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Testing the network centrality hypothesis within process-based acceptance and commitment therapy - A single case experiment utilizing perceived causal networks
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.ORCID iD: 0000-0001-5704-7991
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.ORCID iD: 0000-0002-7032-1614
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
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2026 (English)In: Journal of Contextual Behavioral Science, ISSN 2212-1447, Vol. 40, article id 100997Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Elsevier, 2026. Vol. 40, article id 100997
Keywords [en]
Idiographic, Network analysis, Perceived causal networks, Single case design, Acceptance and commitment therapy, Process-based therapy
National Category
Psychology (Excluding Applied Psychology)
Identifiers
URN: urn:nbn:se:uu:diva-585008DOI: 10.1016/j.jcbs.2026.100997ISI: 001741708400001Scopus ID: 2-s2.0-105035595205OAI: oai:DiVA.org:uu-585008DiVA, id: diva2:2057642
Available from: 2026-05-05 Created: 2026-05-05 Last updated: 2026-06-22Bibliographically approved
In thesis
1. Individualizing psychological treatment for chronic pain: Can network analysis bridge the scientist-practitioner gap?
Open this publication in new window or tab >>Individualizing psychological treatment for chronic pain: Can network analysis bridge the scientist-practitioner gap?
2026 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Psychological treatment for chronic pain can generally help people improve their functioning and well-being. Still, there is room for improvement in terms of overall effect sizes. There is also a need to address the gap between scientists, often focusing treatment on standardized manuals for treatment, and clinicians, often aiming to individualize treatment. One suggested step forward is to adopt the clinician’s agenda for individualization, but in a systematic fashion ensuring a scientific approach. The aim of this thesis was to examine the clinical utility of one method suggested to be useful for systematic individualization; individual level network analysis. Both study I and II tested the clinical utility of using so-called network centrality for treatment guiding, where centrality reflects how well connected one network node is to other nodes. Specifically, we tested whether interventions guided by the most central node were more beneficial for the individual compared with interventions guided by the least central node. In study I, we tested this by using networks based on participants’ one-time ratings of how aspects of psychological inflexibility and pain interference were perceived to cause each other. Results were promising in that individual level treatment effects most often occurred when treatment was guided by the most central node. Study II replicated study I, but networks were instead estimated using repeated measures of the network variables. Results did not indicate utility of guiding treatment based on centrality in such a data driven network. Study III demonstrated that individual level networks can give us information that may be lost in group level networks, but that there are group level connections that are generalizable to many individuals. Such generalizable connections can be used to generate initial hypotheses for individual level treatment, but may not be valid for everyone – prompting us to continue the evaluation of systematic methods for individualization. Further, individual level network connectivity was correlated with depression and pain interference, but did not contribute with unique explained variance in the outcomes when controlling for baseline levels of the outcomes. Finally, overall network connectivity did not predict pain interference or depression on the individual level.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2026. p. 86
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Social Sciences, ISSN 1652-9030 ; 245
Keywords
ergodicity, single case design, network analysis, chronic pain, individualization
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:uu:diva-591557 (URN)978-91-513-2892-8 (ISBN)
Public defence
2026-09-08, Humanistiska teatern, Thunbergsvägen 3C, Uppsala, 13:15 (English)
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Supervisors
Available from: 2026-08-18 Created: 2026-06-22 Last updated: 2026-08-18

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Lavefjord, AmaniSundström, FeliciaClason van de Leur, JakobForslund, SannaBuhrman, MonicaMcCracken, Lance

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