Systematic Review of In-Session Affect Experience in Cognitive Behavioral Therapy for Depression

One way of attempting to improve the efficacy and effectiveness of Cognitive Behavioral Therapy (CBT) for depression is to identify the processes of change that contribute towards its positive outcome. In addition to well-researched cognitive processes, another possible change process is affect experiencing (AE); i.e., a patient's affective experience in-session. Theorists, clinicians and researchers have emphasized the role of affective traits, tendencies and symptoms in the development, maintenance, and treatment of depression. We make the case that it may be important to also consider patients' full range of affect experiencing (AE), as a changeable in-session process that may relate to CBT treatment outcome. This systematic review aimed to clarify what is already empirically known regarding in-session AE in CBT for depression and which gaps in empirical research need to be filled by future studies. The reviewed studies on AE in CBT for depression suggest that it is possible to identify and measure AE. In-session experiencing of positive and negative affect (when it includes cognitive processes) relates to and may predict a reduction of symptoms. We encourage researchers to develop and refine multifaceted process measures and analyses to explore when, how and how much AE can be effectively experienced by patients, and how optimal levels of AE may be facilitated by the therapist.