testing the benefits of a variation of CBT that places greater emphasis on teaching patients CBT skills and makes patients' independent use of these skills a central therapeutic goal. Patients in this study (75 per condition) are being randomized to 12 weeks of standard or skill enhanced CBT for depression. The primary outcomes are change in symptoms and change in CBT skills. We will also evaluate the process of change in the treatments.</p><p class="abstract"><strong>Conclusions: </strong>This study has the potential to suggest an approach to enhancing CBT outcomes through greater focus on patients developing and independently using CBT skills. It will also provide an important context for understanding the role that CBT skills play in the therapeutic outcomes of CBT.</p><p class="abstract"><strong>Trial registration:</strong> The trial has been registered in ClinicalTrials.gov. Registration number: NCT04673513; registered on 17 December 2020.</p>

The therapeutic alliance has been reliably associated with outcome across psychotherapies. We investigated the alliance–outcome relationship in the early sessions of cognitive behavioral therapy of depression using a model that disaggregates within- and between-persons variance while estimating the reciprocal relation between variables. We used this model in a combined data set from two studies totaling 191 patients. In our primary model, we found evidence for a predictive within-patients relationship between alliance and symptoms such that symptoms predicted regressed change in alliance and alliance predicted regressed change in symptoms. In a more conservative detrended model, these relationships were not significant. Given that (a) most of the variability in alliance scores is between patients, (b) the size of the alliance–outcome relationship is modest, and (c) the alliance–outcome relationship is not robust to detrending, our findings suggest that alliance plays at most a small role in improving patient outcomes in cognitive behavioral therapy of depression.