Detecting Impending Symptom Transitions Using Early-Warning Signals in Individuals Receiving Treatment for Depression

• Published in: Clinical psychological science Vol. 11; no. 6; pp. 994 - 1010
• Main Authors: Helmich, Marieke A., Smit, Arnout C., Bringmann, Laura F., Schreuder, Marieke J., Oldehinkel, Albertine J., Wichers, Marieke, Snippe, Evelien
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.11.2023
• Subjects: complexity; preregistered; replicated single-subject design; symptom remission; sudden improvement; personalized models; idiographic change; destabilization; experience sampling method
• ISSN: 2167-7026; 2167-7034
• DOI: 10.1177/21677026221137006

Drawing on dynamical systems theory, we investigated whether within-persons-detected early-warning signals in momentary affect preceded critical transitions toward lower levels of depressive symptoms during therapy. Participants were 41 depressed individuals who were starting psychological treatment. Positive and negative affect (high and low arousal) were measured 5 times a day using ecological momentary assessments over 4 months (M = 522 observations per individual). Depressive symptoms were assessed weekly over 6 months. Within-persons rising autocorrelation was found for 89% of individuals with transitions in at least one variable (vs. 62.5% for individuals without transitions) and in a consistently higher proportion of the separate variables (~44% across affect measures) than for individuals without transitions (~27%). Rising variance was found for few individuals, both preceding transitions (~11%) and for individuals without transitions (~12%). Part of our sample showed critical slowing down, but early-warning signals may have limited value as a personalized prediction method.