Sudden gains in group cognitive-behavioral therapy for panic disorder

doi:10.1016/j.brat.2008.08.002

Behaviour Research and Therapy

Volume 46, Issue 11, November 2008, Pages 1244-1250

https://doi.org/10.1016/j.brat.2008.08.002 Get rights and content

Abstract

The current study investigates sudden gains (rapid symptom reduction) in group cognitive-behavioral therapy for panic disorder. Sudden gains occurring after session 2 of treatment predicted overall symptom reduction at treatment termination and some changes in cognitive biases. Meanwhile, sudden gains occurring immediately following session 1 were not associated with symptom reduction or cognitive change. Together, this research points to the importance of examining sudden gains across the entire span of treatment, as well as the potential role of sudden gains in recovery from panic disorder.

Section snippets

Participants

Participants (N = 43) were adult outpatients who participated in a 12-week CBGT intervention for panic disorder. Consistent with past research (e.g., Hofmann et al., 2006, Tang and DeRubeis, 1999), we only included participants who attended greater than seven therapy sessions to ensure that they had received sufficient CBT treatment. In addition, including participants with only seven or fewer sessions could lead to misleading results, as this would inadvertently inflate the percentage of

Sample characteristics and comparison of groups at baseline

We first examined group differences to ensure that individuals in each SG group (No SG, Session 1 SG, Session 2 + SG) were comparable at baseline on key demographic variables. Chi-square tests revealed that groups did not differ by gender (χ² = 1.06, P > 0.10), race (χ² = 3.48, P > 0.10), or whether participants were taking medication for an emotional (χ² = 2.16, P > 0.10), or physical (χ² = 0.20, P > 0.10) problem. Additionally, a univariate Analysis of Variance (ANOVA) test indicated that there were no

Discussion

In the present study, we examined sudden gains in group CBT for panic disorder. Our goals were to (1) characterize sudden gains in panic disorder; (2) explore whether sudden gains differ as a function of when in treatment they occur; and (3) determine whether sudden gains are associated with cognitive changes. We found that gains occurring after session 2 occurred in 20% of our overall sample and were associated with better symptom outcomes at treatment termination. This finding adds to the

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Cited by (44)

An examination of sudden gain prevalence across cognitive-behavioural therapy for anxiety and depressive disorders: A quantitative analysis and meta-analytic review
2023, Journal of Anxiety Disorders
Sudden gains, incidences of unexpectedly large and stable session to session symptom reductions during psychotherapy, have been shown in samples of individuals receiving treatment for both anxiety and depressive disorders, although seemingly more frequently in sample receiving treatment for depressive disorders. This may suggest that sudden gains are a function of depression, but the high comorbidity between anxiety and depressive disorders makes this difficult to assess. Study One utilised a sample of 117 adults undergoing CBT for a principal anxiety disorder to explore the effect of comorbid depression on sudden gain prevalence. Results indicated that sudden gains were not more prevalent in the comorbid depression group; however, the frequency of sudden gains was significantly related to comorbid depressive disorder severity. Study Two involved a meta-analysis of 48 studies to compare sudden gain prevalence between trials of CBT for depressive disorders versus anxiety-related disorders. The results of the meta-analysis indicated significantly higher rates of sudden gains in samples with a principal depressive disorder diagnosis, compared to a principal anxiety disorder diagnosis. Sudden gains may therefore be driven by depression, but only at the more severe level.
Sudden Gains in Internet-Based Cognitive Behavior Therapy for Body Dysmorphic Disorder
2020, Behavior Therapy
Sudden gains have been associated with better short- and long-term treatment outcomes in a number of psychiatric disorders. However, no studies to date have evaluated sudden gains in body dysmorphic disorder (BDD). We used data from a previous randomized controlled trial evaluating the efficacy of an Internet-based cognitive-behavior treatment (CBT) for BDD. The sample consisted of 47 adults diagnosed with BDD. We compared the treatment outcomes of sudden gainers vs. gradual gainers (i.e., treatment responders with no sudden gains) and non-sudden gainers (i.e., gradual gainers plus nonresponders) at posttreatment and 3, 12, and 24 months after the end of the treatment. Twelve (25.5%) participants experienced a sudden gain. Compared to non-sudden gainers and to gradual gainers, sudden gainers showed significantly larger improvements on the Yale-Brown Obsessive-Compulsive Scale modified for BDD at posttreatment (g = 1.23 and g = .91, respectively), and at 3-month (g = 1.23 and g = 1.00, respectively), 12-month (g = 1.12 and g = .91, respectively), and 24-month follow-up (g = 1.11 and g = .97, respectively). This translated into higher rates of treatment responders and remitters in the sudden gainers across all time points. The occurrence of sudden gains in Internet-based CBT for BDD is associated with favorable short- and long-term treatment outcomes. This suggests that a sudden improvement during the treatment could be a marker of good prognosis, while non-sudden—including gradual—gainers are more likely to need continued support or booster sessions. Early identification of patients who are not progressing as expected and subsequent tailoring of the delivered intervention has the potential to improve treatment outcomes in this group.
A meta-analysis of sudden gains in psychotherapy: Outcome and moderators
2020, Clinical Psychology Review
Sudden gains have been shown to be a common phenomenon and an important predictor of outcome in psychotherapy (Tang & DeRubeis, 1999). The present meta-analysis examined the growing literature on sudden gains in psychotherapy, their effects on outcome, and moderators of these effects. We searched PsycINFO, PubMed, ProQuest Dissertations & Theses, Scholar and Web of Science databases for articles between January 1st 1999 and May 31st 2019 and included 50 studies (n = 6355) in the meta-analysis. Sudden gains were found to significantly predict outcome at post-treatment (g = 0.68) and follow up (g = 0.61) above and beyond treatments, disorders and settings. Studies using Tang and DeRubies's (1999) criteria for identification of sudden gains had smaller effect sizes compared to studies using altered criteria. Pretreatment severity levels did not significantly predict the effects of sudden gains and neither did treatment setting (randomized controlled trials vs. naturalistic settings). Finally, number of sessions and sudden gains' reversal rates were both negatively associated with the effect sizes of sudden gains. These findings suggest that sudden gains are a ubiquitous phenomenon in psychotherapy but their effects may be moderated by a number of factors. Research and clinical implications are discussed.
Do sudden gains predict treatment outcome in social anxiety disorder? Findings from two randomized controlled trials
2019, Behaviour Research and Therapy
Sudden gains (SGs) have been found to occur during randomized controlled trials (RCTs) for social anxiety disorder (SAD). Evidence is mixed whether SGs relate to treatment outcome in SAD. We examined SGs in two RCTs for SAD.
Study 1 (N = 68) examined SGs in individual cognitive-behavioral therapy (CBT), and Study 2 (N = 100) compared SGs in group CBT and Mindfulness-Based Stress Reduction (MBSR). Weekly ratings of social anxiety were used to calculate SGs. The Liebowitz Social Anxiety Scale-Self-Report and the Social Interaction Anxiety Scale were completed at pretreatment, posttreatment, and follow-up to assess outcome.
In Study 1, 17.6% of participants experienced a SG. Participants with SGs started and ended treatment with lower social anxiety. SGs were not associated with greater decreases in social anxiety from pre-to posttreatment or 12-month follow-up. In Study 2, SGs occurred in 27% of participants and at comparable rates in MBSR and group CBT. SGs were not associated with changes in social anxiety during treatment in either condition.
SGs occurred during treatment for SAD. In both RCTs, participants improved regardless of experiencing a SG, suggesting that SGs are not predictive of greater improvement during treatment for SAD.
Sudden gains in cognitive behavioral therapy among children and adolescents with obsessive compulsive disorder
2019, Journal of Behavior Therapy and Experimental Psychiatry
This study examined the occurrence of sudden gains (or reversal of gains) among children with obsessive-compulsive disorder (OCD) during the course of cognitive-behavioral therapy (CBT), as well as the association of sudden gains with treatment response, treatment group, and pre-treatment clinical characteristics.
The sample consisted of 136 youth (ages 7–17) with a primary diagnosis of OCD who were randomized in a double-blinded fashion to 10 sessions of CBT with augmentation of either d-cycloserine or placebo. Sudden gain status was determined based on clinician-rated obsessive-compulsive symptom severity, which was collected on 9 occasions across the study period.
42.6% of youth experienced at least one sudden gain, which tended to occur either after starting exposure and response prevention or towards the end of treatment. After applying the Benjamini-Hochberg procedure for multiple comparisons, there were no significant pre-treatment predictors of sudden gains and only reduced insight predicted the reversal of gains. Individuals with at least one sudden gain had improved overall treatment outcomes, measured both by reduction in OCD symptom severity, and by global illness severity.
Several clinical constructs were not examined. Symptomatology was not assessed at every treatment session. Differences in those who achieved sudden gains and those who did not may be obscured. There is the possibility that a sudden gain reflected a scoring error generated by an optimistic or inaccurate report. Finally, a relatively homogenous sample may limit the generalizability of results.
The course of CBT for pediatric OCD is variable with many children experiencing sudden gains, but a sizable percentage experience a reversal of gains which was related to reduced insight. Sudden gains tended to occur after starting exposure and response prevention and towards the end of treatment.
ClinicaltrialsgovRegistry:NCT00864123. https://www.clinicaltrials.gov/ct2/show/NCT00864123.
Long-term stability of early sudden gains in an acceptance and values-based intervention
2019, Journal of Contextual Behavioral Science
Though previous research has extensively reported that sudden gains are associated with superior treatment results, research on the long-term effects and stability of sudden gains is not as consistent. The current study explored the long-term stability of early sudden gains (ESGs) observed in a brief acceptance and values-based intervention for depression provided by novice therapists. The participants were 56 volunteers diagnosed with major depressive disorder. Among the participants, 23% experienced ESGs, i.e. they reached the status of improved or recovered in the Reliable Change Index (RCI; Jacobson & Truax, 1991) classification after only two sessions. The current study examined the level of depressive symptoms (BDI-II), psychological flexibility (AAQ-II), believability of depressive thoughts (ATQ-B), and hopefulness (ASHS) 6 and 12 months after the intervention. Of the original participants, 77% (n = 43) took part in the 12-month follow-up. The results showed that positive changes achieved during the two first sessions in the ESG group were maintained up to 12 months after the intervention. The ESG group remained improved or recovered in the RCI classification through the 12-month follow-up period. However, at the 12-month follow-up, there were only small differences between the ESG and the non-ESG groups. The results suggest that participants achieving ESGs show stable improvements lasting up to 12 months after the treatment.

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^☆: This research was supported by an NIMH R03 PA-03-039 grant to Bethany Teachman.

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Shorter communicationSudden gains in group cognitive-behavioral therapy for panic disorder☆

Abstract

Section snippets

Participants

Sample characteristics and comparison of groups at baseline

Discussion

Behavior Therapy

Behavior Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Mastery of our anxiety and panic-II

Beck Depression Inventory—II manual

Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study

American Journal of Psychiatry

Cognitive therapy of anxiety disorders

Journal of Consulting and Clinical Psychology

Misinterpretation of body sensations in panic disorder

Journal of Consulting and Clinical Psychology

Shorter communication
Sudden gains in group cognitive-behavioral therapy for panic disorder☆