Sudden gains and ambivalence in the unified protocol for transdiagnostic treatment of emotional disorder

Sudden gains (SG) are large and rapid symptom improvements experienced by clients that are related to positive effects on the outcome. However, little is known about why SGs happen or what are the mechanisms that underlie them. Ambivalence towards change is a client's variable related to outcome that has not been previously studied in the context of SGs. The main purpose of this study was to explore the role of ambivalence in the context of SGs. The sample consisted of 68 outpatients suffering from depression and/or anxiety disorders. The clients were treated using a manualized treatment for emotional disorders at an outpatient university-based clinic. SGs were detected with the Outcome Questionnaire 10.2. A 20.6% of the participants experienced a SG, occurring more frequently in session eight. The SG group presented lower levels of ambivalence and psychological symptoms at the end of the treatment when compared with non-SGs. Multilevel analysis suggested that the trajectory of ambivalence tends to be steeper in the SG group. The results suggest that SGs are associated with ambivalence and reinforce the idea that ambivalence resolution is closely related to treatment success.
This study was conducted at the Psychology Research Centre (PSI/01662), School of Psychology, University
of Minho, and supported by the Portuguese Foundation for Science and Technology and the Portuguese
Ministry of Science, Technology and Higher Education (UID/PSI/01662/2019), through national funds
(PIDDAC). Dr. Oliveira was also supported by the Portuguese Foundation for Science and Technology and
the Portuguese Ministry of Science, Technology and Higher Education, through national funds, within the
scope of the Transitory Disposition of Decree No. 57/2016, of 29 August, amended by Law No. 57/2017 of 19
July. Dr. Machado was supported, in part, by the Portuguese Foundation for Science and Technology and the
Portuguese Ministry of Science, Technology and Higher Education through national funds and co-financed by
FEDER through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-007653); and by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of
Science, Technology and Higher Education (POCI-01-0145-FEDER-028145).