Sudden gains in exposure therapy for obsessive-compulsive disorder
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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COVID-19 and OCD: Potential impact of exposure and response prevention therapy
2020, Journal of Anxiety DisordersCitation Excerpt :While this had required adaptations to ERP to follow public health guidelines, it does not require pausing active treatment. Indeed, ERP is associated with treatment response in approximately 75–80 % of patients (Collins & Coles, 2017). CBT has also been shown to be significantly better than pharmacotherapy for OCD treatment, illustrating the suggestion to have medications serve as first-line options may not prove to have benefits (Öst, Havnen, Hansen, & Kvale, 2015).
Sudden Gains in Internet-Based Cognitive Behavior Therapy for Body Dysmorphic Disorder
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2020, Clinical Psychology ReviewSudden gains in cognitive behavioral therapy among children and adolescents with obsessive compulsive disorder
2019, Journal of Behavior Therapy and Experimental PsychiatryCitation Excerpt :Third, the gain had to be large relative to symptom fluctuations before and after the gain. Similar to prior studies (Collins & Coles, 2017; Hardy et al., 2005), t-tests were conducted between the assessments before and after the gain to determine if the gain was significant. Gains fulfilled this criterion when t ≥ 2.50 when comparing the mean of the three pre-gain scores with the mean of the three post-gain scores, or t ≥ 3.00 if only two pre-gain or two post-gain scores were available (Collins & Coles, 2017; Hardy et al., 2005).
Sudden Gains: How Important Are They During Exposure and Response Prevention for Obsessive-Compulsive Disorder?
2019, Behavior TherapyCitation Excerpt :Although sudden gains have been repeatedly linked to treatment outcome in depression and anxiety treatment, the present study casts doubt on their relevance to long-term outcome in OCD treatment. We agree with the sentiment expressed by Collins and Coles (2017) that the relationship between sudden gains and outcome during psychological treatment is an atheoretical investigation of an observed clinical phenomenon. Future research that empirically investigates theory-driven relationships may lead to more precise identification of treatment mechanisms and ultimately contribute to improving outcomes for individuals with OCD.