Within-Day Sudden Gains and Generalized Anxiety Disorder Psychotherapy Outcome

According to dynamic systems theory, initial symptom instability is necessary for long-term stable change to occur from psychotherapy. Such instability may be assessed using within-day sudden gains (SGs), sudden losses (SLs), and reversals. The present study examined these symptom change patterns and their association with treatment outcome using intensive diary assessment across three psychotherapies for generalized anxiety disorder (GAD). In a secondary analysis of Borkovec and Costello (1993), 59 clients diagnosed with GAD were randomly assigned to applied relaxation (AR; n = 21), cognitive behavioral therapy (CBT; n = 20), or nondirective (ND) therapy (n = 18). Clients completed thrice daily anxiety ratings while receiving psychotherapy. The occurrence of SGs, SLs, and reversals assessed for each individual was calculated using changes between each assessment. We examined the association between occurrence of SGs, SLs, and reversals and symptom change from pretreatment to posttreatment, and 6-month, and 1-year follow-up. Clients in ND (61.1%) were more likely to experience SGs than clients in CBT (20.0%) or AR (38.0%). 92.9% of SGs were followed by a reversal. Experiencing SGs was associated with less symptom change from pretreatment to follow-up in ND and not associated with outcome in CBT or AR. SLs and reversals were not associated with outcome. When measured at a within-day level, SGs are very likely to be reversed and may be associated with poorer long-term outcome in ND. Within-day SGs may have a fundamentally different meaning than session-to-session SGs.

© American Psychological Association, 2022-09-01. This paper is not the copy of record and may not exactly replicate the authoritative document published in the APA journal. Please do not copy or cite without author's permission. The final article is available, upon publication, at: https://doi.org/10.1037/pst0000445

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Work Title Within-Day Sudden Gains and Generalized Anxiety Disorder Psychotherapy Outcome
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Open Access
Creators
  1. Michelle G. Newman
  2. Jeremy T. Schwob
  3. Gavin N. Rackoff
Keyword
  1. Anxiety
  2. Dynamic systems theory
  3. Psychotherapy
  4. Sudden gains
License In Copyright (Rights Reserved)
Work Type Article
Publisher
  1. Psychotherapy
Publication Date September 1, 2022
Publisher Identifier (DOI)
  1. https://doi.org/10.1037/pst0000445
Deposited February 17, 2023

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  • Added Newman-in_p-Within-day_sudden_gains_and_genera.pdf
  • Added Creator Michelle G. Newman
  • Added Creator Jeremy T. Schwob
  • Added Creator Gavin N. Rackoff
  • Published
  • Updated Keyword Show Changes
    Keyword
    • Anxiety, Dynamic systems theory, Psychotherapy, Sudden gains
  • Updated Publication Date Show Changes
    Publication Date
    • 2022-01-01
    • 2022-09-01
  • Updated