title: Sudden gains in two psychotherapies for posttraumatic stress disorder.
abstract: We examined sudden, large, and stable shifts in symptoms from one therapy session to the next in two treatments for posttraumatic stress disorder (PTSD). Shifts in a positive direction (sudden gains) have so far been more frequently analyzed than those in a negative direction (sudden losses). We analyzed data from 102 outpatients suffering from PTSD who received either a cognitive-behavioral or a Gestalt-based intervention. Sudden gains, at 22.5%, were more frequent than sudden losses (3.9% of patients). Participants who had experienced sudden gains had lower PTSD scores at posttreatment, but not at the 6-month follow-up. As sudden losses were so rare, they were not analyzed statistically. Sudden gains accounted for 52% of overall treatment gains or 26% of overall change in a positive direction. Among very successful patients, those with sudden gains were overrepresented, but in absolute terms, there were as many patients without sudden gains in this group. There was no connection between sudden gains and type of intervention or depressive symptoms. Sudden gains and sudden losses occurred in our sample of PTSD patients, but in the light of current results, their clinical importance seems to be limited.
authors.affiliation: Catholic University of Eichstätt-Ingolstadt, Ostenstr. 25, 85072 Eichstätt, Germany. Electronic address: julia.koenig@ku.de.
authors.forename: Julia
authors.initials: J
authors.lastname: König
authors.affiliation: Ludwig Maximilian University Munich, Leopoldstr. 13, 80802 München, Germany. Electronic address: regina.karl@psy.lmu.de.
authors.forename: Regina
authors.initials: R
authors.lastname: Karl
authors.affiliation: Catholic University of Eichstätt-Ingolstadt, Ostenstr. 25, 85072 Eichstätt, Germany. Electronic address: rita.rosner@ku.de.
authors.forename: Rita
authors.initials: R
authors.lastname: Rosner
authors.affiliation: Ludwig Maximilian University Munich, Leopoldstr. 13, 80802 München, Germany. Electronic address: willi@butollo.de.
authors.forename: Willi
authors.initials: W
authors.lastname: Butollo
mesh_terms: D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D007171:Implosive Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cognitive processing therapy; Dialogical exposure therapy; PTSD; Posttraumatic stress disorder; Sudden gain; Sudden loss