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Helmich MA. The Duration-Adjusted Reliable Change Index: Defining Clinically Relevant Symptom Changes of Varying Durations. Assessment 2024; 31:1493-1507. [PMID: 38279795 PMCID: PMC11420589 DOI: 10.1177/10731911231221808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
The time period over which relevant symptoms shifts unfold is not uniform across individuals. This article proposes an adaptation of the Reliable Change Index (RCI) to detect symptom changes of varying durations in individual patients' time series: the Duration-Adjusted RCI (DARCI). The DARCI proportionally raises the RCI cut-off to account for its extension over additional time increments, resulting in different DARCI thresholds for different change durations. The method is illustrated with a simulation study of depressive symptom time series with varying degrees of discontinuity and overall mean change, and four empirical case examples from two clinical samples. The results suggest that the DARCI may be particularly useful for identifying symptom shifts that appear relatively abrupt, which can help indicate when a patient is showing significant improvement or deterioration. Its ease of use makes it suitable for application in clinical contexts and a promising method for exploring transitions in psychiatric populations.
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Affiliation(s)
- Marieke A Helmich
- Department of Psychology, University of Oslo, Oslo, Norway
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands
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Sarasso P, Tschacher W, Schoeller F, Francesetti G, Roubal J, Gecele M, Sacco K, Ronga I. Nature heals: An informational entropy account of self-organization and change in field psychotherapy. Phys Life Rev 2024; 51:64-84. [PMID: 39299158 DOI: 10.1016/j.plrev.2024.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Accepted: 09/04/2024] [Indexed: 09/22/2024]
Abstract
This paper reviews biophysical models of psychotherapeutic change based on synergetics and the free energy principle. These models suggest that introducing sensory surprise into the patient-therapist system can lead to self-organization and the formation of new attractor states, disrupting entrenched patterns of thoughts, emotions, and behaviours. We propose that the therapist can facilitate this process by cultivating epistemic trust and modulating embodied attention to allow surprising affective states to enter shared awareness. Transient increases in free energy enable the update of generative models, expanding the range of experiences available within the patient-therapist phenomenal field. We hypothesize that patterns of disorganization at behavioural and physiological levels, indexed by increased entropy, complexity, and lower determinism, are key markers and predictors of psychotherapeutic gains. Future research should investigate how the therapist's openness to novelty shapes therapeutic outcomes.
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Affiliation(s)
- Pietro Sarasso
- Brain Plasticity and Behaviour Changes Research Group, Department of Psychology, University of Turin, Turin, Italy.
| | - Wolfgang Tschacher
- Department of Experimental Psychology, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Felix Schoeller
- Institute for Advanced Consciousness Studies, Santa Monica, CA, United States; Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Gianni Francesetti
- International Institute for Gestalt Therapy and Psychopathology, Turin, Italy
| | - Jan Roubal
- Gestalt Studia, Training in Psychotherapy Integration, Center for Psychotherapy Research in Brno, Masaryk University, Brno, Czechia
| | - Michela Gecele
- International Institute for Gestalt Therapy and Psychopathology, Turin, Italy
| | - Katiuscia Sacco
- Brain Plasticity and Behaviour Changes Research Group, Department of Psychology, University of Turin, Turin, Italy
| | - Irene Ronga
- Brain Plasticity and Behaviour Changes Research Group, Department of Psychology, University of Turin, Turin, Italy
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3
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Lee R, McMillan D, Delgadillo J, Alexander R, Lucock M. Cognitive change before sudden gains in cognitive behavioural therapy for panic disorder. Behav Cogn Psychother 2024; 52:107-118. [PMID: 37821240 DOI: 10.1017/s1352465823000449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND Sudden gains occur in a range of disorders and treatments and are of clinical and theoretical significance if they can shed light on therapeutic change processes. This study investigated the relationship between sudden gains in panic symptoms and preceding cognitive change during cognitive behavioural therapy (CBT) for panic disorder. METHOD Participants with panic disorder completed in session measures of panic symptoms and catastrophic cognitions. Independent samples t-tests were used to compare the post-treatment score of those who met criteria for one or more sudden gain during treatment with those who did not, and to compare within-session cognitive change between pre-sudden gain sessions and the previous (control) session. RESULTS Twenty-two (42%) of 53 participants experienced a sudden gain during treatment. Participants demonstrating a sudden gain showed more improvement in panic symptoms from pre- to post-treatment than those without a sudden gain. The within-session cognitive change score in the pre-gain session was significantly greater than in the control session. CONCLUSIONS Sudden gains occurred in individual CBT for panic disorder and within-session cognitive change was associated with sudden gains. This is consistent with the cognitive model of panic disorder and highlights how sudden gains can help to identify key change processes.
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Affiliation(s)
- Rachel Lee
- South West Yorkshire Partnership NHS Foundation Trust, Fieldhead, Wakefield, UK
| | - Dean McMillan
- Hull York Medical School and Department of Health Sciences, Mental Health and Addiction Research Group, University of York, Heslington, York, UK
| | - Jaime Delgadillo
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Rachael Alexander
- South West Yorkshire Partnership NHS Foundation Trust, Fieldhead, Wakefield, UK
| | - Mike Lucock
- University of Huddersfield, Huddersfield, UK
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Compère L, Siegle GJ, Riley E, Lazzaro S, Strege M, Pacoe E, Canovali G, Barb S, Huppert T, Young K. Enhanced efficacy of CBT following augmentation with amygdala rtfMRI neurofeedback in depression. J Affect Disord 2023; 339:495-501. [PMID: 37459978 PMCID: PMC10530481 DOI: 10.1016/j.jad.2023.07.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/23/2023] [Accepted: 07/14/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Despite cognitive behavioral therapy (CBT) being a standard treatment in major depressive disorder (MDD), nearly half of patients do not respond. As one of the predictors of CBT's efficacy is amygdala reactivity to positive information, which is often decreased in MDD, we explored whether real-time fMRI neurofeedback (rtfMRI-nf) training to increase amygdala responses during positive memory recall prior CBT would enhance its efficacy. METHODS In a double-blind, placebo controlled, randomized clinical trial, 35 adults with MDD received two sessions of rtfMRI-nf training to increase their amygdala (experimental group, n = 16) or parietal (control group, n = 19) responses during positive memory neurofeedback prior to receiving 10 CBT sessions. Depressive symptomatology was monitored between the rtfMRI sessions, the first three, 9th and 10th sessions of CBT and at 6 months and 1 year follow-up. RESULTS Participants in the experimental group showed decreased depressive symptomatology and higher remission rates at 6 months and 1 year follow-up than the control group. Analysis of CBT content highlighted that participants in the experimental group focused more on positive thinking and behaviors than the control group. LIMITATIONS The study was relatively small and not sufficiently powered to detect small effects. CONCLUSIONS CBT, when combined with amygdala neurofeedback, results in sustained clinical changes and leads to long-lasting clinical improvement, potentially by increasing focus on positive memories and cognitions.
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Affiliation(s)
- Laurie Compère
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
| | - Greg J Siegle
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
| | - Emily Riley
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
| | - Sair Lazzaro
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
| | - Marlene Strege
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
| | - Elizabeth Pacoe
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
| | - Gia Canovali
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
| | - Scott Barb
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
| | - Theodore Huppert
- Department of Radiology and Bioengineering, University of Pittsburgh, 300 Technology Dr, Pittsburgh, PA 15213, USA
| | - Kymberly Young
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
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Brockmeyer T, Titzmann M, Zipfel S, Wild B, Resmark G, Teufel M, Giel K, de Zwaan M, Dinkel A, Herpertz S, Burgmer M, Löwe B, Tagay S, Rothermund E, Zeeck A, Herzog W, Friederich HC. The role of general change mechanisms in sudden gains in the treatment of anorexia nervosa. Behav Res Ther 2023; 163:104285. [PMID: 36913844 DOI: 10.1016/j.brat.2023.104285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/17/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023]
Abstract
Previous research has shown a robust association between sudden gains (SGs) and treatment outcome in psychotherapy for various mental disorders including anorexia nervosa (AN). However, little is known about factors contributing to SGs. This study investigated the role of general change mechanisms in body-weight related SGs in AN. Data were drawn from a randomized-controlled trial on cognitive-behavioral therapy (CBT) and focal psychodynamic therapy (FPT) for adult outpatients with AN. Session-level data on the general change mechanisms 'clarification' (insight), 'mastery' (coping), and 'therapeutic relationship' were analyzed. Pre-gain sessions were compared with control (pre-pre-gain) sessions in 99 patients with a SG in body weight. Additionally, propensity score matching was used to compare data from pre-gain sessions from 44 patients with SG and data from the corresponding session from 44 patients without SG. In the pre-gain session, patients experienced higher levels of clarification and mastery but not therapeutic relationship. Compared to patients without a SG, patients with a SG likewise experienced more clarification and mastery but not a better therapeutic relationship in the pre-gain/corresponding session. CBT and FPT did not differ regarding these effects. The findings suggest that general change mechanisms contribute to SGs in CBT and FPT for AN.
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Affiliation(s)
- Timo Brockmeyer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Goettingen, Goettingen, Germany; Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany.
| | - Marieke Titzmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Goettingen, Goettingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Beate Wild
- Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Gaby Resmark
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR University Hospital, Essen, Germany
| | - Katrin Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stephan Herpertz
- Department for Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-University of Bochum, Bochum, Germany
| | - Markus Burgmer
- Department of Psychosomatic Medicine and Psychotherapy, LWL-Hospital and University Hospital Muenster, Muenster, Germany
| | - Bernd Löwe
- Institute and Outpatients Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Sefik Tagay
- Faculty of Social Sciences, TH Köln-University of Applied Sciences, Köln, Germany
| | - Eva Rothermund
- Ulm University Medical Center, Department of Psychosomatic Medicine and Psychotherapy, Ulm, Germany
| | - Almut Zeeck
- Department of Psychosomatic Medicine and Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Wolfgang Herzog
- Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
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de Felice G, Giuliani A, Pincus D, Scozzari A, Berardi V, Kratzer L, Aichhorn W, Schöller H, Viol K, Schiepek G. Stability and flexibility in psychotherapy process predict outcome. Acta Psychol (Amst) 2022; 227:103604. [PMID: 35537234 DOI: 10.1016/j.actpsy.2022.103604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/23/2022] [Accepted: 04/26/2022] [Indexed: 11/01/2022] Open
Abstract
Ten good outcome and ten poor outcome psychotherapy cases were compared to investigate whether or not the temporal stability and flexibility of their process variables can predict their outcomes. Each participant was monitored daily using the Therapy Process Questionnaire (TPQ), which has 43 items and seven sub-scales, and responses over time were analyzed in terms of correlation robustness and correlation variability across the TPQ sub-scales. "Correlation robustness" and "correlation variability" are two basic characteristics of any correlation matrix: the first is calculated as the sum of the absolute values of Pearson correlation coefficients, the second as the standard deviation of Pearson correlation coefficients. The results demonstrated that the patients within the poor outcome group had lower values on both variables, suggesting lower stability and flexibility. Furthermore, a higher number of cycles of increase and decrease in correlation robustness and variability of the TPQ sub-scales was observed within good outcome psychotherapies, suggesting that, these cycles can be considered as process-markers of good-outcomes. These results provide support for the validity of these quantitative process-parameters, correlation robustness and variability, in predicting psychotherapeutic outcomes. Moreover, the results lend support to the common clinical experience of alternating periods of flexibility and integration being beneficial to good psychotherapeutic processes.
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Kwan B, Rickwood DJ. A routine outcome measure for youth mental health: Clinically interpreting MyLifeTracker. Early Interv Psychiatry 2021; 15:807-817. [PMID: 32662215 PMCID: PMC8359251 DOI: 10.1111/eip.13016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/04/2020] [Accepted: 06/24/2020] [Indexed: 12/22/2022]
Abstract
AIM MyLifeTracker is a session-by-session mental health outcome measure for young people aged 12 to 25 years. The aim of this study was to determine clinically significant change indexes for this measure that would identify developmentally appropriate thresholds. The study also aimed to determine expected change trajectories to enable clinicians to compare a client's progress against average rates of change. METHODS Participants comprised young people aged 12 to 25 years from both a clinical and a community sample from Australia. The clinical sample was 63 840 young people that attended a headspace centre. The non-clinical group was an Australian representative community sample of 4034 young people. RESULTS Clinically significant change indexes were developed for MyLifeTracker specific for age and gender groups by comparing clinical and non-clinical samples. Males and young people aged 12 to 14 years needed to reach higher scores to achieve clinically significant change compared to females and other age groups, respectively. MyLifeTracker expected change trajectories followed a cubic pattern for those with lower baseline scores of 0 to 50, whereas those with baseline scores of 51 and above had varying patterns. For those with lower baseline scores, expected change trajectories showed that stronger change was evident early in treatment, which then tapered off before accelerating again later in treatment. CONCLUSIONS The development of MyLifeTracker benchmarks allows the measure to be used for Feedback Informed Treatment by supporting treatment planning and decision-making. This information can help clinicians to identify clients who are not on track or deteriorating and identify when clients are improving.
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Affiliation(s)
- Benjamin Kwan
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Debra J Rickwood
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia.,headspace National Youth Mental Health Foundation, Melbourne, Victoria, Australia
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Malkomsen A, Røssberg JI, Dammen T, Wilberg T, Løvgren A, Horgen Evensen J. The Synergistic Process of Improvement in Cognitive Behavioral Therapy for Major Depression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2292. [PMID: 33652563 PMCID: PMC7956317 DOI: 10.3390/ijerph18052292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is a substantial lack of qualitative research concerning individual cognitive behavioral therapy (CBT) for patients with major depressive disorder (MDD). In the present study, we wanted to explore how patients suffering from MDD experience improvement in CBT. METHOD Patients with MDD (N = 10) were interviewed at therapy termination with semi-structured qualitative interviews. The transcripts were analyzed using a thematic analysis approach. RESULTS We identified three elements that were relevant to the process of improvement for all patients: the therapeutic relationship, the therapeutic interventions and increased insight. There is a dynamic interrelationship and synergy between these elements that may explain why patients considered the same elements as helpful, but often in different ways and at different stages of therapy. CONCLUSIONS Highlighting the synergies and interrelationship between the elements that patients experience as helpful, may help therapists to learn from and utilize these experiences. This is a reminder of the importance of always being attentive to the individual processes of patients.
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Affiliation(s)
- Anders Malkomsen
- Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway; (J.I.R.); (T.W.); (A.L.)
| | - Jan Ivar Røssberg
- Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway; (J.I.R.); (T.W.); (A.L.)
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
| | - Toril Dammen
- Department of Behavioral Science in Medicine, Faculty of Medicine, University of Oslo, 0372 Oslo, Norway;
| | - Theresa Wilberg
- Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway; (J.I.R.); (T.W.); (A.L.)
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
| | - André Løvgren
- Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway; (J.I.R.); (T.W.); (A.L.)
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Mechler J, Lindqvist K, Falkenström F, Carlbring P, Andersson G, Philips B. Sudden gains and large intersession improvements in internet-based psychodynamic treatment (IPDT) for depressed adolescents. Psychother Res 2020; 31:455-467. [PMID: 32799772 DOI: 10.1080/10503307.2020.1804084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Objective: Sudden gains (SGs) have often been found associated with better treatment outcome across different psychiatric disorders. However, no studies have evaluated SGs in internet-based treatment targeting adolescent depression. Method: The sample consisted of 66 adolescents diagnosed with major depressive disorder, attending psychodynamic internet-based treatment. Effects of SGs were evaluated at posttreatment and 6-month follow-up. We also evaluated effects of large intersession improvements (LIIs; sudden and relatively large gains, between sessions, without the stability criterion). Effects of SGs and LIIs early in treatment were also investigated. Results: A total of 17 patients (25.75%) experienced an SG. The effect of having an SG or early SG was non-significant after treatment (d = 0.48) and at follow-up (d = 0.66). However, having an LII was related to better outcome after treatment (d = 0.97) and at follow-up (d = 0.76). Early LIIs were associated with significantly better results at end of treatment (d = 0.72). Conclusions: The original criteria of SGs might be overly conservative and thus miss important improvements in depression. Relatively large intersession gains, regardless of stability, seem to be predictive of outcome.
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Affiliation(s)
- Jakob Mechler
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Karin Lindqvist
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Fredrik Falkenström
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Björn Philips
- Department of Psychology, Stockholm University, Stockholm, Sweden
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Shalom JG, Aderka IM. A meta-analysis of sudden gains in psychotherapy: Outcome and moderators. Clin Psychol Rev 2020; 76:101827. [PMID: 32036232 DOI: 10.1016/j.cpr.2020.101827] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 10/25/2022]
Abstract
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.
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Affiliation(s)
- Jonathan G Shalom
- Department of Psychology, University of Haifa, Mount Carmel, Haifa 3498838, Israel
| | - Idan M Aderka
- Department of Psychology, University of Haifa, Mount Carmel, Haifa 3498838, Israel.
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11
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Do sudden gains predict treatment outcome in social anxiety disorder? Findings from two randomized controlled trials. Behav Res Ther 2019; 121:103453. [PMID: 31430688 DOI: 10.1016/j.brat.2019.103453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/22/2019] [Accepted: 08/09/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE 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. METHOD 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. RESULTS 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. CONCLUSION 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.
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Donald IN, Carey TA, Rickwood DJ. Therapeutic change in young people-A qualitative investigation of client and therapist perspectives. COUNSELLING & PSYCHOTHERAPY RESEARCH 2018. [DOI: 10.1002/capr.12191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ian N. Donald
- Faculty of Health; University of Canberra; Canberra ACT Australia
| | - Timothy A. Carey
- Centre for Remote Health; Flinders University; Alice Springs NT Australia
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Marsden Z, Teahan A, Lovell K, Blore D, Delgadillo J. Patients' experiences of cognitive behavioural therapy and eye movement desensitisation and reprocessing as treatments for obsessive‐compulsive disorder. COUNSELLING & PSYCHOTHERAPY RESEARCH 2018. [DOI: 10.1002/capr.12159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Zoe Marsden
- Leeds Community Healthcare NHS Trust Leeds UK
| | | | - Karina Lovell
- School of Nursing, Midwifery and Social Work Manchester Academic Health Science Centre University of Manchester Manchester UK
| | | | - Jaime Delgadillo
- Clinical Psychology Unit Department of Psychology University of Sheffield Sheffield UK
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Gastaud MB, Carvalho C, Fiorini GP, Ramires VRR. Psychodynamic Psychotherapy of a Child with Internalizing Symptoms: A Study of Outcomes. BRITISH JOURNAL OF PSYCHOTHERAPY 2017. [DOI: 10.1111/bjp.12303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Improving knowledge about the effectiveness of psychotherapy. PSYCHOTHERAPY AND POLITICS INTERNATIONAL 2017. [DOI: 10.1002/ppi.1424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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O'Mahen HA, Wilkinson E, Bagnall K, Richards DA, Swales A. Shape of change in internet based behavioral activation treatment for depression. Behav Res Ther 2017; 95:107-116. [PMID: 28618298 DOI: 10.1016/j.brat.2017.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 04/14/2017] [Accepted: 05/15/2017] [Indexed: 11/29/2022]
Abstract
Shape of change, sudden gains and depression spikes were examined in an online 12-session Behavioral Activation (BA) treatment for depression. Client and therapist factors related to sudden gains were examined to investigate processes associated with outcome. METHODS Participants were postpartum Women with Major Depressive Disorder (n=42) who received online BA supported in 30-minute telephone sessions by a mental health worker. Depression symptoms were assessed at each session and number of sessions completed were recorded by the online program. Therapist records were rated for client stressful life event and therapist concrete focus. A quadratic pattern provided the best fit with the data; a cubic pattern was a poor fit. Sudden gains, but not depression spikes, predicted lower depression scores at 17-week outcome. Women who had higher baseline social functioning, did not experience a stressful life event during therapy, and completed more online modules, but not more telephone sessions, were more likely to have a sudden gain. A concrete therapist focus was associated with sudden gains. These results extend research on trajectories of change and sudden gains to an online BA treatment and to postpartum depression, and suggest important client and therapist factors associated with sudden gains.
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Affiliation(s)
- Heather A O'Mahen
- Mood Disorders Centre, University of Exeter, Washington Singer Building, Exeter EX4 4QG, UK.
| | | | - Kara Bagnall
- Mood Disorders Centre, University of Exeter, Washington Singer Building, Exeter EX4 4QG, UK.
| | - David A Richards
- University of Exeter Medical School, St. Lukes Campus, South Cloisters, Exeter EX1 2LU, UK.
| | - Amanda Swales
- Mood Disorders Centre, University of Exeter, Washington Singer Building, Exeter EX4 4QG, UK.
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Wucherpfennig F, Rubel JA, Hollon SD, Lutz W. Sudden gains in routine care cognitive behavioral therapy for depression: A replication with extensions. Behav Res Ther 2017; 89:24-32. [DOI: 10.1016/j.brat.2016.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 10/21/2016] [Accepted: 11/07/2016] [Indexed: 11/30/2022]
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Lambert MJ, Kleinstäuber M. Wenn sich Menschen ändern - Veränderungsprozesse in der Psychotherapie und ihre Beziehung zu spezifischen Therapietechniken und allgemeinen Wirkfaktoren. VERHALTENSTHERAPIE 2016. [DOI: 10.1159/000442372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Epstein K, Pruett MK, Cowan P, Cowan C, Pradhan L, Mah E, Pruett K. More than One Way to Get There: Pathways of Change in Coparenting Conflict after a Preventive Intervention. FAMILY PROCESS 2015; 54:610-618. [PMID: 25676082 DOI: 10.1111/famp.12138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study explored pathways of change in the levels of conflict couples experienced after Supporting Father Involvement, an evidence-based, prevention-oriented couples and parenting intervention that included a diverse low-income and working class group of participants. Pathways of change were examined for couples with baseline conflict scores that were initially low, medium, and high. The growth mixture model analysis found that the best-fitting model for change in couples' conflict was represented by three distinctly different change patterns. The intervention was most successful for High-Conflict couples. This finding contributes to a growing literature examining variations in how relationships change over time and the process of change, especially for couples in distress. This study supports further investigation into the impact and costs associated with universal interventions versus those that target specific groups of higher risk families.
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Affiliation(s)
- Kenneth Epstein
- Psychiatry, University of California San Francisco, San Francisco, CA
| | | | - Philip Cowan
- Psychology, University of California Berkeley, Berkeley, CA
| | - Carolyn Cowan
- Psychology, University of California Berkeley, Berkeley, CA
| | - Lisa Pradhan
- School for Social Work, Smith College, Northampton, MA
| | - Elisabeth Mah
- School for Social Work, Smith College, Northampton, MA
| | - Kyle Pruett
- School of Medicine, Yale University, New Haven, CT
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Karam EA, Ko MJ, Pinsof B, Mroczek D, Sprenkle D. The Multisystemic and Multilevel Investigation of the Expanded Therapeutic Alliance-Psychological Functioning Relationship in Individual Therapy. JOURNAL OF MARITAL AND FAMILY THERAPY 2015; 41:401-414. [PMID: 25378075 PMCID: PMC5441553 DOI: 10.1111/jmft.12094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The expanded therapeutic alliance, consisting of multiple interpersonal alliance relationships, is a common factor inherent to the practice of all systemic therapies. The following study has three specific aims: (a) Bring an expanded, multisystemic emphasis to the study of the therapeutic alliance in individual therapy; (b) Understand better the session-by-session relationship between alliance and psychological functioning, including distinguishing within-person from between-person variability by using multilevel modeling techniques; and (c) Explore the role of early attachment relationships and family-of-origin experiences in moderating the alliance-psychological functioning relationship. Instead of taking only one or two alliance measurements throughout treatment like in the majority of previous research, we measured both alliance and psychological functioning continuously at each session for 296 subjects.
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Affiliation(s)
| | | | - Bill Pinsof
- The Family Institute at Northwestern University
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Neue Ansätze zur Modellierung diskontinuierlicher Verläufe in der Psychotherapie. PSYCHOTHERAPEUT 2015. [DOI: 10.1007/s00278-015-0019-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Compare A, Tasca GA. The Rate and Shape of Change in Binge Eating Episodes and Weight: An Effectiveness Trial of Emotionally Focused Group Therapy for Binge-Eating Disorder. Clin Psychol Psychother 2014; 23:24-34. [DOI: 10.1002/cpp.1932] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 10/22/2014] [Accepted: 10/23/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Angelo Compare
- Human and Social Science; University of Bergamo and Human Factors and Technology in Healthcare Research Centre; Bergamo Italy
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Drapkin M, Epstein EE, McCrady B, Eddie D. Sudden gains among women receiving treatment for alcohol use disorders. ADDICTION RESEARCH & THEORY 2014; 23:273-279. [PMID: 33568968 PMCID: PMC7872146 DOI: 10.3109/16066359.2014.981809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Understanding the timing and types of change during treatment for mental health disorders is an important step toward elucidating possible mechanisms of behaviour change in response to therapeutic interventions, yet these issues have not been adequately addressed in the alcohol dependence treatment literature. The current study applied sudden gains (SGs) methodology, an approach originally developed in depression treatment studies, to a sample of women receiving treatment for alcohol use disorders. SGs are drastic improvements in symptoms that occur between two psychotherapy sessions and are hypothesised to be the result of what occurred in the first of those two sessions. SGs can happen at any time during the course of treatment, can happen more than once, and are individualised, as opposed to aggregated for a sample. For the current study, SGs were examined across three variables: percent drinking days (PDD), urge frequency (UF), and urge intensity (UI) in a sample of 102 women receiving either individual or couple cognitive-behavioural therapy for alcohol use disorders. Results indicated the presence of SGs; one-third of the sample experienced at least one SG in either alcohol use or urges to drink; the most common SGs were in frequency of urges to drink. SGs in urge frequency during treatment predicted better post-treatment drinking outcome.
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Affiliation(s)
- Michelle Drapkin
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Mental Health Services, Veterans Affairs Medical Center, Philadelphia, PA, USA
| | | | - Barbara McCrady
- Center on Alcholism, Sustance Use, and Addictions, University of New Mexico, Albuquerque, NM, USA
| | - David Eddie
- Center of Alcohol Studies, Rutgers University, Piscataway, NJ, USA
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Sudden gains in behavioural activation for depression. Behav Res Ther 2014; 60:34-8. [DOI: 10.1016/j.brat.2014.06.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 06/26/2014] [Accepted: 06/30/2014] [Indexed: 11/17/2022]
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Hedman E, Lekander M, Ljótsson B, Lindefors N, Rück C, Hofmann SG, Andersson E, Andersson G, Schulz SM. Sudden gains in internet-based cognitive behaviour therapy for severe health anxiety. Behav Res Ther 2014; 54:22-9. [PMID: 24468920 DOI: 10.1016/j.brat.2013.12.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 12/20/2013] [Accepted: 12/21/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE A sudden gain is defined as a large and stable individual improvement occurring between two consecutive treatment sessions. Sudden gains have been shown to predict better long-term improvement in several treatment studies, including cognitive behavioural therapy for depression and anxiety disorders, but have not been studied in the treatment of health anxiety or any form of internet-based cognitive behavioural therapy. The aim of this study was to investigate the role of sudden gains in internet-based cognitive behavioural therapy for severe health anxiety. METHOD We examined the occurrence and significance of sudden gains in measures of health anxiety in 81 participants receiving internet-based cognitive behavioural therapy. We compared patients with sudden gains, patients without sudden gains, and patients with gradual gains. RESULTS Thirteen participants (16%) experienced one sudden gain in health anxiety with individual sudden gains distributed across the treatment. As expected, patients with a sudden gain showed larger improvements than patients without a sudden gain at post-treatment (d = 1.04) and at one-year follow-up (d = 0.91) on measures of health anxiety. CONCLUSIONS Consistent with previous studies, sudden gains in internet-based cognitive behavioural therapy are associated with significantly larger and stable treatment effects up to one-year follow-up.
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Affiliation(s)
- Erik Hedman
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
| | - Mats Lekander
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
| | - Nils Lindefors
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
| | - Christian Rück
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
| | | | - Erik Andersson
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
| | - Gerhard Andersson
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden; Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden; Swedish Institute for Disability Research, Linköping University, Linköping, Sweden.
| | - Stefan M Schulz
- Department of Psychology I, University of Würzburg, Würzburg, Germany; Comprehensive Heart Failure Center, University of Würzburg, Germany.
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Lorenz TA, Pulverman CS, Meston CM. Sudden Gains During Patient-Directed Expressive Writing Treatment Predicts Depression Reduction in Women with History of Childhood Sexual Abuse: Results from a Randomized Clinical Trial. COGNITIVE THERAPY AND RESEARCH 2013; 37:690-696. [PMID: 25484475 PMCID: PMC4255975 DOI: 10.1007/s10608-012-9510-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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 therapist-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 depression 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.
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Affiliation(s)
- Tierney A. Lorenz
- Department of Psychology, University of Texas at Austin, 108 East Dean Keaton Street, Austin, TX 78712, USA
| | - Carey S. Pulverman
- Department of Psychology, University of Texas at Austin, 108 East Dean Keaton Street, Austin, TX 78712, USA
| | - Cindy M. Meston
- Department of Psychology, University of Texas at Austin, 108 East Dean Keaton Street, Austin, TX 78712, USA
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Jun JJ, Zoellner LA, Feeny NC. Sudden gains in prolonged exposure and sertraline for chronic PTSD. Depress Anxiety 2013; 30:607-13. [PMID: 23633445 PMCID: PMC3930488 DOI: 10.1002/da.22119] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 03/08/2013] [Accepted: 03/19/2013] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Sudden gains are significant, rapid improvements in symptoms, larger than typical between-session symptom reduction.([8]) Sudden gains in a large sample of individuals with posttraumatic stress disorder (PTSD) have not been studied, and only one study has looked at it in pharmacotherapy, but not in PTSD. In the present study, we examined the occurrence of sudden gains in psychotherapy, specifically prolonged exposure (PE), and pharmacotherapy, specifically sertraline, for chronic PTSD. METHOD Sudden gains in PTSD symptoms (PTSD symptom scale self-report([25]) ) were assessed in 200 individuals with PTSD during 10 weeks of PE or sertraline. RESULTS Individuals in both PE (42.2%) and sertraline (31%) exhibited sudden gains. Individuals in PE made more gains toward the end of treatment (7.2%) than sertraline (2%, OR = 3.82). However, individuals in sertraline made larger gains during early treatment (M = 18.35, SD = 8.15) than PE (M = 12.53, SD = 5.16, d = .85). Notably, those on sertraline were more likely to exhibit a reversal of sudden gains than those in PE (OR = .23). Pointing to clinical significance, the presence of a sudden gain was associated with better reduction in symptoms from pre- to posttreatment (β = -.49). CONCLUSIONS Individuals in both PE and sertraline experienced gains, though sertraline was associated with earlier large but reversible gains, and PE was associated with later gains. This differential pattern of discontinuous change highlights potential differential mechanism for these therapies and marks important transition points for further detailed analyses of change mechanisms.
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Thomas C, Persons JB. Sudden gains can occur in psychotherapy even when the pattern of change is gradual. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2013. [DOI: 10.1111/cpsp.12029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Deschênes SS, Dugas MJ. Sudden Gains in the Cognitive-Behavioral Treatment of Generalized Anxiety Disorder. COGNITIVE THERAPY AND RESEARCH 2012. [DOI: 10.1007/s10608-012-9504-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kearns MA, Athay MM, Riemer M. Measuring youths' perceptions of counseling impact: description, psychometric evaluation, and longitudinal examination of the Youth Counseling Impact Scale v.2. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2012; 39:104-17. [PMID: 22407563 DOI: 10.1007/s10488-012-0414-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The Youth Counseling Impact Scale (YCIS) is an empirically validated treatment progress measure that assesses youths' perceptions of the short term effectiveness of therapy. Since its initial publication, the original 10-item measure has been shortened to ease measurement burden and revised to include a question about a youth's insight into his or her strengths. The current study describes the development of the revised YCIS (v.2) and evaluates its psychometric properties. Additionally, this study examines whether the YCIS (v.2) total score or subscale scores change over time and investigates whether there are gender or age differences for youths' perceptions of the impact of therapy. Results found the revised version obtained comparable information to that of the original measure, and that the revised version retained the factor structure of the original model with one primary general factor of Counseling Impact and two secondary factors (Insight and Change). Results also suggested that while the YCIS (v.2) total score and Change subscale score did not change linearly over the course of treatment, the Insight subscale score showed a small but significant linear increase over time. No significant differences in YCIS scores based on youth age or gender were found. The implication of these findings, the clinical and empirical utility of this measure, and its limitations are discussed.
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Affiliation(s)
- Marcia A Kearns
- Department of Psychological Sciences, University of Missouri, Columbia, 65211-2500, USA.
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Flückiger C, Grosse Holtforth M, Znoj HJ, Caspar F, Wampold BE. Is the relation between early post-session reports and treatment outcome an epiphenomenon of intake distress and early response? A multi-predictor analysis in outpatient psychotherapy. Psychother Res 2012; 23:1-13. [PMID: 22708616 DOI: 10.1080/10503307.2012.693773] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
The early phase of psychotherapy has been regarded as a sensitive period in the unfolding of psychotherapy leading to positive outcomes. However, there is disagreement about the degree to which early (especially relationship-related) session experiences predict outcome over and above initial levels of distress and early response to treatment. The goal of the present study was to simultaneously examine outcome at post treatment as a function of (a) intake symptom and interpersonal distress as well as early change in well-being and symptoms, (b) the patient's early session-experiences, (c) the therapist's early session-experiences/interventions, and (d) their interactions. The data of 430 psychotherapy completers treated by 151 therapists were analyzed using hierarchical linear models. Results indicate that early positive intra- and interpersonal session experiences as reported by patients and therapists after the sessions explained 58% of variance of a composite outcome measure, taking intake distress and early response into account. All predictors (other than problem-activating therapists' interventions) contributed to later treatment outcomes if entered as single predictors. However, the multi-predictor analyses indicated that interpersonal distress at intake as well as the early interpersonal session experiences by patients and therapists remained robust predictors of outcome. The findings underscore that early in therapy therapists (and their supervisors) need to understand and monitor multiple interconnected components simultaneously.
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Aderka IM, Anholt GE, van Balkom AJLM, Smit JH, Hermesh H, van Oppen P. Sudden gains in the treatment of obsessive-compulsive disorder. PSYCHOTHERAPY AND PSYCHOSOMATICS 2012; 81:44-51. [PMID: 22116471 DOI: 10.1159/000329995] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 06/10/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND The present study examined sudden gains during treatment for obsessive-compulsive disorder (OCD) and their relationship to short- and long-term outcome. METHODS Ninety-one individuals (age 19-64) completed either cognitive treatment, exposure treatment, or their combination with fluvoxamine for OCD. Participants' obsessive-compulsive symptoms were assessed before each weekly treatment session. In addition, obsessive-compulsive and depressive symptoms were assessed pre treatment and post treatment as well as 12 months following treatment termination. RESULTS Sudden gains were found among 34.1% of participants and constituted 65.5% of the total reduction in obsessive-compulsive symptoms. Compared to individuals who did not experience sudden gains, individuals who experienced sudden gains reported lower levels of OCD symptoms post treatment, and this was maintained during follow-up. CONCLUSIONS Sudden gains are common in treatments for OCD and are predictive of treatment outcome and follow-up. Sudden gains mark a distinct trajectory of response to treatment for OCD. Individuals with sudden gains greatly improve during treatment and maintain their gains during follow-up, whereas individuals without sudden gains improve to a significantly lesser extent. Thus, treatment planning and development can benefit from considering sudden gains and the intra-individual course of improvement.
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Affiliation(s)
- Idan M Aderka
- Department of Psychology, Boston University, Boston, Mass. 02215, USA.
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Hunnicutt-Ferguson K, Hoxha D, Gollan J. Exploring sudden gains in behavioral activation therapy for Major Depressive Disorder. Behav Res Ther 2012; 50:223-30. [PMID: 22336434 PMCID: PMC3299855 DOI: 10.1016/j.brat.2012.01.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 01/20/2012] [Accepted: 01/22/2012] [Indexed: 11/16/2022]
Abstract
Understanding the onset and course of sudden gains in treatment provides clinical information to the patient and clinician, and encourages clinicians to strive for these sudden clinical gains with their patients. This study characterizes the occurrence of sudden gains with Behavioral Activation (BA; Martell, Addis, & Jacobson, 2001), and the extent to which pre-treatment dysfunctional depressive thinking predicts sudden gains during treatment. We enrolled a sample of adults (n = 42) between ages 18-65 diagnosed with primary Major Depressive Disorder. All participants completed a 16-week course of BA, with clinical and self-report assessments at pre-, mid- and post-treatment. Results indicated that sudden gain and non-sudden gain participants showed differential improvement across treatment. No significant effects emerged for the dysfunctional cognitive style as a predictor of sudden gain status. Sudden gains may result from interaction of non-specific factors with the BA techniques implemented during early phases of therapy.
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Affiliation(s)
- Kallio Hunnicutt-Ferguson
- Northwestern University, Department of Psychiatry and Behavioral Sciences, Division of Psychology, 446 E. Ontario Street, Suite 7-302, Chicago, IL 60611, USA.
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Howerter A, Hollenstein T, Boon H, Niemeyer K, Brule D. State-space grid analysis: applications for clinical whole systems complementary and alternative medicine research. ACTA ACUST UNITED AC 2012; 19 Suppl 1:30-5. [PMID: 22327549 DOI: 10.1159/000335187] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This paper presents state space grids (SSGs) as a mathematically less intensive methodology for process-oriented research beyond traditional qualitative and quantitative approaches in whole systems of complementary and alternative medicine (WS-CAM). SSGs, originally applied in developmental psychology research, offer a logical, flexible, and accessible tool for capturing emergent changes in the temporal dynamics of patient behaviors, manifestations of resilience, and outcomes. The SSG method generates a two-dimensional visualization and quantification of the inter-relationships between variables on a moment-to-moment basis. SSGs can describe dyadic interactive behavior in real time and, followed longitudinally, allow evaluation of how change occurs over extended time periods. Practice theories of WS-CAM encompass the holistic health concept of whole-person outcomes, including nonlinear pathways to complex, multidimensional changes. Understanding how the patient as a living system arrives at these outcomes requires studying the process of healing, e.g., sudden abrupt worsening and/or improvements, 'healing crises', and 'unstuckness', from which the multiple inter-personal and intra-personal outcomes emerge. SSGs can document the indirect, emergent dynamic effects of interventions, transitional phases, and the mutual interaction of patient and environment that underlie the healing process. Two WS-CAM research exemplars are provided to demonstrate the feasibility of using SSGs in both dyadic and within-patient contexts, and to illustrate the possibilities for clinically relevant, process-focused hypotheses. This type of research has the potential to help clinicians select, modify and optimize treatment plans earlier in the course of care and produce more successful outcomes for more patients.
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Affiliation(s)
- Amy Howerter
- Department of Family and Community Medicine, The University of Arizona, Tucson, AZ 85719-5052, USA.
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Doss BD, Rowe LS, Carhart K, Madsen JW, Georgia EJ. Sudden gains in treatment-as-usual couple therapy for military veterans. Behav Ther 2011; 42:509-20. [PMID: 21658532 DOI: 10.1016/j.beth.2010.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Revised: 12/02/2010] [Accepted: 12/03/2010] [Indexed: 11/16/2022]
Abstract
Previous studies of couple therapy have conceptualized change as a gradual process. However, there is growing evidence that, for many clients, the majority of gains in other treatment modalities are often achieved between just 2 sessions. Isolating the frequency, nature, and predictors of these sudden gains (SGs) in couple therapy can add to a growing understanding of how and why couple therapy works. In a sample of 67 couples receiving treatment-as-usual couple therapy in two Veterans Affairs hospitals, 25% of individuals experienced a SG in relationship satisfaction. The magnitude of these SGs were large (d=1.62) and fully explained the total pre-post change for individuals who experienced them. Individuals with SGs showed significantly greater satisfaction gains during therapy; however SGs were not related to relationship satisfaction or relationship status at 18-month follow-up. SGs were predicted by the content of the previous session, putative change mechanisms of communication, intimacy, and behavior, as well as the partner's SGs during the same period. Results suggest that SGs are an important component of change during couple therapy for some individuals, challenging the assumption of continuous change in previous studies. In addition, predictors of SGs were generally consistent with theoretical and empirical examinations of mechanisms of change in couple therapy.
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Affiliation(s)
- Brian D Doss
- Department of Psychology, PO Box 248185, Coral Gables, FL 33124-0751, USA.
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Gumz A, Kästner D, Geyer M, Wutzler U, Villmann T, Brähler E. Instability and discontinuous change in the experience of therapeutic interaction: an extended single-case study of psychodynamic therapy processes. Psychother Res 2011; 20:398-412. [PMID: 20234974 DOI: 10.1080/10503300903551021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
The authors developed a concept that applies self-organization theory to psychodynamic principles. According to this concept, episodes of temporary destabilization represent a precondition for abrupt changes within the therapeutic process. The authors examined six courses of therapy (patients diagnosed with depression and personality disorder). After each therapy session, patients rated their experience of the therapeutic interaction. A measure of instability was used to identify episodes of destabilization with respect to patients' interaction experience throughout the process. Episodes of pronounced destabilization occurred in the four courses of therapy that showed better therapy outcomes. These episodes were characterized by temporary strong deteriorations in interaction experience (negative peaks). Three of the four courses showed subsequent discontinuous improvements to a higher level of interaction. Results indicate that the systematic inclusion of a measure of instability is worthwhile in investigations of discontinuous changes. This method allows the theoretical assumptions of the psychodynamic approach to be tested.
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Affiliation(s)
- Antje Gumz
- Department of Psychotherapy and Psychosomatic Medicine, University of Leipzig, Leipzig
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Peeters F, Berkhof J, Rottenberg J, Nicolson NA. Ambulatory emotional reactivity to negative daily life events predicts remission from major depressive disorder. Behav Res Ther 2010; 48:754-60. [PMID: 20537317 DOI: 10.1016/j.brat.2010.04.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Revised: 02/10/2010] [Accepted: 04/22/2010] [Indexed: 11/28/2022]
Abstract
Major depressive disorder (MDD) is often associated with altered emotional reactivity. However, the functional significance of altered emotional reactivity in MDD is uncertain. This study was the first to examine the predictive relationship between intensely sampled ambulatory emotional reactivity and the clinical course of MDD. Forty-six outpatients who met criteria for MDD underwent six days of experience sampling of their ambulatory reactivity to everyday negative and positive life events. After experience sampling, all outpatients received pharmacotherapy with supportive psychotherapy and were followed clinically for 18 months. At one month, less emotional reactivity to negative and positive daily events predicted higher depressive symptom severity. Importantly, patients who exhibited less negative emotional reactivity to daily negative life events were less likely to recover from MDD over the 18 month follow-up. Relationships between ambulatory emotional reactivity and MDD course were not accounted for by the duration or the severity of initial MDD symptoms. Diminished ambulatory emotional reactivity appears to be functionally significant in depression. Intensive sampling of ambulatory emotions may have utility for predicting the clinical course of MDD.
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Affiliation(s)
- Frenk Peeters
- Department of Psychiatry, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
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Doane LS, Feeny NC, Zoellner LA. A preliminary investigation of sudden gains in exposure therapy for PTSD. Behav Res Ther 2010; 48:555-60. [PMID: 20304385 DOI: 10.1016/j.brat.2010.02.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Revised: 02/11/2010] [Accepted: 02/12/2010] [Indexed: 11/24/2022]
Abstract
The purpose of the current study was to examine sudden gains in those receiving treatment for PTSD and whether these rapid changes were related to overall symptom reduction in a small sample of female assault survivors with PTSD undergoing prolonged exposure (PE) therapy. Sudden gains were found to occur in 52% of the sample. Among those who experienced a sudden gain, the average magnitude (12.4 points) accounted for 61% of overall symptom reduction. Importantly, treatment outcome was better for those who experienced sudden gains than those who did not. The experience of a sudden gain may result in patients becoming more fully engaged with treatment, and recognition of them may result in identifying potential process-related predictors of treatment response.
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Affiliation(s)
- Lisa Stines Doane
- Case Western Reserve University, Department of Psychology, 10900 Euclid Ave., Cleveland, OH 44145, USA.
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Hopko DR, Robertson SMC, Carvalho JP. Sudden gains in depressed cancer patients treated with behavioral activation therapy. Behav Ther 2009; 40:346-56. [PMID: 19892080 DOI: 10.1016/j.beth.2008.09.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Revised: 08/19/2008] [Accepted: 09/20/2008] [Indexed: 10/21/2022]
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.
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Affiliation(s)
- Derek R Hopko
- Department of Psychology, University of Tennessee, Knoxville, TN 37996, USA.
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Kelly KA, Rizvi SL, Monson CM, Resick PA. The impact of sudden gains in cognitive behavioral therapy for posttraumatic stress disorder. J Trauma Stress 2009; 22:287-93. [PMID: 19637322 PMCID: PMC2793672 DOI: 10.1002/jts.20427] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
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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Affiliation(s)
- Kacie A. Kelly
- Women’s Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA
| | - Shireen L. Rizvi
- Department of Psychology, New School for Social Research, New York, NY
| | - Candice M. Monson
- Women’s Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University, Boston, MA
| | - Patricia A. Resick
- Women’s Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, and Departments of Psychiatry and Psychology, Boston University, Boston, MA
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Neimeyer RA, Kazantzis N, Kassler DM, Baker KD, Fletcher R. Group cognitive behavioural therapy for depression outcomes predicted by willingness to engage in homework, compliance with homework, and cognitive restructuring skill acquisition. Cogn Behav Ther 2009; 37:199-215. [PMID: 18608311 DOI: 10.1080/16506070801981240] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
There is a need to understand the mechanism through which homework contributes to clinically meaningful change in therapy. Theoretically meaningful factors such as willingness to complete therapeutic assignments and cognitive skill acquisition have not been carefully studied in prior research. Depressed outpatients (N = 46) received cognitive behavioural group therapy for a 10-week period and were assigned relevant homework activities. Patient self-report and independent ratings of homework compliance were obtained on a session-by-session basis. Using path analysis, the authors found evidence that willingness to complete homework assignments and mastery of skill in cognitive restructuring helped account for the relationship between homework compliance and reduced symptom severity (R2 = .40). However, paths were only significant when patient self-report of homework compliance was used in the model. The present study highlights the problems in assessing homework compliance and in assuming that independent assessment of compliance is more accurate than patient self-report.
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Affiliation(s)
- Robert A Neimeyer
- Department of Psychology, The University of Memphis, Memphis, TN 38152, USA.
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Goodridge D, Hardy GE. Patterns of change in psychotherapy: An investigation of sudden gains in cognitive therapy using the assimilation model. Psychother Res 2009; 19:114-23. [PMID: 19058094 DOI: 10.1080/10503300802545611] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Clerkin EM, Teachman BA, Smith-Janik SB. Sudden gains in group cognitive-behavioral therapy for panic disorder. Behav Res Ther 2008; 46:1244-50. [PMID: 18804199 DOI: 10.1016/j.brat.2008.08.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Revised: 08/06/2008] [Accepted: 08/13/2008] [Indexed: 10/21/2022]
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.
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Affiliation(s)
- Elise M Clerkin
- University of Virginia, Charlottesville, VA 22904-4400, USA.
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Abstract
BACKGROUND Considerable progress has been made toward the development of evidence-based treatments for a wide range of psychological disorders; however, little is known about the mechanisms through which these treatments actually lead to clinical change. Although the use of traditional randomized controlled treatment designs and tests of statistical mediation have significantly advanced understanding of psychological treatments, they are insufficient to test mechanisms of change. METHOD This article outlines the conceptual and methodological requirements for evaluating mechanisms of change, highlights the importance of such a focus, and offers specific recommendations for research aimed at elucidating change mechanisms. RESULTS AND CONCLUSIONS Conceptualizing and conducting studies that test mechanisms of change requires substantial modifications to traditional research designs, but doing so will significantly enhance scientific understanding as well as the efficiency and effectiveness of clinical interventions.
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Affiliation(s)
- Matthew K Nock
- Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA 02138, USA.
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Abstract
BACKGROUND In addictions treatment research, there has been a relative paucity of work on mechanisms of action that account for observed treatment effects. In studies that have been done, there is little evidence that the purported active ingredients of behavioral interventions such as cognitive-behavioral treatment or motivational interviewing actually mediate treatment effects. This suggests that new approaches are needed to study the process of change in behavioral treatments for addiction. METHOD This article reviews several approaches that have been taken by psychotherapy researchers to identify mechanisms of change, including studies of critical sessions, change across sessions, and the relative importance of general vs. specific therapeutic factors. RESULTS These approaches all involve careful assessment of both therapist and patient behaviors during treatment sessions and study the relation of these factors to improvements or deteriorations in symptoms over the following weeks. CONCLUSIONS Suggestions are offered for how these methods could be used in addiction treatment research to generate hypotheses regarding mechanisms of change that could subsequently be tested in controlled studies.
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Affiliation(s)
- James R McKay
- University of Pennsylvania, Treatment Research Center, 3900 Chestnut Street, Philadelphia, PA 19104, USA.
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Lutz W, Tschitsaz A. Plötzliche Gewinne und Verluste im Behandlungsverlauf von Angststörungen, depressiven und komorbiden Störungen. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2007. [DOI: 10.1026/1616-3443.36.4.298] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: In der aktuellen Psychotherapieforschung wird die Identifikation und Vorhersage von individuellen sowie kontinuierlichen und diskontinuierlichen Therapieverläufen in Form plötzlicher Gewinne und Verluste immer bedeutsamer. Fragestellungen: Ziel der vorliegenden Studie ist die Identifikation von plötzlichen Gewinnen und Verlusten im Therapieverlauf sowie deren Vorhersagbarkeit und deren Zusammenhang zum Therapieerfolg. Zudem wird eine Erweiterung des Konzeptes der Gewinne in negative Richtung vorgenommen, um Verluste im Behandlungsverlauf zu identifizieren. Methode: In einer ambulanten Patientenstichprobe (N = 434) mit depressiven Patienten (n = 55), Angststörungspatienten (n = 115) und komorbid Angst- und depressiven Störungen (n = 225), wurden die Therapieverläufe hinsichtlich des Auftretens von Veränderungssprüngen sowie deren Zusammenhang zu dem Therapieergebnis untersucht. Resultate: In 26.27% der Patientenstichprobe traten Veränderungssprünge auf. Interessanterweise haben insbesondere Patienten, welche einen Gewinn und einen Verlust in ihrem Verlauf erleben, eine signifikant längere Therapiedauer sowie niedrigere Effektstärken auf der Symptomebene am Therapieende (BSI und BDI). Schlussfolgerung: In dieser Studie werden spezifische Vorgehensweisen zur Analyse von Therapieverläufen, der Identifikation fluktuierender oder negativer Behandlungsverläufe sowie deren Bedeutung für die patientenorientierte Forschung und der Evaluation von Behandlungsfortschritt aufgezeigt und diskutiert.
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Affiliation(s)
| | - Armita Tschitsaz
- Institut für Psychologie, Universität Trier, Institut für Psychologie, Universität Bern
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Lutz W, Bachmann F, Tschitsaz A, Smart DW, Lambert MJ. Zeitliche und sequenzielle Muster von nonlinearen Veränderungen im Therapieverlauf. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2007. [DOI: 10.1026/1616-3443.36.4.261] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Studien zu Sudden Gains bestätigten in hoher Übereinstimmung die prädiktive Validität jener Gains für das Therapieergebnis. Diese Gains wurden bisher in erster Linie als isoliertes, veränderungsinduzierendes Strukturmerkmal eines Therapieverlaufes betrachtet. Unter Routine-Praxisbedingungen fanden sich sehr starke Fluktuationen in den Symptomberichten und eine geringe Stabilität von Sudden Gains über den Therapieverlauf. Fragestellung: Diese Studie untersucht zeitliche und sequentielle Aspekte von substanziellen, nonlinearen Veränderungen in Therapieverläufen mit plötzlichen Gains und/oder Losses. Methode: Untersucht wurden 1640 Psychotherapiepatienten einer US-amerikanischen, universitären Ambulanz mit 5-75 unter Routinebedingungen stattfindenden Psychotherapiesitzungen. Resultate: Sudden Gains traten im Rahmen eines verstärkten Trends zu frühen, großen Verbesserungen auf und gingen mit einem positiven Therapieergebnis einher, insbesondere, wenn Sudden Gains vor der 5. Sitzung auftraten. Mit 11% ist der Anteil von Patienten mit Sudden Gains gering, zudem weisen diese Fälle starke Fluktuationen und eine Rückfallrate von 48% auf. Schlussfolgerung: Unter Routinepraxisbedingungen sind Sudden Gains als Bestandteil einer Reihe substanzieller, plötzlicher Veränderungen zu betrachten; wobei in diesen Therapieverläufen Verbesserungen überwiegen und gehäuft bereits in frühen Therapiephasen auftreten.
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Hofmann SG, Asmundson GJG. Acceptance and mindfulness-based therapy: new wave or old hat? Clin Psychol Rev 2007; 28:1-16. [PMID: 17904260 DOI: 10.1016/j.cpr.2007.09.003] [Citation(s) in RCA: 320] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2007] [Revised: 09/11/2007] [Accepted: 09/12/2007] [Indexed: 11/15/2022]
Abstract
Some contemporary theorists and clinicians champion acceptance and mindfulness-based interventions, such as Acceptance and Commitment Therapy (ACT), over cognitive-behavioral therapy (CBT) for the treatment of emotional disorders. The objective of this article is to juxtapose these two treatment approaches, synthesize, and clarify the differences between them. The two treatment modalities can be placed within a larger context of the emotion regulation literature. Accordingly, emotions can be regulated either by manipulating the evaluation of the external or internal emotion cues (antecedent-focused emotion regulation) or by manipulating the emotional responses (response-focused emotion regulation). CBT and ACT both encourage adaptive emotion regulation strategies but target different stages of the generative emotion process: CBT promotes adaptive antecedent-focused emotion regulation strategies, whereas acceptance strategies of ACT counteract maladaptive response-focused emotion regulation strategies, such as suppression. Although there are fundamental differences in the philosophical foundation, ACT techniques are fully compatible with CBT and may lead to improved interventions for some disorders. Areas of future treatment research are discussed.
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Affiliation(s)
- Stefan G Hofmann
- Department of Psychology, Boston University, 648 Beacon Street, 6th Floor, Boston, MA 02215-2002, United States.
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