2 - (SYM 29) Cognitive Skills as Mechanisms of Symptom Improvement in Psychological Interventions: A Systematic Review and Meta-analysis

Cognitive behavioral therapy (CBT) emphasizes skill acquisition to enable participants to function as their own therapists. Participants' acquired cognitive behavioral skills may constitute a mechanism of symptom improvement. This systematic review and meta-analysis synthesized evidence on whether specific cognitive skills (e.g., reappraisal) mediate the effects of psychological interventions on psychological distress (e.g., depression). A comprehensive search identified 3543 articles. After removing 858 duplicates, 2685 records were screened. Full-text assessment of 152 articles led to 57 inclusions. Examining references/citations of these 57 articles retrieved an additional 4041 records. After deduplication, 3127 articles were screened, with 259 undergoing full-text assessment, resulting in 161 inclusions. The total number of included articles was 218. Among these, 118 were randomized controlled trials (RCTs), and 23 mediation analyses with an RCT design were included. Nineteen mediation studies were included in a meta-analysis; the rest were narratively synthesized. Preliminary findings classified cognitive skills into five domains: CBT skills, cognitive restructuring skills, mindfulness skills, metacognitive skills, and emotion regulation. Studies were counted in multiple categories if they assessed multiple skills. Random-effects meta-analyses with robust variance estimation were conducted. Preliminary analyses indicated mindfulness skills (n=7) and cognitive restructuring skills (n=7) were the most frequently examined mediators, whereas CBT skills (n=2) were less commonly assessed. Changes in specific cognitive skills were generally associated with reductions in psychological distress, though the magnitude of indirect effects varied across skill categories. These findings tentatively support specific cognitive skills as potential mechanisms of change and highlight differential contributions of distinct cognitive processes.