Patient's Attributions about Symptom Improvement in CBT for Depression: Development of a Rating System and an Initial Test of Validity

Sudden gains are large and stable improvements in symptoms that occur within a brief time span. There is evidence that, in cognitive behavioral therapy (CBT) for depression, cognitive changes trigger sudden gains. Patients' understandings of these gains, or the relation of their explanations to outcome, have not been studied. We developed a method for categorizing patients' attributions of large between-session symptom changes, including sudden gains, and examined the relation of these attributions to outcomes in a sample of depressed patients receiving CBT. Therapists conducted brief interviews at the beginning of sessions whenever patients reported a between-session clinically significant reduction in symptoms. Four raters applied our coding system to 694 attributions made by 46 patients. The most common attribution categories were: Cognitive, Behavioral/Environmental, and Problem-solving. Attributions to problem solving and behavioral or environmental changes were associated with less sustained improve...