Category: PTSD


Examination of Discontinuous Patterns of Change in PTSD Treatment

Saturday, November 18
1:45 PM - 3:15 PM
Location: Sapphire Ballroom O & P, Level 4, Sapphire Level

Keywords: Stress | Psychotherapy Process
Presentation Type: Symposium

Discontinuous patterns of symptom change can mark critical points in treatments and have been linked to better treatment outcome for PTSD (e.g., Clapp et al., 2016; Jun et al., 2013). Two distinct patterns have been identified: rapid early responses and sudden gains. Rapid early responses refer to substantial symptom decreases in the beginning of treatment (Ilardi & Craighead, 1999), generally prior to the introduction of active treatment components. Sudden gains are significant reductions in symptoms during between-session intervals that can occur during early, middle, or late treatment (Tang & DeRubeis, 1999). Rapid early responses may be elicited by general factors, such as hope or treatment expectancy. In contrast, sudden gains may be elicited by psychotherapy processes driven by the active treatment components. Identifying in-session process variables associated with discontinuous changes may reveal potential factors causally related to therapeutic change (Hayes et al., 2007). We examined rapid early responses and sudden gains in 138 individuals with chronic PTSD who received 10 weeks of Prolonged Exposure (PE). Using a PE-adapted version of the CHANGE coding system (Hayes et al., 2006), we examined in-session therapy content for potential processes of change. For rapid early responses, we coded baseline hope and hopelessness during session 1 and examined patients’ treatment expectancies assessed prior to treatment. For sudden gains, we coded the pre-gain sessions for hope and hopelessness, cognitive-emotional processing (i.e., exploration of salient themes that results in new perspectives), unproductive processing (i.e., repeatedly thinking about a problem without significant insight), and avoidance. Rapid early responders made fewer hopeless statements in session 1 (r = -.23; p = .01), compared to those who were not early responders. Rapid early response was not associated with treatment expectancy (r = .03, p = .69) or hopeful statements (r = .06; p = .48). Patients who experienced sudden gains expressed more hope (d = .46) and cognitive-emotional processing (d = .42) than those without gains. These findings may highlight key process elements underlying discontinuous change patterns in PTSD treatment. Greater general hopelessness at the beginning of treatment may inhibit experiencing a rapid response, which may in turn affect the patient’s engagement. Greater hope and cognitive-emotional processing may be the key processes of change throughout treatment. Monitoring these processes during treatment may inform clinicians on how to tailor interventions for specific patients based on their needs and strengths.

Janie Jun

Postdoctoral Fellow
National Center for PTSD, Behavioral Sciences Division, VA Boston Healthcare System


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