2 - (SYM 122) What Symptom Spikes and Variability Can Reveal About the Process of Change in Psychotherapy

Abstract Body

Common assumptions in psychotherapy research are that change is gradual and linear and that periods of symptom exacerbation are “off course” and should be quelled or corrected. There is increasing evidence of another type of change in psychotherapy that is nonlinear and preceded by periods of increased turbulence and variability before improvement (Hayes et al., 2007; Hayes & Andrews, 2020). Although this pattern can appear to be deterioration, it can also reflect destabilization of maladaptive patterns and increases in flexibility that, under the right conditions, allow for exposure to new information and for more adaptive and functional patterns to emerge. We will present data from clinical trials of depression treatments to illustrate different ways of examining transient periods of apparent worsening that are associated with therapeutic improvement, including symptom spikes, growth curves with inverted curvilinear or cubic symptom patterns, and indices of variability and disorder in maladaptive patterns. We will discuss the importance of differentiating disturbance associated with pattern breaking and therapeutic change from disturbance that precedes deterioration. We will also introduce the concept of capitalization (Flückiger et al., 2021), which is how therapists and clients can leverage periods of symptom fluctuation to apply new learning and facilitate positive growth.