Marieke A. Helmich

• Helmich, Marieke A. (2024). The Duration-Adjusted Reliable Change Index: Defining Clinically Relevant Symptom Changes of Varying Durations. Assessment (ASM). ISSN 1073-1911. doi: 10.1177/10731911231221808. Full text in Research Archive Show summary

  The time period over which relevant symptoms shifts unfold is not uniform across individuals. This article proposes an adaptation of the Reliable Change Index (RCI) to detect symptom changes of varying durations in individual patients’ time series:the Duration-Adjusted RCI (DARCI). The DARCI proportionally raises the RCI cut-off to account for its extension over additional time increments, resulting in different DARCI thresholds for different change durations. The method is illustrated with a simulation study of depressive symptom time series with varying degrees of discontinuity and overall mean change, and four empirical case examples from two clinical samples. The results suggest that the DARCI may be particularly useful for identifying symptom shifts that appear relatively abrupt, which can help indicate when a patient is showing significant improvement or deterioration. Its ease of use makes it suitable for application in clinical contexts and a promising method for exploring transitions in psychiatric populations.

• Helmich, Marieke A.; Smit, Arnout C.; Bringmann, Laura F.; Schreuder, Marieke J.; Oldehinkel, Albertine J. & Wichers, Marieke [Show all 7 contributors for this article] (2023). Detecting Impending Symptom Transitions Using Early-Warning Signals in Individuals Receiving Treatment for Depression. Clinical Psychological Science. ISSN 2167-7026. 11(6), p. 994–1010. doi: 10.1177/21677026221137006. Show summary

  Drawing on dynamical systems theory, we investigated whether within-persons-detected early-warning signals in momentary affect preceded critical transitions toward lower levels of depressive symptoms during therapy. Participants were 41 depressed individuals who were starting psychological treatment. Positive and negative affect (high and low arousal) were measured 5 times a day using ecological momentary assessments over 4 months (M = 522 observations per individual). Depressive symptoms were assessed weekly over 6 months. Within-persons rising autocorrelation was found for 89% of individuals with transitions in at least one variable (vs. 62.5% for individuals without transitions) and in a consistently higher proportion of the separate variables (~44% across affect measures) than for individuals without transitions (~27%). Rising variance was found for few individuals, both preceding transitions (~11%) and for individuals without transitions (~12%). Part of our sample showed critical slowing down, but early-warning signals may have limited value as a personalized prediction method.

• Helmich, Marieke A.; Wichers, Marieke; Peeters, Frenk & Snippe, Evelien (2022). Daily dynamics of negative affect: indicators of rate of response to treatment and remission from depression? Cognition & Emotion. ISSN 0269-9931. doi: 10.1080/02699931.2022.2129593. Show summary

  More instability (MSSD) and variability (SD) of negative affect (NA) have been related to current and future depressive symptoms. We investigated whether NA instability and variability were predictive of the rate of symptom improvement during treatment and of reaching remission status. Forty-six individuals with major depressive disorder completed six days of ecological momentary assessments (10 beeps/day) before starting a combination of pharmacotherapy and supportive therapy. During and after treatment, the Hamilton Depression Rating Scale (HDRS) diagnostic interview was performed monthly for 18 months. The rate of change in HDRS scores over five months (during treatment) and remission status (HDRS ≤ 7) over eighteen months were predicted by the SD, MSSD and Mean of NA, and relevant baseline predictors. Higher Mean NA and baseline symptom severity, but not NA variability or instability, predicted stronger depressive symptom reduction during treatment. Higher odds of remitting were only associated with lower Mean NA. Higher mean NA may indicate more room for improvement and thus for a steeper rate of symptom change, while lower mean NA levels may imply that remission status is more readily reached. To resolve the inconclusive findings for instability and variability as predictors of symptom improvement replication in larger samples is required.

• Helmich, Marieke A.; Olthof, Merlijn; Oldehinkel, Albertine J; Wichers, Marieke; Bringmann, Laura & Smit, Arnout (2021). Early warning signals and critical transitions: challenges and recommendations. Current Opinion in Psychology. ISSN 2352-250X. 41(October), p. 51–58. doi: 10.1016/j.copsyc.2021.02.008. Show summary

  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.

• Helmich, Marieke A.; Snippe, Evelien; Kunkels, Yoram; Riese, Harriette; Smit, Arnout & Wichers, Marieke (2020). Transitions in Depression (TRANS-ID) Recovery: Study protocol for a repeated intensive longitudinal n = 1 study design to search for personalized early warning signals of critical transitions towards improvement in depression. PsyArXiv. doi: 10.31234/osf.io/fertq. Show summary

  Aim. The Transitions in Depression (TRANS-ID) Recovery study has gathered intensive longitudinal data in a group of individuals with depression during psychological therapy. The study was designed to gather high-resolution time series to monitor individual change processes in great detail, to allow for personalized predictions of shifts in depressive symptoms. Method. The data collection combined experience sampling methods to assess momentary affect and behavior (five 27-item questionnaires a day, for four months), ambulatory assessment of physical activity and heart rate (continuous, for four months), and depression symptom assessments (weekly for six months, and monthly for the six months thereafter, twelve months total). In addition to a baseline diagnostic interview, baseline questionnaires covered a range of constructs, including overall psychopathology symptoms, medication use, psychological treatment history, alexithymia, life events, quality of life, and chronotype. After the four-month ambulatory assessment period, a personal report of the experience sampling data was given to each participant, and a semi-structured qualitative interview was conducted to evaluate participants’ own retrospective experience of symptom changes during the research period. Conclusion. The TRANS-ID Recovery study procedures and materials are described in detail in this document. The study protocol was approved by the Medical Ethical Committee of the University Medical Center Groningen (reg. number: NL58848.04.16).

• Olthof, Merlijn; Hasselman, Fred; Strunk, Guido; van Rooij, Marieke; Aas, Benjamin & Helmich, Marieke A. [Show all 8 contributors for this article] (2020). Critical fluctuations as an early-warning signal for sudden gains and losses in patients receiving psychotherapy for mood disorders. Clinical Psychological Science. ISSN 2167-7026. 8(1), p. 25–35. doi: 10.1177/2167702619865969. Show summary

  Whereas sudden gains and losses (large shifts in symptom severity) in patients receiving psychotherapy appear abrupt and hence may seem unexpected, hypotheses from complex-systems theory suggest that sudden gains and losses are actually preceded by certain early-warning signals (EWSs). We tested whether EWSs in patients’ daily self-ratings of the psychotherapeutic process predicted future sudden gains and losses. Data were collected from 328 patients receiving psychotherapy for mood disorders who completed daily self-ratings about their therapeutic process using the Therapy Process Questionnaire (TPQ). Sudden gains and losses were classified from the Problem Intensity scale of the TPQ. The other items of the TPQ were used to compute the EWSs. EWSs predicted an increased probability for sudden gains and losses in a 4-day predictive window. These results show that EWSs can be used for real-time prediction of sudden gains and losses in clinical practice.

• Helmich, Marieke A.; Wichers, Marieke; Olthof, Merlijn; Strunk, Guido; Aas, Benjamin & Aichhorn, Wolfgang [Show all 8 contributors for this article] (2020). Sudden gains in day-to-day change: revealing nonlinear patterns of individual improvement in depression. Journal of Consulting and Clinical Psychology. ISSN 0022-006X. 88(2), p. 119–127. doi: 10.1037/ccp0000469. Show summary

  OBJECTIVE: We examined individual overall trajectories of change and the occurrence of sudden gains in daily self-rated problem severity and the relation of these patterns to treatment response. METHOD: Mood disorder patients (N = 329, mean age = 44, 55% women) completed daily self-ratings about the severity of their complaints as a standard part of treatment, using the Therapy Process Questionnaire (TPQ). Per individual, the best-fitting defined (linear, log-linear, 1-step) trajectory was tested for significance: for change over time, and for specificity of the best-fitting trajectory. Two-hundred and three cases had ICD-10 Symptom Rating (ISR) depression scores posttreatment: a score ≤1 identified 114 treatment responders. Relation to response was examined for sudden gains and type of change trajectory. RESULTS: 138 cases (42%) had a significant decrease in problem severity, of which 54 cases (16%) had a defined trajectory: 50 cases with one-step improvement, and 4 with a linear improvement in daily problem severity. Sudden gains occurred in 28% of the total sample, and within 58% of improvement patterns. Specifically, sudden gains occurred in 68% of significant 1-step trajectories and 25% of the linear cases. Sudden gains and nonspecific change trajectories were significantly more frequent for treatment responders. CONCLUSIONS: At the day-level, patterns of improvement are nonlinear for most patients. Sudden gains occur within various forms of overall change and are associated with treatment response. Clinically relevant improvements in depression occur both gradually and abruptly, and this finding allows for the possibility that the remission process functions according to dynamical systems principles.

View all works in Cristin

• Bringmann, Laura; Helmich, Marieke A.; Eronen, Markus & Voelkle, Manuel (2023). Complex systems approaches to psychopathology. In Krueger, Robert F. & Blaney, Paul H. (Ed.), Oxford Textbook of Psychopathology. Oxford University Press. ISSN 9780197542521. p. 103–122. doi: 10.1093/med-psych/9780197542521.003.0005. Show summary

  Clinical research and practice are permeated by complexity. In recent years, researchers have witnessed a sharp increase in scientific studies that acknowledge this complexity and approach psychopathology from the perspective of complex systems. In this chapter, the authors provide an introduction to the complex systems approaches that have received the most attention in psychopathology. They begin by discussing the general idea of complexity and complex systems and then turn to the framework of complex dynamic system models and how they have been applied to psychopathology. After this, the authors discuss early warning signals, which hold the promise of using insights from complexity science to enable personalized prediction and timely intervention. Finally, the authors go through the recently popular network approach to psychopathology and how it is related to the broader framework of complex systems. Throughout the chapter, the authors discuss the applications, challenges, and limitations of these approaches.

View all works in Cristin