Sudden gains, critical sessions, and the mechanism of cognitive behavioral therapy for depression.

摘要

Starting from the discovery of the sudden gain/critical session, a series of empirical studies were conducted on the mechanism of change in cognitive behavioral therapy for depression (CBT). The findings offer empirical support for the cognitive mediation hypothesis, especially for its core principle that CBT interventions lead to cognitive changes, and cognitive changes lead to much of the observed symptom improvements. The findings also highlight several aspects of the change process that have previously been neglected, like the idea that therapeutic progress tends to concentrate in a few critical sessions, that symptom improvement tends to concentrate in a few sudden gains, that therapeutic alliance and cognitive interventions interact in complex ways, and that different patients might recover through fundamentally different mechanisms.