Department of Psychology, University of California, Berkeley, CA, USA.
Department of Psychology, University of California, Berkeley, CA, USA.
Behav Res Ther. 2019 Jul;118:43-53. doi: 10.1016/j.brat.2019.03.014. Epub 2019 Mar 27.
In order to develop more targeted, efficient, and effective psychotherapeutic interventions, calls have been made in the literature for greater use of idiographic hypothesis testing. Idiographic analyses can provide useful information regarding mechanisms of change within individuals over time during treatment. However, it remains unclear how clinicians might utilize idiographic statistical analyses during routine treatment to test clinical hypotheses, and in turn, guide treatment. We present an idiographic statistical framework for clinical hypothesis testing with routine treatment data that enables clinicians to examine a) whether the client's symptoms and hypothesized mechanisms change over time, b) whether trajectories of change reflect the timing of interventions, c) whether mechanisms predict subsequent symptoms, and d) whether relationships exist between multiple mechanisms, symptoms, or other treatment-related constructs over time. We demonstrate the utility of the approach for clinical hypothesis testing by applying it to routine treatment data collected from a 56 year-old male who presented with a combination of anger problems, anxiety, and depressive symptoms. We discuss how results from analyses can inform the case-formulation and guide clinical decision-making. We aim to make these methods more accessible by providing an online platform where clinicians can enter client data, test their clinical hypotheses using idiographic analyses, and utilize the results to disseminate their findings.
为了开发更有针对性、更有效率和更有效的心理治疗干预措施，文献中呼吁更多地使用个性化假设检验。个性化分析可以提供有关个体在治疗期间随时间变化的机制的有用信息。然而，目前尚不清楚临床医生如何在常规治疗中使用个性化统计分析来检验临床假设，进而指导治疗。我们提出了一种个性化统计框架，用于使用常规治疗数据进行临床假设检验，使临床医生能够检查：a）患者的症状和假设的机制是否随时间变化；b）变化轨迹是否反映干预的时间；c）机制是否预测随后的症状；d）多个机制、症状或其他治疗相关结构之间是否存在随时间变化的关系。我们通过将其应用于从一名 56 岁男性收集的常规治疗数据来演示该方法在临床假设检验中的实用性，该男性表现出愤怒问题、焦虑和抑郁症状的组合。我们讨论了分析结果如何为案例制定提供信息并指导临床决策。我们旨在通过提供一个在线平台使这些方法更易于访问，临床医生可以在该平台中输入患者数据，使用个性化分析检验其临床假设，并利用结果传播他们的发现。
