Synergetic Navigation System Research Articles

Pattern transitions in diary data of MDD patients: a mixed-methods multiple case study of psychotherapy dynamics.

Mixed-methods approaches promise a deep understanding of psychotherapeutic processes. This study uses qualitative and quantitative data from daily diary entries and daily self-assessments during inpatient treatment. The aim of the study is to get an insight into the similarities and differences between both types of data and how they represent self-organized pattern transitions in psychotherapy. While a complete correlation of results is not expected, we anticipate observing amplifying and subsidiary patterns from both perspectives. Daily, five MDD patients wrote diaries and completed self-assessments using the Therapy Process Questionnaire, a questionnaire for monitoring the change dynamics of psychotherapy. The data were collected using the Synergetic Navigation System, an online tool for real-time monitoring. Diary entries of the patients described their experiences in everyday life. The qualitative text analysis was conducted using Mixed Grounded Theory, which provided categories representing the patients' ongoing experiences of transformation and stagnation. The time series data was analyzed using the dynamic complexity algorithm and the pattern transition detection algorithm. Results from qualitative and quantitative analyses were combined and compared. Following the process of data triangulation, the leading perspective came from the theory of self-organization. In addition to presenting the overall results for all five patients, we delve into two specific case examples in greater detail. Specific and highly diversified diary entries of 5 patients were classified into the categories of perceived pattern stability, noticing improvement, broadening the perspective, critical instability, and experiencing moments of Kairos. Patients reported problems not only related to their disorder (e.g., lack of energy and hopelessness) but also to phases and steps of change, which could be related to the theory of self-organization (e.g., problem attractors, critical fluctuations, pattern transitions, and Kairos). Qualitative and quantitative analysis provide important supplementary results without being redundant or identical. Data triangulation allows for a comprehensive and multi-perspective understanding of therapeutic change dynamics. The different topics expressed in the diary entries especially help to follow micro-psychological processes, which are far from being a simple reaction to interventions. The way patients experience themselves being in stability or instability and stagnation or transformation is surprisingly close to the general features of self-organizing processes in complex systems.

High-frequency monitoring of personalized psychological variables during outpatient psychotherapy in people with seizures: An uncontrolled feasibility study

BackgroundThis feasibility study applied the concept of daily systematic monitoring of personalized psychological variables and investigated patients’ compliance in order to evaluate if its integration in outpatient psychotherapy is feasible and if patients found the development and daily application of personalized questionnaires user-friendly and useful. MethodsA naturalistic sample of patients with epilepsy (PWE) was enrolled to participate in an outpatient psychotherapy program. A personalized process questionnaire was developed with each patient based on an individual psychological system’s model at the outset of therapy. Daily time-stamped self-assessments were collected during outpatient psychotherapy. This process-monitoring was technically realized by an internet-based device for data collection and data analysis, the Synergetic Navigation System (SNS). The reflection of person-specific time series informed by patients’ replies to their personalized process questionnaire was integrated in the therapy process. Compliance rates were assessed during a period of six months (i.e., 180 days) after the first entry of the questionnaire [compliance rate = (number of completed questionnaires/180) × 100]. User-friendliness and usefulness of this process monitoring were evaluated quantitatively. ResultsTwenty patients [15 women/5 men, median age 48 years (range 23–73 years)] were recruited. Compliance rates were high (median: 93%, range 31–100%) among the participants. Participants reported a high overall satisfaction with the application and user-friendliness of SNS. ConclusionThe results support the feasibility of high-frequency monitoring of personalized psychological processes during outpatient psychotherapy. Repeated daily assessments of a personalized questionnaire yield highly resolved, equidistant time series data, which gives insight into individual psychological processes during outpatient psychotherapy.

Overtraining from a sports psychiatry perspective

Overtraining is characterized by a mismatch between exerted strain and exercise tolerance. Overtraining is generally not sufficiently feared nor is enough attention paid to its prevention. As a result, the first warning signals and symptoms are often either perceived too late or there is a delay in the correct interpretation of signs. This often leads to negative consequences over months, which, in turn, can lead to more frequent injuries as well as Depression. Due to the increasing professionalism and density of competition in competitive sports, overtraining occurs more frequently as athletes are left with a shorter period of time to recover. In order to treat overtraining, it is first necessary to identify the syndrome. Symptoms are often disregarded and trainers and athletes attempt to compensate for poor performance with excessive training. This leads to a vicious cycle with significant reduction of the overall performance of the athlete as a consequence. Psychological parameters can also be signs of non-func-tional overload. Examples include restlessness, irritability, emotional instability, recurring states of fear, emerging indifference or reduced performance motivation. However, disturbed cognitive processes as an impairment of central elements of movement control can also occur. As part of sports psychiatric support, conspicuous psychological parameters can be recorded and contextualised. The Synergetic Navigation System (SNS) is available for systematic recording and corresponding process management. The Synergetic Navigation System (SNS) can be used as an instrument for load, training and competition control to prevent non-functional overload and overtraining. It is also suitable for promoting performance and preventing injuries as well as stabilizing the psychological structure. Key Words: Mental Health Symptoms, Mental Disorders, Injury Prevention, Exercise Intolerance, Synergetic Navigation System (SNS)

Integrating the systematic assessment of psychological states in the epilepsy monitoring unit: Concept and compliance

BackgroundAdmission to the epilepsy monitoring unit (EMU) for long-term video-electroencephalography (EEG) monitoring (VEEG) constitutes the gold standard for seizure diagnosis and presurgical evaluation. This study applied the concept of a high-frequency systematic monitoring of psychological states and tested patients' compliance in order to evaluate if its integration in the EMU is feasible and if patients benefit from the graphically underpinned discussion of their EMU stay-related cognitions and emotions. MethodsThe process-monitoring is technically realized by an internet-based device for data collection and data analysis, the Synergetic Navigation System (SNS). A convenient sample was enrolled: All eligible patients who were admitted to the EMU of the Department of Neurology, Christian Doppler Medical Center, Salzburg, Austria, between November 6th 2017 and January 26th 2018 were approached and recruited upon consent. After a short resource-oriented interview, each enrolled patient was provided with a tablet. The daily questionnaire included eight standardized and up to three personalized items. Self-assessments were collected every 5 h prior to meal times (6:30 am, 11:30 am, and 4:30 pm) and at 9:30 pm. The detailed visualizations of the patients' replies were discussed with the participants during a feedback session at the end of the EMU stay. ResultsTwenty-one patients (12 women/9 men, median age 29 years [range 18–74 years]) were consecutively recruited (72% of all eligible patients). Compliance rates were high (median: 82%, range 60%–100%) among the respondents. Mood correlated strongly with hopefulness (r = 0.71) and moderately with energy (r = 0.63) in all patients. When correlating the intraindividual medians of the process questionnaire time series with the pretest total scores, energy correlated moderately and negatively with the Perceived Stress Scale (PSS) (r = −0.45), while self-efficacy correlated moderately and negatively with the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) total scores in all patients (r = −0.5). Nine patients (43%) reported that they learned something meaningful about themselves after the feedback discussion of their individual time series. ConclusionThe results support the feasibility of high-frequency monitoring of psychological states and processes in routine EMU settings. Repeated daily collections four times per day of psychological surveys allow for the assessment of highly resolved, equidistant time series data, which gives insight into psychological states and processes during EMU admission.

Real-Time-Monitoring in der Behandlung komplexer posttraumatischer Belastungsstörung: Ein Fallbericht

Hintergrund: Anhand eines Fallbeispiels soll gezeigt werden, wie Real-Time-Monitoring die Therapie von PatientInnen mit komplexer posttraumatischer Belastungsstörung (PTBS) wirksamer gestalten hilft. Patient und Methoden: Die Fallkonzeption und Behandlung fußten auf einem störungsspezifischen stationären Behandlungsprogramm für komplex traumatisierte Erwachsene und orientierten sich an Empfehlungen bezüglich der traumafokussierten Behandlung von Patienten mit pathologischem Narzissmus. Der Veränderungsprozess des Patienten wurde mit einem webgestützten Tool für Real-Time-Monitoring (Synergetic Navigation System) erfasst und im Therapieverlauf wiederholt gemeinsam mit dem Patienten reflektiert. Ergebnisse: Der Patient remittierte hinsichtlich PTBS, Depression, somatoformer Beschwerden, interaktioneller Schwierigkeiten, Selbstwirksamkeit und Beeinträchtigungen des psychischen Wohlbefindens. Insbesondere konnten im Rahmen von Feedback-Gesprächen die persönlichkeitsspezifischen affektiven Dynamiken von Scham, Schuld und Wut des Patienten sowie deren kritische Instabilitäten und Phasenübergänge im Rahmen der Traumakonfrontation reflektiert werden. Der Patient entwickelte neue Selbstfürsorgemuster und lernte, eigene Gefühle wahrzunehmen, zu verantworten und zu regulieren. Schlussfolgerungen: Die auf Traumakonfrontation ausgerichtete multimodale Therapie erwies sich im vorliegenden Fall als geeignet, neben den Kernsymptomen der PTBS auch bedeutsame komorbide Symptome wirksam zu reduzieren. Das Real-Time-Monitoring unterstützt die Identifizierung und Bearbeitung zentraler affektiver Dynamiken eines Patienten und erlaubt so, die Therapie von Patienten mit komplexen Traumafolgestörungen und persönlichkeitsprägender Symptomatik effektiver zu gestalten.

Perspektiver inden for teknologisk-assisteret indsamling af data i psykologisk forandring – rammesat af den synergetiske psykologi.

It is a methodological challenge to describe change processes within psychology, as change is often characterized by both loss and growth in function. Especially compensatory processes may be impossible to describe by conventional methods. These methods typicallydetect changes in the level of functionality from one point to another, but are unable to identify the processes that mediate the development. A micro-genetic method that is based on high-frequency data collection, may be suitable to describe change processes in normativepopulations, as well as psychopathological. As data density is greater and the observed processes of change can be non-linear, registration, analyzes, and interpretation of microgenetic data do, however, challenge the conventional methods of measurement in psychologicalresearch. Within the framework of Synergetics (a theory of self-organization in complex dynamical systems), Günter Schiepek and colleagues have developed a tool for registration and analysis: the Synergetic Navigation System. This system enables closemonitoring of clients’ mental state during critical development phases and offers support for therapeutic processes. In both cases, clients’ dynamic development processes exhibit characteristics that can be described and analyzed using concepts and methods from Synergetics. This publication describes how the approach can be applied in research in adult development of emotion regulation and how it may be useful in a clinical setting.

Real-Time Monitoring of Psychotherapeutic Processes: Concept and Compliance.

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).

Real-Time Monitoring of Non-linear Suicidal Dynamics: Methodology and a Demonstrative Case Report.

In recent years, a number of different authors have stressed the usefulness of non-linear dynamic systems approach in suicide research and suicide prevention. This approach applies specific methods of time series analysis and, consequently, it requires a continuous and fine-meshed assessment of the processes under consideration. The technical means for this kind of process assessment and process analysis are now available. This paper outlines how suicidal dynamics can be monitored in high-risk patients by an Internet-based application for continuous self-assessment with integrated tools of non-linear time series analysis: the Synergetic Navigation System. This procedure is illustrated by data from a patient who attempted suicide at the end of a 90-day monitoring period. Additionally, future research topics and clinical applications of a non-linear dynamic systems approach in suicidology are discussed.

Self-organization in psychotherapy: testing the synergetic model of change processes.

In recent years, models have been developed that conceive psychotherapy as a self-organizing process of bio-psycho-social systems. These models originate from the theory of self-organization (Synergetics), from the theory of deterministic chaos, or from the approach of self-organized criticality. This process-outcome study examines several hypotheses mainly derived from Synergetics, including the assumption of discontinuous changes in psychotherapy (instead of linear incremental gains), the occurrence of critical instabilities in temporal proximity of pattern transitions, the hypothesis of necessary stable boundary conditions during destabilization processes, and of motivation to change playing the role of a control parameter for psychotherapeutic self-organization. Our study was realized at a day treatment center; 23 patients with obsessive compulsive disorder (OCD) were included. Client self-assessment was performed by an Internet-based process monitoring (referred to as the Synergetic Navigation System), whereby daily ratings were recorded through administering the Therapy Process Questionnaire (TPQ). The process measures of the study were extracted from the subscale dynamics (including the dynamic complexity of their time series) of the TPQ. The outcome criterion was measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) which was completed pre-post and on a bi-weekly schedule by all patients. A second outcome criterion was based on the symptom severity subscale of the TPQ. Results supported the hypothesis of discontinuous changes (pattern transitions), the occurrence of critical instabilities preparing pattern transitions, and of stable boundary conditions as prerequisites for such transitions, but not the assumption of motivation to change as a control parameter.

Real-Time Monitoring in der Psychotherapie

Since several years, internet-based technologies for the monitoring of psychotherapy processes were partially established in in-patient and day treatment centres. We discuss the usefulness and some methodological requirements of process monitoring devices, with a more detailed description of the Synergetic Navigation System (SNS). Continuous self-ratings and the use of feedback-tools like the SNS will have therapeutic implications on patients as well as therapists and their professional cooperation with the patient. Studies on the effects of feedback-systems on patients and therapists should be realized, and the quality of feedback-sessions as well as the competencies in the management of nonlinear processes and feedback-systems should be enhanced. Real-time monitoring is ready to get an integrated part of clinical practice and of clinical training programs.

Beeinflussung des Behandlungsergebnisses einer stationären Psychotherapie von Zwangsstörungen durch den Ausprägungsgrad der Instabilität im Therapieverlauf

The present study evaluates a central hypothesis of synergetic psychotherapy research according to which a marked instability in the psychotherapeutic process is associated with high response rates. 14 patients with obsessive-compulsive disorder (OCD) completed an eight-week in-patient course of multimodal behavior therapy with exposure exercises. The instability during the course of the therapy was recorded by daily selfassessment by the patient using the Synergetic Navigation System (SNS), an Internet-based real-time monitoring procedure. There was a negative correlation between the degree of the instability and the percentage reduction in the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) (r = -0.395; P = 0.199), the "Global Severity Index" (GSI) of the symptom check-list (SCL-90-R) (r = -0.718; P = 0.013), the scale value for obsessive-compulsiveness in the SCL-90-R (r = -0.782; P = 0.004) and the remaining sub-scales of this data-gathering instrument. An unstable progress of the psychotherapy causes a smaller reduction in symptoms than a stable one. The contradiction relative to the study hypothesis is possibly based on the special features of OCD, with a high level of patient insecurity when anticipating new, non-obsessive-compulsive ways of thought and behavior. The relationships between instability and reduction in symptoms appear to be diagnosis-specific.

Nonlinear Dynamics: Theoretical Perspectives and Application to Suicidology

Despite decades of research, the prediction of suicidal behavior remains limited. As a result, searching for more specific risk factors and testing their predictive power are central in suicidology. This strategy may be of limited value because it assumes linearity to the suicidal process that is most likely nonlinear by nature and which can be more adequately described and analyzed with nonlinear dynamics. The goal of moving nonlinear dynamics from theory to practice and to real-world phenomena can now be realized with Internet-based monitoring systems such as the Synergetic Navigation System.

P03-134 - Does a high degree of instability during psychotherapy enhance a positive therapy-response? - an evaluation of an in-patient behavior therapy of obsessive-compulsive disorder

IntroductionThe study evaluates a central hypothesis of synergetic psychotherapy research according to which a marked instability in the psychotherapeutic process is associated with high response rates.Methods14 patients with obsessive-compulsive disorder (OCD) successfully completed an eight-week in-patient course of multi-modal behavior therapy with exposure exercises followed by response management. The instability during the course of the therapy was recorded by daily self-assessment by the patient using the Synergetic Navigation System (SNS), an Internet-based real-time monitoring procedure.ResultsThere was a negative correlation between the degree of the instability and the percentage reduction in the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) (r = −0.395; P = 0.199), the “Global Severity Index” (GSI) of the symptom check-list (SCL-90-R) (r = −0.718; P = 0.013), the scale value for obsessive-compulsiveness in the SCL-90-R (r = −0.782; P = 0.004) and the remaining sub-scales of this data-gathering instrument.ConclusionsAn unstable progress of the psychotherapy causes a smaller reduction in symptoms than a stable one. The contradiction relative to the study hypothesis is possibly based on the special features of OCD, with a high level of patient insecurity when anticipating new, non-obsessive-compulsive ways of thought and behavior. The relationships between instability and reduction in symptoms appear to be diagnosis-specific.

P02-339 - Internet-based therapy process monitoring of psychotherapy using the synergetic navigation system (SNS) -methodology and case report

IntroductionTo improve the quality of psychotherapy, computer-assisted feedback and monitoring systems to evaluate continuously an ongoing course of therapy have gained increased importance in psychotherapy research. They can provide both therapists and the patients themselves with feedback about the progress of the treatment to date while psychotherapy is still taking place. The information gained from them can be used to match the treatment better to patients’ individual needs.MethodThis work presents an Internet-based real-time monitoring method, the Synergetic Navigation System (SNS). This is based on a daily self-assessment by the patient, and is thus characterized by recording the therapy process at particularly narrow time intervals. The technology is illustrated by means of a single case example of a patient with obsessive-compulsive disorder who took part in a two-month inpatient behavioural therapy.ResultsIt can be shown that SNS time-series analysis enables the whole course of therapy to be depicted well, without any serious time delay, and it is possible to record phases in which therapeutic interventions are particularly effective (phases of critical instability).DiscussionOn the one hand monitoring a psychotherapy is useful for psychotherapy research because it enables the dynamics of the therapy progress to be investigated better and it is possible to identify exactly which therapeutic intervention at which time produces what effect on the patient. On the other hand it is useful for the psychotherapist who is working mainly clinically, because the regular feedback enables him to match his therapy to the patient's specific needs.