Fysisk aktivitet och beteendeaktivering har i tidigare forskning påvisats vara effektiv i behandling av depressionstillstånd. Syftet med ACTUA-studien var att utvärdera ett internetbaserat självhjälpsprogram med terapeutstöd via e-post. Totalt deltog 71 individer med egentlig depression som randomiserades till fyra olika behandlingsgrupper, två som ägnade sig åt fysisk aktivitet (FA), två som ägnade sig åt beteendeaktivering (BA) samt en väntelista. Behandlingsprogrammet bestod av åtta moduler som tilldelades deltagaren under en 12 veckor lång behandlingsperiod. Sudden gains, vilket är en företeelse som allmänt anses påverka det slutgiltiga behandlingsresultatet för en individ positivt, kunde påvisas i 47 (66%) deltagares behandlingsprocess. Något samband mellan förekomst av sudden gains och total förbättring under behandlingen kunde inte påvisas i denna studie och det fanns heller inget samband mellan förekomst av sudden gains och typ av behandling. / Physical activity and behavioral activation has been shown in previous research to be effective in the treatment of depressive disorders. The purpose of ACTUA was to evaluate an Internet-based self-help program with therapist support via e-mail. A total of 71 individuals with major depressive disorder were randomized into four treatment groups, two of which contained physical activity (FA), two others comprised of behavioral activation (BA) and one waiting list. The treatment program consisted of eight modules and they were distributed to participants during a 12 week treatment period. Sudden gains, which is a phenomenon that is generally considered to influence the final outcome of treatment for an individual in a positive way was detected in 47 (66%) participants treatment process. A correlation between the occurrence of sudden gains and overall improvement during treatment could not be demonstrated in this study and there was no association between the occurrence of sudden gains and type of treatment.

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Purpose: Postnatal depression (PND) has significant negative outcomes for both mother and baby. The literature indicates that cognitive behavioural interventions can be effective and efficacious treatments, less is known about what mechanisms underpin change in such interventions. The present study aimed to explore severity of depression as a moderator and Behavioural Activation (BA) as a possible mediator of treatment outcome in an online BA intervention for PND. Methods: Follow-up of postnatal women participating in a feasibility Randomised Controlled Trial (RCT) of Netmums, an online BA treatment with telephone support. Results: There was no evidence to support the hypothesis that severity of depression acted as a moderator for treatment outcome. No mediation effects for BA were found. Rumination and avoidance did predict treatment outcome, but this did not differ between the treatment and control group. Post Hoc sudden gains analysis revealed that 48.90% of the treatment group sample experienced a sudden gain. Those who experienced a sudden gain had better post intervention outcomes. Conclusions: The findings have important implications for both theory and the design of future interventions. Future research should consider collecting weekly measures from both treatment and control groups.

Master of Science / School of Family Studies and Human Services / Joyce Baptist / This study examined the efficacy of EMDR therapy as a treatment for unipolar depression. Results provide preliminary evidence for the efficacy of EMDR therapy. Of the 12 participants that received 10 sessions of EMDR therapy, four met the criteria for “Recovered,” six “Improved” and two reported no change in severity of depressive symptoms. Results further indicated that participants who experienced decline in depressive symptoms within the first six sessions of treatment had a higher probability to be meet the criteria for “Recovered.” A small sample comparison between EMDR therapy (n = 4) and CBT (n = 4) did not find any significant difference in terms of treatment outcome. In phase 2, participants in both groups either improved or recovered after 10 sessions of treatment. Sudden gains analysis indicated that 5 out of 12 EMDR therapy participants had sudden gains. Participants in sudden gains group were more likely to meet “Recovered” criteria than participants in no-gains group. Examination of attention bias found that depression was positively related to negative affect fixation duration and negatively related to positive affect fixation duration when only using female affect images. These findings support previous research that used attention bias to differentiate depressed and non-depressed persons. Clinical implication and further research are discussed.

The present study examined whether or not the temporal pattern of symptom change defined as sudden gains is applicable to and has significant ramifications for understanding recovery from eating disorders. Sudden gains were defined as stable and clinically significant changes that take place between two sessions of treatment. Data for the current study were drawn from an efficacy study of CBT for eating disorders which included session-by-session measures of eating disorder symptomatology. Predictors of sudden gains were measured by an observer coded scale that included ratings of therapist use interventions, client change in behaviors and beliefs, client engagement, and homework completion. Three research questions were addressed: First, is the phenomenon of sudden gains present in CBT for eating disorders? Second, do sudden gains in CBT for eating disorders follow the three-stage model proposed for sudden gain recovery in other disorders (i.e., cognitive changes during critical sessions => sudden gains => upward spiral that includes further cognitive changes and greater long-term symptom improvement (Tang & DeRubeis, 1999b)? Third, what are the predictors of sudden gains in CBT for eating disorders that distinguish the critical session that takes place right before the sudden gain? Findings suggest that many eating disordered clients (62%) experienced at least one sudden gain during the course of CBT treatment. Three distinct types of sudden gains were identified: total symptom sudden gains, eating-related sudden gains, and body-related sudden gains. The average magnitude of these sudden gains was large representing on average 35% of total symptom improvement. Clients who experienced total symptom and body-related sudden gains demonstrated fewer eating disordered symptoms than the other clients at posttreatment. During the session preceding the sudden gain, therapists had increased levels of cognitive interventions and empathy, and clients experienced more cognitive changes and increased motivation.

<p>Egentlig depression är en folksjukdom, men i dagsläget är kognitiv beteendeterapi, som fått mest stöd i depressionsforskning, en bristvara. Därav finns ett behov av att med begränsade resurser kunna hjälpa så många patienter som möjligt och då är Internetbaserad självhjälpsbehandling i ett alternativ vid mild till måttlig depression. Denna behandlingsform kan dock inte hjälpa alla, varför de som inte svarat på den inledande behandlingen som ett andra steg bör erbjudas mer intensiv och individualiserad vård; så kallad. stepped care. Vid depression uppvisar vissa patienter sudden gains, det vill säga relativt stora, snabba och stabila minskningar av symptom, som ofta bibehålls på lång sikt.</p><p>Syftet med studien var att undersöka effekten av stepped care vid mild till måttlig depression, vinna ökade kunskaper om sudden gains samt se om överlappningar mellan sudden gains och stepped care fanns.</p><p>85 deltagare inkluderades i studien, varav 69 randomiserades till Internetbaserad självhjälpsbehandling eller live gruppbehandling. Övriga deltagare utgjorde en preferensgrupp där de själva valt Internetbehandling. Båda behandlingsalternativen utgick från samma KBT-baserade behandlingsmoduler, som administrerades under åtta veckor samtidigt som veckovisa självskattningar med MADRS-S hämtades in. Efter avslutad behandling bedömdes vilka deltagare, bland dem som fått Internetbehandling, som var i behov av fortsatt vård och därmed skulle erbjudas ytterligare åtta sessioner med telefonterapi.</p><p>Efter de första åtta veckorna var 70 % av samtliga deltagare utan diagnos och 40 % av deltagarna hade uppvisat sudden gains. Endast 22 % visade sig vid eftermätningen behöva gå vidare till telefonterapi, varav 60 % tackade ja och 40 % fullföljde. Efter avslutad telefonterapi var 75 % av dessa deltagare utan diagnos. En begränsning med studien är att den endast är partiellt randomiserad. Slutsatsen är att den Internetbaserade självhjälpsbehandlingen var så effektiv att få deltagare behövde ytterligare vård i stepped care. De deltagare som uppvisade sudden gains mådde bättre än övriga vid behandlingens slut och fortsatte att må bättre vid enmånadsuppföljning.</p>

Egentlig depression är en folksjukdom, men i dagsläget är kognitiv beteendeterapi, som fått mest stöd i depressionsforskning, en bristvara. Därav finns ett behov av att med begränsade resurser kunna hjälpa så många patienter som möjligt och då är Internetbaserad självhjälpsbehandling i ett alternativ vid mild till måttlig depression. Denna behandlingsform kan dock inte hjälpa alla, varför de som inte svarat på den inledande behandlingen som ett andra steg bör erbjudas mer intensiv och individualiserad vård; så kallad. stepped care. Vid depression uppvisar vissa patienter sudden gains, det vill säga relativt stora, snabba och stabila minskningar av symptom, som ofta bibehålls på lång sikt. Syftet med studien var att undersöka effekten av stepped care vid mild till måttlig depression, vinna ökade kunskaper om sudden gains samt se om överlappningar mellan sudden gains och stepped care fanns. 85 deltagare inkluderades i studien, varav 69 randomiserades till Internetbaserad självhjälpsbehandling eller live gruppbehandling. Övriga deltagare utgjorde en preferensgrupp där de själva valt Internetbehandling. Båda behandlingsalternativen utgick från samma KBT-baserade behandlingsmoduler, som administrerades under åtta veckor samtidigt som veckovisa självskattningar med MADRS-S hämtades in. Efter avslutad behandling bedömdes vilka deltagare, bland dem som fått Internetbehandling, som var i behov av fortsatt vård och därmed skulle erbjudas ytterligare åtta sessioner med telefonterapi. Efter de första åtta veckorna var 70 % av samtliga deltagare utan diagnos och 40 % av deltagarna hade uppvisat sudden gains. Endast 22 % visade sig vid eftermätningen behöva gå vidare till telefonterapi, varav 60 % tackade ja och 40 % fullföljde. Efter avslutad telefonterapi var 75 % av dessa deltagare utan diagnos. En begränsning med studien är att den endast är partiellt randomiserad. Slutsatsen är att den Internetbaserade självhjälpsbehandlingen var så effektiv att få deltagare behövde ytterligare vård i stepped care. De deltagare som uppvisade sudden gains mådde bättre än övriga vid behandlingens slut och fortsatte att må bättre vid enmånadsuppföljning.

Cognitive-behavioral therapy (CBT) is used to treat children and adolescents with depression. Researchers determined that many individuals undergoing CBT and other therapies experienced sudden gains, meaning that they experienced a rapid and large improvement in their symptoms between sessions. The studies demonstrated that by the end of treatment, individuals who experienced sudden gains were significantly less depressed and had better long-term outcomes than individuals who did not experience sudden gains. Previous studies investigated sudden gains in individual therapy while the present study examined sudden gains in group treatment. In addition to replicating results of previous studies, the present study sought to examine the effect of sudden gains on depressive symptoms, family environment, cognitive triad, and negative life events at pre-treatment and at a one year follow-up using multivariate analysis of variance. Participants included 136 girls, aged 9 to 13, in two treatment conditions (CBT, CBT+ parent training (CBT+PT), and a Minimal Contact Control (MCC)). At pre-treatment, post-treatment, and at a one year follow-up, participants completed self-report measures of the family environment, cognitive triad, and negative life events. They also completed a semi-structured diagnostic interview designed to symptoms of depression. After beginning the study, participants’ depressive symptoms were monitored with a brief symptom interview and/or a self-report measure of depressive symptoms. Findings from the study provided further evidence that sudden gains occur during group CBT, and that the majority of sudden gains occur early in CBT. The number of sudden gains did not vary significantly by treatment condition, and similar to previous research, the presence of a parent intervention component did not appear to significantly change the relation between sudden gains and treatment outcome. One important finding was participants in the Minimal Contact Control group experienced sudden gains despite not being in treatment. Another important finding was that the participants who experienced sudden gains differed significantly from the participants who did not experience sudden gains on pre-treatment measures of family environment and the cognitive triad but no differences were found at post-treatment or at a one year follow-up. Implications of these results, limitations, and recommendations for future research are provided. / text

Unexpected dramatic changes in psychotherapy have been observed historically and tied to high recovery rates. Many different methodologies that identify these changes are assumed to be capturing similar or identical phenomena. This study compared three methods – Sudden Gains (SG), Percentage Increase – 50% (PI-50%), and Rapid Response (RR) - in a large database looking for similarities and differences. Results suggest that there are significant differences between SG, RR, and PI-50 as methods for operationally defining unexpected dramatic treatment response, and caution should be used when referring to SG, PI-50, and RR as the same phenomenon or interchangeable terms for unexpected dramatic treatment response. In particular, overlap in clients who experienced both a SG and RR was low. Experiencing any of the three phenomenon was associated with higher recovery rates, while differences abound in both which clients experience each of the phenomena and demographic characteristics of those clients. PI-50 identified inconsequential amounts of clients suggesting under its current methodological construction it would have limited useability. These results tying SG, RR, and PI-50 to significant rates of recovery and positive treatment change suggest possible future use as a predictive feedback tool for clients and clinicians alike to be better able to examine the effectiveness of treatment components during treatment.