Abstract
Personalized case conceptualization is often regarded as a prerequisite for treatment success in psychotherapy for patients with comorbidity. This article presents Perceived Causal Networks, a novel method in which patients rate perceived causal relations among behavioral and emotional problems. First, 231 respondents screening positive for depression completed an online Perceived Causal Networks questionnaire. Median completion time (including repeat items to assess immediate test-retest reliability) was 22.7 minutes, and centrality measures showed excellent immediate test-retest reliability. Networks were highly idiosyncratic, but worrying and ruminating were the most central items for a third of respondents. Second, 50 psychotherapists rated the clinical utility of Perceived Causal Networks visualizations. Ninety-six percent rated the networks as clinically useful, and the information in the individual visualizations was judged to contain 47% of the information typically collected during a psychotherapy assessment phase. Future studies should individualize networks further and evaluate the validity of perceived causal relations.
Highlights
Depression is a psychiatric diagnosis primarily defined as a persistent low mood and/or loss of pleasure
Most psychotherapy research has been focused on evaluating disorder-specific treatment manuals, and there is an increasing awareness of the need to acknowledge the diversity of depression and to individualize treatments based on individual factors (Maj et al, 2020)
We aim to investigate the immediate test–retest reliability and average time needed to complete Perceived Causal Networks (PECAN), explore to which degree the PECAN networks vary across participants and investigate how psychotherapists rate the clinical utility of PECAN networks, for what purpose in an assessment phase the method would be useful, and how the method could be improved
Summary
Depression is a psychiatric diagnosis primarily defined as a persistent low mood and/or loss of pleasure. Most psychotherapy research has been focused on evaluating disorder-specific treatment manuals, and there is an increasing awareness of the need to acknowledge the diversity of depression and to individualize treatments based on individual factors (Maj et al, 2020). There is little evidence that conceptualizations improve treatment effects, it has been suggested that individualization may be most important when patients have comorbid disorders, which has not typically been the case in studies investigating manualized treatments (Kamphuis et al, 2020). Such feedback loops are seen as maintaining a pathological network state (i.e., depression) after it has been activated by, for instance, a negative life event (Borsboom, 2017; Wittenborn et al, 2016)
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