Change Processes in Cognitive Behavioral Therapy and Motivational Interviewing for Depression and Heavy Alcohol Use: A Network Approach

Abstract Objective Both cognitive behavioral therapy for depression (CBT-D) combined with brief motivational interviewing (CBT-D+BMI) and alone are associated with symptom improvement among college students with co-occurring depression and heavy episodic drinking (HED). However, little is known about change processes underlying these different treatments.The current study uses a network approach to examine change process that may differentially underlie CBT-D + BMI relative to CBT alone. Methods Participants included 94 college students with depression and HED who were randomized to either eight weeks of CBT-D + BMI or CBT alone. A network approach was adopted to examine how treatment condition influenced changes in the network structure of depression symptoms, heavy drinking, drinking motives, and consequences of alcohol. Network analyses were conducted using change scores representing the eight-week difference from pre-treatment to post-treatment assessments. Results Relative to CBT-D alone, the combined CBT-D + BMI treatment influenced the symptom network structure by preferentially targeting reductions in drinking to cope motives and in the depression symptom ‘loss of interest’. Conclusion The current study revealed that combined CBT-D + BMI may confer therapeutic benefit through different network structure pathways than CBT-D alone. Specifically, augmenting CBT-D with BMI may influence change processes related to drinking motives, such as drinking to cope.