A Theoretically Based Experimental Manipulation of the Processing of Sudden Gains

Considering Reasons, Meaning, and Opportunities to Leverage the Gain

Shalom, Jonathan G.
Strauss, Asher Y.
Huppert, Jonathan D.
Andersson, Gerhard
Aderka, Idan M.

School of Psychological Sciences, University of Haifa
Department of Psychology, The Hebrew University of Jerusalem
Department of Behavioural Sciences and Learning, Linköping University
Department of Biomedical and Clinical Sciences, Linköping University
Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet

Stephen Schueller served as action editor.

The data used in the analyses, a codebook to ensure all variables are clearly understood, and the code for conducting all the analyses are available online (https://osf.io/8uqye/?view_only=b64ff67795024d189e1e57fc1b45b73e). The manual for processing of sudden gains is available from the corresponding author upon request. The study and its hypotheses were preregistered (https://osf.io/xktr9/?view_only=de9c3ca21c564abbb32e70840a496f15). This study received ethics approval by the institutional review board at the University of Haifa (Protocol No. 288/19). There are no known conflicts of interest associated with this article. This research was supported by the Israel Science Foundation (Grant 1603/19, awarded to Idan M. Aderka).

Jonathan G. Shalom played a lead role in data curation, investigation, project administration, validation, and visualization and an equal role in conceptualization, methodology, software, writing–original draft, and writing–review and editing. Asher Y. Strauss played an equal role in methodology, software, and writing–review and editing. Jonathan D. Huppert played an equal role in methodology, software, and writing–review and editing. Gerhard Andersson played an equal role in methodology, software, and writing–review and editing. Idan M. Aderka played a lead role in formal analysis, funding acquisition, resources, supervision, and writing–original draft and an equal role in conceptualization, data curation, methodology, software, and writing–review and editing.

Idan M. Aderka, School of Psychological Sciences, University of Haifa, 199 Aba Khoushy Avenue, Mount Carmel, Haifa 3498838, Israel [email protected]

Received September 25, 2023

revised October 20, 2024

Accepted October 28, 2024

Journal of Consulting and Clinical Psychology Publish Ahead of Print, December 30, 2024. | DOI: 10.1037/ccp0000941

Objective: Sudden gains in psychotherapy have been found to predict outcome, but the conditions under which this occurs remain understudied. In the present study, we experimentally examined the effects of processing sudden gains on treatment outcome. Method: As part of a large randomized controlled trial of internet-delivered cognitive behavior therapy for social anxiety disorder (n = 182), we experimentally manipulated therapists’ responses to sudden gains. Specifically, we randomized individuals who experienced a sudden gain (n = 52) to either receive (n = 26) or not receive (n = 26) processing of the gain. Results: We found that processed sudden gains were significantly less likely to be reversed compared to unprocessed sudden gains. We also found that individuals with processed sudden gains had lower symptom levels at posttreatment/follow-up compared to individuals with unprocessed sudden gains (M_difference = 15.65, SE = 5.87, p = .023, Cohen’s d = 0.84; M_difference = 16.68, SE = 6.36, p = .026, Cohen’s d = 1.05; respectively). In addition, individuals with unprocessed sudden gains did not have significantly different symptom levels at posttreatment/follow-up compared to individuals who did not experience a sudden gain during treatment. Conclusions: Our findings suggest that in internet-delivered cognitive behavior therapy for social anxiety disorder, the processing of sudden gains (rather than the gains themselves) leads to upward spirals of improvement that affect long-term outcomes. Replication of these findings in additional studies is needed, and, if replicated, such findings could provide the basis for adding processing of sudden gains to existing therapeutic protocols.