Cognitive and Behavioral Changes Related to Symptom Improvement Among Patients with a Mood Disorder Receiving Intensive Cognitive-Behavioral Therapy

Objective: To examine the relationship between cognitive and behavioral changes associated with cognitive-
behavioral therapy (CBT) and treatment response in an intensive partial hospital (PH) setting.
Methods: Study participants were 105 patients with mood disorders receiving treatment in a private
psychiatric PH setting. The flexible treatment model used evidence-based CBT interventions adapted
to the PH context, with emphases on psychoeducation and skills training. Participants completed selfreport
measures at admission and discharge to assess psychological distress, depression, negative automatic
thoughts, and behavioral activation. Mean treatment duration was 9 days. Results: Decreased
negative automatic thoughts and increased behavioral activation predicted reduction of depressive
symptoms; however, only decreased negative automatic thoughts was predictive of patients’ overall
level of psychological distress. Conclusions: These results suggest that a CBT intervention adapted for
use in a PH setting can be an effective treatment for severe mood disorders. Furthermore, although the
design used in this study precludes causal inferences, depressive symptom improvement appears to be
associated with decreased negative automatic thoughts and increased behavioral activation.
Implications for the delivery of CBT in PH programs and future directions for research are discussed.