Differential role of CBT skills, DBT skills and psychological flexibility in predicting depressive versus anxiety symptom improvement

Behav Res Ther. 2016 Jun:81:12-20. doi: 10.1016/j.brat.2016.03.006. Epub 2016 Mar 30.


Objective: Studies have reported associations between cognitive behavioral therapy (CBT) skill use and symptom improvement in depressed outpatient samples. However, little is known regarding the temporal relationship between different subsets of therapeutic skills and symptom change among relatively severely depressed patients receiving treatment in psychiatric hospital settings.

Method: Adult patients with major depression (N = 173) receiving combined psychotherapeutic and pharmacological treatment at a psychiatric hospital completed repeated assessments of traditional CBT skills, DBT skills and psychological flexibility, as well as depressive and anxiety symptoms.

Results: Results indicated that only use of behavioral activation (BA) strategies significantly predicted depressive symptom improvement in this sample; whereas DBT skills and psychological flexibility predicted anxiety symptom change. In addition, a baseline symptom severity X BA strategies interaction emerged indicating that those patients with higher pretreatment depression severity exhibited the strongest association between use of BA strategies and depressive symptom improvement.

Conclusions: Findings suggest the importance of emphasizing the acquisition and regular use of BA strategies with severely depressed patients in short-term psychiatric settings. In contrast, an emphasis on the development of DBT skills and the cultivation of psychological flexibility may prove beneficial for the amelioration of anxiety symptoms.

Keywords: Behavioral activation; Cognitive restructuring; Depression; Psychiatric hospital; Psychological flexibility.

Publication types

  • Clinical Trial

MeSH terms

  • Acceptance and Commitment Therapy*
  • Adaptation, Psychological
  • Adolescent
  • Adult
  • Aged
  • Anxiety / complications
  • Anxiety / therapy*
  • Behavior Therapy*
  • Cognitive Behavioral Therapy*
  • Combined Modality Therapy
  • Depressive Disorder, Major / complications
  • Depressive Disorder, Major / drug therapy
  • Depressive Disorder, Major / therapy*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Psychotropic Drugs / therapeutic use
  • Treatment Outcome
  • Young Adult


  • Psychotropic Drugs