Sudden Gains in PTSD Symptoms and Social Functioning in Cognitive Processing Therapy for Post traumatic Stress Disorder

Sudden gains (SGs) are rapid improvements in symptoms between two consecutive therapy sessions, and have been shown to relate to treatment outcomes. This dissertation investigated SGs in Posttraumatic Stress Disorder (PTSD) symptoms, interpersonal relationship functioning, and social role functioning, in a Cognitive Processing Therapy (CPT) implementation effectiveness trial. This was the first study to the author's knowledge to investigate SGs beyond primary symptoms in CPT. The three forms of SGs were examined to better understand their timing, frequency, overlap, and how they each predict outcomes over time. The results indicated that PTSD SGs occurred more often and at different sessions than SGs in facets of social functioning. Most individuals experienced only one form of SG and there were no significant clinical or demographic differences in those who had PTSD only SGs, social functioning only SGs, or both symptom and functioning SGs. PTSD SGs and interpersonal relationship functioning SGs both predicted changes in PTSD symptoms and interpersonal difficulties over time, but not changes in social role functioning. SGs in social role functioning predicted all three forms of outcomes. The findings suggested that there are multiple forms of SGs beyond primary symptom changes that CPT aims to target, and these various SGs are all predictive of patient outcomes. Clinicians should highlight various SGs that patients may experience to further enhance outcomes. Additional research is needed to better understand the cause of different forms of SGs, additional forms of SGs beyond those measured in the present study, and the most appropriate ways to define SGs or comparison groups.