Sudden gains in internet-based cognitive behaviour therapy for severe health anxiety

Abstract

Objective A sudden gain is defined as a large and stable individual improvement occurring between two consecutive treatment sessions. Sudden gains have been shown to predict better long-term improvement in several treatment studies, including cognitive behavioural therapy for depression and anxiety disorders, but have not been studied in the treatment of health anxiety or any form of internet-based cognitive behavioural therapy. The aim of this study was to investigate the role of sudden gains in internet-based cognitive behavioural therapy for severe health anxiety. Method We examined the occurrence and significance of sudden gains in measures of health anxiety in 81 participants receiving internet-based cognitive behavioural therapy. We compared patients with sudden gains, patients without sudden gains, and patients with gradual gains. Results Thirteen participants (16%) experienced one sudden gain in health anxiety with individual sudden gains distributed across the treatment. As expected, patients with a sudden gain showed larger improvements than patients without a sudden gain at post-treatment (d = 1.04) and at one-year follow-up (d = 0.91) on measures of health anxiety. Conclusions Consistent with previous studies, sudden gains in internet-based cognitive behavioural therapy are associated with significantly larger and stable treatment effects up to one-year follow-up.

Sudden gains in exposure‐focused cognitive‐behavioral group therapy for panic disorder

“…Regarding the impact of SGs on treatment outcome measures, sudden gainers had significantly lower panic severity at posttreatment than nonsudden gainers, and this effect was maintained at 6‐month follow‐up, which is consistent with previous reports (Aderka et al, ; Bohn et al, ; Hedman et al, ). Thus, sudden and relatively marked improvements in symptoms, even late in therapy, were maintained several months after finishing treatment.…”

“…In all of these studies (except Hofmann et al, 2006), sudden gainers showed significantly lower anxiety severity scores at posttreatment than nonsudden gainers. However, the conclusions on long-term severity changes are less consistent, with some studies (e.g., Aderka et al, 2012;Bohn et al, 2013;Hedman et al, 2014), but not all (e.g., Hofmann et al, 2006), showing that SGs are associated with lower anxiety severity scores at follow-up.…”

“…In all of these studies (except Hofmann et al, ), sudden gainers showed significantly lower anxiety severity scores at posttreatment than nonsudden gainers. However, the conclusions on long‐term severity changes are less consistent, with some studies (e.g., Aderka et al, ; Bohn et al, ; Hedman et al, ), but not all (e.g., Hofmann et al, ), showing that SGs are associated with lower anxiety severity scores at follow‐up. Notably, while most previous research has focused on the effects of SGs on specific symptoms (e.g., anxiety), the influence of SGs on other outcome measures (e.g., measures of functional impairment) is relatively unknown.…”

“…SGs have also been reported for anxiety severity scores during the psychological treatment of anxiety and related disorders, including social anxiety disorder (SAD; Bohn, Aderka, Schreiber, Stangier, & Hofmann, ; Hofmann, Schulz, Meuret, Moscovitch, & Suvak, ), generalized anxiety disorder (Present et al, ), panic disorder (PD; Clerkin, Teachman, & Smith‐Janik, ), obsessive–compulsive disorder (Aderka et al, ), posttraumatic stress disorder (PTSD; Doane, Feeny, & Zoellner, ), and health anxiety (Hedman et al, ). In all of these studies (except Hofmann et al, ), sudden gainers showed significantly lower anxiety severity scores at posttreatment than nonsudden gainers.…”

Treatment expectancy for anxiety change and response to cognitive behavioral therapy for OCD

“…Previous research, however, has demonstrated that the majority of improvements in depressive symptoms occur early in treatment (i.e., between sessions one and four; Ilardi & Craighead, 1994) and early symptom change (i.e., change between sessions one and five) significantly predicts treatment response (Lewis et al, 2012). Moreover, sudden gains (i.e., large, rapid, and stable improvements in symptomatology during treatment) have been frequently documented among individuals who respond to CBT for depression (Tang & DeRubeis, 1999), health anxiety (Hedman et al, 2014), and OCD (Rinehart et al, 2013) and these gains have also been found to account for more than half of individuals' total improvement in depressive symptoms (Tang & DeRubeis, 1999). Thus, given that expectancy for anxiety change increased during early treatment sessions (i.e., from pre-treatment to session four), it is possible that nonspecific factors, such as expectancy for anxiety change, may play a role in early symptom change and/or sudden gains during treatment.…”