(PS3-18) Improving Patient Perceptions of Treatment Credibility and Symptom Improvement: The Impact of Memory Support Strategies in the Context of Cognitive Therapy for Depression

Background: Client memory for treatment recommendations is poor, resulting in worse adherence and outcomes. The Memory Support Intervention (MSI) was designed to improve adherence and outcomes by enhancing client memory for treatment via eight memory support (MS) strategies integrated into treatment-as-usual. However, much remains to be learned about the use of strategies that improve memory for treatment content and client perceptions of such treatment. Thus, this study aims to test whether 1) overall use of MS, 2) variation in MS use or 3) use of each specific MS predicts client perceptions of treatment credibility and symptom improvement.

Methods: Adults with major depressive disorder (N=178, mean age=37.93, 63% female, 17% Hispanic/Latinx) were randomized to CT + MSI or CT-as-usual. Clients were assessed at baseline, post-treatment, six and twelve months after treatment. To assess client perceptions, questions were adapted from the Credibility/Expectancy Questionnaire (Devilly & Borkovec, 2000), converted to z-scores, and summed to calculate two scales: perceived (1) credibility and (2) symptom improvement. MS was measured as the average amount of strategies used by therapists per session. As therapists from both conditions utilized MS, data were combined. All analyses used linear regression and adjusted for baseline credibility and expected improvement.

Results: Greater overall use of MS (β = 0.06, SE = 0.02, p = .014, η_p² = 0.05) and variation in MS (β = 0.27, SE = 0.13, p = .038, η_p² = 0.04) predicted higher reports of perceived symptom improvement at six months after treatment. With respect to specific strategies, practice remembering predicted greater perceived symptom improvement at post-treatment (β = 0.37, SE = 0.15, p = .018, η_p² = 0.07) and six months after treatment (β = 0.34, SE = 0.16, p = .034, η_p² = 0.05). Praise recall was associated with greater perceived symptom improvement at twelve months after treatment (β = 0.60, SE = 0.27, p = .027, η_p² = 0.01).

Conclusion: These results are the first to suggest that the use of MS integrated into treatment-as-usual may improve client’s perceived symptom improvement. While some MS did not predict client perceptions, greater overall use, more variation of strategies, and use of certain strategies (e.g., asking a client to recall past treatment material and/or praising them when they successfully recalled a treatment point) did predict greater perceived symptom improvement. This is important given that perceived symptom improvement has been shown to predict clinically significant symptom change and future utilization of services (Karpenko & Owens, 2013; Simon et al., 2012). Future research will test the impact of the relationships between these select MS strategies (i.e., practice remembering/praise recall) and perceived symptom improvement (e.g., on client outcomes and utilization).