Abstract
Background
Facilitating opportunities for patients to express choice within psychological treatment has been encouraged as a means of improving adherence to cognitive behavioral therapy. However, the comparative benefits of choice to a lack thereof in the various decision points likely to be encountered withing cognitive behavioral therapy has received little empirical evaluation and has yet to be evaluated in the context in cognitive behavioral therapy skills.
Methods
In this study, we set out to empirically evaluate the impact of choice on participants’ attitudes towards cognitive behavioral therapy skills, randomizing 400 participants to choose or be randomly assigned to implement cognitive or behavioral coping skills. Analyses evaluated change in participants’ views towards cognitive and behavioral skills after learning about and implementing one of these strategies.
Results
Results indicated an interaction between choice and skill in predicting skill attitudes. Participants developed a more favorable view of the practiced skill in all conditions. Attitude change was largest among those who had the opportunity to choose a skill, particularly in the cognitive condition. Among those randomized to a skill, attitude change was lower overall, but still greater in the cognitive than behavioral condition. We did not find that depression symptoms moderated condition effects.
Conclusions
Our results suggest that skill use is viewed most favorably when one is offered the opportunity to select a skill. However, when a skill is assigned without an opportunity to express choice, attitudes towards practiced strategies still can be expected to improve.
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Data Availability
Data for this study is available upon reasonable request and following permission from the Mississippi State University Institutional Review Board for the Protection of Human Subjects in Research.
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S.T.M. developed the study concept and contributed to the study design. Data collection was completed by S.T.M. S.T.M. performed the data analysis, and interpretation was completed by all authors. All authors drafted the manuscript and provided critical revisions. All authors approved the final version of the paper for submission.
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The study was performed in strict accordance with the ethical principles outlined in the Declaration of Helsinki. The study protocol was reviewed and approved by the Mississippi State University Institutional Review Board (IRB) for the Protection of Human Subjects in Research. Informed consent was obtained from all individual participants in this study.
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Murphy, S.T., O’Brien, I.E., Brown, V.A. et al. The Impact of Choice on Favorability of Cognitive Behavioral Therapy Skills. Cogn Ther Res (2026). https://doi.org/10.1007/s10608-026-10800-8
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DOI: https://doi.org/10.1007/s10608-026-10800-8