Time for Change: Sensitivity to Experimental Perturbations as a Predictor of Anxiety Improvement in Treatment


Anxiety disorders are prevalent and debilitating, but our best treatments are effective for only about half of patients. We do not know which half until after it is too late to intervene. Much effort has been put into studying static, stable predictors of change; however, to date results have been disappointing.
Based on dynamical system models, I propose that to resolve current challenges in treatment response prediction, a fundamentally different approach is needed that takes into account the dynamic nature of psychopathology. Insights from other fields suggest that complex systems show a specific pattern of increased sensitivity to perturbations (disturbances) in the vicinity of a transition point. My hypothesis is that greater sensitivity to an experimental perturbation assessed prior to treatment, will reveal individual readiness to change. For example, if a socially anxious individual responds positively to a 30-min positive interpretation training (i.e., perturbation), this suggests greater readiness to change and benefit from subsequent treatment (see preliminary support from my pilot study).
The aim of this translational research program is to provide a new theoretical and practical avenue with the ultimate aim of improving the prediction and success of treatment. I will integrate theoretical models with methodologically rigorous approaches from experimental psychopathology to develop experimental perturbations. Individual sensitivity to those perturbations is used as a dynamic marker to predict reductions in specific phobia (Project_1) and social anxiety (Project_2) as a result of psychological treatment. Project_3 uses a hybrid experimental-longitudinal design to test the dynamic nature of sensitivity. Collectively, the research opens new avenues to predicting treatment response and provides the unique possibility to improve readiness to change for individuals who are not yet ready (Project_4). This program has the potential to optimize treatment, use scarce therapist time more efficiently, and have significant implications for individual suffering and society in general.





Dr. E. Salemink

Verbonden aan

Universiteit Utrecht


15/10/2019 tot 15/10/2024