Destabilization in self-ratings of the psychotherapeutic process is associated with better treatment outcome in patients with mood disorders

摘要

Objective: While destabilization periods characterized by high variability and turbulence in a patient's psychological state might seem obstructive for psychotherapy, a complex systems approach to psychopathology predicts that these periods are actually beneficial as they indicate possibilities for reorganization within the patient. The present study tested the hypothesis that destabilization is related to better treatment outcome. Method: 328 patients who received psychotherapy for mood disorders completed daily self-ratings about their psychotherapeutic process. A continuous measure of destabilization was defined as the relative strength of the highest peak in dynamic complexity, a measure for variability and turbulence, in the self-ratings of individual patients. Results: Destabilization was found to be related to better treatment outcome. When improvers and non-improvers were analyzed separately, destabilization was found to be related to better treatment outcome in improvers but not in non-improvers. Conclusions: Destabilization in daily self-ratings of the psychotherapeutic process is associated with better treatment outcome. The identification of destabilization periods in process-monitoring data is clinically relevant. During destabilization, patients are believed to be increasingly sensitive to the effects of therapy. Clinicians could tailor their interventions to these sensitive periods.