Previous research has shown that a substantial proportion of clients in cognitive therapy (CT) for depression make rapid symptom improvements in a single between-session interval; these “sudden gains” occur at different sessions across patients and provide an important window to examine factors that may be influencing clinical improvements. People who experienced sudden gains were more likely to be treatment responders, be at a lower risk of relapse, and demonstrate an increase in cognitive change in the session immediately preceding the sudden gain. These findings suggest that improvement in CT may be driven by changing patients' thought processes, supporting the theory behind CT. The current study attempts to replicate previous findings with one important methodological difference: instead of expert cognitive therapists, we utilized therapists-in-training to help determine whether CT achieves effects through similar methods with inexpert therapists.
Forty-one depressed patients enrolled in a study to participate in 16 weeks of CT. Therapists were 4 advanced graduate students with two to three years of clinical experience. Ten independent raters were trained to assess cognitive change and rated sessions surrounding sudden gains. Twenty-four patients reported sudden gains with a mean magnitude of 11.2 BDI points, which represented 52% of the overall symptom improvement from pre- to post-treatment (21.2 BDI points). Results showed (a) no difference in post-treatment outcome between patients who experienced a sudden gain and those who did not, (b) sudden gains did not reduce the risk for relapse, (c) cognitive change was found to be higher in the control (pre-pre-gain sessions) than the pre- or post-gain sessions. While the percentage and magnitude of sudden gains in this study were similar to previous research, these findings failed to replicate previous research that suggested people who experience sudden gains in CT for depression are more likely to be treatment responders and less likely to relapse. We also found a pattern of cognitive change contrary to expectations in that it was greatest two sessions before sudden gains. Our findings suggest that the factors influencing sudden gains in CT provided by therapists-in-training may be different than those previously reported among expert therapists. Perhaps novice therapists' delivery of CT was such that cognitive change was not the primary determinant of sudden gains. Nonetheless, the clinical outcomes obtained compare favorably with those reported in previous clinical trials of CT. Further research needs to be done in order to help explain these findings.
|Advisor:||Strunk, Daniel R.|
|Commitee:||Beck, Steven, Cheavens, Jennifer, Strunk, Daniel R.|
|School:||The Ohio State University|
|School Location:||United States -- Ohio|
|Source:||DAI-B 78/11(E), Dissertation Abstracts International|
|Subjects:||Psychology, Clinical psychology, Cognitive psychology|
|Keywords:||Cognitive therapy, Depression, Sudden gains|
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