Using person-specific networks in psychotherapy: challenges, limitations, and how we could use them anyway

May combine two claims.

Person-specific networks can capture aspects that are captured in the experience sampling method questionnaire, but some aspects are not captured.

“First, PSNs can capture aspects that are captured in the ESM questionnaire. On the one hand, that means that some aspects are not captured.”

May combine two claims.

Methods exist to consider associations on multiple time scales, but they further increase the complexity of person-specific networks, which are already difficult for patients to understand.

“There are methods to consider associations on multiple time scales [43]. However, such methods further increase the complexity of PSNs, which are already difficult to understand for patients.”

• cites [43] Ryan O, Kuiper RM, Hamaker EL. A continuous-time approach to intensive longitudinal data: what, why, and how? In: Kv M, Oud JHL, Voelkle MC, editors. Continuous time modeling in the behavioral and related sciences. New York: Springer; 2018. p. 27–54. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S4 (based).

Changes in the mean of included variables are considered an artifact to correct for in person-specific networks.

“Changes in the mean are considered an artifact to correct for.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

It seems plausible that many processes between variables in a person-specific network occur on such a short time scale.

“It seems plausible that many processes between variables in a PSN occur on such a time scale.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

Changes in the mean are potentially more meaningful than momentary changes that dissipate quickly; they may provide information about what may drive lasting change in the patient and are the very goal of psychotherapy.

“However, such changes in the mean are potentially more meaningful than momentary changes that dissipate quickly—they may provide information about what may drive lasting change in the patient and are the very goal of psychotherapy.”

May combine two claims.

Initial case studies have shown that person-specific networks were feasible, well-received by patients, and provided clinically relevant information.

“Several initial case studies, which collected data through ESM and created PSNs for individual patients, have shown that PSNs were feasible, well-received by patients, and provided clinically relevant information [24–27].”

• cites [24] Bak M, Drukker M, Hasmi L, Van Os J. An n=1 clinical network analysis of symptoms and treatment in psychosis. PLoS One. 2016;11(9):e0162811.Not checked yet

  Not checked in the free run.

• cites [25] Epskamp S, Van Borkulo CD, Van Der Veen DC, Servaas MN, Isvoranu A-M, Riese H, et al. Personalized network modeling in psychopathology: the importance of contemporaneous and temporal connections. Clin Psychol Sci. 2018;6(3):416–27. sourceNot checked yet

  Not checked in the free run.

• cites [26] Frumkin M, Piccirillo M, Beck ED, Grossman J, Rodebaugh T. Feasibility and utility of idiographic models in the clinic: a pilot study: PsyArXiv [preprint]; 2019 [cited 2020 Apr 19] Available from: https://doi.org/10.31234/osf.io/m34aw. sourceNot checked yet

  Not checked in the free run.

• cites [27] Kroeze R, van der Veen DC, Servaas MN, Bastiaansen JA, Oude Voshaar RC, Borsboom D, et al. Personalized feedback on symptom dynamics of psychopathology: a proof-of-principle study. J Person-Oriented Research. 2017;3(1):1–11. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

This assertion is in line with cognitive behavioral therapy, which involves the analysis of connections between momentary affect, behaviors, cognitions, and somatic states in specific moments.

“This assertion is in line with CBT, which involves the analysis of connections between momentary affect, behaviors, cognitions, and somatic states in specific moments [21].”

• cites [21] Beck J. Cognitive behavior therapy: basics and beyond. 2 ed: New York: Guilford Press; 2011.Not checked yet

  Not checked in the free run.

May combine two claims.

Person-specific networks can capture some, but not all, processes.

“Accordingly, they can capture some, but not all, processes.”

May combine two claims.

Patients with the same diagnosis may show different symptom profiles, which may also vary over time.

“Patients with the same diagnosis may show different symptom profiles [1], which may also vary over time.”

• cites [1] Galatzer-Levy IR, Bryant RA. 636,120 ways to have posttraumatic stress disorder. Perspect Psychol Sci. 2013;8(6):651–62. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

The etiology of mental disorders is highly multifactorial and largely unspecific.

“In line with its symptomatology, the etiology of mental disorders also is highly multifactorial and largely unspecific [7, 8].”

• cites [7] Lahey BB, Krueger RF, Rathouz PJ, Waldman ID, Zald DH. A hierarchical causal taxonomy of psychopathology across the life span. Psychol Bull. 2017;143(2):142–86. sourceNot checked yet

  Not checked in the free run.

• cites [8] Cuthbert BN, Insel TR. Toward the future of psychiatric diagnosis: the seven pillars of RDoC. BMC Med. 2013;11(1):126. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Experience sampling method can capture momentary expressions of affect, behaviors, cognitions, and somatic states, with high ecological validity and less retrospective bias.

“On the other hand, ESM is able to capture variables of central interest to CC, namely momentary expressions of affect, behaviors, cognitions, and somatic states. Also, these aspects are captured with high ecological validity and are less affected by retrospective bias [42].”

• cites [42] Hektner JM, Schmidt JA, Csikszentmihalyi M. Psychometrics of ESM data. Experience sampling method: measuring the quality of everyday life. Thousand Oaks; Sage, 2007. p. 104–25. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Person-specific networks only capture processes that are dynamic to begin with; there needs to be variation in all included variables.

“Third, PSNs only capture processes that are dynamic to begin with. That is, there needs to be variation in all included variables.”

May combine two claims.

Bastiaansen and colleagues asked different research teams to recommend treatment targets based on the same experience sampling method time-series data of one particular patient; most research teams included a person-specific network, but choices in the statistical analyses and recommendations for treatment varied widely.

“They asked different research teams to recommend treatment targets based on the same ESM time-series data of one particular patient. Most research teams included a PSN in their analysis, but choices in the statistical analyses and recommendations for treatment varied widely.”

• cites [41] Bastiaansen J, Kunkels Y, Blaauw F, Boker S, Ceulemans E, Chen M, et al. Time to get personal? The impact of researchers’ choices on the selection of treatment targets using the experience sampling methodology: PsyArXiv [preprint]; 2019 [cited 2020 Apr 19] Available from: https://doi.org/10.31234/osf.io/c8vp7. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Person-specific networks capture linear associations between variables but may misrepresent associations that are non-linear.

“Sixth, PSNs capture linear associations between variables but may misrepresent associations that are non-linear.”

May combine two claims.

Case conceptualization is a challenging process involving complex problem solving without a gold standard procedure.

“However, CC is a challenging process, as it involves complex problem solving [12] without a gold standard procedure [13].”

• cites [12] Fischer A, Greiff S, Funke J. The process of solving complex problems. J Probl Solving. 2011;4(1):19–42.Not checked yet

  Not checked in the free run.

• cites [13] Ridley CR, Jeffrey CE, Roberson RB. Case mis-conceptualization in psychological treatment: an enduring clinical problem. J Clin Psychol. 2017;73(4):359–75. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

Psychopathology is complex, with multifactorial etiology and diverse symptom profiles, and this complexity hampers effective treatment.

“The complexity of psychopathology is evident from its multifactorial etiology and diversity of symptom profiles and hampers effective treatment.”

Probably not a substantial claim: may not pass S3 (load-bearing).

There are findings that therapists report doubts on whether person-specific networks can provide new information.

“However, there are also findings that therapists report doubts on whether PSNs can provide new information [26, 28].”

• cites [26] Frumkin M, Piccirillo M, Beck ED, Grossman J, Rodebaugh T. Feasibility and utility of idiographic models in the clinic: a pilot study: PsyArXiv [preprint]; 2019 [cited 2020 Apr 19] Available from: https://doi.org/10.31234/osf.io/m34aw. sourceNot checked yet

  Not checked in the free run.

• cites [28] Zimmermann J, Woods WC, Ritter S, Happel M, Masuhr O, Jaeger U, et al. Integrating structure and dynamics in personality assessment: first steps toward the development and validation of a personality dynamics diary. Psychol Assess. 2019;31(4):516–31. sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

Social psychology teaches that context is important in determining how people feel, think, and behave.

“Social psychology teaches us how important context is in determining how people feel, think, and behave [45].”

• cites [45] Ross L. The intuitive psychologist and his shortcomings: distortions in the attribution process. In: Berkowitz L, editor. Adv Exp Soc Psychol. 10: Elsevier; 1977. p. 173–220. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

Processes that are consistent and independent of context might be the more important and pathological ones.

“On the other hand, it is also worth considering that processes that are consistent and independent of context might be the more important and pathological ones.”

Probably not a substantial claim: may not pass S2 (checkable).

Some aspects of case conceptualization cannot be adequately captured on the rating scale of a questionnaire because they are inherently qualitative.

“Further, there are certain aspects of CC that cannot be adequately captured on the rating scale of a questionnaire because some aspects are inherently qualitative in nature.”

Probably not a substantial claim: may not pass S4 (based).

Person-specific networks may support case conceptualization by providing a schematic representation of association patterns between affective, cognitive, behavioral, and context variables.

“PSNs may support case conceptualization by providing a schematic representation of association patterns between affective, cognitive, behavioral, and context variables.”

May combine two claims.

Person-specific networks capture associations that are consistent over time, or whose inconsistency is captured in the included variables.

“Fourth, PSNs capture associations that are consistent over time, or whose inconsistency (variation) is captured in the included variables.”

May combine two claims.

Experience sampling method time-series data can be analyzed with statistical models that may reveal patterns in daily life dynamics of individual patients and thus provide a useful source of information for case conceptualization.

“Interestingly, ESM time-series data can be analyzed with different statistical models that may reveal patterns in daily life dynamics of individual patients [17, 18] and thus provide a useful source of information for CC.”

• cites [17] Piccirillo ML, Beck ED, Rodebaugh TL. A clinician’s primer for idiographic research: considerations and recommendations. Behav Ther. 2019;50(5):938–51. sourceNot checked yet

  Not checked in the free run.

• cites [18] Piccirillo ML, Rodebaugh TL. Foundations of idiographic methods in psychology and applications for psychotherapy. Clin Psychol Rev. 2019;71:90–100. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Experience sampling method time-series data have high ecological validity and are less affected by retrospective bias.

“The resulting time-series data have high ecological validity and are less affected by retrospective bias.”

• cites [42] Hektner JM, Schmidt JA, Csikszentmihalyi M. Psychometrics of ESM data. Experience sampling method: measuring the quality of everyday life. Thousand Oaks; Sage, 2007. p. 104–25. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Inconsistency in associations is likely to occur because patients react differently in different contexts and context cannot be adequately included in a person-specific network.

“One reason that such inconsistency is likely to occur is the fact that patients react differently in different contexts and we cannot adequately include the context in a PSN.”

May combine two claims.

Not all relevant processes can be captured in person-specific networks, but what can be captured is considerable and relevant to case conceptualization.

“These considerations show that not all relevant processes can be captured in PSNs, but what can be captured is considerable and relevant to CC.”

May combine two claims.

The same symptoms may be present in different diagnoses and are not distinctive for one single disorder.

“Moreover, the same symptoms may be present in different diagnoses and are not distinctive for one single disorder [2, 3].”

• cites [2] Narrow WE, Clarke DE, Kuramoto SJ, Kraemer HC, Kupfer DJ, Greiner L, et al. DSM-5 field trials in the United States and Canada, part III: development and reliability testing of a cross-cutting symptom assessment for DSM-5. Am J Psychiatry. 2013;170(1):71–82. sourceNot checked yet

  Not checked in the free run.

• cites [3] Tio P, Epskamp S, Noordhof A, Borsboom D. Mapping the manuals of madness: comparing the ICD-10 and DSM-IV-TR using a network approach. Int J Methods Psychiatr Res. 2016;25(4):267–76. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

Person-specific networks are based on systematically gathered, ecologically valid experience sampling method data and provide a unique personalized perspective.

“PSNs are based on systematically gathered, ecologically valid ESM data and provide a unique personalized perspective.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

Many of the points and suggestions about PSNs may also generalize to the use of other idiographic models in clinical practice.

“Beyond the topic of PSNs, many of the points and suggestions we make may also generalize to the use of other idiographic models in clinical practice.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Asking good questions is considered a key skill for any therapist and receives considerable attention in their training through techniques like Socratic questioning and motivational interviewing.

“Asking good questions is considered a key skill for any therapist and receives considerable attention in their training through techniques like Socratic questioning [50] and motivational interviewing [51].”

• cites [50] Clark GI, Egan SJ. The Socratic method in cognitive behavioural therapy: a narrative review. Cognit Ther Res. 2015;39(6):863–79. sourceNot checked yet

  Not checked in the free run.

• cites [51] Rollnick S, Miller WR. What is motivational interviewing? Behav Cogn Psychother. 1995;23(4):325–34. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Studies that apply non-personalized experience sampling method questionnaires in clinical samples, including those from our own group, have used a similar or higher number of questions, and compliance rates suggest a manageable burden for participants.

“Studies that apply (non-personalized) ESM questionnaires in clinical samples, including those from our own group, have used a similar or higher number of questions [32–35], and compliance rates suggest a manageable burden for participants.”

• cites [32] Janssens KAM, Bos EH, Rosmalen JGM, Wichers MC, Riese H. A qualitative approach to guide choices for designing a diary study. BMC Med Res Methodol. 2018;18(1):1–12. sourceNot checked yet

  Not checked in the free run.

• cites [33] Bastiaansen JA, Meurs M, Stelwagen R, Wunderink L, Schoevers RA, Wichers M, et al. Self-monitoring and personalized feedback based on the experiencing sampling method as a tool to boost depression treatment: a protocol of a pragmatic randomized controlled trial (ZELF-i). BMC Psychiatry. 2018;18:276. sourceNot checked yet

  Not checked in the free run.

• cites [34] Vachon H, Viechtbauer W, Rintala A, Myin-Germeys I. Compliance and retention with the experience sampling method over the continuum of severe mental disorders: meta-analysis and recommendations. J Med Internet Res. 2019;21(12):e14475. sourceNot checked yet

  Not checked in the free run.

• cites [35] Van Genugten CR, Schuurmans J, Lamers F, Riese H, Penninx BWJH, Schoevers RA, et al. Experienced burden of and adherence to smartphone-based ecological momentary assessment in persons with affective disorders. J Clin Med. 2020;9(2):322. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

Creating a personalized experience sampling method questionnaire in this way is in itself an act of starting case conceptualization.

“Creating a personalized ESM questionnaire in this way is in itself an act of starting CC.”

Probably not a substantial claim: may not pass S2 (checkable).

Large-scale application in clinical practice requires that analysis and visualization steps follow a standardized procedure, enabling the automated generation of person-specific networks.

“Large-scale application in clinical practice requires that these steps follow a standardized procedure, enabling the automated generation of PSNs.”

Probably not a substantial claim: may not pass S4 (based).

PSN-generated questions can only point to processes that are captured in their associations.

“PSN-generated questions can only point to processes that are captured in their associations.”

May combine two claims.

ESM assessment itself is increasingly considered an intervention for psychopathology, and there is first evidence of its benefits.

“First, ESM assessment itself is increasingly considered an intervention for psychopathology, and there is the first evidence of its benefits [30, 52].”

• cites [30] Bos FM, Snippe E, Bruggeman R, Wichers M, Van Der Krieke L. Insights of patients and clinicians on the promise of the experience sampling method for psychiatric care. Psychiatr Serv. 2019;70(11):983–91. sourceNot checked yet

  Not checked in the free run.

• cites [52] Kramer I, Simons CJP, Hartmann JA, Menne-Lothmann C, Viechtbauer W, Peeters F, et al. A therapeutic application of the experience sampling method in the treatment of depression: a randomized controlled trial. World Psychiatry. 2014;13(1):68–77. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

It is a key principle of CC to question one's own perspective and to be open to new information.

“It is a key principle of CC to question one’s own perspective and to be open to new information [49].”

• cites [49] Kuyken W, Padesky CA, Dudley R. Collaborative case conceptualization: working effectively with clients in cognitive-behavioral therapy. New York: Guilford Press; 2009.Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S2 (checkable).

When used responsibly, person-specific networks may be able to support case conceptualization by generating questions that serve as a starting point for a dialog between therapists and patients.

“When used responsibly, PSNs may be able to support case conceptualization by generating questions that serve as a starting point for a dialog between therapists and patients.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

Any idiographic model is bound by its assumptions and based on less-than-perfect data, making far-reaching recommendations problematic.

“Ultimately, any idiographic model is bound by its assumptions and based on less-than-perfect data, making far-reaching recommendations problematic.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

Well-targeted questions are an essential tool for therapists to gain insight into the patients' psychopathology patterns and improve the quality of case conceptualization.

“Well-targeted questions are an essential tool for therapists to gain insight into the patients’ psychopathology patterns and improve the quality of case conceptualization.”

May combine two claims.

Identification of strengths and adaptive skills is central to case conceptualization but can be underrepresented in clinical practice because of the primary focus on psychiatric complaints.

“Importantly, this also includes the identification of the strengths and adaptive skills of the patient, an area that is central to CC, but can be underrepresented in clinical practice because of the primary focus on psychiatric complaints [29].”

• cites [29] Kuyken W, Padesky CA, Dudley R. The science and practice of case conceptualization. Behav Cogn Psychother. 2008;36(6):757–68. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

PSNs cannot directly provide reliable insights into a patient's patterns of psychopathology nor recommendations on treatment targets.

“Taking together these considerations, it is clear that PSNs cannot directly provide reliable insights into a patient’s patterns of psychopathology nor recommendations on treatment targets.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

The collection of objective data, statistical modeling, and smooth visualizations create an appearance of objectivity that is not supported by firm evidence.

“The collection of “objective” data, use of statistical modeling, and smooth visualizations create an appearance of objectivity that is not supported by firm evidence.”

May combine two claims.

The maximum number of variables that are adequate from a statistical perspective depends on a number of circumstances, and clear recommendations are not available at the moment.

“The maximum number of variables that are adequate from a statistical perspective depends on a number of circumstances, and clear recommendations are not available at the moment.”

Probably not a substantial claim: may not pass S2 (checkable).

A standardized procedure is necessary to be able to research the effectiveness of using person-specific networks in psychotherapy.

“This is also necessary to be able to research the effectiveness of using PSNs in psychotherapy.”

May combine two claims.

Formulating experience sampling method questions in the patient's own words may increase their ability to answer accurately and increase compliance.

“Formulating questions in the patient’s own words may also increase their ability to answer accurately and increase compliance [32].”

• cites [32] Janssens KAM, Bos EH, Rosmalen JGM, Wichers MC, Riese H. A qualitative approach to guide choices for designing a diary study. BMC Med Res Methodol. 2018;18(1):1–12. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S4 (based).

Person-specific networks have limitations in terms of the reliability of the insights they provide directly.

“PSNs have limitations in terms of the reliability of the insights they provide directly.”

Probably not a substantial claim: may not pass S4 (based).

From a statistical perspective, the number of variables should not exceed a certain maximum to ensure sufficient power.

“From a statistical perspective, the number of variables should not exceed a certain maximum to ensure sufficient power.”

May combine two claims.

Currently, there are many possible paths to create person-specific networks, and we often do not know how to choose between them.

“Currently, there are many possible paths to create PSNs, and we often do not know how to choose between them.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

PSN-generated questions provide a novel perspective that may be valuable because it is difficult to obtain a comprehensive overview and understanding of a patient's psychopathology.

“They provide a novel perspective that may be valuable, because it is difficult to obtain a comprehensive overview and understanding of a patient’s psychopathology.”

Probably not a substantial claim: may not pass S2 (checkable).

PSNs may have the most potential when and where there is a need to simulate the collaborative exploration in CC.

“PSNs may have the most potential when and where there is a need to simulate the collaborative exploration in CC.”

• AssumptionRests on an assumption: Additional investment into case conceptualization is most indicated in the treatment of patients with complex psychopathology (e.g., with comorbidities).
• AssumptionRests on an assumption: Natural moments of exploration in psychological treatment are the start of treatment and moments of evaluation and reorientation.

Classified as probably not a substantial claim.

Collaboration between patient and therapist is a key principle of case conceptualization.

“Such collaboration is a key principle of CC [29], as it makes use of the introspective capability of the patient and the clinical expertise of the therapist.”

• cites [29] Kuyken W, Padesky CA, Dudley R. The science and practice of case conceptualization. Behav Cogn Psychother. 2008;36(6):757–68. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S2 (checkable).

If PSNs are embedded into psychotherapy in a responsible manner, they may prove useful.

“Yet, if we imbed PSNs into psychotherapy in a responsible manner, it may prove useful.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

PSNs in psychotherapy, like most statistical models in psychiatry, impose a structure on a complex reality.

“PSNs in psychotherapy, like most statistical models in psychiatry, impose a structure on a complex reality.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

A part of relevant processes is likely captured in PSNs.

“As we have argued above, a part of relevant processes is likely captured in PSNs.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Gathered ESM time-series data can easily be presented to patients and therapists descriptively, providing an additional source of information to explore new PSN-generated questions.

“Lastly, the gathered ESM time-series data can easily be presented to patients and therapists descriptively (e.g., by plotting variable course over time).”

• Also stated in: § The potential of person-specific networks · hedged

  “This provides them with an interesting additional source of information that may well be used to further explore new PSN-generated questions.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

If PSNs are used to generate questions, the clinical value of PSNs in psychotherapy is determined by the added value of these questions.

“If PSNs are used to generate questions, the clinical value of PSNs in psychotherapy is determined by the added value of these questions.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.

The different benefits of PSNs integrate well with each other and form a full CC process.

“This example also illustrates a larger point: The different benefits of PSNs integrate well with each other and form a full CC process.”

• AssumptionRests on an assumption: Personalizing the ESM questionnaire in collaboration between patient and therapist may foster their working alliance.

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Personalized experience sampling method has not been empirically studied yet but is currently being investigated in the Therap-i trial.

“Personalized ESM has not been empirically studied yet but is currently being investigated in the Therap-i trial.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

Taking these challenges into account, person-specific networks have potential as a tool to help therapists and patients in their collaborative exploration of a patient's psychopathology.

“However, taking these challenges into account, we believe they have potential as a tool to help therapists and patients in their collaborative exploration of a patient’s psychopathology.”

May combine two claims.

An association between two variables in a PSN may be explained by an indirect causal relationship mediated through an unobserved variable, an unobserved common cause, or a collider structure.

“The direct line between two variables in a network graph appears to suggest a direct (causal) relationship between them, but there are several other possibilities:”

• Also stated in: § Person-specific networks provide ambiguous information · hedged

  “(i) the relationship could be causal but indirect, mediated through some unobserved variable; (ii) it could also be explained by an unobserved variable that affects both variables (a common cause); and (iii) it might even be spurious, if the two variables both have an effect on a variable that is included in the network (a so-called collider structure) [47].”

• cites [47] Elwert F, Winship C. Endogenous selection bias: the problem of conditioning on a collider variable. Annu Rev Sociol. 2014;40(1):31–53. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

The structure imposed by PSNs may help navigate the complexity of psychopathology, but because it relies on simplifications, it can also point in the wrong direction.

“This structure may help us navigate the complexity of psychopathology, but because it relies on certain simplifications, it can also point to the wrong direction.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

By using PSNs to guide collaborative exploration while keeping responsibility for developing a working theory of the patient's pathology with patient and therapist, PSNs may prove an important guiding tool in the collaborative CC process.

“By using PSNs to guide collaborative exploration, but firmly keeping the responsibility for developing a working theory of the patient’s pathology with patient and therapist, PSNs may prove an important guiding tool in the collaborative CC process.”

May combine two claims.

In Kroeze and colleagues' case study, discussion about a PSN led to the formulation of causal hypotheses and motivated the patient to try a new treatment direction she had previously doubted.

“In their case study, Kroeze and colleagues provided an example of a stimulating discussion about a PSN [27].”

• Also stated in: § The potential of person-specific networks · plain

  “Their discussion led to the formulation of causal hypotheses and motivated the patient to try a new treatment direction, which she previously had had doubts about.”

• cites [27] Kroeze R, van der Veen DC, Servaas MN, Bastiaansen JA, Oude Voshaar RC, Borsboom D, et al. Personalized feedback on symptom dynamics of psychopathology: a proof-of-principle study. J Person-Oriented Research. 2017;3(1):1–11. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S2 (checkable).

PSN-generated questions may point to different processes than traditional case conceptualization (CC), as they are conceived through a very different process.

“PSN-generated questions may point to different processes than traditional CC, as they are conceived through a very different process.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

Patients and therapists may only see part of the picture based on retrospective information discussed in therapy sessions and are naturally limited by their own perspectives and biases.

“Just like PSNs, patients and therapists may only see part of the picture based on the retrospective information discussed in therapy sessions and are naturally limited by their own perspectives and biases.”