Sudden gains during therapy of social phobia

Department of Psychology, Boston University, Boston, MA 02215, USA.
Journal of Consulting and Clinical Psychology (Impact Factor: 4.85). 09/2006; 74(4):687-97. DOI: 10.1037/0022-006X.74.4.687
Source: PubMed


The present study investigated the phenomenon of sudden gains in 107 participants with social phobia (social anxiety disorder) who received either cognitive-behavioral group therapy or exposure group therapy without explicit cognitive interventions, which primarily used public speaking situations as exposure tasks. Twenty-two out of 967 session-to-session intervals met criteria for sudden gains, which most frequently occurred in Session 5. Individuals with sudden gains showed similar improvements in the 2 treatment groups. Although cognitive-behavioral therapy was associated with more cognitive changes than exposure therapy, cognitive changes did not precede sudden gains. In general, the results of this study question the clinical significance of sudden gains in social phobia treatment.

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    • "Data Analysis Following Hofmann et al. (2006) "
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    ABSTRACT: Our objective was to examine sudden gains during developmentally adjusted prolonged exposure for posttraumatic stress disorder (PTSD) among children and adolescents. We hypothesized that sudden gains would be detected and would be predictive of treatment outcome and follow-up. Sixty-three youngsters (ages 8-17) completed a developmentally adjusted protocol for the treatment of pediatric PTSD (Foa, Chrestman, & Gilboa-Schechtman, 2008). Participants' posttraumatic and depressive symptoms were assessed before each treatment session, as well as at approximately 3 and 12 months after treatment termination. We measured posttraumatic symptoms with the Child PTSD Symptom Scale (Foa, Johnson, Feeny, & Treadwell, 2001) and measured depressive symptoms with the Beck Depression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) and the Children's Depression Inventory (Kovacs, 1981, 1982). Sudden gains were found among 49.2% of participants and constituted 48.6% of the total reduction in posttraumatic symptoms. Compared to individuals who did not experience sudden gains, individuals who experienced sudden gains reported lower levels of posttraumatic symptoms, F(1, 61) = 14.4, p < .001, and depressive symptoms, F(1, 61) = 7.9, p < .01, at treatment termination. Differences in posttraumatic symptoms were maintained during both follow-up periods. Sudden gains are common in pediatric prolonged exposure for PTSD and are predictive of long-term outcome. Treatment planning can benefit from consideration of the intraindividual course of improvement, and treatment development may be enriched by understanding the mechanisms responsible for sudden gains.
    Journal of Consulting and Clinical Psychology 08/2011; 79(4):441-6. DOI:10.1037/a0024112 · 4.85 Impact Factor
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    • "In the current study, we followed the approach adopted by Tang and DeRubeis (1999; Tang et al., 2005) and had assessors who were blind to sudden gain status, observe and make ratings of cognitive change from video recordings of sessions. It is interesting that studies using direct observation consistently support the " cognitive change " hypothesis whereas those using change on self-report instruments (e.g., Kelly et al., 2005, Hofmann et al., 2006; but see Clerkin et al., 2008) typically do not. Future research is needed to explore and resolve which approach, if either, is producing more valid results. "
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    ABSTRACT: Sudden gains in psychotherapy are characterized by large and relatively stable decreases in psychiatric symptoms and have been associated with cognitive shifts in clients and shown to predict superior treatment outcomes in studies of depression and, to a lesser extent, anxiety disorders. The purpose of this study was to examine prevalence and impact of sudden gains during a transdiagnostic cognitive-behavioral group therapy (CBGT) for anxiety disorders, as well as the temporal relationship between sudden gains and cognitive changes. Data were used from two trials of transdiagnostic CBGT for anxiety disorders (n=130). Criteria for determining sudden gains in anxiety symptoms were based upon previous research on sudden gains from trials of cognitive-behavioral treatments for major depressive disorder. A total of 17 out of 98 (17.3%) clients experienced at least one sudden gain, with three clients showing two sudden gains during treatment. Three patients showing a sudden gain experienced a reversal of these gains, although one of these three had a subsequent second sudden gain. Clients experiencing sudden gains showed greater overall improvement following treatment than did clients who did not experience a sudden gain, with 65% of the sudden gainers' overall improvement accounted for by the sudden gain. Greater cognitive change in the pregain sessions was observed for clients with a sudden gain than those not showing a sudden gain. This finding lends support to the theory of cognitive mediation through CBGT in which substantial cognitive changes in pregain sessions lead to greater improvement overall.
    Journal of anxiety disorders 12/2010; 24(8):887-92. DOI:10.1016/j.janxdis.2010.06.012 · 2.68 Impact Factor
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    • "Additionally , although not targeted in treatment protocols , it also is conceivable that sudden gains reflect self-activation in the absence of therapist guidance. Although not directly assessed in the study, cognitive changes might have contributed to sudden gains (Tang & DeRubeis, 1999; Tang et al., 2005), although this relationship is not always discovered (Hoffman et al., 2006; Kelly et al., 2005), and in the current context, only 1 of 13 patients receiving behavioral activation supplemented with brief cognitive therapy experienced a sudden gain in the session following cognitive intervention. The timing and relevance of sudden gains to treatment outcome also may differ as a function of whether cognitive-behavioral therapies or interpersonal approaches are implemented (Kelly et al., 2007; Tang et al., 2002). "
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    ABSTRACT: Many patients who receive cognitive-behavioral therapy experience sudden gains that are associated with improved treatment response and decreased risk of relapse. Extending prior research, this study examined sudden gains among depressed cancer patients receiving brief (9-session) behavioral activation therapy. Fifty percent of patients experienced sudden gains of large magnitude (M=11.8 BDI-II points), with sudden gains associated with improved treatment response and maintenance of gains at 3-month follow-up. Relative to those without sudden gains, at pretreatment assessment, cancer patients with sudden gains were more likely to present with less severe depression, less somatic anxiety, fewer coexistent anxiety disorders, as well as less bodily pain, better overall physical functioning, and fewer problems with daily activities as a result of emotional problems. These findings provide increasing support for behavioral activation with a difficult-to-treat population but raise important questions regarding mechanism of change. Clinical implications for treating depressed cancer patients are discussed.
    Behavior therapy 12/2009; 40(4):346-56. DOI:10.1016/j.beth.2008.09.001 · 3.69 Impact Factor
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