What works for whom in outpatient cognitive-behavioral therapy? Integration of techniques from different therapeutic orientations and their interactions as predictors of treatment outcome in different diagnostic groups.

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OBJECTIVE: The mechanisms underlying psychotherapy's effects remain debated, with some emphasizing theory-specific therapeutic techniques and others highlighting common factors like therapeutic alliance. Evidence is inconclusive partially because it is rarely assessed which interventions are actually employed in naturalistic outpatient settings. The study thus examined (a) how patient- and therapist-reported interventions during cognitive-behavioral therapy predict outcome, (b) whether naturally occurring integration of intervention from different therapeutic orientations predicts a more or less favorable outcome, and (c) whether the intervention-outcome association depends on specific diagnoses. METHOD: Using the Multitheoretical List of Therapeutic Interventions, 1,050 patients diagnosed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (Mage = 34.65, 58% female), and their 161 cognitive-behavioral therapy therapists reported which interventions were employed during psychotherapy. The patient-reported outcome, the Brief Symptom Checklist, was assessed at the beginning and end of therapy. RESULTS: Bayesian multilevel regression models revealed that patient-reported interventions were more consistently associated with the outcome than therapist-reported interventions. The person-centered subscale-especially reports on the exploration of personal meaning-emerged as the strongest predictor of the outcome. Integration of most interventions (i.e., reports on two subscales of the Multitheoretical List of Therapeutic Interventions) did not predict a more positive or negative outcome, though few combinations were beneficial. Findings regarding stronger intervention-outcome associations for specific diagnoses were not robust. CONCLUSION: By leveraging natural variability in routine clinical practice, this study provides insights into psychotherapy mechanisms beyond controlled trial constraints. It highlights the relevance of patients' perspective and the integration of interventions targeting meaning in predicting the outcome in outpatient cognitive-behavioral therapy. In addition, there seem to be no advantages nor adverse consequences of integrating therapeutic techniques. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

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