Sudden gains in day-to-day change

February 2020

Revealing nonlinear patterns of individual improvement in depression

Helmich, M. A., Wichers, M., Olthof, M., Strunk, G., Aas, B., Aichhorn, W., Schiepek, G. Snippe, E.


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.


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.


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.


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.


  • depression
  • treatment response
  • idiographic change pattern
  • sudden gains
  • daily assessments

Citation and link to full-text article

Helmich, M. A., Wichers, M., Olthof, M., Strunk, G., Aas, B., Aichhorn, W., Schiepek, G. Snippe, E. (2020). Sudden gains in day-to-day change: Revealing nonlinear patterns of individual improvement in depression. Journal of Consulting and Clinical Psychology, 88(2), 119–127. 10.1037/ccp0000469

Full-text available here

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Interview: Marieke Wichers

December 6th, 2016

Op 6 december 2016 hield Marieke Wichers, hoogleraar Dynamiek van emotieregulatie en psychopathologie bij het ICPE (RUG) haar oratie met als titel “Durven zoeken in het donker; op weg naar een kantelpunt in de psychiatrie”.

Is er een kans dat u een psychiatrische stoornis ontwikkelt? En zo ja, is dan te voorspellen wanneer er weer verbetering optreedt? Hoogleraar Marieke Wichers gaat de symptomen van stoornissen live volgen om dat uit te zoeken.