The Content of Personalised Network-Based Case Formulations

Abstract

Case formulation is at the heart of personalized care in psychotherapy. Scientific research into case formulations can provide new insights in the heterogeneity of psychopathology which are relevant for advances in personalized psychopathology research and practice. This mixed-methods study examined the content of 483 fully personalised network-based case formulations in psychotherapy in terms of uniqueness (i.e., frequencies of concepts) and commonality (i.e., the presence of common themes over the different case formulations). In a real-world clinical care setting, patients co-created network-based case formulations with their therapist as part of their routine diagnostic process. These case formulations feature concepts that are highly relevant to individual patients and their current situation. We assessed how often concepts were used by different patients to quantify uniqueness. We applied a bottom-up thematic analysis to identify patient-relevant themes from the concepts. 483 patients diagnosed with mood and/or anxiety disorders created network models yielding a total of 4908 interpretable concepts of which 4272 (87%) were completely unique. Through thematic analysis, we identified seven overarching themes in the concepts: autonomy, connectedness, emotions, self-care, identity, self-efficacy, and bodily sensations. Case formulations were highly unique, thereby illustrating the importance of personalized diagnostics. The unique concepts could be grouped under seven overarching themes which seem to encompass basic human needs. Current advancements in personalized diagnostics and assessment should have a broader scope than symptoms alone, and could use the themes identified here as part of a topic list in the generation of (network-based) case formulations.

The best of both worlds? General principles of psychopathology in personalized assessment.

“…The personalized questionnaires were co-created by therapists and patients based on case formulation using idiographic system modeling (ISM; Schiepek, 1986). The ISM procedure has been described in more detail elsewhere (Schiepek, Eckert, et al, 2016; Schiepek, Stöger-Schmidinger, et al, 2016; van den Bergh et al, 2022). In short, therapists and patients collaboratively identified all concepts crucial to a patient’s current situation and mapped these onto a network visualization.…”

“…We used four outcome measures. Two outcome measures were measured once at the beginning and once at the end of treatment (last or second-last day of stay in the clinic): the ICD-10 Symptom Rating (ISR; Tritt et al, 2013) and the 21-item Depression Anxiety and Stress Scale (DASS-21; Lovibond & Lovibond, 1995), which we refer to as the "standard outcomes." The ISR is based on the ICD-10 (World Health Organization) and measures a broad range of psychopathology symptoms over multiple subscales.…”

“…Psychopathology is highly individualized as studies illustrate vast heterogeneity in symptoms (Allsopp et al, 2019; Fried & Nesse, 2015), case formulations (van den Bergh et al, 2022), and change trajectories (Schiepek et al, 2020). This heterogeneity limits group-level research in psychopathology, which often rests on the assumption of homogenous sets of patients with similar diagnosis.…”