Sudden gains and large intersession improvements in internet-based psychodynamic treatment (IPDT) for depressed adolescents

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 internetbased 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.

Sudden Gains in PTSD Symptoms and Social Functioning in Cognitive Processing Therapy for Post traumatic Stress Disorder

“…Following this study, Mechler et al (2020) Shalom and Aderka (2020) in their meta-analysis reported the average reversal rate to be 31.5%…”

“…This study also used more sophisticated analyses to examine symptom and functioning changes over time because MLM was used. MLM has only recently begun to be used in the SGs literature (e.g., Mechler et al, 2020;Wiedemann et al, 2020) and is a favourable statistical approach because it accounts for clustering effects as well as repeated measures over time.…”

“…The relation between early response and SGs in CPT is yet to be examined. The research on large intersession improvements (i.e., first two criteria of SGs) being more predictive of outcomes than SGs also calls into question the utility of the third SG criterion (Koffmann et al,2019;Mechler et al, 2020). Furthermore, comparing those with SGs to those without SGs as a whole may be deemed problematic as individuals who do not have SGs may not necessarily have experienced gradual change but could have either not improved or worsened, which would lower the average outcome of that group (König et al, 2014).…”

“…They also found that symptom variability occurring prior to the SG significantly predicted having SGs. Interestingly, symptom variability did not predict reversals of SGs (i.e., a loss of 50% of symptom improvement resulting from the SG) Mechler et al (2020). found that 41.2% of the patients with LIIs experienced a reversal before treatment ended, though they did not examine if any patients with SGs worsened prior to having the SG.…”

“…The study authors noted this could have been due to low power. These studies suggest large intersession improvements are significant predictors of outcome and call into question if the definition of SGs should be revised in future research Mechler et al (2020). suggested that their findings on LIIs relate to a study that examined the relation between SGs and symptom variability within patients.…”