Exploring sudden gains in behavioral activation therapy for Major Depressive Disorder

Understanding the onset and course of sudden gains in treatment provides clinical information to the patient and clinician, and encourages clinicians to strive for these sudden clinical gains with their patients. This study characterizes the occurrence of sudden gains with Behavioral Activation (BA; Martell, Addis, & Jacobson, 2001), and the extent to which pre-treatment dysfunctional depressive thinking predicts sudden gains during treatment. We enrolled a sample of adults (n = 42) between ages 18–65 diagnosed with primary Major Depressive Disorder. All participants completed a 16-week course of BA, with clinical and self-report assessments at pre-, mid- and post-treatment. Results indicated that sudden gain and non-sudden gain participants showed differential improvement across treatment. No significant effects emerged for the dysfunctional cognitive style as a predictor of sudden gain status. Sudden gains may result from interaction of non-specific factors with the BA techniques implemented during early phases of therapy.

► This study examines sudden gains in BA outpatient therapy for Major Depressive Disorder. ► We examined the timing and cognitive predictors of sudden gains in BA for MDD. ► We found that sudden gains in BA occur earlier than in previous CBT studies. ► Dysfunctional cognitions did not predict the occurrence of sudden gains. ► Sudden gains in BA may be better predicted by treatment process factors rather than baseline patient variables.