Do the Memory Support Intervention and Improving Memory for Treatment Facilitate Behavior Change in Cognitive Therapy?

Abstract Background The memory support intervention (MSI) was developed to improve patient memory for treatment as poor memory for treatment is associated with poorer adherence and outcomes. This study aimed to (1) validate the Cognitive Behavior Change interview, which was developed for and used as a measure in this study, (2) assess differences in specific factors impacting behavior change (domains) described in the Theoretical Domains Framework (TDF) among participants who received the MSI alongside cognitive therapy (CT) compared to those who received CT-as-usual, and (3) assess whether memory for treatment facilitates behavior change. Methods Participants ( N = 64) from a trial of adults with Major Depressive Disorder were randomly allocated to CT + Memory Support (MS) or CT-as-usual. To ascertain whether CT + MS better improves knowledge of domains of behavior change, the Cognitive Behavior Change Interview was administered at the 12-month follow-up (12FU) assessment. This qualitative and quantitative interview is grounded in the TDF and includes ratings of potential facilitators of behavior change. Regression was used to examine relations between memory support, these facilitators, and behavior change. Results Internal consistency for the Cognitive Behavioral Change interview fell in the acceptable range, whereas interrater reliability ranged from unreliable to excellent. Participants who received CT + MS demonstrated better overall engagement with domains compared to participants who received CT-as-usual. Improved memory for treatment was positively associated with overall engagement and the number of domains engaged. Overall engagement and the number of domains engaged were associated with utilization of skills learned in CT and improved impairment and depression at 12FU. Conclusions This study enhances our understanding of the potential role of memory for treatment improving long-term behavior change. Exploratory analyses highlight specific domains that may be factors driving changes in behavior due to CT resulting in improvements in depression.