Intraindividual Variability in Symptoms Consistently Predicts Sudden Gains: An Examination of Three Independent Datasets

• Published in: Journal of consulting and clinical psychology 2018-11, Vol.86 (11), p.892-902
• Main Authors: Shalom, Jonathan G, Gilboa-Schechtman, Eva, Atzil-Slonim, Dana, Bar-Kalifa, Eran, Hasson-Ohayon, Ilanit, van Oppen, Patricia, van Balkom, Anton J. L. M, Aderka, Idan M
• Format: Article
• Language: English
• Subjects: Adaptation, Psychological; Adolescent; Adult; Child; Clinical outcomes; Clinical psychology; Clinical research; Clinical trials; Cognitive Behavioral Therapy - standards; Combined Modality Therapy; Exposure therapy; Female; Fluvoxamine - therapeutic use; Human; Humans; Implosive Therapy - standards; Individual Differences; Individuality; Intraindividual Variability; Male; Middle Aged; Mood Disorders - psychology; Mood Disorders - therapy; Obsessive compulsive disorder; Obsessive-Compulsive Disorder - psychology; Obsessive-Compulsive Disorder - therapy; Population; Post traumatic stress disorder; Posttraumatic Stress Disorder; Psychodynamic therapy; Psychotherapeutic Breakthrough; Psychotherapeutic Outcomes; Psychotherapy; Psychotherapy, Psychodynamic - standards; Random Sampling; Stress Disorders, Post-Traumatic - psychology; Stress Disorders, Post-Traumatic - therapy; Symptoms; Treatment Outcome; Variability; Young Adult
• ISSN: 0022-006X; 1939-2117
• DOI: 10.1037/ccp0000344

Objective: Sudden gains are robust predictors of outcome in psychotherapy. However, previous attempts at predicting sudden gains have yielded inconclusive findings. The aim of the present study was to examine a novel, transdiagnostic, transtherapeutic predictor of sudden gains that would replicate in different settings and populations. Specifically, we examined intraindividual variability in symptoms. Method: We examined data from a randomized controlled trial (RCT) of prolonged exposure therapy for posttraumatic stress disorder (PTSD) in children and adolescents (n = 63), an RCT of cognitive and behavioral therapies for obsessive-compulsive disorder (OCD) in adults (n = 91), and psychodynamic therapy delivered under routine clinical conditions in a naturalistic setting for diverse disorders (n = 106). In all 3 data sets, we examined whether a measure of variability in symptoms occurring during the first sessions could predict sudden gains. Results: Variability in symptoms was found to be independent of total change during treatment. Variability in symptoms significantly predicted sudden gains in all 3 data sets and correctly classified 81.0%, 69.2%, and 76.9% of individuals to sudden gain or nonsudden gain status, respectively. Conclusions: The present study represents the first examination of variability in symptoms as a predictor of sudden gains. Findings indicated that sudden gains are significantly predicted by intraindividual variability in symptoms, in diverse settings, contexts, and populations. Advantages of this predictor, as well as clinical and research implications are discussed. What is the public health significance of this article? Previous predictors of sudden gains in psychotherapy have been inconsistent. The present study indicates that variability in symptoms may represent a promising transdiagnostic and transtherapeutic predictor of sudden gains that cuts across contexts and populations.