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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Available from: David A Moscovitch
    • "On the other hand, it is impossible to statistically disentangle overall symptomatic improvement from sudden gains because sudden gains are part of overall improvement. Therefore it is equally possible that sudden gains are only an expression of good therapy response, which is a more parsimonious explanation (Hofmann et al., 2006). In addition, there is some evidence that early sudden gains may be more important, suggesting that these early gains may be an expression of the phenomenon of " rapid response " to therapy (e.g. "
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    ABSTRACT: We examined sudden, large, and stable shifts in symptoms from one therapy session to the next in two treatments for posttraumatic stress disorder (PTSD). Shifts in a positive direction (sudden gains) have so far been more frequently analyzed than those in a negative direction (sudden losses). We analyzed data from 102 outpatients suffering from PTSD who received either a cognitive-behavioral or a Gestalt-based intervention. Sudden gains, at 22.5 %, were more frequent than sudden losses (3.9 % of patients). Participants who had experienced sudden gains had lower PTSD scores at posttreatment, but not at the 6-month follow-up. As sudden losses were so rare, they were not analyzed statistically. Sudden gains accounted for 52 % of overall treatment gains or 26 % of overall change in a positive direction. Among very successful patients, those with sudden gains were overrepresented, but in absolute terms, there were as many patients without sudden gains in this group. There was no connection between sudden gains and type of intervention or depressive symptoms. Sudden gains and sudden losses occurred in our sample of PTSD patients, but in the light of current results, their clinical importance seems to be limited.
    No preview · Article · Sep 2014 · Behaviour Research and Therapy
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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.
    Full-text · Article · Aug 2011 · Journal of Consulting and Clinical Psychology
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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.
    Full-text · Article · Dec 2010 · Journal of anxiety disorders
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