Department of Psychology, University of Washington, Seattle, Washington 98195, USA.
Depress Anxiety. 2013 Jul;30(7):607-13. doi: 10.1002/da.22119. Epub 2013 Apr 30.
Sudden gains are significant, rapid improvements in symptoms, larger than typical between-session symptom reduction.([8]) Sudden gains in a large sample of individuals with posttraumatic stress disorder (PTSD) have not been studied, and only one study has looked at it in pharmacotherapy, but not in PTSD. In the present study, we examined the occurrence of sudden gains in psychotherapy, specifically prolonged exposure (PE), and pharmacotherapy, specifically sertraline, for chronic PTSD.
Sudden gains in PTSD symptoms (PTSD symptom scale self-report([25]) ) were assessed in 200 individuals with PTSD during 10 weeks of PE or sertraline.
Individuals in both PE (42.2%) and sertraline (31%) exhibited sudden gains. Individuals in PE made more gains toward the end of treatment (7.2%) than sertraline (2%, OR = 3.82). However, individuals in sertraline made larger gains during early treatment (M = 18.35, SD = 8.15) than PE (M = 12.53, SD = 5.16, d = .85). Notably, those on sertraline were more likely to exhibit a reversal of sudden gains than those in PE (OR = .23). Pointing to clinical significance, the presence of a sudden gain was associated with better reduction in symptoms from pre- to posttreatment (β = -.49).
Individuals in both PE and sertraline experienced gains, though sertraline was associated with earlier large but reversible gains, and PE was associated with later gains. This differential pattern of discontinuous change highlights potential differential mechanism for these therapies and marks important transition points for further detailed analyses of change mechanisms.
突跃式进步是指症状的显著、快速改善，比典型的会话间症状减轻更大。([8]) 创伤后应激障碍（PTSD）患者中大量样本的突跃式进步尚未得到研究，只有一项研究观察了药物治疗，但不是 PTSD。在本研究中，我们研究了心理治疗，特别是延长暴露（PE）和药物治疗，特别是舍曲林，对慢性 PTSD 突跃式进步的发生。
在 200 名 PTSD 患者中，通过 PTSD 症状量表自我报告([25]) 在 10 周的 PE 或舍曲林治疗期间评估 PTSD 症状的突跃式进步。
PE（42.2%）和舍曲林（31%）组的个体都出现了突跃式进步。PE 组的个体在治疗结束时（7.2%）比舍曲林组（2%，OR = 3.82）的进步更大。然而，舍曲林组在早期治疗时的进步更大（M = 18.35，SD = 8.15），而 PE 组（M = 12.53，SD = 5.16，d =.85）。值得注意的是，与 PE 组相比，舍曲林组更有可能出现突跃式进步的逆转（OR =.23）。这指向了临床意义，突跃式进步的存在与从治疗前到治疗后的症状减轻更好相关（β = -.49）。
PE 和舍曲林组的个体都经历了进步，尽管舍曲林组与早期的较大但可逆转的进步相关，而 PE 组与晚期的进步相关。这种不连续变化的差异模式突出了这些治疗方法的潜在不同机制，并标志着对变化机制的进一步详细分析的重要过渡点。
