title: Dynamic patterns in psychotherapy--discontinuous changes and critical instabilities during the treatment of obsessive compulsive disorder.
abstract: In therapy processes of a variety of disorders, discontinuous trajectories of symptom changes have been identified. In this study, we are reporting on such 'sudden gains' that occur in the treatment of clients with obsessive-compulsive disorder (OCD) following cognitive-behavioral group therapy. Time series analysis of data taken from 18 OCD clients revealed that a discontinuously shaped symptom reduction took place already before exposure/response prevention (ERP) in a large number of clients. Coincidently with the steepest gradient of symptom change an increased level of dynamic complexity in daily ratings of 47 items of a specific change questionnaire was observed. Our results support hypotheses from the theory of complex self-organizing systems, postulating nonstationarity and critical instabilities during order transitions. Our study underlines the usefulness of real-time monitoring procedures with high-frequency ratings (daily measurements) in therapeutic routine practice.
authors.affiliation: Humboldt-Universit&#14644;zu Berlin, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Heinzel
authors.affiliation: Clinic of Psychosomatic Medicine, Windach/Ammersee, Germany.
authors.forename: Igor
authors.initials: I
authors.lastname: Tominschek
authors.affiliation: Paracelsus Medical University, Salzburg, Austria.
authors.forename: Gunter
authors.initials: G
authors.lastname: Schiepek
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods / Q000592:standards; D005260:Female; D006801:Humans; D007171:Implosive Therapy / Q000379:methods / Q000592:standards; D008297:Male; D008875:Middle Aged; D017711:Nonlinear Dynamics; D009771:Obsessive-Compulsive Disorder / Q000628:therapy*; D011613:Psychotherapy / Q000379:methods / Q000592:standards*; D011615:Psychotherapy, Group / Q000379:methods / Q000592:standards; D013598:Systems Theory; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult