Real-Time Monitoring of Psychotherapeutic Processes: Concept and Compliance

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).

Attitudes of Austrian psychotherapists towards process and outcome monitoring

“…Item formulations for this "process monitoring questionnaire" (PMQ) were designed to match the content of OMQ items addressing general attitude and intention of use versus criticism. Other items were related to putative specific effects of high-frequency process monitoring like increased self-reflection , improved therapeutic alliance or facilitating detection of possible deterioration, as proposed by Schiepek et al (2016).…”

“…Data on feasibility and patient compliance is promising (Schiepek et al, 2016) and data derived from process monitoring has been shown to be predictive of treatment success (Schiepek, Eckert, Kravanja, Wallot, & Haussmann, 2014).…”

Prozessfeedback in der Psychotherapie

“…Eine andere Strömung besteht in der Nutzung von elektronischem Therapiefeedback (de Jongetal.2014;Lyonetal. 2016;Schiepek et al 2016). Während frühe Studien zeigten, dass mögliche Verschlechterungen damit rechtzeitig erkannt und verhindert werden können, lassen aktuellere Studien auf generelle positive Effekte in unterschiedlichen therapeutischen Settings schließen (Einzelund Paartherapie, ambulante und stationäre Therapie, z.…”

“…B. Ordnungsübergänge, die sich als diskontinuierliche Sprünge im Prozess manifestieren. Klinische Erfahrungen (Schiepek et al 2013;Stöger-Schmidinger et al 2016) und empirische Studien (de Jong et al 2014;Lambert et al 2005) legen nahe, dass das Feedback über die Prozessmuster der Therapie selbst katalysierende und therapieförderliche Effekte hat.…”

“…Es handelt sich dabei nicht um eine technische Notwendigkeit des eingesetzten Monitoring-Systems (Synergetisches Navigationssystem, SNS) -im Gegenteil: das System lässt hinsichtlich der eingesetzten Fragebogen und Messfrequenzen alle Freiheiten -, sondern um eine therapeutische und methodische Entscheidung, um die in Psychotherapien auftretenden selbstorganisierten Musterwechsel rechtzeitig erkennen und therapeutisch nutzen zu können (Schiepek et al 2013). Die ComplianceRaten sind gut bis sehr gut (Schiepek et al 2016) (Haken und Schiepek 2010;Heinzel et al 2014;Schiepek und Strunk 2010 Sammet et al 2015;Schiepek et al 2013;Stöger-Schmidinger et al 2016 Process feedback in psychotherapy. Methods, visualization and case example Abstract Therapy feedback based on high-frequency process monitoring is applied by an increasing number of practitioners.…”