High-frequency monitoring of personalized psychological variables during outpatient psychotherapy in people with seizures: An uncontrolled feasibility study

Highlights

• Daily personalized psychological self-assessments were collected during psychotherapy.

• Detailed visualizations of the patients data entries were discussed regularly during sessions.

• Compliance rates were high among the participants.

• Participants reported a high overall satisfaction with the user-friendliness of this monitoring.

• Monitoring procedures may constitute a warning system of de novo psychiatric destabilization.

Abstract

Background

This feasibility study applied the concept of daily systematic monitoring of personalized psychological variables and investigated patients’ compliance in order to evaluate if its integration in outpatient psychotherapy is feasible and if patients found the development and daily application of personalized questionnaires user-friendly and useful.

Methods

A naturalistic sample of patients with epilepsy (PWE) was enrolled to participate in an outpatient psychotherapy program. A personalized process questionnaire was developed with each patient based on an individual psychological system’s model at the outset of therapy. Daily time-stamped self-assessments were collected during outpatient psychotherapy. This process-monitoring was technically realized by an internet-based device for data collection and data analysis, the Synergetic Navigation System (SNS). The reflection of person-specific time series informed by patients’ replies to their personalized process questionnaire was integrated in the therapy process. Compliance rates were assessed during a period of six months (i.e., 180 days) after the first entry of the questionnaire [compliance rate = (number of completed questionnaires/180) × 100]. User-friendliness and usefulness of this process monitoring were evaluated quantitatively.

Results

Twenty patients [15 women/5 men, median age 48 years (range 23–73 years)] were recruited. Compliance rates were high (median: 93%, range 31–100%) among the participants. Participants reported a high overall satisfaction with the application and user-friendliness of SNS.

Conclusion

The results support the feasibility of high-frequency monitoring of personalized psychological processes during outpatient psychotherapy. Repeated daily assessments of a personalized questionnaire yield highly resolved, equidistant time series data, which gives insight into individual psychological processes during outpatient psychotherapy.

Introduction

Epilepsy is one of the largest groups of serious chronic neurological conditions associated with substantial morbidity including mood disorders and cognitive dysfunction [1], [2]. Psychotherapy has been recommended as a complementary treatment to improve quality of life and reduce psychiatric comorbidity in patients with epilepsy (PWE) [3]. Psychogenic nonepileptic seizures (PNES) are an important differential diagnosis and a common neuropsychiatric comorbidity of epilepsy [4]. Psychological interventions have been recognized as the treatment of choice for PNES [5].

Adequately powered randomized controlled trials (RCTs) are considered a suitable design to determine general efficacy of psychological interventions for predefined patient groups. However, the question which specific intervention component may be suitable for what individual patient at what particular time during the treatment process cannot be answered by RCTs which are limited to pre- and post-intervention outcome comparisons. To answer this question in light of discontinuous nonlinear psychological processes that are subject to sudden changes, so-called phase transitions, frequent and systematic psychological assessments yielding time series of individual psychological dynamics, as well as analysis tools to investigate these time series are needed [6]. Such an integration of systematic and frequent data collection of psychological variables has been recommended to allow for the investigation of the complex dynamics of thoughts, mood, behavior, and symptoms during the course of treatment in patients with seizures [7].

Up to date, only few studies have integrated electronic data acquisition to provide a more reliable time-stamped data collection method in outpatients with seizures [8], [9]. Modern web-based devices such as laptops, tablets, or smartphones facilitate easy access to electronic questionnaires that yield time–stamped data series. However, irregular and infrequent sampling rates decrease data validity and hamper the identification of psychological dynamics [6]. The frequent and equidistant time sampling of subjective experiences in close temporal proximity to their actual occurrence may, on the other hand, reduce memory biases and distortions [10]. In addition, only such systematic assessments allow for the meaningful application of time series analysis methods particularly in the domain of frequency and nonlinear dynamics [11].