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Sudden Gains and Deteriorations in the Treatment of Posttraumatic Stress Disorder in World Trade Center Responders

Haugen, Peter Tejas PhD*; Goldman, Rachel E. MA; Owen, Jesse PhD

The Journal of Nervous and Mental Disease: March 2015 - Volume 203 - Issue 3 - p 205–209
doi: 10.1097/NMD.0000000000000263
Original Articles

This study sought to examine the prevalence of sudden gains and deteriorations (i.e., symptom reduction/improvement during treatment) and their influence on treatment outcomes among World Trade Center responders with probable posttraumatic stress disorder. Thirty-six outpatient clients received at least three sessions of integrative psychotherapy, which included elements of psychodynamic and cognitive-behavioral therapy approaches, under routine clinical conditions. Approximately 19% of clients experienced a sudden gain and 27% of clients experienced a sudden deterioration. Those who experienced deteriorations had worse therapy outcomes compared with those who did not. Clinical implications are discussed, including the importance of routine monitoring of client treatment response for sudden deteriorations to enhance positive treatment outcomes. Future research with larger samples is needed to further evaluate the mechanisms of sudden gains and sudden deteriorations in this population.

*New York University School of Medicine World Trade Center Health Program Clinical Center of Excellence, and Departments of Psychiatry and Pulmonary Medicine, New York University; †Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, NY; and ‡Department of Counseling Psychology, University of Denver, Denver, CO.

Send reprint requests to Peter Tejas Haugen, PhD, NYU School of Medicine World Trade Center Health Program Clinical Center of Excellence, Bellevue Hospital Center, Room A720, 462 First Ave, New York, NY 10016. E-mail:

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