E-ISSN : 2733-4538
Sudden gains (SG) are the phenomena of sudden symptom improvements from one session to the next (Tang & DeRubeis, 1999). SG are known to be related to greater symptom reductions at post-treatment and follow-up session. It is also suggested that SG represent abrupt but sustainable symptom improvements which affect treatment outcome. SG are referred to as phenomena that support the cognitive modification hypothesis; cognitive changes function as a precedent factor that leads to symptom reductions in Cognitive Behavior Therapy (CBT). However, there is lack of consensus on the mechanism underlying SG or its effect on prognosis. Furthermore, in contrast to the growing number of SG studies on various different psychopathologies and interventions within Western culture, SG studies have been relatively scarce in Asian culture. The aim of this study was to investigate SG in Cognitive Behavioral Group Therapy (CBGT) for individuals with Social Anxiety Disorder (SAD) in Korea. Data were collected from 32 individuals with SAD who visited the Social Anxiety Counseling Center at Korea University. According to the results, Korean SAD participants showed comparable frequency and magnitude of SG to those reported in previous studies with Western populations. Sudden gainers, compared to non-sudden gainers, showed greater reductions in symptoms associated with social interaction anxiety from pre- to post-assessment. They also demonstrated greater symptom abbreviations in performance anxiety from post- to follow-up assessment. Moreover, the decrease in social anxiety was preceded by reduction of dysfunctional belief and catastrophic anticipation on social interactions. This study was the first to explore SG in Asian culture. In results of this study, patterns of SG in the Korean SAD sample were similar to those reported in Western culture. In addition, sudden gainers showed significantly greater symptom reductions compared to non-sudden gainers. These results support the conceptual importance of SG as both a predictor of positive treatment outcome and evidence to support the cognitive modification hypothesis. In addition, we found temporal difference in the occurrence of SG in social interaction anxiety and performance anxiety, suggesting that individually tailored assessment and intervention based on varying subtypes of social anxiety symptoms may be helpful in promoting better treatment outcome.
권정혜, 이정윤, 조선미 (1998). 수줍음도 지나치면 병. 서울: 학지사.
김소정 (2006). 사회공포증에 대한 과제집중 훈련의 효과. 고려대학교 일반대학원 석사학위 청구논문.
김소정, 윤혜영, 권정혜 (2013). 한국판 사회적 상호작용 불안척도(K-SIAS)와 한국판 사회공포증 척도(K-SPS)의 단축형 타당화 연구. 인지행동치료, 13(3), 511-535.
김향숙 (2001). 사회공포증 하위유형의 기억편향. 서울대학교 일반대학원 석사학위 청구논문.
육성필, 김중술 (1997). 한국판 Beck Anxiety Inventory의 임상적 연구: 환자군과 비환자군의 비교. 한국심리학회지: 임상, 16, 185-197.
윤혜영, 권정혜 (2013). 사회불안장애의 인지행동치료효과: 주의편향과 암묵적 자존감을 중심으로. 인지행동치료, 13(2), 211-234.
이영호, 송종용 (1991). BDI, SDS, MMPI-D 척도의 신뢰도 및 타당도에 대한 연구. 한국심리학회지: 임상, 10, 98-113.
이정윤, 최정훈 (1997). 한국판 사회공포증 척도(K-SAD, K-FNE)의 신뢰도 및 타당도 연구. 한국심리학회지: 임상, 16, 251-264.
조명숙 (2000). 부정적인 사회적 사건의 발생 확률 판단 및 부담 정도 판단과 사회적 상황에서의 자기 효능감이 사회불안에 미치는 영향. 가톨릭대학교 일반대학원 석사학위 청구논문.
조용래, 원호택 (1999). 사회공포증에 대한 인지적 평가 Ⅲ: 역기능적 신념 검사의 개발 및 타당화. 한국심리학회지: 임상, 18, 141-162.
최병휘 (2007). 사회공포증의 인지행동집단치료. 서울: 시그마프레스.
한오수, 홍진표 (2000). DSM-IV의 제 1축 장애의 구조화된 임상적 면담: SCID-1. 서울: 하나의학사.
홍세희, 조용래 (2006). 역기능적 신념검사 단축판의 구성: Rasch 평정척도 모형의 적용. 한국심리학회지: 임상, 25, 865-880.
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.
Aderka, I. M., Nickerson, A., Bøe, H. -J., & Hofmann, S. G. (2012). Sudden gains during psychological treatments of anxiety and depression: A meta-analysis. Journal of consulting and clinical psychology, 80, 92-101.
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, 526-535.
Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893-897.
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of general psychiatry, 4, 561-571.
Bӧgels, S. M., Mulkens, S., & De Jong, P. J. (1997). Task concentration training and fear of blushing. Journal of Clinical Psychology and Psychotherapy, 4, 251-258.
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, 177-182.
Busch, A. M., Kanter, J. W., Landes, S. J., & Kohlenberg, R. J. (2006). Sudden gains and outcome: A broader temporal analysis of cognitive therapy for depression. Behavior therapy, 37(1), 61-68.
Butler, G., & Mathew, A. (1983). Cognitive processes in anxiety. Advances in Behaviour Research and Therapy, 5(1), 51-62.
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.
Di Nardo, P., Brown, T., & Barlow, D. (1994). Anxiety Disorders Interview Schedule for DSM-IV- lifetime version. Albany, NY: Graywind.
Doane, L. S., Feeny, N. C., & Zoellner, L. A. (2010). A preliminary investigation of sudden gains in exposure therapy for PTSD. Behaviour Research and Therapy, 48(6), 555-560.
Gaynor, S. T., Weersing, R., Kolko, D. J., Birmaher, B., Heo, J., & Brents, 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, 386-393.
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.
Haas, E., Hill, R. D., Lambert, M. J., & Morell, B. (2002). Do early responders to psychotherapy maintain treatment gains?. Journal of clinical psychology, 58(9), 1157-1172.
Hardey 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, 59-67.
Hayes, A. M., Feldman, G. C., Beevers, C., G., Laurenceau, J. P., Cardaciotto, L., & Lewis-Smith, J. (2007). Discontinuities and cognitive change in an exposure-based cognitive therapy for depression. Journal of consulting and clinical psychology, 75, 409-421.
Heimberg, R. G. (1991). A manual for conducting cognitive-behavioral group therapy for social phobia. Unpublished manuscript, State University of New York at Albany, Center for Stress and Anxiety Disorders, Albany, NY.
Heimberg, R. G. (2002). Cognitive-behavioral therapy for social anxiety disorder: current status and future directions. Biological Psychiatry, 51(1), 101-108.
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), 687-697.
Hopko, D. R., Robertson, S. M. C., & Carvalho, J. P. (2009). Sudden gains in depressed cancer patients treated with behavioral activation therapy. Behavior Therapy, 40(4), 346-356.
Howard, K. I., Kopta, S. M., Krause, M. S., & Orlinsky, D. E. (1986). The dose-effect relationship in psychotherapy. American Psychologist, 41, 159-164.
Ilard, S. S., & Craighead, W. E. (1994). The role of nonspecific factors in cognitive-behavior therapy for depression. Clinical psychology: Science and practice, 1, 138-156.
Ilard, S. S., & Craighead, W. E. (1999). Rapid early response, cognitive modification, and nonspecific factors in cognitive behavior therapy for depression: A replay to Tang and DeRubeis. Clinical psychology: Science and Practice, 6, 295-299.
Kelly, K. A., Rizvi, S. L., Monson, C. M., & Resick, P. A. (2009). The impact of sudden gains in cognitive behavioral therapy for posttraumatic stress disorder. Journal of Traumatic Stress, 22(4), 287-293.
Kelly, M. A. R., Roberts, J. E., & Bottonari, K. A. (2007). Non-treatment related sudden gains in depression: The role of self-evaluation. Behaviour Research and Therapy, 45, 737-747
Kelly, M. A. R., Roberts, J. E., & Ciesla, J. A. (2005). Sudden gains in cognitive behavioral treatment for depression: When do they occur and do they matter?. Behavior Research and Therapy, 43(6), 703-714.
Kwon, S. (1993). Differential roles of dysfunctional attitudes and automatic thoughts in depression: An integrated cognitive model of depression. Doctoral dissertation, University of Queensland, Australia.
Lambert, M. J., Hansen, N. B., & Finch, A. E. (2001). Patient-focused research: Using patient outcome data to enhance treatment effects. Journal of Consulting and Clinical Psychology, 69, 159-172.
Leary, M. (1983). A brief version of the fear of negative evaluation scale. Personality and Social Psychology Bulletin, 9, 371-375.
Luts, W. (2002). Patient-focused psychotherapy research and individual treatment progress as scientific groundwork for an empirically based clinical practice. Psychotherapy research, 12(3), 251-272.
Lutz, W., Ehrlich, T., Rubel., J., Hallwachs, N., Rӧttger, 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.
Mattick, R. P. & Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36, 455-470.
McNally, R. J., & Foa, E. B. (1987). Cognition and Agoraphobia: Bias in the interpretation of threat. Cognitive Therapy and Research, 11(5), 567-581.
Orsillo, S. M. (2001). Measures for social phobia. In M. M. Antony, Orsilllo, S. M., & Roemer, L. (Ed.), Practitioner's guide to empirically based measures of anxiety (pp. 165-187). New York: Springer.
Present, J., Crits-Christoph, P., Connolly, G. 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.
Rodebaugh, T. L., Holaway, R. M., & Heimberg, R. G. The treatment of social anxiety disorder. Clinical Psychology Review, 24, 883-908.
Stiles, W. B., Barkam, M, Connell, J, & Mellor-Clark, J. (2008). Responsive regulation of treatment duration n routine practice in United Kingdom primary care setting: Replication in a larger sample. Journal of Consulting and Clinical Psychology, 76(2), 298-305.
Stiles, W. B., Leach, C., Barkham, M., Lucock, M., Iveson, S., Shapiro, D. A., & Iveson, M. (2003). Early sudden gains in psychotherapy under routine clinic conditions: practice-based evidence. Journal of Consulting and Clinical Psychology, 71(1), 14-21.
Tang, T. Z., & DeRubeis, R. J. (1999). Sudden gains and critical sessions in cognitive- behavioral therapy for depression. Journal of Consulting and Clinical Psychology, 67, 894-904.
Tang, T., Z, DeRubeis, R. J., Beberman, R., & Pham, T. (2005). Cognitive changes, critical sessions, and sudden gains in cognitive- behavioral therapy for depression. Journal of Consulting and Clinical Psychology, 73(1), 168- 172.
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, 444-447.
Thomas, C., & Persons, J. B. (2013). Sudden gains can occur in psychotherapy even when the pattern of change is gradual. Clinical psychology: Science and Practice, 20(2), 127-142.
Vittengl, J. R., Clark, L. A., & Jarret, R. B. (2005). Validity of sudden gains in acute phase treatment of depression. Journal of Consulting and Clinical Psychology, 73, 173-182.
Watson, D., & Friend, R. (1969). Measurement of social-evaluative anxiety. Journal of Consulting and Clinical Psychology, 33, 448-457.
Wells, A., Stopa, L. A., & Clark, D. M. (1993). Social cognitions questionnaire. Unpublished manuscript, Department of psychiatry, Oxford University, England.