Abstract
BackgroundThe past decades of research have seen an increase in statistical tools to explore the complex dynamics of mental health from patient data, yet the application of these tools in clinical practice remains uncommon. This is surprising, given that clinical reasoning, e.g., case conceptualizations, largely coincides with the dynamical system approach. We argue that the gap between statistical tools and clinical practice can partly be explained by the fact that current estimation techniques disregard theoretical and practical considerations relevant to psychotherapy. To address this issue, we propose that case conceptualizations should be formalized. We illustrate this approach by introducing a computational model of functional analysis, a framework commonly used by practitioners to formulate case conceptualizations and design patient-tailored treatment.MethodsWe outline the general approach of formalizing idiographic theories, drawing on the example of a functional analysis for a patient suffering from panic disorder. We specified the system using a series of differential equations and simulated different scenarios; first, we simulated data without intervening in the system to examine the effects of avoidant coping on the development of panic symptomatic. Second, we formalized two interventions commonly used in cognitive behavioral therapy (CBT; exposure and cognitive reappraisal) and subsequently simulated their effects on the system.ResultsThe first simulation showed that the specified system could recover several aspects of the phenomenon (panic disorder), however, also showed some incongruency with the nature of panic attacks (e.g., rapid decreases were not observed). The second simulation study illustrated differential effects of CBT interventions for this patient. All tested interventions could decrease panic levels in the system.ConclusionsFormalizing idiographic theories is promising in bridging the gap between complexity science and clinical practice and can help foster more rigorous scientific practices in psychotherapy, through enhancing theory development. More precise case conceptualizations could potentially improve intervention planning and treatment outcomes. We discuss applications in psychotherapy and future directions, amongst others barriers for systematic theory evaluation and extending the framework to incorporate interactions between individual systems, relevant for modeling social learning processes. With this report, we hope to stimulate future efforts in formalizing clinical frameworks.
Highlights
The past decades of research have seen an increase in statistical tools to explore the complex dynamics of mental health from patient data, yet the application of these tools in clinical practice remains uncommon
Formalizing idiographic theories is promising in bridging the gap between complexity science and clinical practice and can help foster more rigorous scientific practices in psychotherapy, through enhancing theory development
Arguably most relevant for psychotherapy, tools for idiographic network analysis have been developed [16, 17], allowing us to explore patientspecific symptom dynamics from data collected using the experience sampling method (ESM) [18]. This approach may be especially relevant for psychotherapy, as it has the potential to be embedded within clinical practice through informing the formulation of idiographic theories and the identification of patient-tailored intervention targets [19]
Summary
The past decades of research have seen an increase in statistical tools to explore the complex dynamics of mental health from patient data, yet the application of these tools in clinical practice remains uncommon. We argue that the gap between statistical tools and clinical practice can partly be explained by the fact that current estimation techniques disregard theoretical and practical considerations relevant to psychotherapy To address this issue, we propose that case conceptualizations should be formalized. Arguably most relevant for psychotherapy, tools for idiographic network analysis have been developed [16, 17], allowing us to explore patientspecific symptom dynamics from data collected using the experience sampling method (ESM) [18] This approach may be especially relevant for psychotherapy, as it has the potential to be embedded within clinical practice through informing the formulation of idiographic theories (i.e., case conceptualizations) and the identification of patient-tailored intervention targets [19]. It seems surprising that, despite the availability of supportive statistical tools and efforts to provide primers for conducting idiographic research [20], the actual application of personalized network modeling within psychotherapy is to date rare
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