Category: Treatment - CBT

PS4- #A1 - Sudden Gains in a Naturalistic Study of CBT for OCD, GAD, PTSD, and Panic

Friday, Nov 17
12:15 PM – 1:15 PM
Location: Indigo Ballroom CDGH, Level 2, Indigo Level

Keywords: Treatment-CBT | CBT | Adult Anxiety

Sudden gains in treatment have been shown to be predictive of positive outcomes in cognitive behavioral therapy (CBT). Specifically, sudden gains are defined by meeting the following three criteria (as defined by Tang & DeRubeis, 1999): a decrease in symptom severity in absolute magnitude, a decrease of at least 25% in symptom severity from the previous session, and stability over time when comparing the three pre-gain sessions to three post-gain sessions. In the current study, we hypothesized that sudden gains in treatment would be associated with improved treatment outcomes in a naturalistic study of CBT for obsessive-compulsive disorder (OCD), generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), and panic disorder (PD) provided by unlicensed pre- and post-doctoral level trainees. Participants were 43 outpatients with a diagnosed psychiatric condition (OCD = 15, GAD = 11, PTSD = 10, PD = 7) who completed between 3 and 24 treatment sessions. They completed disorder-specific symptom severity questionnaires at each treatment session, including the Yale-Brown Obsessive Compulsive Scale (YBOCS) for OCD, the Penn State Worry Questionnaire (PSWQ) for GAD, the Post-Traumatic Checklist Scale (PCLS) for PTSD and the Panic Disorder Severity Scale (PDSS) for PD.  Our outcome was defined as percent improvement in the clinical severity measure for the disorder (change between baseline and last session score divided by the total possible change score on that outcome measure). Only treatment completers were included in this analysis (with patients completing a mean number of 17.37 sessions, range = 3 – 24 sessions). Across all disorders, 13 sudden gains were observed, with 9 patients (21%) having at least 1 sudden gain. Overall, 15% of these gains occurred before treatment session 5. An independent samples t-test revealed that patients with sudden gains had significantly more improvement during treatment overall (38% reduction of symptoms) than patients without sudden gains (17% reduction of symptoms), and this effect remained significant even after controlling for number of treatment sessions (F(1,39) = 12.28, p < .05). Of the patients with sudden gains, the number of gains significantly predicted improvement (β = .14, t(41) =3.88, p < .05), with greater gains associated with greater reductions in symptoms. These findings suggest that sudden gains may be an indicator of overall treatment response in CBT provided by trainees. 

Dylan H. Abrams

Clinical Research Coordinator
Massachusetts General Hospital

Angela Fang

Assistant in Psychology, Instructor in Psychiatry
Massachusetts General Hospital/Harvard Medical School
Boston, Massachusetts

Eliza J. Davidson

Clinical Research Coordinator
Massachusetts General Hospital, Department of Psychiatry
Boston, Massachusetts

Rachel E. Porth

Clinical Research Cordinator
Massachusetts General Hospital
Boston, Massachusetts

Hilary Weingarden

Clinical research fellow
Massachusetts General Hospital/Harvard Medical School

Susan Sprich

Massachusetts General Hospital

Hannah Reese

Massachusetts General Hospital

Steven Safren

Massachusetts General Hospital

Sabine Wilhelm

Professor
Massachusetts General Hospital/Harvard Medical School
Boston, Massachusetts