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A complex systems approach to the study of change in psychotherapy
Open accessAbstract
BACKGROUND: A growing body of research highlights the limitations of traditional methods for studying the process of change in psychotherapy. The science of complex systems offers a useful paradigm for studying patterns of psychopathology and the development of more functional patterns in psychotherapy. Some basic principles of change are presented from subdisciplines of complexity science that are particularly relevant to psychotherapy: dynamical systems theory, synergetics, and network theory. Two early warning signs of system transition that have been identified across sciences (critical fluctuations and critical slowing) are also described. The network destabilization and transition (NDT) model of therapeutic change is presented as a conceptual framework to import these principles to psychotherapy research and to suggest future research directions. DISCUSSION: A complex systems approach has a number of implications for psychotherapy research. We describe important design considerations, targets for research, and analytic tools that can be used to conduct this type of research. CONCLUSIONS: A complex systems approach to psychotherapy research is both viable and necessary to more fully capture the dynamics of human change processes. Research to date suggests that the process of change in psychotherapy can be nonlinear and that periods of increased variability and critical slowing might be early warning signals of transition in psychotherapy, as they are in other systems in nature. Psychotherapy research has been limited by small samples and infrequent assessment, but ambulatory and electronic methods now allow researchers to more fully realize the potential of concepts and methods from complexity science.
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“Modeling downstream mechanisms will likely require complex approaches such as network analytic frameworks”
From Measuring the active elements of cognitive-behavioral therapies (2023) · cites this paper as Hayes & Andrews, 2020
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“Vi ved ganske enkelt ikke ret meget om, hvad det egentlig er, der virker i en terapisession, og dermed hvad vi skal gøre mere eller mindre af (Hayes & Andrews, 2020).”
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Andrews, L. A., Curtiss, J. E., & Hayes, A. M. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-818697-8.00220-x · Cited by 1
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“The adoption of CAS in alternate fields has demonstrated efficacy in generating insights for psychotherapy, behavioural and social contexts [24]–[26].”
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“Inherent disposition (high sensitivity, anxiety), combined with various environmental factors or adverse personal history, may lead some to avoid certain social settings or interactions (Hayes & Andrews, 2020).”
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“Participants’ struggles did not van-ish but became manageable, reflecting a central finding on psychotherapy research: healing involves gradual reductions in symptoms by developing new coping strategies rather than complete eradication of difficulties (Hayes & Andrews, 2020).”
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“When neither the personal nor task alliance reach threshold, the client cannot benefit from treatment and it is essential to prioritise alliance building in this situation (Binnie, 2012; Hayes and Andrews, 2020).”
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“Ultimately, merging complex systems thinking (Dahia & Szabo, 2024; Hayes & Andrews, 2020; Hofkirchner & Schafranek, 2011; Liu & Barabási, 2016; Ryan, 2011; Sawyer, 2022) with psychological expertise, the 16Q framework offers a stronger and more promising pathway for globally addressing hate crimes…”
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Pérez-Barrero, A., Pérez‐Esteban, A., Díez-Gómez, A., Pérez‐Albéniz, A., Al‐Halabí, S., Lucas‐Molina, B., Inchausti-Gómez, F., & Fonseca‐Pedrero, E. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1918211
“The findings of this study are consistent with the growing call for complex dynamic systems models, staging approaches, and transdi-agnostic frameworks in the understanding and prevention of suicidal behaviour (Hayes and Andrews, 2020; Nelson et al., 2017; Rief et al., 2023).”
Metadata
- Authors
- Hayes, A. M., & Andrews, L. A.
- Affiliations
- University of Delaware (US)
- Corresponding author
- Hayes, Adele M.
- Venue
- BMC Medicine
- Published
- 2020-07-14
- Volume
- 18
- Issue
- 1
- Pages
- 197-197
- ISSN
- 1741-7015 (ISSN-L)
- PMC
- PMC7359463
- OpenAlex
- W3042416448
- Cited by
- 149
- References
- 128
- Citations by year
- 2026: 25 · 2025: 31 · 2024: 25 · 2023: 33 · 2022: 22 · 2021: 11 · 2020: 2
- FWCI
- 6.81
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Foundation for the National Institutes of Health (R21-MH062662, R01-MH086558)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Social Sciences › Education › Chaos, Complexity, and Education
- Keywords
- psychotherapeutic change, complex systems, dynamical systems theory, synergetics, network theory, critical slowing down, critical fluctuations, early warning indicators, system transition, nonlinear dynamics, psychopathology, ambulatory assessment, digital assessment
- MeSH terms
- Delivery of Health Care, Feedback, Humans, Psychotherapy
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