Sudden Gains in Day-to-Day Change: Revealing Nonlinear Patterns of Individual Improvement in Depression

Marieke A. Helmich*, Marieke Wichers, Merlijn Olthof, Guido Strunk, Benjamin Aas, Wolfgang Aichhorn, Günter Schiepek, Evelien Snippe

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

8 Citations (Scopus)
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Abstract

OBJECTIVE: We examined individual overall trajectories of change and the occurrence of sudden gains in daily self-rated problem severity and the relation of these patterns to treatment response. METHOD: Mood disorder patients (N = 329, mean age = 44, 55% women) completed daily self-ratings about the severity of their complaints as a standard part of treatment, using the Therapy Process Questionnaire (TPQ). Per individual, the best-fitting defined (linear, log-linear, 1-step) trajectory was tested for significance: for change over time, and for specificity of the best-fitting trajectory. Two-hundred and three cases had ICD-10 Symptom Rating (ISR) depression scores posttreatment: a score ≤1 identified 114 treatment responders. Relation to response was examined for sudden gains and type of change trajectory. RESULTS: 138 cases (42%) had a significant decrease in problem severity, of which 54 cases (16%) had a defined trajectory: 50 cases with one-step improvement, and 4 with a linear improvement in daily problem severity. Sudden gains occurred in 28% of the total sample, and within 58% of improvement patterns. Specifically, sudden gains occurred in 68% of significant 1-step trajectories and 25% of the linear cases. Sudden gains and nonspecific change trajectories were significantly more frequent for treatment responders. CONCLUSIONS: At the day-level, patterns of improvement are nonlinear for most patients. Sudden gains occur within various forms of overall change and are associated with treatment response. Clinically relevant improvements in depression occur both gradually and abruptly, and this finding allows for the possibility that the remission process functions according to dynamical systems principles. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Original languageEnglish
Pages (from-to)119-127
Number of pages9
JournalJournal of Consulting and Clinical Psychology
Volume88
Issue number2
DOIs
Publication statusPublished - Feb-2020

Keywords

  • depression
  • treatment response
  • idiographic change pattern
  • sudden gains
  • daily assessments
  • COGNITIVE-BEHAVIORAL THERAPY
  • SYMPTOM-CHANGE TRAJECTORIES
  • DOSE-EFFECT RELATIONSHIP
  • CRITICAL SLOWING-DOWN
  • ICD-10-SYMPTOM-RATING ISR
  • PSYCHOMETRIC PROPERTIES
  • CRITICAL SESSIONS
  • RATING ISR
  • PSYCHOTHERAPY
  • INVENTORY

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