Abstract
Background and Objective(s)While psychotherapy treatments are largely effective, the processes and mechanisms underlying such positive changes remain somewhat unknown. Focusing on a single participant from a treatment outcome study that used a modular-based cognitive behavior therapy protocol, this article aims to answer this question by identifying changes in specific symptomatology over the course of the treatment. Using quantitative data derived from digital health methodology, we analyzed whether a given therapeutic intervention was related to downstream effects in predicted symptom domains, to assess the accuracy of our interventions.MethodsThis case study employed an observational N-of-1 study design. The participant (n = 1) was a female in the age range of 25–35 years. Using digital health data from ambulatory assessment surveys completed prior to and during therapy, separate linear regression analyses were conducted to assess if hypothesized treatment targets reduced after a given module, or intervention.ResultsSupport was found for some of the hypothesized quantitative changes (e.g., decreases in avoidance after exposures module), yet not for others (e.g., decreases in rumination following the mindfulness module).ConclusionWe present data and results from our analyses to offer an example of a novel design that may allow for a greater understanding of the nature of symptom changes with increased granularity throughout the course of a psychological treatment from the use of digital health tools.
Highlights
The field of clinical psychology has undergone many changes in the past decade
While the development of the Research Domain Criteria (RDoC) was not intended to replace the Diagnostic and Statistical Manual of Mental Disorders (DSMV) and serve as a diagnostic guide, its introduction serves as a reminder that our current diagnostic system, and treatment development efforts, may be structurally flawed by the sheer heterogeneity underlying diagnostic labels as they currently stand
Taking the diagnosis of Posttraumatic Stress Disorder (PTSD) as an example, current DSM-5 criteria allow 636,120 combinations of presenting symptoms to exist in order to meet criteria for the diagnosis, meaning that it is possible for 636,120 individuals to meet criteria for PTSD, with no repeats in the exact constellation of symptoms from person to person (GalatzerLevy and Bryant, 2013)
Summary
The field of clinical psychology has undergone many changes in the past decade. After the introduction of the Research Domain Criteria (RDoC; Insel et al, 2010) in 2010, researchers seeking external funding have been incentivized to move away from investigating psychopathological constructs at a disorder-level, in order to explore a dimensional system that encompasses multipleIdiographic Mechanisms of Change levels units and of analysis, from genes at the most basic, granular level to behavior at the most macroscopic. Taking the diagnosis of Posttraumatic Stress Disorder (PTSD) as an example, current DSM-5 criteria allow 636,120 combinations of presenting symptoms to exist in order to meet criteria for the diagnosis, meaning that it is possible for 636,120 individuals to meet criteria for PTSD, with no repeats in the exact constellation of symptoms from person to person (GalatzerLevy and Bryant, 2013). Treatments for such conditions have been historically developed by researchers based on diagnostic categories and group-level (i.e., nomothetic) information. Using quantitative data derived from digital health methodology, we analyzed whether a given therapeutic intervention was related to downstream effects in predicted symptom domains, to assess the accuracy of our interventions
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