title: Sudden gains in prolonged exposure and sertraline for chronic PTSD.
abstract: BACKGROUND
  Sudden gains are significant, rapid improvements in symptoms, larger than typical between-session symptom reduction.([8]) Sudden gains in a large sample of individuals with posttraumatic stress disorder (PTSD) have not been studied, and only one study has looked at it in pharmacotherapy, but not in PTSD. In the present study, we examined the occurrence of sudden gains in psychotherapy, specifically prolonged exposure (PE), and pharmacotherapy, specifically sertraline, for chronic PTSD.
  
  
  METHODS
  Sudden gains in PTSD symptoms (PTSD symptom scale self-report([25]) ) were assessed in 200 individuals with PTSD during 10 weeks of PE or sertraline.
  
  
  RESULTS
  Individuals in both PE (42.2%) and sertraline (31%) exhibited sudden gains. Individuals in PE made more gains toward the end of treatment (7.2%) than sertraline (2%, OR = 3.82). However, individuals in sertraline made larger gains during early treatment (M = 18.35, SD = 8.15) than PE (M = 12.53, SD = 5.16, d = .85). Notably, those on sertraline were more likely to exhibit a reversal of sudden gains than those in PE (OR = .23). Pointing to clinical significance, the presence of a sudden gain was associated with better reduction in symptoms from pre- to posttreatment (β = -.49).
  
  
  CONCLUSIONS
  Individuals in both PE and sertraline experienced gains, though sertraline was associated with earlier large but reversible gains, and PE was associated with later gains. This differential pattern of discontinuous change highlights potential differential mechanism for these therapies and marks important transition points for further detailed analyses of change mechanisms.
authors: Department of Psychology, University of Washington, Seattle, Washington 98195, USA. janiejun@uw.edu
authors: Janie J
authors: JJ
authors: Jun
authors: Lori A
authors: LA
authors: Zoellner
authors: Norah C
authors: NC
authors: Feeny
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007171:Implosive Therapy / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D057566:Self Report; D020280:Sertraline / Q000627:therapeutic use*; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D020280:Sertraline
keywords: PTSD; anxiety; assessment/diagnosis; cognitive behavior therapy; pharmacotherapy
references: Arch Gen Psychiatry. 1961 Jun;4:561-71
references: 13688369
references: J Consult Clin Psychol. 1991 Feb;59(1):12-9
references: 2002127
references: Am J Psychiatry. 2001 Dec;158(12):1974-81
references: 11729012
references: Behav Res Ther. 2010 Jun;48(6):555-60
references: 20304385
references: Neuropsychologia. 2009 Mar;47(4):1200-3
references: 19166863
references: J Consult Clin Psychol. 2011 Jun;79(3):364-8
references: 21381809
references: J Consult Clin Psychol. 2006 Aug;74(4):687-697
references: 16881776
references: J Consult Clin Psychol. 2001 Feb;69(1):114-6
references: 11302266
references: Arch Gen Psychiatry. 2011 Dec;68(12):1227-37
references: 22147842
references: Behav Res Ther. 1986;24(1):1-8
references: 3947307
references: J Consult Clin Psychol. 2011 Aug;79(4):441-6
references: 21787047
references: J Consult Clin Psychol. 2003 Apr;71(2):386-93
references: 12699032
references: Arch Gen Psychiatry. 2001 May;58(5):485-92
references: 11343529
references: Behav Ther. 2006 Mar;37(1):61-8
references: 16942961
references: J Consult Clin Psychol. 1991 Oct;59(5):715-23
references: 1955605
references: J Consult Clin Psychol. 2002 Apr;70(2):444-7
references: 11952204
references: J Consult Clin Psychol. 2002 Aug;70(4):867-79
references: 12182270
references: J Consult Clin Psychol. 1999 Apr;67(2):194-200
references: 10224729
references: JAMA. 2000 Apr 12;283(14):1837-44
references: 10770145
references: J Trauma Stress. 2009 Aug;22(4):287-93
references: 19637322
references: J Consult Clin Psychol. 2005 Feb;73(1):59-67
references: 15709832
references: Acta Psychiatr Scand. 1991 Aug;84(2):167-73
references: 1950612
references: J Consult Clin Psychol. 2005 Feb;73(1):173-82
references: 15709845
references: J Consult Clin Psychol. 1999 Dec;67(6):894-904
references: 10596511
references: J Clin Psychiatry. 2011 Nov;72(11):1478-84
references: 22127194
references: J Consult Clin Psychol. 2005 Oct;73(5):953-64
references: 16287395
references: Clin Psychol Rev. 2007 Jul;27(6):682-95
references: 17328996
references: J Consult Clin Psychol. 2003 Feb;71(1):14-21
references: 12602421