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J Consult Clin Psychol. 2011 Aug;79(4):441-6. doi: 10.1037/a0024112.

Sudden gains in prolonged exposure for children and adolescents with posttraumatic stress disorder.

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Department of Psychology, Boston University, Boston, MA 02215, USA.



Our objective was to examine sudden gains during developmentally adjusted prolonged exposure for posttraumatic stress disorder (PTSD) among children and adolescents. We hypothesized that sudden gains would be detected and would be predictive of treatment outcome and follow-up.


Sixty-three youngsters (ages 8-17) completed a developmentally adjusted protocol for the treatment of pediatric PTSD (Foa, Chrestman, & Gilboa-Schechtman, 2008). Participants' posttraumatic and depressive symptoms were assessed before each treatment session, as well as at approximately 3 and 12 months after treatment termination. We measured posttraumatic symptoms with the Child PTSD Symptom Scale (Foa, Johnson, Feeny, & Treadwell, 2001) and measured depressive symptoms with the Beck Depression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) and the Children's Depression Inventory (Kovacs, 1981, 1982).


Sudden gains were found among 49.2% of participants and constituted 48.6% of the total reduction in posttraumatic symptoms. Compared to individuals who did not experience sudden gains, individuals who experienced sudden gains reported lower levels of posttraumatic symptoms, F(1, 61) = 14.4, p < .001, and depressive symptoms, F(1, 61) = 7.9, p < .01, at treatment termination. Differences in posttraumatic symptoms were maintained during both follow-up periods.


Sudden gains are common in pediatric prolonged exposure for PTSD and are predictive of long-term outcome. Treatment planning can benefit from consideration of the intraindividual course of improvement, and treatment development may be enriched by understanding the mechanisms responsible for sudden gains.

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