Patient constructive learning behavior in cognitive therapy: A pathway for improving patient memory for treatment?

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Highlights

  • Constructive learning behavior (CLB) was examined during cognitive therapy sessions.

  • Patient CLBs occur when patients generate new ideas about treatment contents.

  • Patients who engaged in more CLBs showed better recall of treatment contents.

  • Patient CLBs may be a pathway for improving patient memory for treatment.

Abstract

Patient memory for treatment is poor and associated with worse outcome. The Memory Support Intervention was designed to improve outcome by enhancing patient memory for treatment. Half of the strategies comprising the Memory Support Intervention (termed constructive memory support strategies) involve therapists inviting patients to construct new ideas, inferences, or connections related to treatment material that go beyond information already presented by therapists. This study investigated the relationship between patient responses to therapist use of constructive memory support strategies and patient recall of treatment contents. Therapist uses of constructive memory support strategies were coded from sessions recorded during a pilot trial of the Memory Support Intervention in the context of cognitive therapy for depression (n = 44 patients). Patients who successfully constructed new ideas, inferences, or connections (termed patient constructive learning behavior) in response to therapist use of constructive memory support strategies showed greater recall of treatment contents. Mediation analyses provided some evidence that patient constructive learning behavior may be a mechanism through which the Memory Support Intervention results in enhanced patient memory. Results highlight patient constructive learning behavior as a potential pathway for improving patient memory for treatment.

Section snippets

Study overview

Data for the current study were drawn from a pilot randomized controlled trial (NCT01790919) comparing cognitive therapy-as-usual (CT-as-usual) to cognitive therapy integrated with the Memory Support Intervention (CT + Memory Support) for adults with Major Depressive Disorder (N = 48). Patients in both conditions received 14 weekly, 50-min, individual sessions with a therapist holding a master's or doctoral degree in psychology. All sessions were video recorded. Therapists in both conditions

Aim 1: describe the frequency of patient constructive learning behavior in the context of therapist use of constructive memory support strategies

Among the 468 instances of therapist use of constructive memory support strategies, patient constructive learning behavior was observed in 177 (37.82%). Across all sessions (N = 154), the average number of patient constructive learning behaviors was 1.15 per session (SD = 1.48).

Aim 2: examine the effect of therapist invitation to respond and therapist scaffolding on the likelihood of patient constructive learning behavior

Among the 468 instances of therapist use of constructive memory support, 273 instances (58.33%) involved the therapist inviting a response from the patient, and 131 instances (28.00%) involved the therapist using

Discussion

This study sought to inform future iterations of the Memory Support Intervention (Harvey et al., 2014) by applying novel theories from cognitive psychology to identify effective intervention components, potential mechanisms of action, and methods to optimally engage mechanisms of action. Specifically, the construct of constructive educational activities (Chi & Wylie, 2014) was used to distinguish constructive memory support strategies from non-constructive memory support strategies, and to

Conclusion

In summary, based on a small, pilot sample, this study provides initial evidence that patient constructive learning behaviors may represent an important pathway to enhanced patient memory for treatment. These constructive learning behaviors can be elicited by strategies comprising the Memory Support Intervention, and may be more likely to occur if therapists are trained to invite patients to express ideas, inferences, and connections about treatment contents and provide scaffolding to patients

Acknowledgements

We thank Cara Woodworth and Sydney Garcia for assistance with data coding.

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    This research was supported by National Institute of Mental Health Grants R34 MH094535.

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