Sudden Gains in Cognitive Therapy for Depression: A Replication and Extension.

Hardy, Gillian E.; Cahill, Jane; Stiles, William B.; Ispan, Caroline; Macaskill, Norman D.; Barkham, Michael

doi:10.1037/0022-006x.73.1.59

Cited by 122 publications

(210 citation statements)

References 32 publications

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Section: Discussionsupporting

confidence: 91%

“…In contrast, we observed no differences in outcome between individuals with and without sudden gains at the posttreatment or 6-month follow-up assessments. This finding is in line with some studies (Tang et al, 2002;Vittengl et al, 2005) but at odds with other reports (Gaynor et al, 2003;Hardy et al, 2005).It is interesting that we found that participants with sudden gains had higher levels of pretreatment social anxiety. Similarly, previous studies on sudden gains during the treatment for depression also observed higher levels of pretreatment symptomatology in individuals who later experienced sudden gains (e.g., Vittengl et al, 2005).…”

supporting

confidence: 91%

“…Predictions for long-term maintenance of gains, however, were mixed. Some studies showed better outcomes at follow-up for patients with sudden gains (Gaynor et al, 2003;Hardy et al, 2005;Stiles et al, 2003;Tang & DeRubeis, 1999b), whereas other studies found no differences at follow-up for patients with and without sudden gains (Tang et al, 2002;Vittengl et al, 2005). Vittengl et al (2005) reported that patients with sudden gains during acute treatment actually showed more depressive symptoms and negative failure attributions at follow-up than those who had not experienced sudden gains.…”

mentioning

confidence: 99%

“…In fact, when we used an LSAS cutoff score of 16, the sudden gains accounted for 63.57% (M = 23.59, SD = 10.45) of the total symptom reduction (M = 37.11, SD = 17.52), which is substantially higher than what has been reported in the sudden gains literature on depression. Therefore, we adopted the strategies by Hardy et al (2005) and Stiles et al (2003) for defining the cutoff score. comparisons with missing data points did not differ between the two groups (CBGT: 3 of 112 vs. EGT: 1 of 27), χ 2 (1) = 0.14, p = .71.…”

mentioning

confidence: 99%

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Sudden gains during therapy of social phobia.

Hofmann

Schulz

Meuret

et al. 2006

Journal of Consulting and Clinical Psychology

104

109

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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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Section: Discussionsupporting

confidence: 91%

supporting

confidence: 91%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Sudden gains during therapy of social phobia.

Hofmann

Schulz

Meuret

et al. 2006

Journal of Consulting and Clinical Psychology

104

109

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show abstract

“…However, others have had difficulty replicating this finding using alternate assessment methods in a CBT-oriented intervention (Kelly, Roberts & Ciesla, 2005). Further, as previously stated, sudden gains have been found to occur across several treatment modalities (Tang & DeRubeis, 1999b;Tang et al, 2002Tang et al, , 2005Stiles et al, 2005;Andrusyna et al, 2006) and among samples who are not receiving active treatment (Kelly et al, 2007;Vittengl et al 2003). This suggests that the precipitants and meaning of sudden gains in the remediation of depressive symptoms have yet to be fully understood.…”

Section: Introductionmentioning

confidence: 78%

Sudden gains in interpersonal psychotherapy for depression

Kelly

Cyranowski

Frank

2007

Behaviour Research and Therapy

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Sudden, precipitous improvements in depressive symptom severity have been identified as occurring among unipolar depressed individuals. These "sudden gains" have been associated with superior acute treatment outcome in several treatment modalities, including cognitive therapy. A better understanding of sudden gains may provide insight into the mechanisms of action in these and other psychotherapies. One efficacious therapy that has been overlooked in sudden gains research is interpersonal psychotherapy (IPT;Weissman et al. 2000). The present research examined the rates and concomitant features of sudden, precipitous improvements in depressive symptomotology among 185 women receiving IPT for recurrent depression. Sudden gains, defined using extant criteria for the Beck Depression Inventory, were assessed over 12 weeks of acute IPT treatment for depression and occurred for 33.5% of the sample. Sudden gains were not associated with diagnostic and demographic characteristics or with differential likelihood of achieving depression remission with IPT monotherapy during active treatment. Further, those with sudden gains were no more likely to maintain their recovery through maintenance treatment. The lack of impact of sudden gains on eventual outcome is discussed in terms of potentially disparate emphases and mechanisms of change between IPT and CBT.

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Sudden Gains

Tang

2015

The Encyclopedia of Clinical Psychology

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Psychotherapy theorists have long speculated on the existence of critical sessions. Sudden gains in cognitive therapy of depression were first investigated in order to identify such critical sessions. They are sudden and drastic symptom improvement experienced by patients in one between‐session interval. Since its introduction a little over 10 years ago, sudden gains have been investigated in cognitive therapy of depression as well as many other treatments of various disorders. This entry reviews the current state of sudden gains research and discusses its implications for psychotherapy research and practice.

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Sudden Gains in Cognitive Therapy for Depression: A Replication and Extension.

Cited by 122 publications

References 32 publications

Sudden gains during therapy of social phobia.

Sudden gains during therapy of social phobia.

Sudden gains in interpersonal psychotherapy for depression

Sudden Gains

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