The Impact of Sudden Gains in Cognitive Behavioral Therapy for Posttraumatic Stress Disorder

Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA 02130, USA.
Journal of Traumatic Stress (Impact Factor: 2.72). 08/2009; 22(4):287-93. DOI: 10.1002/jts.20427
Source: PubMed


This study investigated sudden gains, i.e., rapid and stable improvements, in posttraumatic stress disorder (PTSD) symptoms that may occur in cognitive-behavioral therapy. Twenty-nine of 72 participants (39.2%) experienced a sudden gain during treatment. Mixed model ANOVAs analyzed sudden gains impact on clinician-rated PTSD symptom severity, patient-rated PTSD symptom severity, and patient-rated depressive symptom severity. Sudden gains in PTSD symptomology were associated with greater reductions in PTSD symptom severity for the avoidance/numbing and hyperarousal symptom clusters at posttreatment. By 6-month follow-up, the sudden gains group had maintained those reductions in symptoms, but the nonsudden gains group had achieved equal reductions in symptom severity. Participants experiencing sudden gains on PTSD measures had lower depression severity at posttreatment and follow-up.

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Available from: Candice M Monson, Oct 27, 2014
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    • "If the therapeutic alliance is essential for sudden gains, then we would not expect to observe sudden gains with a client-directed treatment. To our knowledge, the majority of studies to date have only examined sudden gains within the context of therapist-guided treatments, with only one study examining client-directed treatments (Kelly et al. 2009). In this study we tested for sudden gains in a client-directed intervention to help explicate whether the therapist is a key factor in producing sudden gains. "
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    ABSTRACT: Sudden gains are large reductions in symptoms measured in a single between-session interval and are positively associated with long-term treatment outcomes. To date, sudden gains have mostly been observed in ther- apist-directed psychotherapies. There are currently mixed findings surrounding the mechanisms underlying sudden gains, with some support for a cognitive mechanism and some support for therapist characteristics such as the therapeutic alliance. In this study of 77 female survivors of childhood sexual abuse, sudden gains in trauma symptoms were found in a randomized clinical trial of a patient- directed expressive writing intervention. Women in the active treatment condition (who wrote about their beliefs related to sexuality or trauma) exhibiting sudden gains in trauma symptoms showed larger improvements in depres- sion than those in the control condition (who merely wrote about their daily needs). The extension of sudden gains from psychotherapy to a client-directed treatment refines our understanding of the mechanisms underlying these gains, and supports the hypothesis that cognitive change is a likely mechanism underlying sudden gains.
    Full-text · Article · Aug 2013 · Cognitive Therapy and Research
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    • "pretreatment to follow-up were found for primary outcome measures (Hedges's g ϭ 0.56). Although some studies reported that reductions in symptoms associated with sudden gains at posttreatment did not endure to follow-up assessments (Clerkin et al., 2008; K. A. Kelly et al., 2009; Tang et al., 2002; Vittengl et al., 2005), our quantitative review indicates that sudden gains have a lasting, long-term effect on psychiatric symptoms. It should be noted that the present review found no differences in the effect sizes of sudden gains when comparing studies in which the original sudden gains criteria were used as described by Tang and DeRubeis (1999) with studies in which modified criteria were used. "
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    ABSTRACT: The present study quantitatively reviewed the literature on sudden gains in psychological treatments for anxiety and depression. The authors examined the short- and long-term effects of sudden gains on treatment outcome as well as moderators of these effects. The authors conducted a literature search using PubMed, PsycINFO, the Cochrane Library, and manual searches. The meta-analysis was based on 16 studies and included 1,104 participants receiving psychological treatment for major depressive disorder or an anxiety disorder. Effect size estimates suggest that sudden gains had a moderate effect on primary outcome measures at posttreatment (Hedges's g = 0.62) and follow-up (Hedges's g = 0.56). These effect sizes were robust and unrelated to publication year or number of treatment sessions. The effect size of sudden gains in cognitive-behavioral therapy was higher (Hedges's g = 0.75) than in other treatments (Hedges's g = 0.23). These results suggest that sudden gains are associated with short-term and long-term improvements in depression and anxiety, especially in cognitive-behavioral therapy.
    Full-text · Article · Nov 2011 · Journal of Consulting and Clinical Psychology
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    ABSTRACT: The current study examines trauma narratives from 28 survivors of interpersonal violence. A mixed-method approach assessed coherence and explored narrative characteristics among differentially exposed groups. The quantitative analysis revealed: (1) exposure to repetitive interpersonal violence was described with greater perception of severity and emotional tone than single interpersonal violence episodes, and (2) exposure to interpersonal violence in childhood was described with greater emotional tone than exposure to interpersonal violence in adulthood. The qualitative analysis revealed: (1) traumatic events were connected to proceeding adverse experiences, (2) attempted avoidance of memories of the violence, (3) an altered view of the self, and (4) lacked recognition that the violence was abnormal. The study supports the "dose-response relationship" of trauma exposure, and the life-altering, transformative nature of trauma exposure.
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