Rutgers University.
Rutgers University.
Behav Ther. 2018 Sep;49(5):823-835. doi: 10.1016/j.beth.2018.01.006. Epub 2018 Feb 2.
Sudden gains (SGs), referring to large, stable symptom improvement occurring between consecutive treatment sessions, have been associated with improved outcomes among adults with various psychological disorders. Little research exists on SGs or sudden symptom worsening (i.e., sudden regressions [SRs]) during treatment for youth disorders. The current study examined predictors and outcomes of SGs/SRs via multiple informants in youth anxiety treatment. Participants were 118 youth (age M = 11.6, SD = 2.5; 53.8% female) and their caregivers receiving a cognitive-behavioral therapy protocol for a principal anxiety disorder. Anxiety symptom severity was assessed weekly via the State-Trait Anxiety Inventory for Children-Trait-Child/Parent versions. SGs and SRs occurred in 45.8 and 31.3% of youth, respectively. SRs were more common among youth with comorbid mood or externalizing disorders, while SGs occurred more often among youth with greater pretreatment anxiety symptom severity. SGs were not associated with posttreatment outcomes, but SRs predicted significantly higher posttreatment internalizing symptoms based on child report (β = .23, p = .03) and externalizing symptoms based on child (β = .15, p = .04) and parent report (β = .16, p = .03), controlling for overall magnitude of symptom change. SRs among youth receiving cognitive-behavioral therapy for anxiety are associated with pretreatment clinical complexity and poorer posttreatment outcomes and may serve as a warning sign to clinicians of possible treatment failure.
突飞猛进（SGs），是指在连续治疗过程中出现的症状大幅改善且稳定，这与各种心理障碍的成年人的治疗结果改善有关。对于青少年障碍治疗期间的 SGs 或突然症状恶化（即突然倒退[SRs]），研究甚少。目前的研究通过多种信息源检查了青少年焦虑症治疗中的 SGs/SRs 的预测因素和结果。参与者为 118 名青少年（年龄 M = 11.6，SD = 2.5；53.8%为女性）及其接受认知行为治疗方案治疗主要焦虑症的照料者。焦虑症状严重程度每周通过儿童状态-特质焦虑量表特质-儿童/父母版本进行评估。分别有 45.8%和 31.3%的青少年出现 SGs 和 SRs。SRs 在共患心境或外化障碍的青少年中更为常见，而 SGs 在治疗前焦虑症状严重程度更高的青少年中更为常见。SGs 与治疗后结局无关，但 SRs 根据儿童报告预测治疗后内化症状显著升高（β =.23，p =.03），根据儿童（β =.15，p =.04）和父母报告预测外化症状升高（β =.16，p =.03），同时控制了症状变化的总体幅度。接受认知行为治疗治疗焦虑的青少年中出现的 SRs 与治疗前的临床复杂性和较差的治疗后结局相关，可能是治疗失败的临床医生的警告信号。
