Applications of the network perspective in clinical psychology and psychotherapy

The complex network perspective is becoming increasingly popular in the field of clinical psychology and psychotherapy and assumes that the occurrence of a mental disorder can be characterized by the activation of a network of interrelated elements (previously termed ‘symptoms’). This perspective adopts an advanced computational method, network analysis (NA), which gives empirical data a new framework with the aim of extracting information relevant to clinical research and practice. In this thesis, we describe three applications of NA in clinical psychology and psychotherapy. First, we examined multimorbidity patterns as a function of psychopathology severity levels. We found that major mental symptom domain interrelations become consistent at and above a subthreshold level suggesting that specific patterns emerge as psychopathology severity levels increase. Second, we scrutinized how mental health (MH) service use is related to transdiagnostic symptom networks. Findings suggest that after adjusting for potential confounding by indication for service use, there was no indication of an association in overall connectivity or network structure of networks with versus without MH services use. However, selected structurally important symptoms differed consistently between networks with versus without MH service use indicating that more granular network characteristics on the node level may complement and enrich traditional outcomes in clinical research. Third, we applied dynamic NA techniques to model temporal and cross-sectional associations of symptoms and affective, cognitive, and behavioral elements in patients with Globus Sensations (GS) over the course of psychotherapy. We found that GS were not temporally associated with any affective, cognitive, and behavioral elements. We did find indications for potential causal pathways between catastrophizing cognitions and bodily weakness as well as GS and somatic distress, which may reflect temporal associations in patients with GS in the context of treatment. Our findings have several implications for clinical research and practice and further provide a theoretical basis and guidance for future research using cross-sectional and dynamical NA in the context of clinical psychology and psychotherapy.