BRIEF REPORTS The Prevalence and Impact of Large Sudden Improvements During Adolescent Therapy for Depression: A Comparison Across Cognitive–Behavioral, Family, and Supportive Therapy

This study assessed the treatment specificity and impact on outcome of large, abrupt symptomatic improvements occurring prior to and during cognitive–behavioral, family, and supportive therapy. Eighty-seven depressed adolescents receiving at least 8 therapy sessions were included. Abrupt large decreases in depressive symptoms were identified by changes in weekly Beck Depression Inventory scores. Overall, 28 % experienced a pretreatment gain and 39 % a sudden within-treatment gain. Both types of gains were associated with superior outcome on self-report and interviewer ratings of depression. Among those participants failing to experience a pretreatment or sudden within-treatment gain, cognitive–behavioral therapy produced the superior outcomes. These findings suggest pretreatment and sudden within-treatment gains are important therapeutic events worthy of further investigation. Meta-analyses support the efficacy of cognitive–behavioral therapy (CBT) in the treatment of depressed adults (Barlow, 1994) and adolescents (Lewinsohn & Clarke, 1999). Despite these pos-itive findings, there is little information on whether CBT works through specific cognitive mechanisms (Kopta, Lueger, Saunders, & Howard, 1999; Whisman, 1993). For example, we have foun