Sudden Gains in Cognitive-Behavioral Therapy for Eating Disorders

Abstract

The present study examined whether or not the temporal pattern of symptom change defined as sudden gains is applicable to and has significant ramifications for understanding recovery from eating disorders. Sudden gains were defined as stable and clinically significant changes that take place between two sessions of treatment. Data for the current study were drawn from an efficacy study of CBT for eating disorders which included session-by-session measures of eating disorder symptomatology. Predictors of sudden gains were measured by an observer coded scale that included ratings of therapist use interventions, client change in behaviors and beliefs, client engagement, and homework completion. Three research questions were addressed: First, is the phenomenon of sudden gains present in CBT for eating disorders? Second, do sudden gains in CBT for eating disorders follow the three-stage model proposed for sudden gain recovery in other disorders (i.e., cognitive changes during critical sessions => sudden gains => upward spiral that includes further cognitive changes and greater long-term symptom improvement (Tang & DeRubeis, 1999b)? Third, what are the predictors of sudden gains in CBT for eating disorders that distinguish the critical session that takes place right before the sudden gain? Findings suggest that many eating disordered clients (62%) experienced at least one sudden gain during the course of CBT treatment. Three distinct types of sudden gains were identified: total symptom sudden gains, eating-related sudden gains, and body-related sudden gains. The average magnitude of these sudden gains was large representing on average 35% of total symptom improvement. Clients who experienced total symptom and body-related sudden gains demonstrated fewer eating disordered symptoms than the other clients at posttreatment. During the session preceding the sudden gain, therapists had increased levels of cognitive interventions and empathy, and clients experienced more cognitive changes and increased motivation.

Are sudden gains important in the treatment of eating disorders?

“…6 These findings from the anxiety/depression literature suggest that SGs can occur at any point in treatment and require sudden and substantial improvement rather than cumulative improvement and are, therefore, theoretically different from RR. Moreover, Cavallini and Spangler (2013) found that 53% of their ED sample experienced at least one SG in ED symptomatology, providing preliminary evidence that SGs do occur in ED treatment. As discussed below, SGs also appear to have utility in predicting treatment outcome.…”

“…A similar, albeit distinct construct involving the timing and course of treatment response is that of sudden gains (SGs; large symptomatic improvements experienced spontaneously during treatment). SGs have received much attention in the anxiety/depression literature, yet only one study has examined this construct in ED treatment . Given SGs may be relevant to both clinicians and patients in clinical settings, this article will review the literature from other fields as a basis for examining SGs in ED treatment.…”

“…SGs have received much attention in the anxiety/depression literature, yet only one study has examined this construct in ED treatment. 1 Given SGs may be relevant to both clinicians and patients in clinical settings, this article will review the literature from other fields as a basis for examining SGs in ED treatment. First, we will compare and contrast RR and SGs in order to emphasize the distinctive elements of SGs.…”

Sudden gains in the outpatient treatment of anorexia nervosa: A process‐outcome study

“…Future research could also explore whether there are SGs in psychological symptoms of AN, and, if present, whether these are related to better outcomes. This would also allow comparisons to be made with research into SGs in CHEDS scores during treatment for bulimia nervosa (Cavallini & Spangler, ).…”

“…SGs were defined using two criteria: the “absolute magnitude criterion” required a decrease of at least 12 points on the CHEDS, and the “stability criterion” was based on that originally used by Tang and DeRubeis (). Over 50% of participants had at least one SG, and those experiencing SGs had better CHEDS outcome scores post‐treatment (Cavallini & Spangler, ). To date, no study has assessed whether SGs occur in patients with AN during treatment, and, if so, whether these are related to treatment outcomes.…”