Critical Fluctuations as an Early-Warning Signal for Sudden Gains and Losses in Patients Receiving Psychotherapy for Mood Disorders

Merlijn Olthof*, Fred Hasselman, Guido Strunk, Marieke van Rooij, Benjamin Aas, Marieke A. Helmich, Guenter Schiepek, Anna Lichtwarck-Aschoff

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Whereas sudden gains and losses (large shifts in symptom severity) in patients receiving psychotherapy appear abrupt and hence may seem unexpected, hypotheses from complex-systems theory suggest that sudden gains and losses are actually preceded by certain early-warning signals (EWSs). We tested whether EWSs in patients' daily self-ratings of the psychotherapeutic process predicted future sudden gains and losses. Data were collected from 328 patients receiving psychotherapy for mood disorders who completed daily self-ratings about their therapeutic process using the Therapy Process Questionnaire (TPQ). Sudden gains and losses were classified from the Problem Intensity scale of the TPQ. The other items of the TPQ were used to compute the EWSs. EWSs predicted an increased probability for sudden gains and losses in a 4-day predictive window. These results show that EWSs can be used for real-time prediction of sudden gains and losses in clinical practice.

Original languageEnglish
Number of pages11
JournalClinical Psychological Science
Publication statusPublished - 24-Sep-2019


  • early-warning signals
  • sudden gains
  • mood disorders
  • complex systems
  • psychotherapy
  • open data
  • preregistered
  • cognitive-behavioral therapy
  • dynamic-systems approach
  • depression
  • replication
  • patterns
  • onset

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