Sudden gains in prolonged exposure for children and adolescents with posttraumatic stress disorder.

During the last decade researchers have examined instances in which sudden reductions in symptoms occurred between consecutive sessions in treatment. These large, sudden reductions were referred to as sudden gains (Tang & DeRubeis, 1999). Sudden gains were defined as between-session improvements that (a) are large in absolute terms, (b) represent at least a 25% reduction from the pre-gain level of symptoms, and (c) are stable, such that the mean symptom level in the three pre-gain sessions is significantly higher than the mean symptom level in the three post-gain sessions. Sudden gains were initially examined in the treatment of depression and were found to be common, occurring in more than 50% of responders to treatment (Tang & DeRubeis, 1999). Individuals who experienced sudden gains had reduced depression scores at post-treatment, and at follow-up measurements, compared to individuals who did not experience sudden gains (Tang & DeRubeis, 1999). This indicates that sudden gains are an important phenomenon occurring in the treatment for depression and have an impact both on outcome and follow-up. Since the initial study, the phenomenon of sudden gains has been repeatedly examined in various treatments for depression (e.g., Vittengl, Clark, & Jarrett, 2005). Importantly, sudden gains were also detected in treatments for adolescents including cognitive behavioral, family and supportive treatments (Gaynor, Weersing, Kolko, Birmaher, Heo, & Brent, 2003). Sudden gains have been consistently found to predict post-treatment depression (e.g., Gaynor et al., 2003; Vittengl et al., 2005). However, whereas some studies find that sudden gains are predictive of follow-up measurements (e.g., Gaynor et al., 2003), others do not (e.g., Vittengl et al., 2005). Evidence is accumulating that sudden gains may play an important role in additional disorders beside depression. Stiles et al. (2003) found sudden gains in the treatment of individuals who suffered from a variety of disorders and were treated with a diverse set of clinical approaches in a naturalistic setting. Moreover, sudden gains were found in treatments for panic disorder (Clerkin, Teachman, & Smith-Janik, 2008), generalized anxiety disorder (Present et al., 2008), and posttraumatic stress disorder (PTSD; Doane, Feeny, & Zoellner, 2010; Kelly, Rizvi, Monson, & Resick, 2009). In the present study, we examined sudden gains in prolonged exposure (PE) treatment for pediatric PTSD. To our knowledge, no study has examined sudden gains in PTSD symptoms among children and adolescents. Prolonged exposure (PE) is a well-validated treatment for PTSD among adult survivors of trauma (Rothbaum, Meadows, Resick, & Foy, 2000). PE has also been found to be effective among children and adolescents in an open trial (Foa, Chrestman, Gilboa-Schechtman, 2008) and in a randomized controlled trial (Gilboa-Schechtman et al., 2010). The aim of the present study was to examine sudden gains in PE for PTSD among children and adolescents. We hypothesized that sudden gains in posttraumatic symptoms would be detected and that individuals with sudden gains would report lower PTSD and depressive symptoms compared to individuals without sudden gains, both at post-treatment and at follow-up.