Thursday, 27 November 2008

When clients in therapy show sudden, dramatic improvements

There's growing evidence that people who undergo psychological therapy often demonstrate sudden, dramatic improvements, almost as though they've had a revelatory change of outlook and thinking style. What's more, these sudden changes appear to be clinically meaningful. People who exhibit sudden improvements from one session to the next are more likely than other clients to show greater and more sustained improvement after they've stopped participating in therapy.

Now Elise Clerkin and colleagues at the University of Virginia have investigated the significance of sudden gains among 30 clients undertaking 12 weeks of group Cognitive Behavioural Therapy (CBT) for panic disorder - a context in which the sudden-improvement phenomenon has yet to be studied.

Clerkin's team found that 43 per cent of clients exhibited at least one dramatic burst of improvement during the course of therapy. Approximately half of these clients showed this improvement between the first and second sessions, while the other half showed their gains later on.

The timing of the sudden improvement proved to be significant. Only those clients who showed dramatic gains after the second session or later tended to show better symptom outcomes at the end of the course of therapy relative to non-dramatic improvers. This makes sense given that the first session was really just an introduction and didn't include any of the active ingredients of CBT.

Moreover, the later dramatic improvers showed a greater reduction in their fear of anxiety-related symptoms (e.g. a racing heart-beat) at the end of the course of therapy (and at six months' follow-up) than did the very early dramatic improvers. This suggests that when a dramatic improvement occurred after the second session or later it probably had to do with the clients changing how they interpreted their anxiety symptoms - one of the key goals of CBT. By contrast, very early dramatic improvement may have reflected a meaningless fluctuation of symptoms.

The researchers said more work is needed to find out what psychological processes underlie the effects of a dramatic improvement during therapy. "We suspect these effects occur because of changes in self-efficacy that follow a large, dramatic improvement, which likely engenders hope for further recovery, and enhances commitment to the therapy," they surmised. "In fact, the sudden gain itself may confer a critical belief change regarding the patient's ability to overcome symptoms of panic."

ResearchBlogging.orgE CLERKIN, B TEACHMAN, S SMITHJANIK (2008). Sudden gains in group cognitive-behavioral therapy for panic disorder. Behaviour Research and Therapy DOI: 10.1016/j.brat.2008.08.002

Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.


Speedwell said...

Good that the study de-emphasized first-session effects. I always find that when I start with a new therapist, in the first session I put on my best "face" and everything seems so clear and obvious. Then when I go home, I feel terrible because I was too busy being "good" to really bring out and address the issues that put me there to begin with. I am an awful therapy dropout for that reason. Wish I wasn't.

L K Tucker said...

Sudden improvements in psychiatric symptoms point to a little known problem of human physiology, Subliminal Distraction. I began to look at it when my wife had a psychotic break thirty days after her work area was changed eliminating Cubicle Level Protection.

SD was discovered as a problem when it caused mental breaks for office workers. The cubicle was created to deal with the vision startle reflex to stop the mental events by 1968.

Although explained in first semester psychology under psychophysics, it is unknown in medicine or psychiatry. In a six year research project I have been unable to find anyone aware of it.

Panic attacks can be correlated with this phenomenon. I have personal experience with it and panic attacks. Lowering exposure would stop symptoms quickly.

How many of those who quickly recover have jobs or activities that allow Subliminal Distraction exposure?


L K Tucker said...

Since this post I found a single psychiatrist, an associate professor at Tuffs University, who said he had seen the episodes from offices when he was in residency. He, like everyone else aware of the problem believes the episodes are harmless, temporary, transient.

No one screens for this simple problem before beginning treatment for what they see and believe to be mental illness.

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