Complexity Science: A Framework for Psychotherapy Integration

The paradigm of complexity science provides a new way to address the problem of psychotherapy integration and allows us to bypass the various shortcomings of the linear-interventionist perspective. Nine criteria are outlined, which should be satisfied by any integrative approach to psychotherapy: (a) the use of complexity science to provide a meta-theoretical and generic understanding of change processes (from neuronal to social system levels); (b) a comprehensive and formalised modelling of change processes and personality development; (c) an integrative method of case formulation; (d) the ability to understand a variety of techniques in terms of basic change principles; (e) criteria to guide microdecisions; (f) the application of data-driven feedback and real-time monitoring of change dynamics; (g) standardised assessment of outcomes in naturalistic settings; (h) guidelines for training; and (i) strategies that are well-suited to science–practice integration. Using these criteria as a framework for evaluation, one may grasp the potential of complexity science to drive innovation in the pursuit of psychotherapy integration

Real-Time-Monitoring in der Behandlung von Zwangsstörungen: Technologie und Fallbeispiel

Background: New methods of internet-based real-time monitoring of psychotherapy processes allow for the documentation, analysis, and data-driven control of behaviour therapy. Daily ratings of the patient result in highly resolved time series of the change dynamics. Method and Patient: The Synergetic Navigation System was used in the treatment setting of a day hospital. This method is specialized in the representation of critical instabilities and pattern transitions of the process. The patient of this case report had the combined diagnosis of obsessive-compulsive disorder and depressive episodes. Result: Quantitative time-series and qualitative data from the internet-assisted diaries mirror important features of the change process. Conclusion: The method could help optimise treatment effects of behavioural interventions by using the feedback on necessary conditions, appropriate timing, and short-term effects of these interventions. Patients' motivation for change can be enhanced and the navigation system realises the continuous documentation of treatment processes and effects

Sudden Gains in Day-to-Day Change:Revealing Nonlinear Patterns of Individual Improvement in Depression

Item does not contain fulltextObjective: We examined individual overall trajectories of change and the occurrence of sudden gains in daily self-rated problem severity and the relation of these patterns to treatment response. Method: Mood disorder patients (N = 329, mean age = 44, 55% women) completed daily self-ratings about the severity of their complaints as a standard part of treatment, using the Therapy Process Questionnaire (TPQ). Per individual, the best-fitting defined (linear, log-linear, 1-step) trajectory was tested for significance: for change over time, and for specificity of the best-fitting trajectory. Two-hundred and three cases had ICD-10 Symptom Rating (ISR) depression scores posttreatment: a score <= 1 identified 114 treatment responders. Relation to response was examined for sudden gains and type of change trajectory. Results: 138 cases (42%) had a significant decrease in problem severity, of which 54 cases (16%) had a defined trajectory: 50 cases with one-step improvement, and 4 with a linear improvement in daily problem severity. Sudden gains occurred in 28% of the total sample, and within 58% of improvement patterns. Specifically, sudden gains occurred in 68% of significant 1-step trajectories and 25% of the linear cases. Sudden gains and nonspecific change trajectories were significantly more frequent for treatment responders. Conclusions: At the day-level, patterns of improvement are nonlinear for most patients. Sudden gains occur within various forms of overall change and are associated with treatment response. Clinically relevant improvements in depression occur both gradually and abruptly, and this finding allows for the possibility that the remission process functions according to dynamical systems principles.9 p

Stability and Flexibility in Psychotherapy Process Predict Outcome

Ten good outcome and ten poor outcome psychotherapy cases were compared to investigate whether or not the temporal stability and flexibility of their process variables can predict their outcomes. Each participant was monitored daily using the Therapy Process Questionnaire (TPQ), which has 43 items and seven sub-scales, and responses over time were analyzed in terms of correlation robustness and correlation variability across the TPQ sub-scales. “Correlation robustness” and “correlation variability” are two basic characteristics of any correlation matrix: the first is calculated as the sum of the absolute values of Pearson correlation coefficients, the second as the standard deviation of Pearson correlation coefficients. The results demonstrated that the patients within the poor outcome group had lower values on both variables, suggesting lower stability and flexibility. Furthermore, a higher number of cycles of increase and decrease in correlation robustness and variability of the TPQ sub-scales was observed within good outcome psychotherapies, suggesting that, these cycles can be considered as process-markers of good-outcomes. These results provide support for the validity of these quantitative process-parameters, correlation robustness and variability, in predicting psychotherapeutic outcomes. Moreover, the results lend support to the common clinical experience of alternating periods of flexibility and integration being beneficial to good psychotherapeutic processes

SNS-process monitoring in coaching. Resources of young adults in transitions. Project Kraftquellen, final report on youth and work

Das Projekt \u27Kraftquellen\u27 schreibt eine Studie, die im ‚Fachreferat Jugend und Arbeit‘ des Erzbischöflichen Jugendamtes München und Freising zwischen 2015 und 2021 durchgeführt wurde. Untersucht wurden Coachingprozesse junger Erwachsener in ihrer Veränderungsdynamik. Die Teilnehmer*innen kamen aus dem Freiwilligen Sozialen Jahr (FSJ), da diese Lebensphase zwischen Schule, Studium und/oder Ausbildung mit vielen Entscheidungen verbunden ist. Als Begleitprojekt des 2021 veröffentlichten Forschungsprojektes \u27Geduld als Ressource\u27 soll es Aufschluss darüber geben, wie junge Erwachsene in beruflich-privaten Übergängen ressourcenorientiert durch Einzelcoaching gefördert werden können. Die Coachingprozesse wurden methodisch durch das Synergetische Navigationssystem (SNS) begleitet und durch Prof. Dr. Dr. Günter Schiepek, Leiter des Institutes für Synergetik und Psychotherapieforschung von der Paracelsus Medizinischen Privatuniversität Salzburg, beraten. Basierend auf einer idiographischen Systemmodellierung wurde mit jeder/m Teilnehmer*in ein individueller Fragebogen entwickelt. Dieser wurde digital ca. 70 Tage/Teilnehmer*in bearbeitet und über ein Monitoring auf der SNS-Plattform begleitet. In den Fragebogen gingen Ressourcen des gesundheitlichen Wohlbefindens (WHO-5) und der Geduld (Studie \u27Geduld als Ressource\u27) mit ein. Die Untersuchung kommt zu dem Ergebnis, dass das Zusammenspiel der individuellen Ressourcen eine motivierende Wirkung für den Coachingprozess hat. Die Ressourcen im Feld des Wohlbefindens entsprechen dem Wunsch vieler junger Erwachsener nach Gesundheit. Die Geduld hat eine prozessstabilisierende Wirkung, sie verändert sich im zeitlichen Verlauf und im Kontext, entwickelt sich aber die die Reflektion von Geduld weiter. Insgesamt beschreiben die Coachees die Geduld als wichtige Alltagsressource. Das Projekt \u27Kraftquellen\u27 empfiehlt eine weitergehende Prozessforschung zu Coachingverläufen junger Erwachsener. (Verfasser)The Kraftquellen project is writing a study that was carried out in the \u27Fachreferat Jugend und Arbeit\u27 of the Archbishop\u27s Youth Welfare Office in Munich and Freising between 2015 and 2021. Coaching processes of young adults were examined in terms of their change dynamics. The participants came from the Voluntary Social Year (FSJ), as this phase of life between school, studies and / or training is associated with many decisions. As a companion project to the research project Patience as Resource published in May 2021 (May; Tectum Verlag), it is intended to provide information on how young adults can be promoted in a resource-oriented manner through individual coaching in professional-private transitions. The coaching processes were methodically accompanied by the Synergetic Navigation System (SNS) and by Prof. Dr. Dr. Günter Schiepek, head of the Institute for Synergetics and Psychotherapy Research at the Paracelsus Medical Private University in Salzburg. Based on an idiographic system modeling, an individual questionnaire was developed with each participant. This was processed digitally for about 70 days / participant and accompanied by monitoring on the SNS platform. In the questionnaire, resources of health well-being (WHO-5) and patience (study patience as a resource) were included. The study comes to the conclusion that the interplay of individual resources has a motivating effect on the coaching process. The resources in the field of wellbeing correspond to the desire for health of many young adults. Patience has a process-stabilizing effect, it changes over time and in context, but the reflection of patience continues to develop. Overall, the coachees describe patience as an important everyday resource. The Kraftquellen project recommends further process research on coaching courses for young adults. (Author

Psychotherapy Is Chaotic-(Not Only) in a Computational World

Objective: The aim of this article is to outline the role of chaotic dynamics in psychotherapy. Besides some empirical findings of chaos at different time scales, the focus is on theoretical modeling of change processes explaining and simulating chaotic dynamics. It will be illustrated how some common factors of psychotherapeutic change and psychological hypotheses on motivation, emotion regulation, and information processing of the client's functioning can be integrated into a comprehensive nonlinear model of human change processes. Methods: The model combines 5 variables (intensity of emotions, problem intensity, motivation to change, insight and new perspectives, therapeutic success) and 4 parameters into a set of 5 coupled nonlinear difference equations. The results of these simulations are presented as time series, as phase space embedding of these time series (i.e., attractors), and as bifurcation diagrams. Results: The model creates chaotic dynamics, phase transition-like phenomena, bi-or multi-stability, and sensibility of the dynamic patterns on parameter drift. These features are predicted by chaos theory and by Synergetics and correspond to empirical findings. The spectrum of these behaviors illustrates the complexity of psychotherapeutic processes. Conclusion: The model contributes to the development of an integrative conceptualization of psychotherapy. It is consistent with the state of scientific knowledge of common factors, as well as other psychological topics, such as: motivation, emotion regulation, and cognitive processing. The role of chaos theory is underpinned, not only in the world of computer simulations, but also in practice. In practice, chaos demands technologies capable of real-time monitoring and reporting on the nonlinear features of the ongoing process (e.g., its stability or instability). Based on this monitoring, a client-centered, continuous, and cooperative process of feedback and control becomes possible. By contrast, restricted predictability and spontaneous changes challenge the usefulness of prescriptive treatment manuals or other predefined programs of psychotherapy

Depressione – un sistema dinamico complesso

Der vorliegende Beitrag befasst sich mit neueren Befunden zur Depressionsforschung, vor allem zur psychotherapeutischen Behandlung von Depression. Auf Wunsch der Redaktion sollte damit auch eine Synopse der wissenschaftlichen und praktischen Entwicklungen gegeben werden, die am Institut für Synergetik und Psychotherapieforschung der Paracelsus Medizinischen Privatuniversität Salzburg und der kooperierenden Forschergruppen stattfinden. Ein Schwerpunkt liegt in der Personalisierung der Psychotherapie und betrifft sowohl neuere Methoden der Fallkonzeption (z.B. idiografische Systemmodellierung und deren computerbasierte Visualisierung) als auch Verfahren des hochfrequenten Prozessmonitorings und Prozessfeedbacks. Hierfür wurde das Internetund App-basierte Synergetische Navigationssystem (SNS) entwickelt und erprobt. Die Verläufe der Psychotherapie depressiver Patient*innen zeigen diskontinuierlich Sprünge dynamischer Muster (sogenannte Ordnungsübergänge), die von einer erhöhten kritischen Instabilität (dynamische Komplexität) und zeitlich begrenzter Synchronisation der Items eines Prozessbogens eingeleitet werden. Erhöhte kritische Instabilität ist zudem prädiktiv für besseren Therapieerfolg. In einer Studie an komorbid depressiven Patient*innen mit Zwangsstörungen wurde deutlich, dass sich neben klinischen Verbesserungen auch die funktionelle Konnektivitätsdynamik neuronaler Netze verändert. Wiederholte fMRT-Scans zeigten, dass Flexibilität und Fluidität der Neurodynamik mit der Psychopathologie (z.B. Depressionsintensität, BDI) negativ assoziiert sind, aber im Verlauf von Psychotherapie zunehmen. Abschliessend erfolgt eine Einschätzung von Möglichkeiten, nichtinvasive Neurostimulation mit Psychotherapie zu kombinieren.This article focuses on some new developments in the treatment of Major Depressive Disorder with the question of how to optimize psychotherapeutic procedures. Following the intention of the editor of this journal, a short synopsis is given on the scientific and practical developments at the Institute of Synergetics and Psychotherapy Research at the Paracelsus Medical University Salzburg. One focus is on the personalization of psychotherapy, which concerns new methods of case formulation (e.g., Idiographic System Modelling and computer-based tools for its visualization) and technologies for high-frequency process-monitoring and -feedback. For this reason, we developed and validated the Synergetic Navigation System (SNS) which is an Internetand App-based application for data collection, data analysis, and visualization of change dynamics and outcome. Based on this methodology, it became evident that the psychotherapeutic processes of depressive disorders are characterized by discontinuous patterns, so called «order transitions». The precursors of these discontinuous transitions are critical fluctuations represented by increased dynamic complexity, and an increase in the synchronization of the inter-item dynamics of the therapy process questionnaire. The amount of critical instabilities occurring before order transitions revealed to be predictive for treatment outcome. Beside clinical improvement also neural connectivity patterns are changing by psychotherapy, as could be shown in repeated fMRI scans during inpatient treatment of comorbid depressive patients with obsessive compulsive disorder. The functional connectivity dynamics of 119 brain regions was assessed during the resting state periods of the repeated scans, showing that neural rigidity (a loss of flexibility and fluidity) is associated with psychopathology (e.g., depression, BDI), but flexibility increases during psychotherapy. Finally, the option of combining psychotherapy with noninvasive neurostimulation will be discussed.il presente studio si focalizza sulle ultime scoperte della ricerca sulla depressione, con particolare riguardo al trattamento di tale patologia in ambito psicoterapeutico. Su richiesta della redazione, verranno passati in rassegna anche gli sviluppi scientifici e pratici registrati presso l’Institut für Synergetik und Psychotherapieforschung (Istituto di sinergetica e ricerca psicoterapeutica) della Paracelsus Medizinischen Privatuniversität (Università medica privata Paracelsus) di Salisburgo e dei gruppi di ricercatori che vi collaborano. Uno dei temi principali è rappresentato dalla personalizzazione della psicoterapia e riguarda sia i più recenti metodi di concettualizzazione del caso del paziente (ad es. modellazione sistemica idiografica e relativa visualizzazione computerizzata) sia la metodologia di monitoraggio (ad alta frequenza) e il feedback dei processi neuronali che intervengono durante la terapia. A questo riguardo è stato sviluppato e testato un sistema di navigazione sinergetico basato su app e internet (SNS). Lo svolgimento delle sedute di psicoterapia di pazienti con depressione ha mostrato cambiamenti discontinui dei modelli dinamici (i cosiddetti passaggi ad altro stato di ordine), che sono generati da un’instabilità critica elevata (complessità dinamica) e da una sincronizzazione limitata nel tempo degli elementi dello schema del processo terapeutico. Un’elevata instabilità critica è inoltre predittiva di migliori risultati nel corso della terapia. In uno studio svolto su pazienti depressi e inoltre affetti da disturbi compulsivi, oltre a miglioramenti clinici, si sono evidenziati anche cambiamenti nella dinamica di connettività delle reti neuronali. Ripetuti esami effettuati tramite fRMN hanno evidenziato l’associazione negativa della flessibilità e della fluidità delle dinamiche neuronali con la psicopatologia (ad es. intensità della depressione, BDI), tuttavia con un loro aumento nel corso della psicoterapia. Infine segue una valutazione delle possibilità di combinare la neurostimolazione non invasiva alla psicoterapia