Nonlinear Dynamics, Psychology, and Life Sciences, Vol. 18, Iss. 2, April, 2014, pp. 155-176
@2014 Society for Chaos Theory in Psychology & Life Sciences


Dynamic Patterns in Psychotherapy - Discontinuous Changes and Critical Instabilities during the Treatment of Obsessive Compulsive Disorder

Stephan Heinzel, Humboldt-Universität zu Berlin, Germany
Igor Tominschek, Clinic of Psychosomatic Medicine, Windach/Ammersee, Germany
Gunter Schiepek, Paracelsus Medical University, Salzburg, Austria

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.

Keywords: process-outcome research, sudden gains, obsessive-compulsive disorder, nonlinear dynamics, critical instability