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Introduction:

Idiographic network analysis, where associations between multiple nodes are estimated, can potentially guide choice of interventions in psychological treatment. In this single case experiment using ecological momentary assessment data to estimate continuous time network models, we aimed to test the so-called centrality hypothesis. We did so by comparing effects of interventions guided by the most central node to those guided by the least central node. We used the composite level psychological inflexibility processes lack of openness, lack of awareness, and lack of engagement, alongside an interference outcome, as network nodes. Effects on pain interference, motivation, and pain intensity were examined.

Method:

We employed a multiple baseline design across six participants. Therapists and participants were blinded to participants' treatment conditions. Baseline length and order of treatment phases were randomized.

Results:

Four participants had an overall treatment effect on pain interference, but it was generally not possible to discern that one particular phase was more beneficial than another. For three participants, the picture was somewhat clearer, indicating one of the treatment phases as more beneficial, although the results for these participants were not consistently in line with hypotheses. Retrospectively examining other potential guidance methods for these three participants, we saw a potential in discrete time contemporaneous network models.

Discussion:

Current results are not in line with previous assumptions or research on idiographic network models for treatment personalization, although the previous research in this area is scarce. Future research should investigate alternative network models or estimation choices to determine the potential utility of data driven idiographic networks.

Introduction: Idiographic network analysis, assessing associations between a system of variables of interest, also called nodes, is a proposed method for personalizing psychological treatment. The aim of this study was to test the centrality hypothesis that a treatment condition delivering interventions guided by the most central network node will yield better outcomes compared to a treatment condition delivering interventions guided by the least central node. We tested this using perceived causal networks (PECAN) and focusing on psychological inflexibility processes. Effects were examined in terms of pain interference, motivation, and pain intensity.

Method: We used a single case design with multiple baselines across six participants. Therapists were blind to treatment conditions. While participants were not blind to the responses that they provided for creating the PECAN, they were blind to the resulting network and the treatment conditions. Randomization was applied to baseline length and to whether the most central node or the least central node intervention came first.

Results: All participants had at least one outcome changing in beneficial directions in line with hypotheses. However, two participants also had one outcome each that changed in contradiction to the hypotheses.

Discussion: Adapting psychological treatment by matching interventions to the most central node in a perceived causal network looks promising. However, it is unlikely that this method will always be the best matching method. We need to keep exploring additional personalization methods and under which circumstances they are efficient.

Background: Guided Internet-based Cognitive Behavioral Therapy (iCBT) typically involves text correspondence with a clinician who provides feedback and answers questions during the course of the treatment. Previous research indicates that therapist guidance can improve outcomes. A few studies show that therapists' type of feedback, and possibly participant's choice of questions, are associated with treatment adherence and outcome. While a small number of studies have been published on this topic, few has reported on both therapist and patient correspondence in the same study, and to our knowledge no studies have been published on correspondence in iCBT for patients with chronic pain. Aims: The aim of the current study was to characterize therapist-participant correspondence and to examine whether specific behaviors correlate with treatment adherence and/or clinical outcomes in a guided, individually tailored iCBT for individuals with chronic pain and psychological distress. Methods: Data were obtained from a previously published randomized controlled trial (Gasslander et al., 2022). The study included 1240 therapist messages and 609 participant messages, which were coded using two separate coding schemes. Proportions of coded behaviors were analyzed through correlations to explore associations between therapist-participant communication patterns, treatment adherence (defined as the number of completed treatment steps), and treatment outcomes (pre-to post treatment change scores). Results: Participant and therapist behaviors were identified and comparisons with previous studies revealed notable similarities and differences. Correlational analyses showed associations both between and within therapist and participant behaviors. No significant associations were observed between specific behaviors and outcome. However, several observed behaviors demonstrated significant correlations with treatment adherence. Conclusions: Distinct therapist and participant behaviors can be identified in guided iCBT for individuals with chronic pain. While the relationship with treatment outcome is unclear, adherence to treatment seems to be related to the specific types of behaviors exhibited in the text-based correspondence.

Psychological distress, including depression, anxiety, and stress, requires time-efficient assessment tools suited for digital and momentary settings. The Screening Tool for Psychological Distress (STOP-D) is a five-item scale developed for brief mental health screening, but it has not yet been validated in Swedish. This study aimed to evaluate the psychometric properties and diagnostic accuracy of the Swedish STOP-D in a non-clinical adult sample. A total of 427 Swedish-speaking adults (mean age = 49.42, SD = 16.34 years) completed the STOP-D, the Patient Health Questionnaire-4 (PHQ-4), the Single-Item Stress Scale (SISE), and the Need Satisfaction and Frustration Scale (NSFS). ROC analyses were conducted using PHQ-2 and GAD-2 (cut-off >= 3) and the SISE (cut-off >= 6 and 7). Feature importance was examined using the Boruta algorithm. Exploratory Graph Analysis (EGA) assessed the internal structure. The STOP-D items for Sadness and Anxiety showed excellent classification accuracy for depression and anxiety (AUC = 0.87-0.89). Stress showed lower accuracy (AUC = 0.65-0.67). EGA supported a two-factor model, with STOP-D items for Sad, Anxiety and Stress clustering separately from Anger and Lack of Social Support. The Swedish STOP-D is a valid brief tool for assessing core psychological distress. Items for anger and social support may add clinical value and represent distinct processes relevant for future individualized and ecological assessment.

This study investigates whether data from people with endometriosis (n = 58) and fibromyalgia (n = 58) exhibit what is called "ergodicity," meaning that results from analyses of aggregated group data can be used to support conclusions about the individuals within the groups. The variables studied here are commonly investigated in chronic pain: pain intensity, pain interference, depressive symptoms, psychological flexibility, and pain catastrophizing. Data were collected twice daily for 42 days from each participant and analyzed in 2 ways: as separate cross-sectional group studies using the timepoints as the separate data sets (between-person) and as individual longitudinal studies using each person's time series data (within person). To confirm ergodicity, the results from the 2 analyses should agree. However, this is not what was observed in several respects. The between-person data showed substantially less variability compared with within-person data. This was evident in both the summary statistics involving single variables and in the correlational analyses. Overall, between-person correlations were relatively restricted in range, while within-person correlations varied widely. These findings have potentially profound implications for the field of chronic pain research. Because ergodicity was not found, this raises doubts around the assumption that aggregated data collected from groups can accurately represent the range of individual experiences in chronic pain. These results advocate for a shift toward inclusion of more individual person-focused approaches as an addition to group-based approaches. This shift could lead to more personalized and effective treatments by better capturing and then clarifying the heterogeneous nature of chronic pain, including the processes that underlie it.

BackgroundThe Multidimensional Psychological Flexibility Inventory (MPFI) is a measure of all facets of psychological flexibility and inflexibility, potentially important processes of change in psychological treatment for chronic pain. In some contexts, it can be considered too long. The aim of this study was, therefore, to validate a short form MPFI (MPFI-24P) in a chronic pain sample.MethodsAdults with chronic pain were recruited online (N = 404) for a cross-sectional survey study. They first completed pain background questions and the MPFI. For examining convergent construct validity and explained variance in pain-related outcomes, participants also completed the Brief Pain Inventory (BPI) Pain Interference Scale, the Work and Social Adjustment Scale (WSAS) and the Patient Health Questionnaire (PHQ-9), a depression measure. Data were collected on two occasions, 2 weeks apart. Item response theory (IRT) and confirmatory factor analysis (CFA) were used for selecting the best-performing items.ResultsIRT parameters were overall adequate, and hierarchical CFA demonstrated a good model fit. Network analysis of the MPFI items indicated that, in general, items intended to measure the same facets were substantially interconnected, more so for the inflexibility items. Temporal stability was adequate, and internal consistency was good. The MPFI-24P correlated with pain interference, work and social adjustment and depression, with the inflexibility scale better predicting these outcomes. The MPFI-24P correlated strongly with the full-length MPFI.ConclusionsThe MPFI-24P for chronic pain is generally valid and reliable, especially the inflexibility scale. It performs similarly to the full-length MPFI.SignificanceThis paper contributes with a measure that is both feasible to use in clinical practice and research, while being able to measure all facets of psychological flexibility and inflexibility-psychological processes of change that are important to evaluate in psychological treatment of chronic pain in order to better individualize treatment.

Psychological treatments tend to be created based on group averaged results of how variables relate to each other. This means that treatments may not be applicable to individual people where variables may relate to each other in other ways than seen in the group models. While the personalization of psychological treatments is on the rise, such attempts need to be accompanied by idiographic research methods in order to achieve a high degree of personalization. Ideally, treatments can be formed targeting individual specific psychological processes of change. If personalization is conducted on the basis of subgroups, such subgrouping needs to be done using idiographic methods rather than using categories defined in nomothetic research.

Objective: Ineffective pediatric post-operative pain management increases the risk of Chronic Post-Surgical Pain (CPSP), affecting around 20% of children undergoing major surgery. Psychological predictors of recovery, in both children and their parents, have been identified. However, how these variables change throughout the recovery process remains unclear. The aim of the present study was to investigate the associations of adolescent and parental risk and resilience variables in everyday life, during post-operative recovery, for adolescents undergoing spinal fusion surgery.

Methods: Participants were adolescents with Idiopathic Scoliosis (AIS), aged 12-18 years, undergoing spinal fusion surgery, and their parents, recruited at four hospitals in Belgium. Participants completed daily assessments for 7 consecutive days, at 5 time-points, before surgery, and at 3 and 6 weeks, and 6 and 12 months, post-surgery. Diary measures included adolescent and parental pain and recovery variables known to be relevant in the context of pediatric post-operative pain. Network analysis was used to explore correlations between all variables throughout the post-operative recovery process.

Results: The sample comprised N=190 participants. Associations were stronger within adolescent and parent variables, than between them. For adolescents, psychological flexibility was associated with positive mood and activity engagement, and pain intensity with pain catastrophizing and activity avoidance. For parents, higher levels of pain-related fear and catastrophizing were related to more parent-to- child instructions to avoid activities. Regarding adolescent-parent between correlations, parental instructions to avoid activities were associated with adolescent physical complaints and activity avoidance, and parent pain catastrophizing was associated with adolescent pain- related fear and catastrophizing. Generally, networks displayed both similarities and differences across post-operative phases.

Discussion: The study sample was small in relation to the statistical analyses conducted. Even so, the present findings provide a new perspective on psychological predictors at play in everyday life throughout the pediatric post-operative recovery process, indicating important targets, both clinical and for future investigation.

Introduction. Premenstrual dysphoric disorder (PMDD) is a cyclic mood disorder affecting around 2%–5% of women of reproductive age. Pharmacological interventions exist, but many patients with PMDD experience residual symptoms, discontinue medications or refrain from them due to side effects. Thus, non-pharmacological treatments are needed as an alternative or additive treatment strategy. Evidence indicates that cognitive behavioural therapy (CBT) is a promising candidate. However, further research is required to establish its efficacy and identify ways to improve the treatment. Specifically, incorporating components targeting emotional and interpersonal dysregulation could theoretically enhance its effects. Furthermore, increasing the generally low accessibility of CBT for PMDD necessitates scalable and cost-effective ways to deliver treatment. The current study aims to evaluate the effects and cost-effectiveness of an internet-delivered CBT (ICBT) intervention for PMDD incorporating skills training in emotion regulation and interpersonal effectiveness.

Methods and analysis. The study is a parallel two-group randomised controlled trial with 1:1 allocation to 8 weeks of therapist-guided ICBT or a waitlist control condition. Following recruitment and inclusion, 164 individuals aged 18–45 years who fulfil the Diagnostic Manual of Mental Disorders-5 criteria for PMDD will be randomly assigned to the two groups. Primary outcomes are pretreatment to post-treatment group differences in premenstrual symptoms and their impact on everyday life, as well as psychological and functional impairment during the premenstrual phase. Secondary outcomes include treatment effects on quality of life and difficulties in emotion regulation. Long-term treatment effects will be assessed 6 and 12 months postintervention. Data will be analysed using latent Gaussian process modelling and linear mixed models. The economic evaluation will analyse individual-level societal costs and outcomes between trial arms. Recruitment is expected to begin in February 2025, with study completion anticipated by February 2028.

Ethics and dissemination. The study has been approved by the Swedish Ethical Review Authority (2023-00655-01). Results will be disseminated via presentations and publications in international journals and national outlets for clinicians and patients with PMDD.

Background Chronic post-surgical pain (CPSP) affects approximate to 20% of children after major surgery, and the condition is associated with functional disability and ill-health. Psychological flexibility (PF) and parental factors have been shown to predict CPSP in youth following spinal fusion surgery. However, the daily dynamics of these processes throughout post-surgical recovery remain unknown. This study aimed at exploring how PF fluctuates in everyday life for youths undergoing spinal fusion surgery, and to investigate the associations between parental responses and adolescent PF.

Methods Adolescents with Idiopathic Scoliosis (AIS), aged 12-18 years, undergoing spinal fusion surgery at four hospitals in Belgium, and their parents, completed diaries, measuring adolescent PF and parental responses (including instructions to avoid or engage in activities, parental protective behavior, and parental pain catastrophizing) for 7 days, at five phases: before surgery (T0), at 3 (T1) and 6 weeks (T2), and 6 (T3) and 12 (T4) months, post-surgery. A single-case approach with aggregated results was used, including Tau-U calculations and cross-lagged correlations.

Results In total, data from 47 adolescents and seven parents were analyzed. Substantial within- and between-person variability characterized the patterns of adolescent PF. Cross-lagged correlations showed bidirectional relationships, demonstrating that parental responses predicted adolescent PF, and that adolescent PF, similarly, predicted parental responses.

Discussion The results reveal the complex dynamics of PF among adolescents following surgery, and that parent-adolescent patterns after surgery may vary across both individuals and time. These findings also emphasize the need for idiographic pain research and individual-level assessments as well as person-centered treatments in clinical practice.