Sudden gains in exposure therapy for obsessive-compulsive disorder

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Highlights

  • Sudden gains (SGs) often lead to better outcome in CBT for depression and anxiety.

  • We examined SGs in exposure therapy for OCD.

  • SGs were found in 52% of patients and occurred throughout treatment.

  • SGs led to lower CGI severity at post, but not greater OCD symptom reduction.

Abstract

Prior research in the treatment of depression and anxiety has demonstrated that a sudden reduction in symptoms between two consecutive sessions (sudden gain) is related to lower post-treatment symptom severity (e.g. Hofmann, Schulz, Meuret, Moscovitch, & Suvak, 2006; Tang & DeRubeis, 1999). However, only one study has examined sudden gains in the treatment of obsessive compulsive disorder (OCD). In that study, one-third of the patients with OCD experienced a sudden gain (Aderka et al., 2012). Further, patients who had a sudden gain had lower clinician-rated OCD symptom severity post-treatment (Aderka et al., 2012). In replication, the current study examined the frequency, characteristics, and clinical impact of sudden gains in 27 OCD patients during exposure and response prevention (ERP) therapy. Fifty two percent of patients experienced a sudden gain. The mean magnitude of a sudden gain represented, on average, 61.4% of total symptom reduction. Following treatment, individuals who had experienced a sudden gain were rated as less severe on the clinical global impression scale, but they did not experience a greater reduction in OCD symptoms (pre-to post-treatment) than those without a sudden gain. None of the pre-treatment characteristics tested were found to significantly predict whether a patient would have a sudden gain. Additional research examining predictors of, and patterns of, change in OCD symptoms is warranted.

Section snippets

Participants

Participants included 27 Caucasian patients (14 females) between 18 and 66 years old (M = 32.3, SD = 13.8) who completed at least 14 sessions of ERP for OCD. All participants were diagnosed with primary OCD according to DSM-IV and DSM-V criteria prior to treatment (Anxiety Disorders Interview Schedule; Brown and Barlow, 2014, DiNardo et al., 1994). Participants were only included if they completed at least 14 sessions of ERP. Out of the 48 people that were offered treatment, 11 refused

Occurrence of sudden gains

Using the criteria outlined above based on guidelines derived by Tang and DeRubeis (1999), 52% (14/27) of patients had at least one sudden gain including three patients who experienced two gains. The average magnitude of a sudden gain was 4.36 points (SD = 1.38), representing, on average, 61.4% of total symptom reduction (see Fig. 1). The most common time points for a sudden gain were after sessions 10 and 13, with 3 patients experiencing a sudden gain at each of these points. The remaining 8

Discussion

This is the second study to show that sudden gains occur during ERP for OCD. In our small sample, sudden gains occurred in 52% of patients. This is similar and even larger than the 34% found by Aderka, Nickerson, et al. (2012). This provides additional evidence that sudden gains are prevalent in OCD treatment (at least 1/3) and suggests that sudden gains are more likely in exposure therapy than in other therapies for OCD (e.g. cognitive therapy and fluvoxamine). For individuals with a sudden

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