University of Groningen, University Medical Center Groningen, University Center Psychiatry (UCP) Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
University of Amsterdam, Institute for Advanced Study, Amsterdam, The Netherlands.
BMC Med. 2020 Apr 8;18(1):99. doi: 10.1186/s12916-020-01558-1.
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.
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.
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.
Formalizing idiographic theories is promising in bridging the gap between complexity science and clinical practice and can help foster more rigorous scientific practices in psychotherapy, through enhancing theory development. More precise case conceptualizations could potentially improve intervention planning and treatment outcomes. We discuss applications in psychotherapy and future directions, amongst others barriers for systematic theory evaluation and extending the framework to incorporate interactions between individual systems, relevant for modeling social learning processes. With this report, we hope to stimulate future efforts in formalizing clinical frameworks.
过去几十年的研究见证了统计工具的发展，这些工具可以从患者数据中探索心理健康的复杂动态，但这些工具在临床实践中的应用仍然不常见。这令人惊讶，因为临床推理，例如病例概念化，在很大程度上与动力系统方法相吻合。我们认为，统计工具与临床实践之间的差距部分可以解释为，当前的估计技术忽略了与心理治疗相关的理论和实际考虑因素。为了解决这个问题，我们提出应该使病例概念化形式化。我们通过引入功能分析的计算模型来说明这种方法，这是从业者用于制定病例概念化和设计针对患者的治疗方案的常用框架。
我们概述了形式化个体理论的一般方法，以一位患有惊恐障碍的患者的功能分析为例。我们使用一系列微分方程来指定系统，并模拟了不同的场景；首先，我们模拟了没有干预系统的数据，以检查回避应对策略对惊恐症状发展的影响。其次，我们形式化了认知行为疗法（CBT）中常用的两种干预措施（暴露和认知重评），然后模拟了它们对系统的影响。
第一次模拟表明，指定的系统可以恢复现象（惊恐障碍）的几个方面，但也显示出与惊恐发作的性质不一致的地方（例如，没有观察到快速下降）。第二次模拟研究说明了针对该患者的 CBT 干预措施的不同效果。所有测试的干预措施都可以降低系统中的惊恐水平。
形式化个体理论有望弥合复杂性科学与临床实践之间的差距，并通过增强理论发展，有助于促进心理治疗中更严格的科学实践。更精确的病例概念化可能会潜在地改善干预计划和治疗效果。我们讨论了在心理治疗中的应用和未来的方向，其中包括系统理论评估的障碍和扩展框架以纳入对建模社会学习过程具有重要意义的个体系统之间的相互作用。通过本报告，我们希望激发未来在形式化临床框架方面的努力。
