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Linking in-session change to overall outcome in short-term cognitive therapy.

To better understand the mechanisms of change in psychotherapy, it is important to validate suboutcome measures that represent intermediate links between more molecular in-session changes and ultimate outcome. The present study involved the collection of pre- and postsession ratings from 53 patients in a 20-session protocol of cognitive therapy, which yielded 5 suboutcome measures: Anxiety Shift, Depression Shift, Cognitive Shift, Optimism Shift, and Therapeutic Alliance. From a series of regression analyses of repeated measures with a generalized estimating equations approach, results regarding the predictive relationship of these variables to a number of patient and therapist-rated outcome criterion variables indicated that change in cognition and quality of the therapeutic alliance were the strongest predictors.