Sudden gains and critical sessions in cognitive-behavioral therapy for depression.

In this study of cognitive-behavioral therapy for depression, many patients experienced large symptom improvements in a single between-sessions interval. These sudden gains' average magnitude was 11 Beck Depression Inventory points, accounting for 50% of these patients' total improvement. Patients who experienced sudden gains were less depressed than the other patients at posttreatment, and they remained so 18 months later. Substantial cognitive changes were observed in the therapy sessions preceding sudden gains, but few cognitive changes were observed in control sessions, suggesting that cognitive change in the pregain sessions triggered the sudden gains. Improved therapeutic alliances were also observed in the therapy sessions immediately after the sudden gains, as were additional cognitive changes, suggesting a three-stage model for these patients' recovery: preparation-->critical session/sudden gain-->upward spiral.

[1]  Jacob Cohen.  Statistical Power Analysis for the Behavioral Sciences , 1969, The SAGE Encyclopedia of Research Design.

[2]  M. Sidman.  A note on functional relations obtained from group data. , 1952, Psychological bulletin.

[3]  S. Hollon,et al.  6 – Cognitive Therapy of Depression1 , 1979 .

[4]  D. Bakan,et al.  A generalization of Sidman's results on group and individual functions, and a criterion. , 1954, Psychological bulletin.

[5]  J. Solomon,et al.  Predicting the outcomes of psychotherapy by the Penn Helping Alliance Rating Method. , 1982, Archives of general psychiatry.

[6]  R. DeRubeis,et al.  Empirically supported individual and group psychological treatments for adult mental disorders. , 1998, Journal of consulting and clinical psychology.

[7]  The process of cognitive therapy: the first dysfunctional thought changes less than the last one. , 1986, Behaviour research and therapy.

[8]  A. Simons,et al.  Cognitive therapy and pharmacotherapy. Singly and together in the treatment of depression. , 1984, Archives of general psychiatry.

[9]  A. Horvath,et al.  Relation between Working Alliance and Outcome in Psychotherapy: A Meta-Analysis. , 1991 .

[10]  R. DeRubeis,et al.  The temporal relation of adherence and alliance to symptom change in cognitive therapy for depression. , 1999, Journal of consulting and clinical psychology.

[11]  W. E. Craighead,et al.  The Role of Nonspecific Factors in Cognitive‐Behavior Therapy for Depression , 1994 .

[12]  W M Grove,et al.  Cognitive therapy and pharmacotherapy for depression. Singly and in combination. , 1992, Archives of general psychiatry.

[13]  M. Whisman.  Mediators and moderators of change in cognitive therapy of depression. , 1993, Psychological bulletin.

[14]  J. Christopher Muran,et al.  The Therapeutic Alliance in Brief Psychotherapy , 2001, Journal of Cognitive Psychotherapy.

[15]  S. Nolen-Hoeksema,et al.  Therapeutic empathy and recovery from depression in cognitive-behavioral therapy: a structural equation model. , 1992, Journal of consulting and clinical psychology.

[16]  S D Imber,et al.  National Institute of Mental Health Treatment of Depression Collaborative Research Program. General effectiveness of treatments. , 1989, Archives of general psychiatry.

[17]  M. J. Allen.  Introduction to Measurement Theory , 1979 .

[18]  J. Safran,et al.  The resolution of ruptures in the therapeutic alliance. , 1996, Journal of consulting and clinical psychology.

[19]  R. Elliott.  "That in your hands". A comprehensive process analysis of a significant event in psychotherapy. , 1983, Psychiatry.

[20]  L. Thompson,et al.  Alliance, Technique, and their Interactions in Predicting Outcome of Behavioral, Cognitive, and Brief Dynamic Therapy , 1998 .

[21]  S. Shapiro,et al.  An Analysis of Variance Test for Normality (Complete Samples) , 1965 .

[22]  A. Horvath,et al.  The development of the Working Alliance Inventory. , 1986 .

[23]  M. Seligman,et al.  Explanatory style change during cognitive therapy for unipolar depression. , 1988, Journal of abnormal psychology.

[24]  W. Estes.  The problem of inference from curves based on group data. , 1956, Psychological bulletin.

[25]  D. M. Stein,et al.  Therapist interpersonal skills: process, outcome, methodological considerations, and recommendations for future research. , 1978, Psychological bulletin.

[26]  Jeremy D. Safran,et al.  The relative predictive validity of two therapeutic alliance measures in cognitive therapy , 1991 .

[27]  P. Crits-Christoph,et al.  The Accuracy of Therapists' Interpretations and the Development of the Therapeutic Alliance , 1993 .

[28]  K. O’grady,et al.  Applying the Collaborative Study Psychotherapy Rating Scale to rate therapist adherence in cognitive-behavior therapy, interpersonal therapy, and clinical management. , 1992, Journal of consulting and clinical psychology.

[29]  I. Blackburn,et al.  Changes in Cognition with Pharmacotherapy and Cognitive Therapy , 1983, British Journal of Psychiatry.

[30]  N. Jacobson,et al.  A component analysis of cognitive-behavioral treatment for depression. , 1996, Journal of consulting and clinical psychology.

[31]  M. Goldfried,et al.  Predicting the effect of cognitive therapy for depression: a study of unique and common factors. , 1996, Journal of consulting and clinical psychology.

[32]  R. Elliott.  "That in Your Hands". , 1983, Psychiatry.