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Originalia

Zeitliche und sequenzielle Muster von nonlinearen Veränderungen im Therapieverlauf

Published Online:November 26, 2007https://doi.org/10.1026/1616-3443.36.4.261

Abstract

Zusammenfassung.Theoretischer Hintergrund: Studien zu Sudden Gains bestätigten in hoher Übereinstimmung die prädiktive Validität jener Gains für das Therapieergebnis. Diese Gains wurden bisher in erster Linie als isoliertes, veränderungsinduzierendes Strukturmerkmal eines Therapieverlaufes betrachtet. Unter Routine-Praxisbedingungen fanden sich sehr starke Fluktuationen in den Symptomberichten und eine geringe Stabilität von Sudden Gains über den Therapieverlauf. Fragestellung: Diese Studie untersucht zeitliche und sequentielle Aspekte von substanziellen, nonlinearen Veränderungen in Therapieverläufen mit plötzlichen Gains und/oder Losses. Methode: Untersucht wurden 1640 Psychotherapiepatienten einer US-amerikanischen, universitären Ambulanz mit 5-75 unter Routinebedingungen stattfindenden Psychotherapiesitzungen. Resultate: Sudden Gains traten im Rahmen eines verstärkten Trends zu frühen, großen Verbesserungen auf und gingen mit einem positiven Therapieergebnis einher, insbesondere, wenn Sudden Gains vor der 5. Sitzung auftraten. Mit 11% ist der Anteil von Patienten mit Sudden Gains gering, zudem weisen diese Fälle starke Fluktuationen und eine Rückfallrate von 48% auf. Schlussfolgerung: Unter Routinepraxisbedingungen sind Sudden Gains als Bestandteil einer Reihe substanzieller, plötzlicher Veränderungen zu betrachten; wobei in diesen Therapieverläufen Verbesserungen überwiegen und gehäuft bereits in frühen Therapiephasen auftreten.


Temporal and sequential patterns of nonlinear change psychotherapy. The phenomenon of sudden gains and sudden losses in its context

Abstract.Theoretical background: Across multiple sudden-gain studies, the predictive validity of sudden gains has been established by showing its coincidence with favorable treatment outcomes. So far, sudden gains have primarily been studied as an isolated mechanism of change in treatment trajectories. Symptom intensity among clients in routine clinical settings has been found to fluctuate highly and sudden gains among these conditions turned out to be less stable. Objective: The present study aimed to explore the existence, timing, and sequence of substantial nonlinear changes in trajectories of patients with sudden gains and sudden losses. Method: The sample consisted of 1640 outpatients from a university-based US counselling center, patients receiving 5-75 sessions. Results: Sudden gains occurred within an increased trend of substantial, early positive changes and were associated with positive treatment outcomes, especially if they happened before the 5th therapy session. The proportion of clients experiencing sudden gains was low (11%) and co-occurred with other substantial shifts; furthermore, sudden gains were highly unstable, with a reversal rate of 48%. Conclusion: In routine clinical settings, sudden gains are to be seen as one element in a sequence of various, substantial nonlinear changes, which predominately consist of improvements and occur in the early stages of treatment.

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