I’m Changing and I Know It? - A Daily Diary Study Concerning People’s Ability to Identify Sudden Gains and Losses.

Abrupt, large changes in symptom severity (sudden gains or sudden losses) can have a lasting impact on the outcome of psychological treatment. Recent theories suggest that for a lasting effect to happen, the sudden gain must be perceived and processed by both the patient and the therapist. However, it remains unclear whether patients notice sudden changes in their symptom severity. In a first attempt to close this gap, we conducted a daily diary study with a non-clinical sample consisting of 138 participants. The participants were asked to rate their self-esteem, personality, and affect, as well as to indicate whether they perceived any changes in these variables since the previous day or week. Our results replicated previous findings that sudden gains and sudden losses also occur in non-clinical samples, but are unstable and not associated with depressive symptoms in such samples. Furthermore, although we found that participants' perceptions of change were associated with their actual experiences, more fine-grained analyses showed that this association was mainly due to participants reporting correctly that they experienced no change. That is, participants had difficulty identifying sudden shifts in their experience. Altogether this suggests that sudden gains and sudden losses are not easily identified by those who experience them. We discuss limitations of our study and also point to questions for future research.