Richards-Belle Alvin, Linton Daniela, Cross J Helen, Heyman Isobel, Dalrymple Emma, Chorpita Bruce, Varadkar Sophia, Shah Mariam, Shafran Roz, Bennett Sophie
Division of Psychiatry, University College London, London, UK.
UCL Great Ormond Street Institute of Child Health, University College London, London, UK.
J Child Psychol Psychiatry. 2025 Oct;66(10):1526-1538. doi: 10.1111/jcpp.14164. Epub 2025 Mar 20.
Sudden gains (rapid, large, stable improvements in symptoms) are common in psychological therapy and are associated with favourable outcomes, but no studies have investigated sudden gains in children and young people (CYP) with a chronic physical condition.
Within-group study nested in the Mental Health Intervention for Children with Epilepsy (MICE) randomised trial of modular cognitive-behavioural therapy for CYP with epilepsy, utilising goal-based outcomes (GBOs) and standardised session-by-session measures (including the brief parental self-efficacy scale and Strengths and Difficulties Questionnaire [SDQ] session-by-session measure). The occurrence and potential predictors of sudden gains, and the association of sudden gains with outcomes at final session and follow-up were investigated using multivariable logistic and linear regression.
Among 147 participants (mean age: 10.4 years, 49% female) and across nine measures, 39% experienced between two and four sudden gains, most frequently on the mean GBO (occurrence, 44.9%). Characteristics such as intellectual disability, pretreatment scores and the number of sessions received were associated with significantly greater odds of sudden gains in some measures, whereas nonwhite ethnicity and nonemployment of the primary caregiver were associated with reduced odds. Sudden gains were associated with favourable final-session scores for mean GBO (GBO, adjusted mean difference [aMD]: 0.9, 95% CI: 0.3 to 1.6, p = .004, D = 0.63), parental self-efficacy (aMD: 1.2, 95% CI, 0.1 to 2.4, p = .027, D = 0.37) and the SDQ session-by-session measure (aMD: -1.7, 95% CI, -3.0 to -0.3, p = .014, D = -0.44), but not with 6-month adjusted SDQ total difficulties scores.
Sudden gains were common in this population, occurring most frequently on personalised measures, and were associated with favourable final-session scores. Personalised measures taken at each session with a focus on sudden gains may be a useful adjunct to treatment. Future research and clinical practice should investigate how to increase the occurrence of sudden gains in CYP with long-term conditions receiving psychological therapy.
突然改善（症状迅速、大幅、稳定地改善）在心理治疗中很常见，且与良好的治疗效果相关，但尚无研究调查患有慢性身体疾病的儿童和青少年（CYP）中的突然改善情况。
本研究为嵌套在癫痫儿童心理健康干预（MICE）随机试验中的组内研究，该试验针对患有癫痫的CYP进行模块化认知行为疗法，采用基于目标的结果（GBO）和标准化的逐节测量（包括简短的父母自我效能量表和优势与困难问卷[SDQ]逐节测量）。使用多变量逻辑回归和线性回归研究突然改善的发生情况和潜在预测因素，以及突然改善与最后一节和随访时结果的关联。
在147名参与者（平均年龄：10.4岁，49%为女性）中，在九项测量指标上，39%的人经历了两到四次突然改善，最常见于平均GBO（发生率为44.9%）。智力残疾、治疗前得分和接受的节数等特征在某些测量指标上与突然改善的几率显著更高相关，而非白人种族和主要照顾者无工作则与几率降低相关。突然改善与平均GBO的最后一节良好得分相关（GBO，调整后平均差异[aMD]：0.9，95%CI：0.3至1.6，p = 0.004，D = 0.63）、父母自我效能（aMD：1.2，95%CI，0.1至2.4，p = 0.027，D = 0.37）以及SDQ逐节测量（aMD：-1.7，95%CI，-3.0至-0.3，p = 0.014，D = -0.44），但与6个月调整后的SDQ总困难得分无关。
突然改善在该人群中很常见，最常出现在个性化测量指标上，且与最后一节的良好得分相关。每次治疗时关注突然改善的个性化测量指标可能是治疗的有益辅助手段。未来的研究和临床实践应调查如何增加接受心理治疗的患有长期疾病的CYP中突然改善的发生率。
