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01-04-2025 | Original Article

Tolerating Uncertainty: Short- and Long-Term Effects of Sudden Gains in Behavioral Experiments for Generalized Anxiety Disorder

Auteurs: Isabelle Fortin-Delisle, Michel J. Dugas

Gepubliceerd in: Cognitive Therapy and Research

Abstract

Background

Sudden gains are significant symptom improvements occurring between therapy sessions. Approximately 20% of individuals with generalized anxiety disorder (GAD) experience sudden gains during psychotherapy (Deschênes and Dugas in Cogn Ther Res 37:805–811, 2013. https://doi.org/10.1007/s10608-012-9504-1; Flückiger et al. in J Consult Clin Psychol 89(5):454, 2021. https://doi.org/10.1037/ccp0000639). This study explores the frequency and impact of sudden gains during a novel cognitive-behavioral treatment (CBT) for GAD—Behavioral Experiments for Intolerance of Uncertainty (Dugas et al. in Behav Ther 53(6):1147–1160, 2022. https://doi.org/10.1016/j.beth.2022.05.003)—a treatment designed to reduce intolerance of uncertainty via behavioral experiments that expose individuals to uncertainty-inducing situations and help them develop more adaptive beliefs and emotional reactions toward uncertainty (Robichaud et al. in Cognitive behavioral treatment for generalized anxiety disorder: from science to practice, Routledge, London, 2019).

Methods

The study tested three hypotheses: (1) at least 20% of participants would experience a sudden gain, (2) participants with sudden gains would demonstrate greater progress during treatment, and (3) these improvements would persist at 6-month follow-up. Forty-eight (48) adults with primary GAD completed 12 sessions of CBT. Sudden gains were identified using the Penn State Worry Questionnaire—Past Week (PSWQ-PW; Stöber and Bittencourt in Behav Res Ther 36(6):645–656, 1998. https://doi.org/10.1016/S0005-7967(98)00031-X), which was administered weekly during treatment. GAD symptoms were assessed with the Worry and Anxiety Questionnaire (WAQ; Dugas et al. in Journal de Thérapie Comportementale et Cognitive 11:31–36, 2001) administered at baseline, post-treatment, and 6-month follow-up to track symptom changes over time.

Results

Fifteen participants (31.25%) experienced a sudden gain. Mixed ANOVAs revealed that participants with sudden gains achieved significantly greater symptom reductions from pre- to post-treatment (WAQ [F(1,46) = 4.51, p =.039, partial η² =.09]). These improvements were sustained at 6-month follow-up (WAQ [F(2,82) = 4.91, p =.01, partial η² =.11]).

Conclusions

Sudden gains during CBT for GAD are both frequent and impactful. In the context of Behavioral Experiments for Intolerance of Uncertainty, these gains contribute to superior outcomes observed at post-treatment and sustained over the long term. Their mechanisms of action and implications for enhancing treatment efficacy warrant further investigation.

T-tests were also performed for complementary analyses with the ADIS-IV, IUS, BAI and BDI-II. Only the mean BDI-II score was significantly different between groups, with higher scores in the SG group than in the NSG group.

Abel, A., Hayes, A. M., Henley, W., & Kuyken, W. (2016). Sudden gains in cognitive–behavior therapy for treatment-resistant depression: Processes of change. Journal of Consulting and Clinical Psychology, 84(8), 726. https://doi.org/10.1037/ccp0000101CrossRefPubMed

Aderka, I. M., & Shalom, J. G. (2021). A revised theory of sudden gains in psychological treatments. Behaviour Research and Therapy, 139, 103830. https://doi.org/10.1016/j.brat.2021.103830CrossRefPubMed

Aderka, I. M., Appelbaum-Namdar, E., Shafran, N., & Gilboa-Schechtman, E. (2011). Sudden gains in prolonged exposure for children and adolescents with posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 79(4), 441–446. https://doi.org/10.1037/a0024112CrossRefPubMedPubMedCentral

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text rev.). Washington, DC: Author.

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders: DSM-5-TR (5th ed.). American Psychiatric Association Publishing.

Andrews, G., Titov, N., Team, T. (2006). Tolkien II: A needs-based, costed, stepped-care model for mental health services, clinical pathways, treatment flowcharts, costing structures. World Health Organization, Collaborating Centre for Classification in Mental Health.

Andrusyna, T. P., Luborsky, L., Pham, T., & Tang, T. Z. (2006). The mechanisms of sudden gains in Supportive-Expressive therapy for depression. Psychotherapy Research, 16(5), 526–535. https://doi.org/10.1080/10503300600591379CrossRef

Appelbaum, M., Cooper, H., Kline, R. B., Mayo-Wilson, E., Nezu, A. M., & Rao, S. M. (2018). Journal article reporting standards for quantitative research in psychology: The APA publications and communications board task force report. American Psychologist, 73(1), 3. https://doi.org/10.1037/amp0000191CrossRefPubMed

Bak, P., & Chen, K. (1991). Self-organized criticality. Scientific American, 264(1), 46–53.

Bauer, J. J., McAdams, D. P., & Sakaeda, A. R. (2005). Crystallization of desire and crystallization of discontent in narratives of life-changing decisions. Journal of Personality, 73(5), 1181–1214. https://doi.org/10.1111/j.1467-6494.2005.00346.xCrossRefPubMed

Baumeister, R. F. (1991). Meanings of life. Guilford.

Beck, A. T., Epstein, N., Brown, G. K., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56(6), 893–897. https://doi.org/10.1037/0022-006X.56.6.893CrossRefPubMed

Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy for depression. Guilford Press.

Beck, A. T., Steer, R. A., & Brown, G. (1996). Beck depression inventory–II. Psychological Assessment. https://doi.org/10.1037/t00742-000CrossRef

Beesdo-Baum, K., & Knappe, S. (2012). Developmental epidemiology of anxiety disorders. Child and Adolescent Psychiatric Clinics, 21(3), 457–478. https://doi.org/10.1016/j.chc.2012.05.001CrossRef

Bohn, C., Aderka, I. M., Schreiber, F., Stangier, U., & Hofmann, S. G. (2013). Sudden gains in cognitive therapy and interpersonal therapy for social anxiety disorder. Journal of Consulting and Clinical Psychology, 81(1), 177–182. https://doi.org/10.1037/a0031198CrossRefPubMed

Brown, T. A., Barlow, D. H., & Liebowitz, M. R. (1994). The empirical basis of generalized anxiety disorder. American Journal of Psychiatry, 151, 1272–1280.

Brown, T. A., Di Nardo, P. A., Lehman, C. L., & Campbell, L. A. (2001). Reliability of DSM-IV anxiety and mood disorders: Implications for the classification of emotional disorders. Journal of Abnormal Psychology, 110(1), 49–58. https://doi.org/10.1037/0021-843X.110.1.49CrossRefPubMed

Butler, R. M., O’Day, E. B., Kaplan, S. C., Swee, M. B., Horenstein, A., Morrison, A. S., Goldin, P. R., Gross, J. J., & Heimberg, R. G. (2019). Do sudden gains predict treatment outcome in social anxiety disorder? Findings from two randomized controlled trials. Behaviour Research and Therapy, 121, 103453. https://doi.org/10.1016/j.brat.2019.103453CrossRefPubMedPubMedCentral

Carleton, R. N. (2016). Into the unknown: A review and synthesis of contemporary models involving uncertainty. Journal of Anxiety Disorders, 39, 30–43. https://doi.org/10.1016/j.janxdis.2016.02.007CrossRefPubMed

Caspar, F., Rothenfluh, T., & Segal, Z. (1992). The appeal of connectionism for clinical psychology. Clinical Psychology Review, 12(7), 719–762. https://doi.org/10.1016/0272-7358(92)90022-ZCrossRef

Clerkin, E. M., Teachman, B. A., & Smith-Janik, S. B. (2008). Sudden gains in group cognitive-behavioral therapy for panic disorder. Behaviour Research and Therapy, 46(11), 1244–1250. https://doi.org/10.1016/j.brat.2008.08.002CrossRefPubMedPubMedCentral

Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10–23. https://doi.org/10.1016/j.brat.2014.04.006CrossRefPubMedPubMedCentral

Davis, C. G., & Morgan, M. S. (2008). Finding meaning, perceiving growth, and acceptance of tinnitus. Rehabilitation Psychology, 53(2), 128. https://doi.org/10.1037/0090-5550.53.2.128CrossRef

Deisenhofer, A. K., Rubel, J. A., Bennemann, B., Aderka, I. M., & Lutz, W. (2022). Are some therapists better at facilitating and consolidating sudden gains than others? Psychotherapy Research, 32(3), 343–357. https://doi.org/10.1080/10503307.2021.1921302CrossRefPubMed

Dugas, M. J. (2018). Le traitement de l’anxiété généralisée: Plus on en sait, moins on en fait [The treatment of generalized anxiety: The more we know, the less we do]. Canadian Psychology/psychologie Canadienne, 59(2), 126–131. https://doi.org/10.1037/cap0000144CrossRef

Deschênes, S. S., & Dugas, M. J. (2013). Sudden gains in the cognitive-behavioral treatment of generalized anxiety disorder. Cognitive Therapy and Research, 37, 805–811. https://doi.org/10.1007/s10608-012-9504-1CrossRef

Dugas, M. J., Brillon, P., Savard, P., Turcotte, J., Gaudet, A., Ladouceur, R., Leblanc, R., & Gervais, N. J. (2010). A randomized clinical trial of cognitive-behavioral therapy and applied relaxation for adults with generalized anxiety disorder. Behavior Therapy, 41(1), 46–58. https://doi.org/10.1016/j.beth.2008.12.004CrossRefPubMed

Dugas, M. J., Freeston, M. H., Provencher, M. D., Lachance, S., Ladouceur, R., & Gosselin, P. (2001). Le questionnaire sur l’inquiétude et l’anxiété. Validation dans des échantillons non cliniques et cliniques [The Worry and Anxiety Questionnaire: Validation in non-clinical and clinical samples]. Journal De Thérapie Comportementale Et Cognitive, 11, 31–36.

Dugas, M. J., Gagnon, F., Ladouceur, R., & Freeston, M. H. (1998a). Generalized anxiety disorder: A preliminary test of a conceptual model. Behaviour Research and Therapy, 36(2), 215–226. https://doi.org/10.1016/S0005-7967(97)00070-3CrossRefPubMed

Dugas, M. J., Laugesen, N., & Bukowski, W. M. (2012). Intolerance of uncertainty, fear of anxiety, and adolescent worry. Journal of Abnormal Child Psychology, 40, 863–870. https://doi.org/10.1016/j.jad.2017.07.035CrossRefPubMed

Dugas, M. J., Langlois, F., Rhéaume, J., & Ladouceur, R. (1998). Intolerance of uncertainty and worry: Investigating causality. In Stöber, J. (Ed.) (Chair), Worry: New findings in applied and clinical research. Symposium presented at the annual conference of the Association for Advancement of Behavior Therapy, Washington, D.C.

Dugas, M. J., Sexton, K. A., Hebert, E. A., Bouchard, S., Gouin, J. P., & Shafran, R. (2022). Behavioral experiments for intolerance of uncertainty: A randomized clinical trial for adults with generalized anxiety disorder. Behavior Therapy, 53(6), 1147–1160. https://doi.org/10.1016/j.beth.2022.05.003CrossRefPubMed

Durland, P. H., Wyszynski, C. M., & Chu, B. C. (2018). Predictors and outcomes of sudden gains and sudden regressions in cognitive behavioral therapy for youth anxiety. Behavior Therapy, 49(5), 823–835. https://doi.org/10.1016/j.beth.2018.01.006CrossRefPubMed

Festinger, L., & Katz, D. (Eds.). (1953). Research methods in the behavioral sciences. Dryden Press.

Flückiger, C., Vîslă, A., Wolfer, C., Hilpert, P., Zinbarg, R. E., Lutz, W., & Allemand, M. (2021). Exploring change in cognitive-behavioral therapy for generalized anxiety disorder—A two-arms ABAB crossed-therapist randomized clinical implementation trial. Journal of Consulting and Clinical Psychology, 89(5), 454. https://doi.org/10.1037/ccp0000639CrossRefPubMed

Fortin-Delisle, I., Marcotte-Beaumier, G., Koerner, N., Langlois, F., Gosselin, P., & Dugas, M. J. (2021). Modification des interprétations et thérapie cognitivo-comportementale pour le trouble d’anxiété généralisée: Un essai randomisé [Modification of Interpretations and Cognitive-Behavioral Therapy for Generalized Anxiety Disorder: A Randomized Trial]. Canadian Journal of Behavioural Science/revue Canadienne DES Sciences Du Comportement, 53(1), 12. https://doi.org/10.1037/cbs0000180CrossRef

Freeston, M. H., Rhéaume, J., Letarte, H., Dugas, M. J., & Ladouceur, R. (1994). Why do people worry? Personality and Individual Differences, 17(6), 791–802. https://doi.org/10.1016/0191-8869(94)90048-5CrossRef

Gaynor, S. T., Weersing, V. R., Kolko, D. J., Birmaher, B., Heo, J., & Brent, D. A. (2003). The prevalence and impact of large sudden improvements during adolescent therapy for depression: A comparison across cognitive-behavioral, family, and supportive therapy. Journal of Consulting and Clinical Psychology, 71(2), 386. https://doi.org/10.1037/0022-006X.71.2.386CrossRefPubMed

Gosselin, P., Ladouceur, R., Morin, C. M., Dugas, M. J., & Baillargeon, L. (2006). Benzodiazepine discontinuation among adults with GAD: A randomized trial of cognitive-behavioral therapy. Journal of Consulting and Clinical Psychology, 74(5), 908. https://doi.org/10.1037/0022-006X.74.5.908CrossRefPubMed

Greenberg, L. S., Rice, L. N., & Elliott, R. (1996). Facilitating emotional change: The moment-by-moment process. Guilford Press.

Greenfield, M. F., Gunthert, K. C., & Haaga, D. A. F. (2011). Sudden gains versus gradual gains in a psychotherapy training clinic. Journal of Clinical Psychology, 67(1), 17–30. https://doi.org/10.1002/jclp.20748CrossRefPubMed

Haken, H. (1992). Synergetics in psychology. In W. Tschacher, G. Schiepek, & E. J. Brunner (Eds.), Self-organization and clinical psychology: Empirical approaches to synergetics in psychology (pp. 32–54). Springer Berlin Heidelberg.

Hardy, G. E., Cahill, J., Stiles, W. B., Ispan, C., Macaskill, N., & Barkham, M. (2005). Sudden gains in cognitive therapy for depression: A replication and extension. Journal of Consulting and Clinical Psychology, 73(1), 59. https://doi.org/10.1037/0022-006X.73.1.59CrossRefPubMed

Hayes, A. M., Feldman, G. C., Beevers, C. G., Laurenceau, J. P., Cardaciotto, L., & Lewis-Smith, J. (2007a). Discontinuities and cognitive changes in an exposure-based cognitive therapy for depression. Journal of Consulting and Clinical Psychology, 75(3), 409. https://doi.org/10.1037/0022-006X.75.3.409CrossRefPubMedPubMedCentral

Hayes, A. M., Laurenceau, J. P., Feldman, G., Strauss, J. L., & Cardaciotto, L. (2007b). Change is not always linear: The study of nonlinear and discontinuous patterns of change in psychotherapy. Clinical Psychology Review, 27(6), 715–723. https://doi.org/10.1016/j.cpr.2007.01.008CrossRefPubMedPubMedCentral

Hayes, A. M., & Strauss, J. L. (1998). Dynamic systems theory as a paradigm for the study of change in psychotherapy: An application to cognitive therapy for depression. Journal of Consulting and Clinical Psychology, 66(6), 939. https://doi.org/10.1037/0022-006X.66.6.939CrossRefPubMed

Hebert, E. A., & Dugas, M. J. (2019). Behavioral experiments for intolerance of uncertainty: Challenging the unknown in the treatment of generalized anxiety disorder. Cognitive and Behavioral Practice, 26(2), 421–436. https://doi.org/10.1016/j.cbpra.2018.07.007CrossRef

Hofmann, S. G., Schulz, S. M., Meuret, A. E., Moscovitch, D. A., & Suvak, M. (2006). Sudden gains during therapy of social phobia. Journal of Consulting and Clinical Psychology, 74(4), 687. https://doi.org/10.1037/0022-006X.74.4.687CrossRefPubMedPubMedCentral

Hu, T., Zhang, D., & Yang, Z. (2015). The relationship between attributional style for negative outcomes and depression: A meta-analysis. Journal of Social and Clinical Psychology, 34(4), 304. https://doi.org/10.1521/jscp.2015.34.4.304CrossRef

Jacobson, N. S., & Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research.

Kazdin, A. E. (2009). Understanding how and why psychotherapy leads to change. Psychotherapy Research, 19(4–5), 418–428. https://doi.org/10.1080/10503300802448899CrossRefPubMed

Kelly, K. A., Rizvi, S. L., Monson, C. M., & Resick, P. A. (2009). The impact of sudden gains in cognitive behavioral therapy for post-traumatic stress disorder. Journal of Traumatic Stress: Official Publication of the International Society for Traumatic Stress Studies, 22(4), 287–293. https://doi.org/10.1002/jts.20427CrossRef

Kelso, J. S. (1997). Dynamic patterns: The self-organization of brain and behavior. MIT Press.

Koerner, N., & Dugas, M. J. (2006). A cognitive model of generalized anxiety disorder: The role of intolerance of uncertainty. In G. C. L. Davey & A. Wells (Eds.), Worry and its psychological disorders: Theory, assessment and treatment (pp. 201–216). Wiley. https://doi.org/10.1002/9780470713143.ch12CrossRef

Krüger, A., Ehring, T., Priebe, K., Dyer, A. S., Steil, R., & Bohus, M. (2014). Sudden losses and sudden gains during a DBT-PTSD treatment for posttraumatic stress disorder following childhood sexual abuse. European Journal of Psychotraumatology, 5(1), 24470. https://doi.org/10.3402/ejpt.v5.24470CrossRef

Ladouceur, R., Dugas, M. J., Freeston, M. H., Léger, E., Gagnon, F., & Thibodeau, N. (2000). Efficacy of a cognitive–behavioral treatment for generalized anxiety disorder: Evaluation in a controlled clinical trial. Journal of Consulting and Clinical Psychology, 68(6), 957–964. https://doi.org/10.1037/0022-006X.68.6.957CrossRefPubMed

Lee, R., McMillan, D., Delgadillo, J., Alexander, R., & Lucock, M. (2024). Cognitive change before sudden gains in cognitive behavioural therapy for panic disorder. Behavioural and Cognitive Psychotherapy, 52(2), 107–118. https://doi.org/10.1017/S1352465823000449CrossRefPubMed

Lemmens, L. H. J. M., DeRubeis, R. J., Arntz, A., Peeters, F. P. M. L., & Huibers, M. J. H. (2016). Sudden gains in cognitive therapy and interpersonal psychotherapy for adult depression. Behaviour Research and Therapy, 77, 170–176. https://doi.org/10.1016/j.brat.2015.12.014CrossRefPubMed

Lorenzo-Luaces, L., & DeRubeis, R. J. (2018). Miles to go before we sleep: Advancing the understanding of psychotherapy by modeling complex processes. Cognitive Therapy and Research, 42, 212–217. https://doi.org/10.1007/s10608-018-9893-xCrossRef

Lorenzo-Luaces, L., German, R. E., & DeRubeis, R. J. (2015). It’s complicated: The relation between cognitive change procedures, cognitive change, and symptom change in cognitive therapy for depression. Clinical Psychology Review, 41, 3–15. https://doi.org/10.1016/j.cpr.2014.12.003CrossRefPubMed

Lutz, W., Ehrlich, T., Rubel, J., Hallwachs, N., Röttger, M. A., Jorasz, C., Mocanu, S., Vocks, S., Schulte, D. & Tschitsaz-Stucki, A. (2013). The ups and downs of psychotherapy: Sudden gains and sudden losses identified with session reports. Psychotherapy Research, 23(1), 14–24. https://doi.org/10.1080/10503307.2012.693837

Mahoney, M. J. (1991). Human change processes: The scientific foundations of psychotherapy. Basic Books, Inc.

Marcotte-Beaumier, G., Hebert, E. A., & Dugas, M. J. (2020). Le Questionnaire sur les comportements sécurisants du trouble d’anxiété généralisée (QCS-TAG): Validation auprès d’un échantillon clinique [The Safety Behaviors Questionnaire for Generalized Anxiety Disorder (SBQ-GAD): Validation in a Clinical Sample]. Canadian Journal of Behavioural Science/revue Canadienne des Sciences Du Comportement, 52(4), 324. https://doi.org/10.1037/cbs0000181CrossRef

Masterson, C., Ekers, D., Gilbody, S., Richards, D., Toner-Clewes, B., & McMillan, D. (2014). Sudden gains in behavioural activation for depression. Behaviour Research and Therapy, 60, 34–38. https://doi.org/10.1016/j.brat.2014.06.008CrossRefPubMed

McManus, F., Van Doorn, K., & Yiend, J. (2012). Examining the effects of thought records and behavioral experiments in instigating belief change. Journal of Behavior Therapy and Experimental Psychiatry, 43, 540–547. https://doi.org/10.1016/j.jbtep.2011.07.003CrossRefPubMed

McMillan, D., & Lee, R. (2010). A systematic review of behavioral experiments vs. exposure alone in the treatment of anxiety disorders: A case of exposure while wearing the emperor’s new clothes? Clinical Psychology Review, 30, 467–478. https://doi.org/10.1016/j.cpr.2010.01.003CrossRefPubMed

Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and validation of the Penn state worry questionnaire. Behaviour Research and Therapy, 28(6), 487–495. https://doi.org/10.1016/0005-7967(90)90135-6CrossRefPubMed

Neimeyer, R. A. (2006). Complicated grief and the reconstruction of meaning: Conceptual and empirical contributions to a cognitive-constructivist model. Clinical Psychology: Science and Practice, 13(2), 141–145. https://doi.org/10.1111/j.1468-2850.2006.00016.xCrossRef

Nogueira-Arjona, R., Santacana, M., Montoro, M., Rosado, S., Guillamat, R., Vallès, V., & Fullana, M. A. (2017). Sudden gains in exposure-focused cognitive-behavioral group therapy for panic disorder. Clinical Psychology & Psychotherapy, 24(4), 1285–1291. https://doi.org/10.1002/cpp.2093CrossRef

Norton, P. J., Klenck, S. C., & Barrera, T. L. (2010). Sudden gains during cognitive–behavioral group therapy for anxiety disorders. Journal of Anxiety Disorders, 24(8), 887–892. https://doi.org/10.1016/j.janxdis.2010.06.012CrossRefPubMedPubMedCentral

Present, J., Crits-Christoph, P., Connolly Gibbons, M. B., Hearon, B., Ring-Kurtz, S., Worley, M., & Gallop, R. (2008). Sudden gains in the treatment of generalized anxiety disorder. Journal of Clinical Psychology, 64(1), 119–126. https://doi.org/10.1002/jclp.20435CrossRefPubMed

Rescorla, R. A., & Wagner, A. R. (1972). A theory of Pavlovian conditioning: Variations in the effectiveness of reinforcement and nonreinforcement. In R. O. Mowrer & S. Klein (Eds.), Handbook of contemporary learning theories. Lawrence Erlbaum.

Robichaud, M., Koerner, N., & Dugas, M. J. (2019). Cognitive behavioral treatment for generalized anxiety disorder: From science to practice. Routledge.

Rosen, N. O., & Knäuper, B. (2009). A little uncertainty goes a long way: State and trait differences in uncertainty interact to increase information seeking but also increase worry. Health Communication, 24(3), 228–238. https://doi.org/10.1080/10410230902804125CrossRefPubMed

Roy, P., Dugas, M. J., Langlois, F., & Gosselin, P. (2013). DSM–5 behavioural symptoms of GAD: A comparaison between a clinical and a non-clinical sample. In Poster presented at the annual conference of the Canadian Association of cognitive and behavioral therapies. Montreal, QC.

Salkovskis, P. M., Hackmann, A., Wells, A., Gelder, M. G., & Clark, D. A. (2006). Belief disconfirmation versus habituation approaches to situational exposure in panic disorder with agoraphobia: A pilot study. Behaviour Research and Therapy, 45(5), 877–885. https://doi.org/10.1016/j.brat.2006.02.008CrossRef

Schiepek, G., Heinzel, S., Karch, S., Plöderl, M., & Strunk, G. (2016). Synergetics in psychology: patterns and pattern transitions in human change processes. In Selforganization in complex systems: The Past, present, and future of synergetics: proceedings of the international symposium, Hanse Institute of advanced studies, Delmenhorst, Germany, November 13–16, 2012 (pp. 181–208). Springer International Publishing. https://doi.org/10.1007/978-3-319-27635-9_12

Schiepek, G., Eckert, H., & Weihrauch, S. (2003). Critical Fluctuations and Clinical Change: Data-Based Assessment in Dynamic Systems. Constructivism in the Human Sciences, 8(1), 57.

Schiepek, G., Fricke, B., & Kaimer, P. (1992). Synergetics of psychotherapy (pp. 239–267). Springer.

Shalom, J. G., & Aderka, I. M. (2020). A meta-analysis of sudden gains in psychotherapy: Outcome and moderators. Clinical Psychology Review, 76, 101827. https://doi.org/10.1016/j.cpr.2020.101827CrossRefPubMed

Shalom, J. G., Gilboa-Schechtman, E., Atzil-Slonim, D., Bar-Kalifa, E., Hasson-Ohayon, I., Van Oppen, P., van Balkom, A. J. L. M., & Aderka, I. M. (2018). Intraindividual variability in symptoms consistently predicts sudden gains: An examination of three independent datasets. Journal of Consulting and Clinical Psychology, 86(11), 892. https://doi.org/10.1037/ccp0000344CrossRefPubMed

Stöber, J., & Bittencourt, J. (1998). Weekly assessment of worry: An adaptation of the Penn State Worry Questionnaire for monitoring changes during treatment. Behaviour Research and Therapy, 36(6), 645–656. https://doi.org/10.1016/S0005-7967(98)00031-XCrossRefPubMed

Stöber, J., & Joormann, J. (2001). Worry, procrastination, and perfectionism: Differentiating amount of worry, pathological worry, anxiety, and depression. Cognitive Therapy and Research, 25, 49–60. https://doi.org/10.1023/A:1026474715384CrossRef

Sweeney, P. D., Anderson, K., & Bailey, S. (1986). Attributional style in depression: A meta-analytic review. Journal of Personality and Social Psychology, 50(5), 974. https://doi.org/10.1037/0022-3514.50.5.974CrossRefPubMed

Tang, T. Z., & DeRubeis, R. J. (1999a). Reconsidering rapid early response in cognitive behavioral therapy for depression. Clinical Psychology: Science and Practice, 6(3), 283–288. https://doi.org/10.1093/clipsy.6.3.283CrossRef

Tang, T. Z., & DeRubeis, R. J. (1999b). Sudden gains and critical sessions in cognitive-behavioral therapy for depression. Journal of Consulting and Clinical Psychology, 67(6), 894. https://doi.org/10.1037/0022-006X.67.6.894CrossRefPubMed

Tang, T. Z., DeRubeis, R. J., Hollon, S. D., Amsterdam, J., & Shelton, R. (2007). Sudden gains in cognitive therapy of depression and depression relapse/recurrence. Journal of Consulting and Clinical Psychology, 75(3), 404. https://doi.org/10.1037/0022-006X.75.3.404CrossRefPubMed

Tang, T. Z., Luborsky, L., & Andrusyna, T. (2002). Sudden gains in recovering from depression: Are they also found in psychotherapies other than cognitive-behavioral therapy? Journal of Consulting and Clinical Psychology, 70(2), 444.PubMed

Tolin, D. F. (2019). Inhibitory learning for anxiety-related disorders. Cognitive and Behavioral Practice, 26(1), 225–236. https://doi.org/10.1016/j.cbpra.2018.07.008CrossRef

Van der Heiden, C., Muris, P., & van der Molen, H. T. (2012). Randomized controlled trial on the effectiveness of metacognitive therapy and intolerance-of-uncertainty therapy for generalized anxiety disorder. Behaviour Research and Therapy, 50(2), 100–109. https://doi.org/10.1016/j.brat.2011.12.005CrossRefPubMed

Van der Maas, H., & Molenaar, P. (1992). Stagewise cognitive development: An application of catastrophe theory. Psychological Review, 99(3), 395–417. https://doi.org/10.1037/0033-295X.99.3.395CrossRefPubMed

Vincent, L., & Norton, P. J. (2019). Predictors and consequences of sudden gains in transdiagnostic cognitive-behavioural therapy for anxiety disorders. Cognitive Behaviour Therapy, 48(4), 265–284. https://doi.org/10.1080/16506073.2018.1513557CrossRefPubMed

Weisman, J. S., & Rodebaugh, T. L. (2018). Exposure therapy augmentation: A review and extension of techniques informed by an inhibitory learning approach. Clinical Psychology Review, 59, 41–51. https://doi.org/10.1016/j.cpr.2017.10.010CrossRefPubMed

Wong, P. T. P. (2010). Meaning therapy: An integrative and positive existential psychotherapy. Journal of Contemporary Psychotherapy, 40(2), 85–93. https://doi.org/10.1007/s10879-009-9132-6CrossRef

Wucherpfennig, F., Rubel, J. A., Hofmann, S. G., & Lutz, W. (2017). Processes of change after a sudden gain and relation to treatment outcome—Evidence for an upward spiral. Journal of Consulting and Clinical Psychology, 85(12), 1199. https://doi.org/10.1037/ccp0000263CrossRefPubMed

Titel: Tolerating Uncertainty: Short- and Long-Term Effects of Sudden Gains in Behavioral Experiments for Generalized Anxiety Disorder
Auteurs: Isabelle Fortin-Delisle
Michel J. Dugas
Publicatiedatum: 01-04-2025
Uitgeverij: Springer US
Gepubliceerd in: Cognitive Therapy and Research
Print ISSN: 0147-5916
Elektronisch ISSN: 1573-2819
DOI: https://doi.org/10.1007/s10608-025-10598-x

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Tolerating Uncertainty: Short- and Long-Term Effects of Sudden Gains in Behavioral Experiments for Generalized Anxiety Disorder

Abstract

Background

Methods

Results

Conclusions

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Abstract

Background

Methods

Results

Conclusions

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