Transdiagnostic symptom dynamics during psychotherapy

Scientific Reports, vol. 12, pp. 10881

Abstract

Psychotherapy is an effective treatment for many common mental health problems, but the mechanisms of action and processes of change are unclear, perhaps driven by the focus on a single diagnosis which does not reflect the heterogeneous symptom experiences of many patients. The objective of this study was to better understand therapeutic change, by illustrating how symptoms evolve and interact during psychotherapy. Data from 113,608 patients from psychological therapy services who completed depression and anxiety symptom measures across three to six therapy sessions were analysed. A panel graphical vector-autoregression model was estimated in a model development sample (N = 68,165) and generalizability was tested in a confirmatory model, fitted to a separate (hold-out) sample of patients (N = 45,443). The model displayed an excellent fit and replicated in the confirmatory holdout sample. First, we found that nearly all symptoms were statistically related to each other (i.e. dense connectivity), indicating that no one symptom or association drives change. Second, the structure of symptom interrelations which emerged did not change across sessions. These findings provide a dynamic view of the process of symptom change during psychotherapy and give rise to several causal hypotheses relating to structure, mechanism, and process.

Authors 9

1. Ciarán O’Driscoll

   University College London

   Affiliation as printed

   Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational, and Health Psychology, UCL, London, UK

2. Sacha Epskamp

   University of Amsterdam

   Affiliation as printed

   Centre for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands

   Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands

3. Eiko I. Fried Aachen Department of Clinical Psychology

   Leiden University

   Affiliation as printed

   Department of Clinical Psychology, Leiden University, Leiden, The Netherlands

4. Rob Saunders

   University College London

   Affiliation as printed

   Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational, and Health Psychology, UCL, London, UK

5. Joshua C. H. Stott

   University College London

   Affiliation as printed

   ADAPT Lab, Research Department of Clinical, Educational, and Health Psychology, UCL, London, UK

   Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational, and Health Psychology, UCL, London, UK

6. Mirko Cirkovic

   Homerton University Hospital NHS Foundation Trust

   Affiliation as printed

   Talk Changes: City and Hackney IAPT Service, Homerton University Hospital NHS Foundation Trust, London, UK

7. Syed Ali Naqvi

   North East London NHS Foundation Trust

   Affiliation as printed

   Barking and Dagenham and Havering IAPT Services - North East London Foundation Trust, Essex, UK

   Barking and Dagenham and Havering IAPT Services – North East London Foundation Trust, Essex, UK

8. Joshua E. J. Buckman corresponding

   University College London · Camden and Islington NHS Foundation Trust

   Affiliation as printed

   Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational, and Health Psychology, UCL, London, UK. joshua.buckman@ucl.ac.uk

   iCope - Camden and Islington Psychological Therapies Services - Camden and, Islington NHS Foundation Trust, London, UK. joshua.buckman@ucl.ac.uk

   iCope - Camden and Islington Psychological Therapies Services - Camden and, Islington NHS Foundation Trust, London, UK

9. Stephen Pilling

   University College London · Camden and Islington NHS Foundation Trust

   Affiliation as printed

   Camden and Islington NHS Foundation Trust, London, UK

   Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational, and Health Psychology, UCL, London, UK