What Happens When There Is a Lapse vs a Relapse during CCT

It is important to teach patients to discriminate a full "relapse" (a syndrome with impairment that lasts 2 weeks or more) from a "blip" or "lapse" (transient symptoms that may resolve with intensified use of critical skills). Attention to the temporal aspects of the diagnosis and the effect of symptoms on functioning helps with this discrimination. Furthermore, it can be helpful to teach patients to use self-rating scales (e.g., BDI or IDS-SR) to detect depressive symptoms and to learn when to intensify the use of critical skills, to call the therapist for extra help, or to request an appointment.

A "lapse" can cue therapist and patient to design specialized homework over the telephone to address the symptoms and to determine whether a session should be scheduled soon or "out of sequence." The therapist's aim is to promote a sense of mastery and self-efficacy and to help the patient learn that he/she can use compensatory strategies successfully and independently to reduce depressive symptoms. If a patient relapses during C-CT, the frequency of sessions can be increased until the symptoms of MDD have remitted and functioning is restored. If the relapse is detected immediately rather than later, we predict that fewer sessions of C-CT will be necessary to restore remission.

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