Sudden gains in interpersonal psychotherapy for depression

Kelly, Morgen A. R.; Cyranowski, Jill M.; Frank, Ellen

doi:10.1016/j.brat.2007.07.007

Cited by 42 publications

(50 citation statements)

References 24 publications

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“…In a role dispute that has reached an impasse, the patient may initially feel more distressed as she brings up long-suppressed feelings. In a brief (12–16) week acute therapy, in which many patients improve rapidly (Kelly, Cyranowski, & Frank, 2007), the window for detecting mediation effects is narrow.…”

Section: Summary and Future Directionsmentioning

confidence: 99%

Mechanisms of change in interpersonal therapy (IPT)

Lipsitz

Markowitz

2013

Clinical Psychology Review

155

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Although interpersonal therapy (IPT) has demonstrated efficacy for mood and other disorders, little is known about how IPT works. We present interpersonal change mechanisms that we hypothesize account for symptom change in IPT. IPT’s interpersonal model integrates both relational theory, building on work by Sullivan, Bowlby, and others, and insights based on research findings regarding stress, social support, and illness to highlight contextual factors thought to precipitate and maintain psychiatric disorders. IPT frames therapy around a central interpersonal problem in the patient’s life, a current crisis or relational predicament that is disrupting social support and increasing interpersonal stress. By mobilizing and working collaboratively with the patient to resolve (better manage or negotiate) this problem, IPT seeks to activate several interpersonal change mechanisms. These include: 1) enhancing social support, 2) decreasing interpersonal stress, 3) facilitating emotional processing, and 4) improving interpersonal skills. We hope that articulating these mechanisms will help therapists to formulate cases and better maintain focus within an IPT framework. We propose interpersonal mechanisms that might explain how IPT’s interpersonal focus leads to symptom change. Future work needs to specify and test candidate mediators in clinical trials of IPT. We anticipate that pursuing this more systematic strategy will lead to important refinements and improvements in IPT and enhance its application in a range of clinical populations.

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Section: Summary and Future Directionsmentioning

confidence: 99%

Mechanisms of change in interpersonal therapy (IPT)

Lipsitz

Markowitz

2013

Clinical Psychology Review

155

View full text Add to dashboard Cite

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“…[6,17]]. Alternatively, sudden gains may represent normal fluctuations in symptoms that are consolidated when active treatment is provided [8]. …”

Section: Discussionmentioning

confidence: 99%

“…A large body of research has examined sudden gains in various treatments for depression [2,3,4,5,6,7,8]. In all of these studies, sudden gains were significantly associated with post-treatment depression or with changes during treatment.…”

Section: Introductionmentioning

confidence: 99%

Sudden Gains in the Treatment of Obsessive-Compulsive Disorder

Aderka

Anholt

Balkom

et al. 2011

Psychother Psychosom

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Background: The present study examined sudden gains during treatment for obsessive-compulsive disorder (OCD) and their relationship to short- and long-term outcome. Methods: Ninety-one individuals (age 19–64) completed either cognitive treatment, exposure treatment, or their combination with fluvoxamine for OCD. Participants’ obsessive-compulsive symptoms were assessed before each weekly treatment session. In addition, obsessive-compulsive and depressive symptoms were assessed pre treatment and post treatment as well as 12 months following treatment termination. Results: Sudden gains were found among 34.1% of participants and constituted 65.5% of the total reduction in obsessive-compulsive symptoms. Compared to individuals who did not experience sudden gains, individuals who experienced sudden gains reported lower levels of OCD symptoms post treatment, and this was maintained during follow-up. Conclusions: Sudden gains are common in treatments for OCD and are predictive of treatment outcome and follow-up. Sudden gains mark a distinct trajectory of response to treatment for OCD. Individuals with sudden gains greatly improve during treatment and maintain their gains during follow-up, whereas individuals without sudden gains improve to a significantly lesser extent. Thus, treatment planning and development can benefit from considering sudden gains and the intra-individual course of improvement.

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“…Finally, very little work has been done to assess psychotherapy process variables, including how different intervention components may be more or less critical toward eliciting change in depressive affect. In a recent study with depressed cancer patients (Hopko, Robertson, & Carvalho, 2009) and consistent with the larger literature (Kelly, Cyranowski, & Frank, 2007;Mohr et al, 2005;Stiles et al, 2003;Tang, DeRubeis, Beberman, & Pham, 2005), it was discovered that 50% of cancer patients exhibit sudden gains (or improvements) during cognitive-behavioral therapy, and that three-quarters of these sudden gains occur during the first half of psychotherapy. This finding may be largely reflective of therapeutic alliance, psychoeducation, reduced reinforcement for depressed behavior, a structured value assessment, and self-initiated behavioral activation (Hopko et al, in press).…”

mentioning

confidence: 80%

“…As presented in Figure 1, both patients also were administered the BDI-II at each treatment session. To interpret these data, sudden gain criteria were used as established in prior research (Kelly et al, 2007;Tang & DeRubeis, 1999). Specifically, sudden gains were postulated to occur when a BDI-II score changed in absolute terms (i.e., decreased by a minimum of seven points from the previous session), represented at least a 25% reduction of the previous BDI-II score, and was substantial in relation to symptom fluctuations around the gain (i.e., significantly higher mean in the three pre-gain scores than in the three post-gain scores).…”

Section: Quantitative Treatment Outcome Datamentioning

confidence: 99%

The Impact of Cognitive Interventions in Treating Depressed Breast Cancer Patients

Hopko¹,

Colman²

2010

J Cogn Psychother

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In behavioral medicine, there is adequate support for behavior modification strategies in reducing depression and anxiety in medical patients. There is comparably less support for cognitive interventions with these patients. Treatment outcome studies with cancer patients generally support the efficacy of cognitive-behavioral interventions, but studies have significant methodological limitations. Additionally, cognitive-behavioral therapy for depression incorporates numerous treatment components, and when examining data with nomothetic statistics, important individual differences may go unrecognized. With reference to the sudden gain literature on significant session-by-session treatment gains, this paper highlights the cognitive-behavioral treatment of two breast cancer patients with clinical depression. In addition to positive treatment outcome in which depression was significantly reduced and quality of life and medical outcomes improved, session-based sudden change data suggest that for these cancer patients, cognitive interventions were most significant in accounting for treatment gains. Findings are reviewed in the context of mechanism of change issues in the cognitive-behavioral treatment of depression.

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Sudden gains in interpersonal psychotherapy for depression

Cited by 42 publications

References 24 publications

Mechanisms of change in interpersonal therapy (IPT)

Mechanisms of change in interpersonal therapy (IPT)

Sudden Gains in the Treatment of Obsessive-Compulsive Disorder

The Impact of Cognitive Interventions in Treating Depressed Breast Cancer Patients

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