title: Reversals of sudden gains made during cognitive therapy with depressed adults: a preliminary investigation.
abstract: BACKGROUND
  This study investigated sudden reversals during cognitive therapy (CT), through the comparison of "in-session" activity and "out-of-session" life events.
  
  
  METHODS
  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.
authors.affiliation: Centre for Psychological Services Research, University of Sheffield, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Manning
authors.forename: Gillian
authors.initials: G
authors.lastname: Hardy
authors.forename: Stephen
authors.initials: S
authors.lastname: Kellett
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003674:Defense Mechanisms; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D037001:Directive Counseling; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010555:Personality Inventory / Q000706:statistics & numerical data; D011369:Professional-Patient Relations; D011594:Psychometrics; D012008:Recurrence; D012307:Risk Factors; D012650:Self Disclosure; D055815:Young Adult