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Socratic questioning improves depressive symptoms regardless of therapeutic relationship

Use of Socratic questioning predicted symptom improvement among adults with depression regardless of the therapeutic relationship, according to study findings in Behavior Research and Therapy.

“In using Socratic questioning, experts typically emphasize the use of open-ended questions aimed at helping patients to consider new sources of information or to adopt broader perspectives. The importance of using a Socratic approach has been emphasized, with experts suggesting that the use of this approach helps patients to take new perspectives, use cognitive therapy skills, and experience improvements in depressive symptoms,” Justin D. Braun, BA, a doctoral student at the Ohio State University, and colleagues wrote. “Even outside of [cognitive therapy], Socratic questioning is a key strategy in several psychotherapies, perhaps most notably Motivational Interviewing. However, not all psychotherapy developers have shared the same view on Socratic questioning.”

To assess therapist use of Socratic questioning as a predictor of symptom change, researchers evaluated 55 adults with depression who participated in a 16-week course of cognitive therapy. Socratic questioning was evaluated by observer ratings of the first three sessions.

Within-patient Socratic questioning significantly predicted symptom changes from session to session early in the study period. One standard deviation increase in Socratic questioning predicted a 1.51-point decrease in Beck Depression Inventory-II scores in the following session.

When controlling for within-patient ratings of therapeutic alliance (ie, relationship and agreement), Socratic questioning continued to predict symptom change. This suggests that the association between Socratic questioning and symptom change were independent of stable characteristics and within-patient variation in the alliance.

“Our findings are consistent with the view that therapists’ use of Socratic questioning promotes therapeutic gains. One implication of this is therapists learning cognitive therapy would do well to master the use of this questioning strategy. We think this questioning approach is powerful because it prompts clients to actively consider new perspectives and ultimately adopt a more skeptical attitude about their negative thoughts and beliefs,” study researcher Daniel R. Strunk, PhD, of the Ohio State University, told Healio.com/Psychiatry. – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.