Objective: Although most studies investigating sudden gains in treatments for posttraumatic stress disorder (PTSD) report a positive association between sudden gains and outcomes at the end of treatment, less is known about sudden gains in routine clinical care and the processes involved in their occurrence. This study investigated changes in cognitive factors (negative appraisals, trauma memory characteristics) before, during, and after sudden gains in PTSD symptom severity. Method: Two samples (N1 = 248, N2 = 234) of patients who received trauma-focused cognitive therapy for PTSD in routine clinical care were analyzed. Mahalanobis distance matching, including the propensity score, was used to compare patients with sudden gains and similar patients without sudden gains. Estimates from both samples were meta-analyzed to obtain pooled effects. Results: Patients with sudden gains (n1 = 76, n2 = 87) reported better treatment outcomes in PTSD symptom severity, depression, and anxiety at the end of therapy and follow-up than those without sudden gains. No baseline predictors of sudden gains could be reliably identified. During sudden gains, those with sudden gains had greater changes in both cognitive factors than matched patients. Meta-analyses of the two samples showed that negative appraisals had already decreased in the session prior to sudden gains compared with matched patients. Conclusions: The pooled estimates suggest that changes in negative trauma-related appraisals precede sudden gains in PTSD symptoms. The results suggest that interventions that promote change in appraisals may also facilitate sudden gains in therapy.

中文翻译：

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与常规护理中创伤后应激障碍的认知治疗突然获得相关的认知过程。

目标：虽然大多数调查创伤后应激障碍 (PTSD) 治疗突然获益的研究报告了突然获益与治疗结束时结果之间的正相关，但对常规临床护理的突然获益及其发生过程知之甚少。本研究调查了 PTSD 症状严重程度突然增加之前、期间和之后认知因素（负面评价、创伤记忆特征）的变化。方法：分析了在常规临床护理中接受创伤聚焦认知治疗的 PTSD 患者的两个样本（N1 = 248，N2 = 234）。Mahalanobis 距离匹配，包括倾向评分，用于比较突然增加的患者和没有突然增加的相似患者。对来自两个样本的估计值进行荟萃分析以获得汇总效应。结果：在治疗结束和随访时，突然增加的患者（n1 = 76，n2 = 87）在 PTSD 症状严重程度、抑郁和焦虑方面的治疗结果比没有突然增加的患者更好。无法可靠地确定突然收益的基线预测因素。在突增期间，突增者在这两个认知因素上的变化都比匹配患者更大。两个样本的荟萃分析表明，与匹配的患者相比，在突然收益之前的会话中负面评价已经减少。结论：汇总估计表明，与创伤相关的负面评价的变化先于 PTSD 症状的突然增加。结果表明，促进评估变化的干预措施也可能促进治疗的突然进展。n2 = 87) 报告了在治疗结束和随访时 PTSD 症状严重程度、抑郁和焦虑的治疗结果比没有突然增加的治疗结果更好。无法可靠地确定突然收益的基线预测因素。在突增期间，突增者在这两个认知因素上的变化都比匹配患者更大。两个样本的荟萃分析表明，与匹配的患者相比，在突然收益之前的会话中负面评价已经减少。结论：汇总估计表明，与创伤相关的负面评价的变化先于 PTSD 症状的突然增加。结果表明，促进评估变化的干预措施也可能促进治疗的突然进展。n2 = 87) 报告了在治疗结束和随访时 PTSD 症状严重程度、抑郁和焦虑的治疗结果比没有突然增加的治疗结果更好。无法可靠地确定突然收益的基线预测因素。在突增期间，突增者在这两个认知因素上的变化都比匹配患者更大。两个样本的荟萃分析表明，与匹配的患者相比，在突然收益之前的会话中负面评价已经减少。结论：汇总估计表明，与创伤相关的负面评价的变化先于 PTSD 症状的突然增加。结果表明，促进评估变化的干预措施也可能促进治疗的突然进展。治疗结束和随访时的焦虑程度高于没有突然增加的患者。无法可靠地确定突然收益的基线预测因素。在突增期间，突增者在这两个认知因素上的变化都比匹配患者更大。两个样本的荟萃分析表明，与匹配的患者相比，在突然收益之前的会话中负面评价已经减少。结论：汇总估计表明，与创伤相关的负面评价的变化先于 PTSD 症状的突然增加。结果表明，促进评估变化的干预措施也可能促进治疗的突然进展。治疗结束和随访时的焦虑程度高于没有突然增加的患者。无法可靠地确定突然收益的基线预测因素。在突增期间，突增者在这两个认知因素上的变化都比匹配患者更大。两个样本的荟萃分析表明，与匹配的患者相比，在突然收益之前的会话中负面评价已经减少。结论：汇总估计表明，与创伤相关的负面评价的变化先于 PTSD 症状的突然增加。结果表明，促进评估变化的干预措施也可能促进治疗的突然进展。与匹配的患者相比，那些突然增加的患者在这两个认知因素上都有更大的变化。两个样本的荟萃分析表明，与匹配的患者相比，在突然收益之前的会话中负面评价已经减少。结论：汇总估计表明，与创伤相关的负面评价的变化先于 PTSD 症状的突然增加。结果表明，促进评估变化的干预措施也可能促进治疗的突然进展。与匹配的患者相比，那些突然增加的患者在这两个认知因素上都有更大的变化。两个样本的荟萃分析表明，与匹配的患者相比，在突然收益之前的会话中负面评价已经减少。结论：汇总估计表明，与创伤相关的负面评价的变化先于 PTSD 症状的突然增加。结果表明，促进评估变化的干预措施也可能促进治疗的突然进展。