Early warning signals and critical transitions in psychopathology: Challenges and recommendations

Marieke A. Helmich*, Merlijn Olthof, Tineke Oldehinkel, Marieke Wichers, Laura F. Bringmann, Arnout C. Smit

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

22 Downloads (Pure)


Empirical evidence is mounting that monitoring momentary experiences for the presence of early warning signals (EWS) may allow for personalized predictions of meaningful symptom shifts in psychopathology. Studies aiming to detect EWS require intensive longitudinal measurement designs that center on individuals undergoing change. We recommend that researchers: (a) define criteria for relevant symptom shifts a priori to allow specific hypothesis testing; (b) balance the observation period length and high-frequency measurements with participant burden by testing ambitious designs with pilot studies; (c) choose variables that are meaningful to their patient group and facilitate replication by others. Thoroughly considered designs are necessary to assess the promise of EWS as a clinical tool to detect, prevent or encourage impending symptom changes in psychopathology.
Original languageEnglish
Pages (from-to)51-58
Number of pages8
JournalCurrent Opinion in Psychology
Publication statusPublished - Oct-2021


  • psychopathology
  • Ecological momentary assessment
  • symptom change
  • Early warning signals
  • critical transitions

Cite this