Cognitive processes associated with sudden gains in cognitive therapy for posttraumatic stress disorder in routine care.
Open Access
- 1 May 2020
- journal article
- research article
- Published by American Psychological Association (APA) in Journal of Consulting and Clinical Psychology
- Vol. 88 (5), 455-469
- https://doi.org/10.1037/ccp0000488
Abstract
Objective: Although most studies investigating sudden gains in treatments for posttraumatic stress disorder (PTSD) report a positive association between sudden gains and outcomes at the end of treatment, less is known about sudden gains in routine clinical care and the processes involved in their occurrence. This study investigated changes in cognitive factors (negative appraisals, trauma memory characteristics) before, during, and after sudden gains in PTSD symptom severity. Method: Two samples (N-1 = 248, N-2 = 234) of patients who received trauma-focused cognitive therapy for PTSD in routine clinical care were analyzed. Mahalanobis distance matching, including the propensity score, was used to compare patients with sudden gains and similar patients without sudden gains. Estimates from both samples were meta-analyzed to obtain pooled effects. Results: Patients with sudden gains (n(1) = 76, n(2) = 87) reported better treatment outcomes in PTSD symptom severity, depression, and anxiety at the end of therapy and follow-up than those without sudden gains. No baseline predictors of sudden gains could be reliably identified. During sudden gains, those with sudden gains had greater changes in both cognitive factors than matched patients. Meta-analyses of the two samples showed that negative appraisals had already decreased in the session prior to sudden gains compared with matched patients. Conclusions: The pooled estimates suggest that changes in negative trauma-related appraisals precede sudden gains in PTSD symptoms. The results suggest that interventions that promote change in appraisals may also facilitate sudden gains in therapy.Keywords
Funding Information
- Wellcome Trust (069777; 200796)
- Mental Health Research United Kingdom
- National Institute for Health Research (NIHR) South London and Maudsley and Oxford Health and National Health Service Foundation Trust Biomedical Research Centres
This publication has 46 references indexed in Scilit:
- Cognitive change predicts symptom reduction with cognitive therapy for posttraumatic stress disorder.Journal of Consulting and Clinical Psychology, 2013
- Exploring sudden gains in behavioral activation therapy for Major Depressive DisorderBehaviour Research and Therapy, 2012
- Sudden gains in prolonged exposure for children and adolescents with posttraumatic stress disorder.Journal of Consulting and Clinical Psychology, 2011
- A preliminary investigation of sudden gains in exposure therapy for PTSDBehaviour Research and Therapy, 2010
- The impact of sudden gains in cognitive behavioral therapy for posttraumatic stress disorderJournal of Traumatic Stress, 2009
- Sudden gains in group cognitive-behavioral therapy for panic disorderBehaviour Research and Therapy, 2008
- Do cognitive models help in predicting the severity of posttraumatic stress disorder, phobia, and depression after motor vehicle accidents? A prospective longitudinal study.Journal of Consulting and Clinical Psychology, 2008
- Sudden gains during therapy of social phobia.Journal of Consulting and Clinical Psychology, 2006
- A Brief Measure for Assessing Generalized Anxiety DisorderArchives of Internal Medicine, 2006
- The PHQ-9Journal of General Internal Medicine, 2001