Process-symptom-bridges in psychotherapy: an idiographic network approach

Abstract

Aim: Real-time monitoring of psychotherapeutic processes was recently described as a promising, new way of track-ing periods of change in ongoing treatments. This approach generates complex, multivariate datasets that have to be presented in an intuitive way for clinicians to aid their clinical decision-making. Using network modeling and new approaches in centrality analyses, we examine “bridge nodes” between symptom stress and aspects of the psychotherapeutic process between therapy session (intersession processes, ISP). Method: We recorded intersession processes as well as depressive and anxiety symptoms using daily questionnaires in ten cases. Regularized, thresholded intraindividual dynamic networks were estimated. We applied bridge centrality analysis to identify individual bridges between psychotherapeutic processes and symptoms in the resulting models. Casewise interpretations of bridge centrality values are offered. Results: Bridge centrality analysis revealed individual bridge nodes between intersession processes and symptom severity. Strength and direction of bridges varied substantially across individuals. Conclusion: Given current methodological challenges, idiographic network studies are feasible and offer important insights for psychotherapy process research. In this case, we demonstrated how patients deal with periods of increased symptom stress. In this case we have described how patients deal with their therapy under increased symptom load. Bridges between psychotherapeutic processes and symptom stress are a promising target for monitoring systems based on ISP. Future studies should examine the clinical utility of network-based monitoring and feedback in ongoing therapies. In the near future, process feedback systems based on idiographic models could serve clinicians to improve treatments. Keywords: depression, anxiety, intersession processes, ecological momentary assessment, network analysis

Insights of Patients and Clinicians on the Promise of the Experience Sampling Method for Psychiatric Care

“…Only one qualitative study reported that patients with psychosis recognized the advantages of ESM, but did not include clinician views (13). Although patients will be the primary users of ESM, clinicians might be important stakeholders in introducing ESM, and might use ESM themselves to inform treatment decisions (9,14). Therefore, the present study is the first to 1) map the relevance of ESM for psychiatric practice and 2) inquire into barriers and facilitators for implementation through focus groups and interviews with patients and clinicians.…”

Towards a Person-Oriented Approach to Psychotherapy Research

“…One possibility would also be to integrate alliance-related items into the experience sampling of intersession experiences (e.g., asking about experiences of feeling understood by the therapist, looking forward to future collaboration with the therapist, etc. ), in a similar way to that done by Kaiser and Laireiter (2018).…”

“…Network models need not be limited to symptoms of psychopathology. Kaiser and Laireiter ( 2018 ) expanded the focus from symptoms of psychopathology by including measures also of patients’ intersession experiences, such as thoughts about past and present sessions, imagined dialogues with the therapist, and positive and negative treatment-related emotions, into the network model. Their results showed a substantial interpersonal variation in how symptom stress interacted with various kinds of such intersession experiences.…”

Cognitive Behavior Therapy at the Crossroads

“…This is of course not a straightforward question to answer, but it is one that researchers have been addressing from a number of different angles in recent years. Some potentially promising ideas in evidence at WCBCT 2019 included the ever-growing interest in network analysis approaches to the conceptualization, measurement, and modeling of underlying processes or symptoms in psychopathology (e.g., Bringmann et al 2013 ), and a resurgence of interest in idiographic and single case-level approaches (e.g., Fisher and Bosley 2020 ; Kaiser and Laireiter 2018 ). Other developments include using a broader range of trial designs to answer different questions around mechanisms and optimization of multi-component interventions (e.g., Watkins et al 2016 ), adaptive designs that allow addition and replacement of arms in an ongoing trial (e.g., Blackwell et al 2019 ), and designs intended to test sequential allocation to different treatments (e.g., Nelson et al 2018 ).…”