ISTSS Award Recipient Reflections from 2013 Frank W. Putnam Trauma Research Scholar Award Recipient

Janie J. Jun, MS

Attending the ISTSS annual meetings has always been inspiring and stimulating for me. One of my favorite events is the annual student lunch meetings, which allow encourage conversations with fellow students, future colleagues and leaders in the field of traumatic stress. Being part of the ISTSS community has positioned me at the forefront of new developments in trauma research and clinical practice, which has shaped my development as a scientist-practitioner.

My research interests are in the investigation of mechanisms underlying therapeutic change in anxiety and trauma-related disorders. Traditional intervention research methods focus heavily on outcome data, focusing largely on pre- to post-treatment time points. This approach allows us to identify effective interventions, but it treats what is occurring during treatment as an elusive “black box.” Thus, it is important for us to take a process-oriented approach to gain a better understanding of how and why interventions actually work.

I am particularly interested in examining individual trajectories of symptom change and identifying key treatment components that could maximize an individual’s improvement. I believe this is a critical step toward enhancing and personalizing our interventions to unique individuals.

For a substantial minority of individuals with PTSD, change during therapy is not linear and continuous (Jun et al., 2013). My master’s thesis examined the occurrence of discontinuous change, sudden gains (Tang & DeRubeis, 1999), in a PTSD clinical trial, where individuals received either prolonged exposure (PE) psychotherapy alone or sertraline pharmacotherapy alone.

We found that the experience of a rapid, sudden decreases in symptoms between sessions was strongly associated with better treatment outcome, and the timing and magnitude of the gains varied by treatment modality, such that individuals receiving sertraline made larger early gains, while those receiving PE made more multiple gains throughout treatment. This differential pattern of gains potentially highlights distinct mechanisms. Thus, we were eager to get a better understanding of what underlies these sudden gains.

To examine this, it is important to do more in-depth contextual and temporal analysis of what occurs prior to the experience of a sudden therapeutic gain. My dissertation research expanded on my master’s thesis by further examining sudden gains in individuals with PTSD, examining the content of therapeutic sessions prior to the experience of a sudden gain in individuals receiving PE alone or a combined treatment of PE plus sertraline.

We investigated specific psychotherapy processes underlying sudden gains, by coding the content of individual therapy sessions with an adapted Change and Growth Experiences Scale (Hayes et al., 2006), an observational measure that captures therapeutic processes thought to be crucial in cognitive-behavioral therapies. Identifying potential therapeutic precipitants of sudden gains is compelling, because it will allow clinicians to focus on these factors to better promote therapeutic change.

One factor that emerged as a temporal predictor of sudden gains was hope, which captures the individual’s capacity to recognize recent positive changes and see the possibility of change in the future. Another factor that emerged as a predictor of sudden gains was cognitive-emotional processing, which is the exploration and questioning of difficult experiences and emotions with new connections and meaning leading to new perspectives.

Thus, clinicians should enhance their therapeutic techniques with the goal of further promoting both of these elements and refining our existing treatments in order to promote more rapid improvements. Specifically, to bolster hope therapists could regularly help individuals identify changes and progress made, connecting them to behaviors in order to encourage beliefs of capability of attaining goals.

To promote cognitive-emotional processing, therapists could identify factors reinforcing an individuals’ rigidity to question and explore problem areas and help them practice consolidating new learning. I look forward to presenting and discussing my findings with the ISTSS community.

As I continue to grow as a scientist-practitioner, I am eager to further develop expertise in psychotherapy change process research in anxiety and traumatic stress-related disorders. I hope to identify key, modifiable components of treatment and therapeutic skills, which will allow us to achieve the ultimate goal of enhancing the efficiency and efficacy of our treatments.

About the Author
Janie J. Jun, MS, is a doctoral student in clinical psychology at the University of Washington, where she is working with Dr. Lori Zoellner. She is currently a psychology intern at the Boston Consortium Internship in Clinical Psychology. Her research interests are in understanding the processes of change that underlie our treatments for anxiety and trauma-related disorders. Her research has been funded by the National Institute of Mental Health (NIH), the International Society for Traumatic Stress Studies (ISTSS), the American Psychological Foundation (APF), and the University of Washington ALCOR Fellowship.

References

Hayes, A. M., Feldman, G. C., & Goldfried, M. R. (2006). The Change and Growth Experiences Scale: A Measure of Insight and Emotional Processing. In L. G. Castonguay & C. Hill (Eds.), Insight in psychotherapy. (pp. 231–253). Washington, DC. doi:10.1037/11532-011

Jun, J. J., Zoellner, L. A., & Feeny, N. C. (2013). Sudden gains in prolonged exposure and sertraline for chronic PTSD. Depression and Anxiety, 30, 607–613. doi:10.1002/da.22119

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. doi:10.1037/0022-006X.67.6.894