Sudden Gains in the Treatment of Obsessive-Compulsive Disorder

Aderka, Idan M.; Anholt, Gideon E.; Balkom, A.J.L.M. van; Smit, Johannes H.; Hermesh, Haggai; Oppen, P.C. van

doi:10.1159/000329995

Cited by 38 publications

(34 citation statements)

References 82 publications

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“…These studies reported that 34–52% of individuals experienced SGs. The between group effect size at post-treatment (SG vs. no SG) of d = 1.04 in the present study is in the same range as in the mean d of 0.75 across CBT studies found in the meta-analysis (Aderka et al, 2012a). …”

Section: Discussionsupporting

confidence: 82%

“…Aside from CBT for depression, SGs have also been shown to be a common feature in CBT for social anxiety disorder (Hofmann, Schulz, Meuret, Moscovitch, & Suvak, 2006), panic disorder (Clerkin, Teachman, & Smith-Janik, 2008), generalized anxiety disorder (Present et al, 2008), and obsessive-compulsive disorder (Aderka et al, 2012a). A recent meta-analytic review investigating the effect of SGs for depression and anxiety disorders showed that the between-group effect size of individuals with vs. without SG was moderate to large (Hedges’ g = 0.62) on primary outcomes (Aderka et al, 2012b).…”

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confidence: 99%

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Sudden gains in internet-based cognitive behaviour therapy for severe health anxiety

Hedman

Lekander

Ljótsson

et al. 2014

Behaviour Research and Therapy

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Objective A sudden gain is defined as a large and stable individual improvement occurring between two consecutive treatment sessions. Sudden gains have been shown to predict better long-term improvement in several treatment studies, including cognitive behavioural therapy for depression and anxiety disorders, but have not been studied in the treatment of health anxiety or any form of internet-based cognitive behavioural therapy. The aim of this study was to investigate the role of sudden gains in internet-based cognitive behavioural therapy for severe health anxiety. Method We examined the occurrence and significance of sudden gains in measures of health anxiety in 81 participants receiving internet-based cognitive behavioural therapy. We compared patients with sudden gains, patients without sudden gains, and patients with gradual gains. Results Thirteen participants (16%) experienced one sudden gain in health anxiety with individual sudden gains distributed across the treatment. As expected, patients with a sudden gain showed larger improvements than patients without a sudden gain at post-treatment (d = 1.04) and at one-year follow-up (d = 0.91) on measures of health anxiety. Conclusions Consistent with previous studies, sudden gains in internet-based cognitive behavioural therapy are associated with significantly larger and stable treatment effects up to one-year follow-up.

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Section: Discussionsupporting

confidence: 82%

mentioning

confidence: 99%

Sudden gains in internet-based cognitive behaviour therapy for severe health anxiety

Hedman

Lekander

Ljótsson

et al. 2014

Behaviour Research and Therapy

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“…7 Sudden gains predict superior end-oftreatment outcomes and long-term maintenance of gains. 7,8 While cognitive changes during the critical session appear to account for the sudden gains, the nature of these changes has not been fully explained, and no detailed reports of how therapists and patients experience these changes have been presented. Therefore, this case study discusses the nature of the cognitive changes that both the patient and therapist understood to occur during the critical session and that they believed contributed to the remission of major depressive disorder over a 2-year period.…”

Section: Case Presentationmentioning

confidence: 99%

“I Didn’t Know Cognitive Therapy Was Deep”

Warren

Burrow

Conroy³

et al. 2014

Journal of Psychiatric Practice

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"Sudden gains" is a robust phenomenon that has been found to occur among a variety of psychotherapies, clinical conditions, settings, patient populations, and differing levels of therapist expertise. Sudden gains predict superior end-of-treatment outcomes and long-term maintenance of gains. While cognitive changes during the critical session appear to account for the sudden gains, the nature of these changes has not been fully explained, and no detailed reports of how therapists and patients explain these changes have been presented. This case involved a 61-year-old woman with depression, fibromyalgia, and severe osteoarthritis who, after being in psychotherapy treatment for nearly a year, achieved sudden gains after one particular psychotherapy session. The authors discuss the nature of the cognitive changes that both the patient and therapist understood to occur during that critical session and that they believed contributed to the remission of major depressive disorder over a 2-year period. This case study also explores the possible synergistic effects of medications and cognitive interventions on sudden gains. The commentary on the case links this discussion of sudden gains to an intervention created by Viederman and Perry in the 1980s called the psychodynamic life narrative, which they found could sometimes alleviate symptoms rapidly and dramatically by reframing a person's self-image during a depressive crisis, especially one related to a feeling of despair triggered by medical illness. An increased understanding of the nature of interventions that produce cognitive changes leading to immediate, dramatic, and lasting improvement could potentially contribute to the development of more effective treatments for depression and other clinical conditions.

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“…Following research confirmed these results and showed that sudden gains are a frequent phenomenon among patients with different disorders like depression (Hardy et al, ; Lutz et al, ; Tang, DeRubeis, Beberman, & Pham, ), social anxiety disorder (Bohn, Aderka, Schreiber, Stangier, & Hofmann, ; Hofmann, Schulz, Meuret, Moscovitch, & Suvak, ), generalized anxiety disorder (Deschênes & Dugas, ), posttraumatic stress disorder (Aderka, Appelbaum‐Namdar, Shafran, & Gilboa‐Schechtman, ; Doane, Feeny, & Zoellner, ; Krüger et al, ), or obsessive‐compulsive disorder (Aderka, Nickerson, Bøe, & Hofmann, ). A meta‐analysis also showed that the occurrence of sudden gains within a therapy predicts significantly better outcomes at the end of therapy (Aderka et al, ).…”

Section: Introductionmentioning

confidence: 99%

An exploratory study of patients’ sudden losses during outpatient CBT and therapists’ experience of difficulties

et al. 2019

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Objective Patients’ sudden deterioration in symptomatology, also called sudden losses, is a rarely explored phenomenon. Method Psychological distress of 1,763 patients treated by 140 therapists was monitored after every therapy session. Patient‐reported outcome measures and patients’ therapy satisfaction was assessed. Therapists rated their experience of difficulties for every patient repeatedly over the course of therapy. Results More than one‐quarter of patients (26.5%) experienced at least one sudden loss during therapy. Patients with sudden losses did not differ significantly in psychotherapy outcome and therapy satisfaction from patients without sudden shifts. Therapists did not experience professional self‐doubt more often when working with sudden loss patients. Conclusion Sudden losses were not necessarily harmful for the outcome of psychotherapy and patients’ global therapy satisfaction. The results suggest that sudden losses can be compensated over the course of treatment.

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Sudden Gains in the Treatment of Obsessive-Compulsive Disorder

Cited by 38 publications

References 82 publications

Sudden gains in internet-based cognitive behaviour therapy for severe health anxiety

Sudden gains in internet-based cognitive behaviour therapy for severe health anxiety

“I Didn’t Know Cognitive Therapy Was Deep”

An exploratory study of patients’ sudden losses during outpatient CBT and therapists’ experience of difficulties

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