Chair: Jan Richter
University of Hildesheim

Traditional concepts of nosology emphasizes the existence of distinct mental disorders based on clinical consensu about observations of subjective symptom reports by the patients, observable behavioral clusters, and associated features. However, these diagnoses can be seen as theoretical constructs and it remains unclear whether the diagnostic constructs refers to some real illness. The existing procedure in the classification systems traditionally aims to ensure diagnostic reliability. However, to date, it has not been possible to also ensure diagnostic validity. The a) polythetic and b) overlapping criteria of the diagnostic rubrics impede convergent and discriminant validity resulting in large heterogenity between patients with the same diagnoses but also a large amount of comorbidity between mental disorders. These weaknesses of traditional nosology have so far made it difficult to find the mechanisms underlying the disorders‘ etiology and maintenance. In fact, no risk factor could be identified specifically relevant to the development of a specific disorder. In contrast, experimental biological-based research target to identify those mechanisms and correlates for dysfunctional biopsychologcal processing that leads to specifc symptoms of psychopathology. It is emphasized that subjective experienced symptoms can result from a variety of different process disruptions. In addition, the same disruptions in biopsychological processes can equally lead to symptoms that we today assign to different disorder categories. In this symposium, we want to use current research findings and innovative models to discuss new ways of conceptualizing psychopathological phenomena from a transdiagnostic perspective. We are very pleased that we were able to win over the renowned international experts Christina Ottaviani, Julian Thayer and Omer Van den Bergh. We are also pleased that after the impulse lectures , together with the discussants Alfons Hamm (University of Greifswald) and Michael Witthöft (University of Mainz), we will shed light on the possibilities but also on the existing limits of progress.

Understanding dispositional negativity as a broad dimension of psychopathology
Omer Van den Bergh
Health Psychology, University of Leuven, Belgium

While there is growing consensus that categorical models of psychopathology and psychiatric disorders have little empirical ground, a transdiagnostic approach creates new challenges. For example, one question is how to parsimoniously model the observed variation in psychopathology using a limited number of (hierarchically arranged) dimensions. Another question is how to under­stand the critical processes involved in these transdiagnostic dimensions. A typical response to the latter question is to sort an array of empirically associated clinical characteristics into a framework providing a coherent overview. For example, the dimension “dispositional negativity” (or neuroticism) is associated with a large number of transdiagnostic clinical characteristics, such as repetitive negative thinking, reduced autobiographical memory specificity, compromised fear learning, etc.. However, investigating them in separate research lines does not make clear why and how these separate processes relate to this transdiagnostic dimension. Taking a more radical functional perspective, we suggest that dispositional negativity can be understood as a pervasive processing heuristic of the brain representing a “better safe than sorry”-strategy. This strategy implies that information processing tends to be low in sensory-perceptual detail, allowing threat-related categorical priors to dominate conscious experience. We suggest that the phenomenal difference of associated clinical characteristics results from applying this general processing heuristic to different content rather than from different processes. Considering this underlying processing heuristic in the brain may deepen our understanding in a more parsimoniousway and suggest new treatment approaches.

Heart Rate Variability as a Transdiagnostic Marker of Psychopathology
Julian F. Thayer, PhD
University of California, Irvine and The Ohio State University

The Research Domain Criteria (RDoC), was developed by the National Institute of Mental Health as a neuroscience-informed alternative to traditional psychiatric nosology. Although RDoC is often presented as a new approach, a dimensional view of psychopathology predates RDoc and can be found in the functional psychopathology literature and within psychophysiology. In this talk, I briefly review the history and emergence of physiologically-informed dimensional trait models of psychopathology. Based on extensive literature I will provide evidence for the idea that vagally-mediated heart rate variability (vmHRV) may be a transdiagnostic biomarker of psychopathology. Drawing on the work on a general p-factor of psychopathology I will show how vmHRV maps onto several aspects of this unifying p-factor model. Thus, it is proposed that vmHRV can be viewed as an autonomic, transdiagnostic biomarker of mental illness.

The transdiagnostic value of perseverative cognition: A precision-based framework
Cristina Ottaviani and Martino Schettino
Department of Psychology, Sapienza University of Rome, Rome, Italy and IRCCS Santa Lucia Foundation, Rome, Italy

The concept of precision medicine is gradually expanding in psychiatry, with the aim to reduce the gap between scientific innovation and clinical application. Growing evidence suggests that perseverative cognition, a form of cognition characterized by repetitive, intrusive, and uncontrollable thoughts, is a transdiagnostic risk factor for different psychiatric disorders. Although perseverative cognition characterizes both hypo-motivational (e.g., depression) and hyper-motivational (e.g., addiction) disorders, it has been almost exclusively studied within the context of the negative valence systems and only anecdotal evidence exists about its effects on reward processing. Here, a series of studies will be presented, characterized by the overall objective of identifying positive and negative reinforcers responsible for the maintenance of perseverative cognition. To do so, multiple levels of complexity, from brain functions to the integration of autonomic, affective, and cognitive processes, will be considered. In particular, the presentation will focus on two studies combining laboratory-based, magnetic resonance spectroscopy, computational and ecological assessments. Results support the view of intrusive thinking as a “better safe than sorry” strategy that aims to avoid the transition from a relaxed state to a s spike of autonomic activation. The discussion will stress the importance of harnessing neurobiological scientific advances to select treatment options with the greatest likelihood of success.

An invited international double symposium: Improving outcome of psychotherapy by personalization?
Psychotherapy Congress, Berlin, May 2023

Talks

• Symposium 1
  • Prof. Dr. Pim Cuijpers
  • Prof. Dr. Kim de Jong
  • Discussants: Prof. Dr. Sigal Zilcha-Mano und Prof. Dr. Julian Rubel
• Symposium 2
  • Dr. Harriëtte Riese
  • Prof. Dr. Michael Barkham
  • Discussants: Prof. Dr. Wolfgang Lutz und Dr. Tim Kaiser

Several psychological treatments have shown their efficacy and effectiveness in randomized controlled trials and routine care settings, respectively. Still, up to 40-50% of patients do not benefit or even deteriorate. Optimizing the fit between the offered interventions and the individual patient (i.e., treatment personalization) has been identified in recent years as a promising route to a further enhancement of psychotherapy outcome. Diverse approaches and methodologies ranging from big data and machine-learning algorithms to intensive longitudinal N=1 designs have been employed to support data-informed decision-making for an individual patient. Reflecting this diversity, in this double symposium four international experts present their vision of how personalized psychotherapy research can help to improve psychotherapy. Pim Cuijpers starts with an introduction into personalized treatment selection in depression and how meta-analytic techniques (especially individual patient data meta-analyses) can help to answer the question of what works for whom. In the second talk, Kim de Jong focuses on the use of session-by-session assessments (i.e., routine outcome monitoring) and feedback for a continuous adaptation of treatments to the needs of the respective patient. In the second symposium, Harriëtte Riese talks about more intensive longitudinal assessments of personalized questions about affect, cognitions, behaviour, and context as well as their use to enhance case conceptualizations and treatment planning. Last, Michael Barkham will provide a broader reflection about the definition of psychotherapy personalization and associated potentials and challenges for delivery, research designs and communication, as well as dissemination. The double symposium is complemented by a general discussion about psychotherapy personalization with the four panelists, the four discussants, and the audience.

Personalized psychotherapies for depression: The contribution of meta-analytic research
Pim Cuijpers, Professor of Clinical Psychology
Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam

There are several treatments of depression, including psychological and pharmacological interventions, but none of these has been proven to be more effective than others. And although we have all these different effective interventions, hardly anything is known about what works for whom. One important reason is that randomized controlled trials are typically designed to examine whether an intervention is effective, and they do not have the statistical power to examine for whom an intervention is more effective than others. Meta-analytic research can help with that. Conventional meta-analytic studies have resulted in some preliminary knowledge on who benefits from which treatment. But the best knowledge comes from ‘individual patient data’ (IPD) meta-analyses, in which the primary data of trials are pooled into one big dataset. This solves the issue of low power and allows to examine who benefits more or less from a treatment. In this presentation I will give an overview of what IPD meta-analyses have found until now about personalizing therapies.

The promise of personalized self-monitoring for psychotherapy
Harriëtte Riese, Associate Professor
University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands

There is a need to improve the effectiveness of treatments for psychopathology, possibly through innovations in treatment personalization. The Lancet-World Psychiatric Association Commission has urged for united action to increase the efficacy of treatments for depression (Herrman et al., 2022). In their recommendations, they mentioned the urgency to „develop a collaborative and multidisciplinary approach to reduce the burden of depression“. In psychotherapeutic treatments, this could potentially be achieved by supporting case-conceptualization with the experience sampling methodology (ESM). ESM is a scientific method designed for data collection, which shows great promise to become a useful tool in psychotherapy. It involves repeated daily sampling (e.g., for weeks) of momentary affect, cognitions, behavior, or (social) context variables by clients on their smartphones. The Therap-i RCT study tests the efficacy of a personalized ESM diary and feedback module integrated into outpatient psychotherapeutic depression treatment on its ability to; decrease depressive symptoms, improve general functioning, therapeutic working alliance, and illness perception. Based on this and other research on the needs of clients and clinicians, the transdiagnostic Personalized Treatment by Real-time Assessment (PETRA) tool was developed. This ESM-tool has been integrated into electronic health record systems to ensure ease of use and sustainable integration into clinical care, while adhering to privacy regulations. The clinical effectiveness of integrating personalized ESM diaries into care through PETRA, however, requires further research. A detailed exploration of the difficulties and possibilities for self-monitoring with personalised ESM for psychotherapy will be given.

Personalization: Definitions, delivery, designs, detection, and dissemination
Professor Michael Barkham
University of Sheffield

In recent years, there has been increased research activity addressing the theme of ‘personalisation’ of therapy in an attempt to deliver on Gordon Paul’s (1967) litany: “What treatment, by whom, is most effective for this individual with that specific problem, and under which set of circumstances, and how does it come about?”. Such activity is reorienting the field of psychological therapies away from a focus on treatment comparisons per se towards better matching and utilisation of existing treatments and resources to meet patient needs. However, key methodological issues exist, informed by psychological therapies outcome research in general, that need to be considered. First, definitions: a clearer use of terminology in the field would be beneficial as different terms carry differing expectations for patients and reduce research specificity. Second, delivery: manifestations of personalisation across the range from the application of machine learning to advanced clinical skills need to be considered that lead to a realistic impact for patients within any given context comprising finite resources. Third, designs: a strategy is required for utilising large N studies but also with the necessary rigour of trials methodology so as to maximise the scientific underpinnings. Fourth, detection: the nature of findings will invariably yield smaller effects and the scientific community needs to readjust expectations in order that such effects are valued. Fifth, dissemination: the resulting clinical actions need to reach across the range of socioeconomic and cultural diversity as well as being potentially scalable at a population health level. Each of these elements is expanded on to highlight both the problems and potential for the field.