Bridging the gap between complexity science and clinical practice by formalizing idiographic theories: a computational model of functional analysis

Abstract

Background: The past decades of research have seen an increase in statistical tools to explore the complex dynamics of mental health from patient data, yet the application of these tools in clinical practice remains uncommon. This is surprising, given that clinical reasoning, e.g., case conceptualizations, largely coincides with the dynamical system approach. We argue that the gap between statistical tools and clinical practice can partly be explained by the fact that current estimation techniques disregard theoretical and practical considerations relevant to psychotherapy. To address this issue, we propose that case conceptualizations should be formalized. We illustrate this approach by introducing a computational model of functional analysis, a framework commonly used by practitioners to formulate case conceptualizations and design patient-tailored treatment. Methods: We outline the general approach of formalizing idiographic theories, drawing on the example of a functional analysis for a patient suffering from panic disorder. We specified the system using a series of differential equations and simulated different scenarios; first, we simulated data without intervening in the system to examine the effects of avoidant coping on the development of panic symptomatic. Second, we formalized two interventions commonly used in cognitive behavioral therapy (CBT; exposure and cognitive reappraisal) and subsequently simulated their effects on the system. Results: The first simulation showed that the specified system could recover several aspects of the phenomenon (panic disorder), however, also showed some incongruency with the nature of panic attacks (e.g., rapid decreases were not observed). The second simulation study illustrated differential effects of CBT interventions for this patient. All tested interventions could decrease panic levels in the system.

Complexity Theory of Psychopathology

“…First, our theory implies that classification systems have limited utility as instruments for clinical case formulation as psychopathological patterns are fundamentally idiographic. An alternative is contextualprecision diagnosis (van Os, Delespaul, Wigman, Myin-Germeys, & Wichers, 2013), in which individual psychopathological patterns are contextually examined through interviewing and process-monitoring with experience sampling techniques (e.g., Burger et al, 2020;Schiepek, Stöger-Schmidinger, Aichhorn, Schöller, & Aas, 2016). This may lead to the identification of personalized treatment targets.…”

Lack of theory building and testing impedes progress in the factor and network literature

“…Somewhat surprisingly, since starting to work on this paper in early 2019, numerous contributions in different areas of psychology have identified this crisis of theory as a crucial challenge moving forward (Borsboom et al, 2020;Burger et al, 2019;Gershman, 2019;Guest & Martin, 2020;Haslbeck et al, 2019;Kellen, 2019;Lakens & Debruine, 2020;Muthukrishna & Henrich, 2019;Oberauer & Lewandowsky, 2019;Robinaugh, Haslbeck, et al, 2019;Savi et al, 2019;Smaldino, 2019;Szollosi et al, 2019;Van Rooij & Baggio, 2020), and both the Journal of Abnormal Psychology and Perspective of Psychological Science have opened calls for special issues on theory.…”

Early warning signals in psychopathology: what do they tell?

“…The majority of earlier studies concerning complex system principles in psychopathology involved either simulated data [52,53] or intensive longitudinal data collected within individuals [11,13]. Examples of the latter include two earlier case studies that adopted an experience sampling design, which allows for monitoring symptom shifts as well as affect dynamics (including autocorrelations; EWS) as they evolve within individuals.…”