The mechanisms of sudden gains in Supportive-Expressive therapy for depression

A sudden gain is a large symptom improvement in one between-session interval. Studies of cognitive-behavioral therapy (CBT) reported that many more cognitive changes occurred in pregain sessions (sessions immediately preceding sudden gains) than in control sessions. This study investigated sudden gains in supportive-expressive therapy (SE) for depression. Compared with control sessions, in these SE pregain sessions the authors found significantly greater therapist interpretation accuracy, better therapeutic alliance at a trend level, but an almost identical number of cognitive changes. Results from this SE study and past CBT studies suggest that sudden gains in different treatments may be associated with different mechanism factors: cognitive changes in CBT and accurate interpretations and possibly therapeutic alliance in SE.