Sudden gains in recovering from depression: Are they also found in psychotherapies other than cognitive-behavioral therapy?

Following T. Z. Tang and R. J. DeRubeis's (1999) report of sudden gains (a sudden and substantial improvement in depression symptoms in 1 between-session interval) in cognitive-behavioral therapy (CBT) for depression, this study explored sudden gains in supportive-expressive (SE) psychotherapy. Studies suggested that CBT sudden gains are caused by cognitive changes, which is a factor specific to CBT. Thus, sudden gains might not be expected in SE psychotherapy. Contrary to that expectation, sudden gains in SE psychotherapy were found, and they showed similar magnitude, affected a similar percentage of patients, and occurred at about the same time in treatment as CBT sudden gains. However, the symptom gains from the SE psychotherapy sudden gains were much less stable than the CBT sudden gains and showed a much higher rate of reversal before treatment ended. The long-term benefits of SE psychotherapy sudden gains also appear less robust than CBT sudden gains. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors and consequences of early gains in child psychotherapy.

This study examined the predictors and consequences of early gains among children (n = 130) receiving psychotherapeutic treatment as usual for a variety of disorders. Classification tree analysis showed that not receiving Medicaid, plus receiving a medication consult, were associated with any early gain (i.e., reliable change on one or more clinical scales, with the early gain either remaining in the clinical range or moving to a subclinical level) within the first eight treatment sessions, but only Medicaid status predicted subclinical gains. Overall, patients showing a subclinical early gain showed better long-term improvement in treatment than those with no subclinical gain; patterns of change for those with and without any early gain were similar but with smaller differences between groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Shapes of early change in psychotherapy under routine outpatient conditions.

Although improvement of clients' state is a central concern for psychotherapy, relatively little is known about how change in outcome variables unfolds during psychotherapy. Client progress may follow highly variable temporal courses, and this variation in treatment courses may have important clinical implications. By analyzing treatment progress using growth mixture modeling up to the 6th session in a sample of 192 outpatients treated under routine clinic conditions, the authors identified 5 client groups based on similar progress on the short form versions of the Clinical Outcomes in Routine Evaluation-Outcome Measure. The shapes of early change typical for these client groups were characterized by (a) high initial impairment, (b) low initial impairment, (c) early improvement, (d) medium impairment with continuous treatment progress, or (e) medium impairment with discontinuous treatment progress. Moreover, the shapes of early change were associated with different treatment outcomes and durations, and several intake variables (depression, anxiety, and age) enabled prediction of the shape of early change and/or prediction of individual treatment progress within client groups with similar shapes of change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sudden gains in the treatment of depression in a partial hospitalization program.

Objective: This study examines sudden gains (SGs), or rapid improvements in symptoms, among adults in treatment for depression in a partial hospitalization program (PHP). This study identifies the proportion of people who experience SGs in a PHP, when SGs occur in treatment, and the association of SGs with outcomes at the end of treatment. Method: The sample included 664 adults consecutively admitted to a PHP program for treatment of depression. Patients were administered the 24-item Behavior and Symptom Identification Scale and the short form of the Quality of Life Enjoyment and Satisfaction Questionnaire. We conducted t tests, multiple regressions, and generalized estimating equations (GEE). Results: Over 40% of the sample experienced SGs, and most of those who experienced SGs did so by the 2nd week of treatment. SGs were associated with significantly greater improvement in depression and quality of life scores at the end of treatment. Results of the GEE indicate that although depression scores significantly decreased for the entire sample, the SG group improved to a greater degree than the group without SGs. Conclusions: The proportion of SGs among people in a PHP is similar to proportions found in traditional outpatient psychotherapy, suggesting that a subset of people receiving psychotherapy may be predisposed to SGs. The timing of SGs in a PHP suggests that SGs are associated with the dose of treatment received. Future research should focus on identifying people predisposed to SGs, as well as the mechanisms by which SGs occur. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Sudden gains in cognitive therapy of depression and depression relapse/recurrence.

Cognitive therapy (CT) may have significant advantages over antidepressants in preventing depression relapses. Many CT patients experience sudden gains: large symptom improvement in 1 between-session interval. Past studies have associated CT sudden gains with in-session cognitive changes but not with life events. This study examined sudden gains and depression relapse/recurrence among 60 CT clinical-trial patients. Survival analyses showed that only one third of sudden-gain-responders relapsed in 2 years, and they had 74% lower relapse risks than did non-sudden-gain-responders. Among patients with sustained responses, 73% experienced sudden gains. The authors also replicated J. R. Vittengl, L. A. Clark, and R. B. Jarrett's (see record 2005-01321-021) finding that sudden gains identified with their unique criteria did not predict relapse. The current authors' findings suggest that CT sudden gains are not measurement artifacts, and that sudden gains and their causes and consequences might be important in preventing relapses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sudden gains during therapy of social phobia.

The present study investigated the phenomenon of sudden gains in 107 participants with social phobia (social anxiety disorder) who received either cognitive-behavioral group therapy or exposure group therapy without explicit cognitive interventions, which primarily used public speaking situations as exposure tasks. Twenty-two out of 967 session-to-session intervals met criteria for sudden gains, which most frequently occurred in Session 5. Individuals with sudden gains showed similar improvements in the 2 treatment groups. Although cognitive-behavioral therapy was associated with more cognitive changes than exposure therapy, cognitive changes did not precede sudden gains. In general, the results of this study question the clinical significance of sudden gains in social phobia treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sudden Gains in Cognitive Therapy for Depression: A Replication and Extension.

Of 76 clients receiving 8-20 sessions of cognitive therapy (CT) in a joint university and a national health service clinic, 31 experienced sudden gains that appeared very similar to those first reported in clinical trials of CT by T. Z. Tang and R. J. DeRubeis (1999) and subsequently replicated in other studies. The sudden gains appeared less stable in the present study's more routine clinical practice settings than they were in the clinical trials. Life events did not appear to account for sudden gains. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Test of the phase model of psychotherapy in a training clinic.

Recent publications suggest that psychotherapy models generated in outpatient settings do not fully generalize to the training clinic. A possible explanation for these findings is that the nature in which change occurs during psychotherapy may actually differ according to setting. To examine this possibility, the phase model of psychotherapy was tested in an outpatient training clinic. Results partially support the phase model, suggesting that the nature of change during effective psychotherapy within the training clinic setting does not differ from that in other outpatient settings. That is, clients who completed effective courses of treatment in the training clinic environment generally experience an improvement in subjective well-being before evidencing a reduction in symptom distress. Obtaining success in role performances (i.e., work or school) appears to emerge last. Practitioners may enhance treatment outcomes by targeting interventions that are congruent with the phase of the individual client presenting for treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Benchmarking the effectiveness of psychotherapy treatment for adult depression in a managed care environment: A preliminary study.

This preliminary study evaluated the effectiveness of psychotherapy treatment for adult clinical depression provided in a natural setting by benchmarking the clinical outcomes in a managed care environment against effect size estimates observed in published clinical trials. Overall results suggest that effect size estimates of effectiveness in a managed care context were comparable to effect size estimates of efficacy observed in clinical trials. Relative to the 1-tailed 95th-percentile critical effect size estimates, effectiveness of treatment provided in this setting was observed to be between 80% (patients with comorbidity and without antidepressants) and 112% (patients without comorbidity concurrently on antidepressants) as compared to the benchmarks. Because the nature of the treatments delivered in the managed care environment were unknown, it was not possible to make conclusions about treatments. However, while replications are warranted, concerns that psychotherapy delivered in a naturalistic setting is inferior to treatments delivered in clinical trials appear unjustified. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Benchmarks for psychotherapy efficacy in adult major depression.

This study estimates pretreatment-posttreatment effect size benchmarks for the treatment of major depression in adults that may be useful in evaluating psychotherapy effectiveness in clinical practice. Treatment efficacy benchmarks for major depression were derived for 3 different types of outcome measures: the Hamilton Rating Scale for Depression (M. A. Hamilton, 1960, 1967), the Beck Depression Inventory (A. T. Beck, 1978; A. T. Beck & R. A. Steer, 1987), and an aggregation of low reactivity-low specificity measures. These benchmarks were further refined for 3 conditions: treatment completers, intent-to-treat samples, and natural history (wait-list) conditions. The study confirmed significant effects of outcome measure reactivity and specificity on the pretreatment-posttreatment effect sizes. The authors provide practical guidance in using these benchmarks to assess treatment effectiveness in clinical settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Validity of Sudden Gains in Acute Phase Treatment of Depression.

The authors examined the validity of sudden gains identified with T. Z. Tang and R. J. DeRubeis's (1999) method in 2 clinical data sets that involved treatment of major depressive disorder (N=227). Sudden gains replicated among self- and clinician reports of depressive symptoms and predicted better psychosocial functioning at the acute phase treatment end point, in support of their validity. However, sudden gains occurred with roughly the same moderate frequency in pill placebo and pharmacotherapy with clinical management as in cognitive therapy. Furthermore, sudden gains predicted more depressive symptoms and negative failure attributions in longitudinal follow-up of responders to acute phase cognitive therapy. On the basis of these findings, the authors conceptualize sudden gains as one of several possible patterns of acute phase treatment response. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Community clinic treatment of depressed youth: Benchmarking usual care against CBT clinical trials.

This study used a benchmarking strategy to evaluate the effectiveness of community psychotherapy for depressed youth relative to evidence-based treatment in clinical trials. Symptom trajectories of depressed youth treated in community mental health centers (CMHCs) were compared with trajectories of youth treated with cognitive-behavioral therapy (CBT) in clinical trials. Overall, outcomes of CMHC youth more closely resembled those of control condition youth than youth treated with CBT. Within the CMHC sample, ethnic minority status and low therapy dose were related to worse outcomes. However, when outcomes for Caucasian youth and youth receiving longer term services were examined, the CMHC sample still performed more poorly than youth treated with CBT. The findings support the value of developing, testing, and exporting effective therapies for depressed youth to community clinic settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Play in child development and psychotherapy: Toward empirically supported practice.

Reviews the book, Play in child development and psychotherapy: Toward empirically supported practice by Sandra Russ (see record 2003-88219-000). Clinical child psychologists have used play as a vehicle for psychotherapy for over 75 years. However, current demands of managed care systems emphasize the need for time limited and empirically supported treatments. Although play techniques are commonly incorporated by psychologists of various theoretical orientations, Sandra Russ points out in this book the disparity between the theoretical role of play in psychotherapy and the actual evidence supporting these techniques. The first four chapters of the book provide literature reviews of the history, theory, and research on pretend play, considering both normative and clinical populations. The next three chapters focus more specifically on the current developments in understanding play from research and practice perspectives. Finally, Russ considers future objectives for researchers and practitioners who seek to expand and enhance the utility of play techniques in child psychotherapy. Russ's book clearly provides a basis for understanding the current state of the child play therapy field while strongly emphasizing the need for additional research. This book may be useful for practitioners who strive to provide empirically supported treatments because it provides theoretical and available research perspectives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The outcome of psychotherapy: A selected analysis of research findings.

A selective review of outcome studies of psychotherapy with emphasis on the major methodological issues of spontaneous recovery and methods of experimental control. The results of 9 studies which used experimental controls were assessed in terms of their limitations and merits in demonstrating the effectiveness of psychotherapy. It is concluded that outcome research with available techniques could be fruitful even though conclusions based on present research must be carefully qualified. (30 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clients' emotional processing in psychotherapy: A comparison between cognitive-behavioral and process-experiential therapies.

The authors compared clients' emotional processing in good and bad outcome cases in cognitive behavioral therapy (CBT) and process-experiential therapy (PET) and investigated whether clients' emotional processing increases over the course of therapy. Twenty minutes from each of 3 sessions from 40 clients were rated on the Experiencing Scale. A 2 × 2 × 3 analysis of variance showed a significant difference between outcome and therapy groups, with clients in the good outcome and PET groups showing significantly higher levels of emotional processing than those in the poor outcome and CBT groups, respectively. Clients' level of emotional processing significantly increased from the beginning to the midpoint of therapy. The results indicate that CBT clients are more distant and disengaged from their emotional experience than clients in PET. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

All interventions were not created equal: The case against an anything goes approach to psychotherapy.

Reviews the book, A guide to treatments that work by P. E. Nathan and J. M. Gorman (see record 1998-07090-000). There has been a fervor of activity within psychology and psychiatry, especially during the last decade, aimed at uncovering scientifically established principles that guide therapy decisions. A Guide to Treatments That Work is a product of this scholarly pursuit of the hard facts about intervention effectiveness. The criteria advocated by Nathan and Gorman for classifying treatment outcomes are unique and advance considerably our scientific understanding of what works. Clearly, the structure for evaluating evidence in support of an intervention emanating through an application of the six types of studies has raised the bar in providing standards of proof and as a way for conceptualizing differences in what is truly known about specific interventions for specific problems. This book also provides an important basis for appreciating the many complex issues that are involved in delineating practice guidelines and for mobilizing efforts to integrate what is known about effective interventions into the practice of psychology. In many ways this book is a foundation to help move practitioners toward evidence-based intervention (EBI) procedures. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Behavioral Activation Group Therapy in Public Mental Health Settings: A Pilot Investigation.

Depression is among the most common psychiatric disorders seen in mental health practices. Although effective treatments for the condition exist, managed care pressures providers to utilize empirically supported, cost-effective treatments. Behavioral activation (BA) treatment for depression has emerged in recent years as a promising, cost-effective intervention for major depressive disorder. If its effectiveness could be established. BA delivered through a group format would offer additional cost effectiveness over its individual therapy counterpart. This investigation examined the effects of behavioral activation group therapy (BAGT) for depression in public mental health settings. The results suggest that BAGT can be a valuable addition to the practicing psychologist's set of interventions to use with depressed clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mindfulness-based cognitive therapy: Evaluating current evidence and informing future research.

Mindfulness-based cognitive therapy (MBCT) is a recently developed class-based program designed to prevent relapse or recurrence of major depression (Z. V. Segal, J. M. G. Williams, & J. Teasdale, 2002). Although research in this area is in its infancy, MBCT is generally discussed as a promising therapy in terms of clinical effectiveness. The aim of this review was to outline the evidence that contributes to this current viewpoint and to evaluate the strengths and weaknesses of this evidence to inform future research. By systematically searching 6 electronic databases and the reference lists of retrieved articles, the authors identified 4 relevant studies: 2 randomized clinical trials, 1 study based on a subset of 1 of these trials, and 1 nonrandomized trial. The authors evaluated these trials and discussed methodological issues in the context of future research. The current evidence from the randomized trials suggests that, for patients with 3 or more previous depressive episodes, MBCT has an additive benefit to usual care. However, because of the nature of the control groups, these findings cannot be attributed to MBCT-specific effects. Further research is necessary to clarify whether MBCT does have any specific effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized trial of telephone psychotherapy and pharmacotherapy for depression: Continuation and durability of effects.

Randomized trial evidence and expert guidelines are mixed regarding the value of combined pharmacotherapy and psychotherapy as initial treatment for depression. This study describes long-term results of a randomized trial (N = 393) evaluating telephone-based cognitive-behavioral therapy (CBT) plus care management for primary care patients beginning antidepressant treatment versus usual care. In a repeated measures linear model with adjustment for baseline scores, the phone therapy group showed significantly lower mean Hopkins Symptom Checklist (HSCL) Depression Scale scores (L. Derogatis, K. Rickels, E. Uhlenhuth, & L. Covi, 1974) from 6 months to 18 months versus usual care, F(1, 336) = 11.28, p = .001. Average HSCL depression scores over the period from 6 months to 18 months were 0.68 (SD = 0.55) in the telephone therapy group and 0.85 (SD = 0.65) in the usual-care comparison group. Addition of a brief, structured CBT program can significantly improve clinical outcomes for the large number of patients beginning antidepressant treatment in primary care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)