Predicting sudden gains before treatment begins: An examination of pretreatment intraindividual variability in symptoms.

Abstract

Objective: Sudden gains during psychotherapy have been found to be predictive of positive treatment outcomes. Previous attempts at predicting occurrence of sudden gains have yielded equivocal findings. Recently, intraindividual variability in symptoms during treatment was suggested as a trans-therapeutic and trans-diagnostic predictor of sudden gains. The goal of the present study was to examine this predictor in Internet-delivered treatment for social anxiety disorder (SAD) and to examine whether this predictor predicts sudden gains when measured before treatment begins. Method: We examined data from a preregistered randomized controlled trial (RCT) of Internet-delivered cognitive-behavioral therapy (CBT) for SAD (n ϭ 101). We measured variability in symptoms both within-treatment and before treatment (i.e. during waitlist). Results: Intraindividual variability in symptoms significantly predicted sudden gains both when measured before treatment or within-treatment and correctly classified 84% and 83% of individuals to sudden gains versus non-sudden gains status, respectively. Conclusions: Intraindividual variability in symptoms can predict sudden gains in Internet-delivered treatment for SAD, thus supporting its trans-diagnostic and trans-therapeutic nature. Predicting sudden gains before treatment begins has implications for treatment planning and clinical decision making as well as for personalized tailoring of interventions. What is the public health significance of this article?This study demonstrates that sudden gains in psychotherapy can be predicted by symptom fluctuations measured before treatment. Such early prediction of sudden gains can facilitate personalizing and tailoring future interventions to individuals based on likelihood of sudden gains.

Swipe right, swipe left: Initial interactions in social anxiety disorder.

“…High inter-rater agreement for a diagnosis of SAD was found between the assessor in the present study and other assessors in a recent published study (Shalom et al, 2020; Kappa = 0.86).…”

“…High inter-rater agreement for a diagnosis of SAD was found between the assessor in the present study and other assessors in a recent published study(Shalom et al, 2020; Kappa = 0.86).3 Four participants indicated that they were attracted to individuals of the same sex and were thus shown pictures of same-sex individuals. However, data from these four participants are not included in the present analysis.4 ROZEN AND ADERKAThis document is copyrighted by the American Psychological Association or one of its allied publishers.…”

“…Second, participants were interviewed by a single assessor to assign diagnoses. The assessor was found to have high interrater agreement with other assessors in a recent study (Shalom et al, 2020). However, this remains a potential limitation of the present study.…”

Negative Emotion Differentiation Predicts Psychotherapy Outcome: Preliminary Findings

“…For these patients, their affect and symptomatology may be relatively malleable or plastic. Supporting this hypothesis, Shalom et al (2020) found that variability in social anxiety symptoms (that include some affective items) before psychotherapy is predictive of sudden gains during the treatment.…”

“…Though single-time clinician assessment is still considered the gold standard in psychotherapy practice and research, pre-treatment ecological momentary assessment (EMA) is increasingly being employed to assess clinically relevant factors (e.g., Lutz et al, 2018 ; Rubel et al, 2018 ; Fisher et al, 2019 ; Shalom et al, 2020 ). It allows for intensive repeated measurement of variables of interest and modeling their dynamic inter-relationships (e.g., Fisher and Boswell, 2016 ).…”