Sudden gains during therapy of social phobia.

Abstract

The present study investigated the phenomenon of sudden gains in 107 participants with social phobia (social anxiety disorder) who received either cognitive-behavioral group therapy or exposure group therapy without explicit cognitive interventions, which primarily used public speaking situations as exposure tasks. Twenty-two out of 967 session-to-session intervals met criteria for sudden gains, which most frequently occurred in Session 5. Individuals with sudden gains showed similar improvements in the 2 treatment groups. Although cognitive-behavioral therapy was associated with more cognitive changes than exposure therapy, cognitive changes did not precede sudden gains. In general, the results of this study question the clinical significance of sudden gains in social phobia treatment.Keywords sudden gains; social anxiety disorder; social phobia; cognitive-behavioral therapy; exposure therapyIn recent years, psychotherapy researchers have investigated the phenomenon of large, rapid, and stable decreases in symptomatology during treatment, which has been referred to as sudden gains (Tang & DeRubeis, 1999b). Sudden gains are typically defined by a set of three quantitative criteria: (a) the sudden gain must be large in absolute terms, (b) the sudden gain must represent at least a 25% reduction from the level of symptomatology before the gain occurred, and (c) the mean level of symptomatology in the three therapy sessions preceding the gain must be significantly higher than the mean level of symptomatology in the three postgain sessions. Most studies of sudden gains have examined treatment changes in depression with the Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961; but see also Stiles et al., 2003;Vittengl, Clark, & Jarrett, 2005).When applying these criteria, Tang and DeRubeis (1999b) found that sudden gains occurred in more than 50% of individuals who responded to cognitive-behavioral therapy for depression and that these gains accounted for more than 50% of these individuals' total improvement in depression. Compared with participants who did not experience sudden gains at posttreatment, individuals with sudden gains showed better outcome at posttreatment and at 6-month and 18-month follow-ups.The initial study by Tang and DeRubeis (1999b) was followed by a number of other studies examining sudden gains (Gaynor et al., 2003;Hardy et al., 2005;Kelly, Roberts, & Ciesla, 2005;Tang, DeRubeis, Beberman, & Pham, 2005;Tang, Luborsky, & Andrusyna, 2002;Vittengl, Clark, & Jarrett, 2005). Interventions in these studies ranged from traditional cognitive therapy to supportive expressive therapy or pharmacotherapy. Although sudden gains were primarily assessed in efficacy trials of time-limited individual treatments (e.g., Tang NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript DeRubeis, 1999b;Vittengl et al., 2005), their incidence was also assessed in group therapy for depression (Kelly et al., 2005) and individuals with mixed psychiatric diagnoses who were g...

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Assessing Client Progress Session by Session in the Treatment of Social Anxiety Disorder: The Social Anxiety Session Change Index

“…For example, by examining frequent assessments during treatment for depression, Tang and DeRubeis (1999) found that change occurs in sudden gains rather than in a linear pattern. In contrast, Hofmann, Schulz, Meuret, Moscovitch, and Suvak (2006) found few sudden gains in the treatment of social anxiety disorder. Answering questions about the pattern and timing of change will also be of interest to the scientist-practitioner concerned with maximizing outcome and understanding the psychotherapeutic process.…”

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“…The percentage of sudden gains was 19% for social phobia (Hofmann, Schulz, Meuret, Moscovitch, & Suvak, 2006), 17% for a sample with various anxiety disorders (Norton, Klenck, & Barrera, 2010), 43% for panic disorder (Clerkin, Teachman, & Smith-Janik, 2008) 4 and 16% for clients with generalized anxiety disorder when all the clients seen at intake were included (Present et al, 2008). However, in this last study, with the sample restricted to those with a Beck Anxiety Inventory (BAI) score of 15 or greater at session one (which excluded more than half the original sample), the percent with sudden gains rose to 35%.…”