Abstract
Objective: The feasibility of a high-frequency real-time monitoring approach to psychotherapy is outlined and tested for patients' compliance to evaluate its integration to everyday practice. Criteria concern the ecological momentary assessment, the assessment of therapy-related cognitions and emotions, equidistant time sampling, real-time nonlinear time series analysis, continuous participative process control by client and therapist, and the application of idiographic (person-specific) surveys.Methods: The process-outcome monitoring is technically realized by an internet-based device for data collection and data analysis, the Synergetic Navigation System. Its feasibility is documented by a compliance study on 151 clients treated in an inpatient and a day-treatment clinic.Results: We found high compliance rates (mean: 78.3%, median: 89.4%) amongst the respondents, independent of the severity of symptoms or the degree of impairment. Compared to other diagnoses, the compliance rate was lower in the group diagnosed with personality disorders.Conclusion: The results support the feasibility of high-frequency monitoring in routine psychotherapy settings. Daily collection of psychological surveys allows for the assessment of highly resolved, equidistant time series data which gives insight into the nonlinear qualities of therapeutic change processes (e.g., pattern transitions, critical instabilities).
Highlights
These time series can be submitted to several analyses, e.g., Dynamic Complexity (Schiepek and Strunk, 2010), Recurrence Plots (Eckmann et al, 1987; Webber and Zbilut, 1994), Permutation Entropy (Bandt and Pompe, 2002), or the visualization of synchronization patterns by item-to-item intercorrelations calculated in a running window
The mean compliance of the sample was 78.3% (SD 26.0; median 89.4%). 66.4% of all clients realized a compliance rate of 80% or more, 49.3% realized a compliance rate of 90% or more, and 25 clients (16.4%) had a compliance rate of 100%
Treatment completers realized a high rate of monitoring compliance
Summary
Concept and Criteria of High-Frequency Real-Time MonitoringOutcome monitoring and feedback on therapeutic progress has become popular and has been adopted by many mental health providers all over the world (e.g., Howard et al, 1996; Evans et al, 2002; Kraus et al, 2005; Miller et al, 2005; Trauer, 2010; Schiepek and Aichhorn, 2013). Lambert (2007) or Newnham and Page (2010) describe it as an important feature of good clinical practice and ask for an integration of monitoring procedures into routines of mental health care (Lambert, 2010). Concept and Criteria of High-Frequency Real-Time Monitoring. Outcome monitoring and feedback on therapeutic progress has become popular and has been adopted by many mental health providers all over the world (e.g., Howard et al, 1996; Evans et al, 2002; Kraus et al, 2005; Miller et al, 2005; Trauer, 2010; Schiepek and Aichhorn, 2013). Lambert (2007) or Newnham and Page (2010) describe it as an important feature of good clinical practice and ask for an integration of monitoring procedures into routines of mental health care (Lambert, 2010). Real-Time Monitoring of Psychotherapeutic Processes its potentials are not yet exhausted. The feasibility of fulfilling these criteria will be demonstrated by reporting on compliance data from the application of an internet-based feedback technology (Synergetic Navigation System) to inpatient and day treatment settings.
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