A recent study conducted in the United Kingdom examined the frequency of sudden and significant reductions in social anxiety symptoms during face-to-face and internet-based therapy sessions. Results revealed that 64% of patients who received in-person treatment and 51% of patients who received internet-based treatment experienced significant symptom relief. Negative social cognition and attention to self tended to decrease immediately before improvement. This study behavioral research and treatment.
In psychotherapy, “sudden improvement” refers to a significant and rapid improvement in a client's symptoms or overall health that occurs between two treatment sessions. This reduction in symptoms occurs over a short period of time, such as 1 to 2 weeks. Researchers and therapists have noted the sudden increase occurring across a variety of treatment approaches and client populations. For this reason, the phenomenon of sudden increase is considered an important aspect of the therapeutic process.
Some theories suggest that sudden progress may result from cognitive changes, increased insight, or consolidation of learning during therapy sessions. Therapists often track and investigate sudden growth to better understand the factors contributing to a client's progress. Studies of individuals suffering from social anxiety disorder have shown that typically about 20% of patients suddenly experience improvement in symptoms, whereas the overall rate for all disorders is 34% of their symptoms. Despite the importance of sudden increases, scientists are still unsure about the exact factors and their interactions that produce sudden increases.
Study author Graham R. Thew and his colleagues wanted to examine the possible determinants of the occurrence of sudden effects in individual cognitive therapy for social anxiety disorder. Specifically, they wanted to compare in-person therapy to internet-based therapy in terms of how often sudden effects are achieved. Sudden increases have been reported in Internet-based treatments, but it is unclear whether they occur as frequently as in-person treatments.
The study involved 99 people between the ages of 18 and 65 who had been diagnosed with social anxiety disorder and was part of a larger study comparing in-person therapy to internet-based therapy. Of these, 50 participated in face-to-face therapy and 49 participated in internet-based therapy. Treatment lasted for 14 weeks and follow-up was done 3 months after treatment and 12 months later.
Face-to-face sessions were conducted weekly and each lasted 90 minutes. In contrast, internet-based sessions included his 20-minute phone call between patient and therapist and additional communication via messaging and SMS throughout the week. The internet-based treatment also incorporated a webcam experiment during the second week.
Before each face-to-face session, or once a week for Internet-based treatment patients, participants completed social anxiety symptoms (Leibowitz Social Anxiety Scale – Self-Report Version and Anxiety Disorders Interview Schedule), negative social cognitions (Social Cognitive Questionnaire, SCQ), self-focused attention (two items from the Social Phobia Weekly Summary), and depressive symptoms (Patient Health Questionnaire).
Researchers defined a sudden increase as a decrease in anxiety symptom scale scores that significantly exceeds regular fluctuations in anxiety symptoms. They also reviewed the sessions before the sudden gain and thought that events within these sessions may be crucial in understanding the gain. These sessions were analyzed to identify the occurrence of generalized learning. Generalized learning is defined as “new learning that results from any therapeutic activity that is applied to a variety of social situations and that involves drawing more general conclusions about self, others, or the social situation.” Masu.
Of the 1,089 intersession intervals analyzed, 77 (7%) were classified as sudden increases. Thirty-two patients (64%) who received in-person treatment and 25 (51%) who received internet-based treatment experienced a sudden increase. However, statistical tests showed that the difference in incidence between the two treatment modes was not significant enough to infer a general trend. The mean magnitude of the sudden increase was similar for both treatment types.
Further analysis revealed that participants who experienced sudden weight gain had fewer social anxiety symptoms both at the end of treatment and at follow-up compared to those who did not. This indicates that the effect of the sudden gain was not temporary but sustained.
At the same time that the sudden increase occurred, that is, when social anxiety symptoms decreased, self-focus, negative social cognition, and depressive symptoms decreased as well. Self-focused attention and negative social cognition (but not depressive symptoms) also showed a decrease in the session immediately preceding the session in which the sudden increase was detected. The researchers detected significant general learning in the session immediately preceding the sudden increase.
“This study showed that online therapy can produce sudden effects, and that the frequency, magnitude, and clinical significance of these effects are similar to those seen with face-to-face cognitive therapy.” concluded the study authors. “Sudden growth predicted better overall treatment outcomes. We found evidence that negative social cognition and self-focused attention are reduced prior to sudden growth. Clients' statements in cognitive therapy sessions indicated greater generalization learning during pre-acquisition compared to control sessions; This suggests that there may be a link between morphological learning and the occurrence of sudden acquisition.”
Although this study sheds light on the nature of sudden effects in psychotherapy, it also has limitations. The study authors noted that the method of detecting sudden increases could lead to false positives. Additionally, because the assessments were conducted before weekly treatment sessions, we were unable to distinguish between gains that occurred during sessions and gains that occurred during intervening weeks.
the study, “Face-to-face and internet-based cognitive therapies for social anxiety disorder are rapidly increasing” was written by Graham R. Thew, Anke Ehlers, and David M. Clark.
