Cited by 146Psychotherapy Techniques and ApplicationsMental Health Research TopicsEcosystem dynamics and resilience

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Critical Fluctuations as an Early-Warning Signal for Sudden Gains and Losses in Patients Receiving Psychotherapy for Mood Disorders

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Olthof, Merlijn, Hasselman, Fred, Strunk, Guido, van Rooij, Marieke, Aas, Benjamin, Helmich, Marieke A., Schiepek, Günter, Lichtwarck-Aschoff, Anna·2020·Clinical Psychological Science

DOI 10.1177/2167702619865969

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Abstract

Whereas sudden gains and losses (large shifts in symptom severity) in patients receiving psychotherapy appear abrupt and hence may seem unexpected, hypotheses from complex-systems theory suggest that sudden gains and losses are actually preceded by certain early-warning signals (EWSs). We tested whether EWSs in patients’ daily self-ratings of the psychotherapeutic process predicted future sudden gains and losses. Data were collected from 328 patients receiving psychotherapy for mood disorders who completed daily self-ratings about their therapeutic process using the Therapy Process Questionnaire (TPQ). Sudden gains and losses were classified from the Problem Intensity scale of the TPQ. The other items of the TPQ were used to compute the EWSs. EWSs predicted an increased probability for sudden gains and losses in a 4-day predictive window. These results show that EWSs can be used for real-time prediction of sudden gains and losses in clinical practice.

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Authors: Olthof, M., Hasselman, F., Strunk, G., van Rooij, M., Aas, B., Helmich, M. A., Schiepek, G., & Lichtwarck-Aschoff, A.
Affiliations: Radboud University Nijmegen (NL)
TU Dortmund University (DE)
Behavioural Science Institute, Radboud University
LMU Klinikum (DE)
University Medical Center Groningen (NL)
Paracelsus Medical University (AT)
Corresponding author: Olthof, Merlijn
ORCID: Olthof, Merlijn
Hasselman, Fred
Strunk, Guido
Aas, Benjamin
Helmich, Marieke A.
Schiepek, Günter
Venue: Clinical Psychological Science
Publisher: SAGE Publications
Published: 2019-09-24
Volume: 8
Issue: 1
Pages: 25-35
ISSN: 2167-7026 (ISSN-L)
2167-7034
DOI: 10.1177/2167702619865969
OpenAlex: W2976346093
Cited by: 146
References: 53
Citations by year: 2026: 11 · 2025: 12 · 2024: 20 · 2023: 30 · 2022: 32 · 2021: 23 · 2020: 16 · 2019: 2
FWCI: 21.34
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by-nc
creativecommons.org/licenses/by-nc/4.0/ (unspecified)
Locations: Clinical Psychological Science (publishedVersion, cc-by-nc)
University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, cc-by-nc)
Open access LMU (Ludwid Maxmilian's Universitat Munchen) (submittedVersion, cc-by-nc)
Radboud Repository (Radboud University) (submittedVersion)
Radboud Repository (Radboud University) (submittedVersion, other-oa)
University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by-nc)
Funders: h2020 european research council (ERC-CoG-2015; No 681466)
Topics: Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
Physical Sciences › Environmental Science › Global and Planetary Change › Ecosystem dynamics and resilience
Keywords: early warning indicators, critical fluctuations, psychotherapy outcome prediction, mood disorders, therapeutic process, complexity theory

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Critical Fluctuations as an Early-Warning Signal for Sudden Gains and Losses in Patients Receiving Psychotherapy for Mood Disorders

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