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

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.

Detecting Sudden Gains during Treatment of Major Depressive Disorder: Cautions from a Monte Carlo Analysis

“…In a review of the sudden gains literature and concept, we consider whether published rates of sudden gains substantively exceed Type I error rates from Monte Carlo simulations. We focus our review on studies of MDD, the disorder for which Tang and DeRubeis proposed sudden gains, because the extent to which patterns of sudden gains from episodic MDD generalize to other disorders with different courses (e.g., sexual disorders [6], social phobia [7]), although hypothesized, remains to be demonstrated.…”

Expressive writing as an intervention to decrease distress in pediatric critical care nurses

“…[28,39] The nurse may write about one experience, multiple experiences and in first person or third person at his own pace. [52] Approximately 20 minutes should be spent writing. If you find you have written everything, but still have time left, start writing from the beginning.…”

“…The control groups are instructed to focus on non-consequential events such as needs from the previous day. [28,52] Craft and colleagues used reflection/reframing as the theoretical model as the reason expressive writing is successful in a change in perspective. [41] Our minds may form narratives of events before we have had time to reflect on the experience and make take an inaccurate assessment of the experience.…”

“…[51] Expressive writing and reflection are similar, although reflection is focused on a "critical analysis" of the event, [54] whereas expressive writing concentrates more on a simpler recounting of the event. [55] The literature provides many examples of how participating in an expressive writing intervention may improve mental [41,50,52,56] and physical health. [28,39] A new perspective regarding the past event and ability to handle new stressful situations may occur because of the "cognitive change".…”

Mindfulness Intervention for Child Abuse Survivors: A 2.5-Year Follow-Up

“…Alternatively, others have sought to develop or test distinct treatments that might be particularly effective in addressing the range of symptoms experienced by victims of CSA. For example, Lorenz, Pulverman, and Meston () have shown that patient‐directed expressive writing about one's trauma can significantly and suddenly reduce symptoms of depression. Another approach has been to utilize so called “third wave” treatments, those that integrate mindfulness training with traditional CBT and behavioral principles, and have been shown to be efficacious in treating a broad range of clinical problems including mood and anxiety disorders, substance abuse disorders, and personality difficulties (Baer, ).…”