Sudden gains and early response in routine outpatient psychotherapy: a study protocol for predicting symptom change
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L Claus1,2, F Raulfs1,2, J Goltermann1,2
1Department of Psychiatry and Psychotherapy, Evangelisches Klinikum Bethel, Universitätsklinikum OWL of Bielefeld University, Bielefeld, Germany.
Background:
Sudden gains and early response have been established as reliable predictors of psychotherapy outcomes. However, there is still a lack of consistent findings regarding the predictors of these patterns of therapeutic change themselves. Thus far, demographic and clinical variables have provided only limited insight into why sudden gains and early response occur in some patients during therapy, are absent in others, or are reversed in the form of sudden losses.
Methods:
This prospective, transdiagnostic cohort study aims to identify therapy process variables and therapy-related patient variables that predict sudden gains/losses and early response in routine outpatient psychotherapy. Particular attention is given to common factors as mechanisms of change that operate across different therapeutic approaches, including therapeutic alliance, resource activation, problem activation, problem solving and motivational clarification. Treatment trajectories of 300 patients at a psychotherapy training center will be assessed from the initial trial sessions through session 27 using weekly therapy monitoring, including brief measures of symptom distress, daily functioning, and common factors. Follow-up data will be collected up to 3 months after treatment completion. Early response is defined as reliable symptom improvement by session 5, and sudden gains and sudden losses are determined according to established criteria. Regression analyses will be used to examine the contribution of therapy process variables, their temporal dynamics, and therapy-related patient variables to the prediction of sudden gains, sudden losses, and early response. In addition, the study will investigate whether reductions in symptom distress are accompanied by improvements in daily functioning. If sudden gains are detected by the monitoring system, qualitative telephone interviews will be conducted to explore patients' subjective attributions regarding mechanisms of change.
Discussion:
Improved knowledge of mechanisms of change may help refine psychotherapy processes and support more targeted treatment planning. The methodological and practical challenges of the study are discussed.
Clinical Trial Registration:
https://www.drks.de/search/de/trial/DRKS00039264, identifier DRKS00039264.
