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. These sudden gains' average magnitude was 11 Beck Depression Inventory points, a ccounting for 50% of these patients' total improvement. Patients who experi enced sudden gains were: less depressed than the other patients at posttrea tment, and they remained so IB months later. Substantial cognitive changes were observed in the therapy sessions preceding sudden gains, but few cogni tive! changes were observed in control sessions, suggesting that cognitive change in the pregain sessions triggered the sudden gains, improved therape utic 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.