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Reversals of Sudden Gains Made During Cognitive Therapy with Depressed Adults: A Preliminary Investigation

Published online by Cambridge University Press:  21 April 2010

Paul Manning ,
Gillian Hardy  and
Stephen Kellett
Paul Manning
Affiliation:
Centre for Psychological Services Research, University of Sheffield, UK
Gillian Hardy
Affiliation:
Centre for Psychological Services Research, University of Sheffield, UK
Stephen Kellett*
Affiliation:
Centre for Psychological Services Research, University of Sheffield, UK
*
Reprint requests to Stephen Kellett, IAPT Programme Director, Clinical Psychology Unit, University of Sheffield, Sheffield S10 2TN, UK. E-mail: [email protected]
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Abstract

Background: This study investigated sudden reversals during cognitive therapy (CT), through the comparison of “in-session” activity and “out-of-session” life events. Method: The sample comprised 20 clients who experienced sudden gains during CT for depression: 10 who subsequently suffered a reversal of this gain and 10 matched clients who maintained progress. Measures of client resistance and therapist responses were scored by judges from session transcripts and clients completed measures of life events and depression at each session. This enabled the Reversal and Non-Reversal groups to be compared during pre-sudden gain, pre-reversal or matched sessions. Results: No differences were apparent between the Reversal and Non-reversal groups or between the pre-gain and pre-reversal sessions in terms of client or therapist “in-session” activities. In the Reversals group, 6 out of 10 clients recovered their level of symptom improvement, following the reversal. Therapists showed higher levels of reflection and self-disclosure with clients who did not recover their symptom gain following the Reversal than with clients who did recover their symptom gain following the Reversal. Conclusions: The study is discussed in terms of the manner by which reversals can be more effectively measured and researched.

Keywords

Sudden reversalssudden gainsdepressionoutcomes
Type
Brief Clinical Reports
Information
Behavioural and Cognitive Psychotherapy , Volume 38 , Issue 4 , July 2010 , pp. 491 - 495
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2010

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References

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: American Psychiatric Association.Google Scholar
Barrett, M. S. and Berman, J. S. (2001). Is psychotherapy more effective when therapists disclose information about themselves? Journal of Consulting and Clinical Psychology, 69, 597–603.Google Scholar
Beck, A. T., Steer, R. A. and Brown, G. K. (1996). Manual for the Beck Depression Inventory – 2nd edn. (BDI-II). San Antonio, TX: Psychological Corporation.Google Scholar
Beutler, L. E., Moleiro, C. and Talebi, H. (2002). Resistance in psychotherapy: what conclusions are supported by research? Journal of Clinical Psychology, 58, 207–217.Google Scholar
Bischoff, M. M. and Tracey, T. J. G. (1995). Client resistance as predicted by therapist behavior: a study of sequential dependence. Journal of Counseling Psychology, 42, 487–495.Google Scholar
Busch, A. M., Kanter, J. W., Landes, S. J. and Kohlenberg, R. J. (2006). Sudden gains and outcome: a broader temporal analysis of cognitive therapy for depression. Behavior Therapy, 37, 61–68.Google Scholar
Goodridge, D. and Hardy, G. E. (2009). Patterns of change in psychotherapy: an investigation of sudden gains in cognitive therapy using the assimilation model. Psychotherapy Research, 19, 113–123.Google Scholar
Gaynor, S. T., Weersing, R., Kolko, D. J., Birmaher, B., Heo, J. and Brent, D. A. (2003). The prevalence and impact of large sudden improvements during adolescent therapy for depression: a comparison across cognitive-behavioural, family and supportive therapy. Journal of Consulting and Clinical Psychology, 71, 386–393.Google Scholar
Hardy, G. E., Cahill, J., Stiles, W. B., Ispan, C., Macaskill, N. and Barkham, M. (2005). Sudden gains in cognitive therapy for depression: a replication and extension. Journal of Consulting and Clinical Psychology, 73, 59–67.Google Scholar
Harris, T., Brown, G. W. and Robinson, R. (1999). Befriending as an intervention for chronic depression among women in an inner city: 2: role of fresh-start experiences and baseline psychological factors in remission from depression. British Journal of Psychiatry, 174, 225–232.Google Scholar
Hill, C. E. (2004). Helping Skills: facilitating exploration, insight, and action (2nd edn.) Washington, DC: American Psychological Association.Google Scholar
Jacobson, N. S. and Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.Google Scholar
Llewelyn, S. P., Elliott, R. K., Shapiro, D. A., Hardy, G. E. and Firth-Cozens, J. (1988). Client perceptions of significant events in prescriptive and exploratory periods of individual therapy. British Journal of Clinical Psychology, 27, 105–114.Google Scholar
Mahalik, J. R. (1994). Development of the client resistance scale. Journal of Counseling Psychology, 41, 58–68.Google Scholar
Manly, B. F. J. (1991). Randomization and the Monte Carlo Methods in Biology. London: Chapman.Google Scholar
Palombo, J. (1987). Spontaneous self disclosure in psychotherapy. Clinical Social Work Journal, 15, 107–120.Google Scholar
Stiles, W. B., Elliott, R., Llewelyn, S. P., Firth-Cozens, J. A., Margison, F. R., Shapiro, D. A. and Hardy, G. (1990). Assimilation of problematic experiences by clients in psychotherapy. Psychotherapy, 27, 411–420.Google Scholar
Tang, T. Z. and DeRubeis, , , R. J. (1999). Sudden gains and critical sessions in cognitive-behavioural therapy for depression. Journal of Consulting and Clinical Psychology, 67, 894–904.Google Scholar
Tang, T. Z., DeRubeis, R. J., Hollon, S. D., Amsterdam, J. A. and Shelton, R. C. (2007). Sudden gains in cognitive therapy of depression and depression relapse/recurrence. Journal of Consulting and Clinical Psychology, 75, 404–408.Google Scholar
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