Günter Schiepek

This article presents the Synergetic Navigation System (SNS), an Internet and app-based tool for monitoring and analyzing change dynamics and outcomes in psychotherapy. It is generic in the sense that a variety of outcome and process questionnaires can be selected (personalized process questionnaires can also be created, based on case conceptualizations) and sampling rates can be defined. The SNS visualizes the results of screening or outcome questionnaires using bar charts, and the data and analysis results of process assessment using time series charts. Many different methods of nonlinear time series analysis are available, particularly for identifying pattern transitions and precursors of transitions as well as stable and unstable periods during the therapeutic process, which helps to exploit windows of opportunity and “kairos” moments. Experiences in implementation, technical requirements, training programs, and required competencies as well as the therapeutic effects and additional benefits of using the SNS in routine practice are delineated. Scientific projects based on data from the SNS are listed, and a short description of ongoing developments is given (fourth technological generation).

Zusammenfassung: Dieser Beitrag stellt mit Bezug auf die Befundlage von Outcome- und Prozessfeedback die Ergebnisse einer anonymisierten Online-Befragung von 53 Psychotherapeut*innen und 31 Patient*innen dar. Die Befragten arbeiteten mit dem Synergetischen Navigationssystem (SNS), das hinsichtlich der verwendeten Fragebögen und der Abtastrate generisch, also flexibel ist. Die Routinepraxis der Befragten (ambulante, teilstationäre, stationäre Psychotherapie) nutzt neben seltenen Messungen (monatlich, prä-post) immer auch hochfrequentes Monitoring, d. h. tägliche Selbsteinschätzungen, wobei die resultierenden Zeitreihen und Diagramme mitlaufend analysiert und mit den Patient*innen während der Sitzungen besprochen werden. Diese intensive Form des Feedbacks wird mit dieser Befragungsstudie auch auf Praktikabilität und Machbarkeit geprüft. Aus Sicht der Befragten resultiert ein vielfältiger (subjektiv erkennbarer) Mehrwert aus der praktischen Anwendung des SNS, der sich unter anderem auf die Verstärkung der Therapiemotivation und der Therapiebeziehung, auf die Unterstützung von Selbstreflexion und Selbstkontrolle/-regulation oder auf die Verfügbarkeit zusätzlicher relevanter Informationen für die Prozessgestaltung bezieht („roter Faden“). Therapeut*innen und Patient*innen berichten von diesen positiven Effekten weitgehend übereinstimmend, unabhängig vom Setting, der Therapierichtung und den Diagnosen. Am Ende des Beitrags werden verschiedene Kriterien für die Anwendung und Implementierung von Prozessfeedback in der Psychotherapie benannt, die für dessen praktischen Erfolg von Bedeutung sein können.

This work explores the application of a Category Theory model, advocating a paradigm for comprehending human experience and the communication process of a complex system from the perspective of a living Anticipatory System. Following the principles created by Robert Rosen for the anticipatory system and associated models—models that respect the principles of impredicativity, anticipation, and closure to efficient cause (CLEF)—we propose the Performance–Resilience–Sustainability (PRS) model. This new model introduces a new way to explain how anticipatory systems can elucidate the portions of variability observed in practice and research. Anticipatory system theory suggests that models such as PRS have significant potential to complement and explain dynamic phenomena observed in communication and experience development research, as well as in practical applications, underscoring the transformative potential for both fields. This class of models for complex systems may introduce a new dimension of emergent causality and its impact on current behavior, which was not previously considered.

Background: In recent years, routine outcome monitoring has been increasingly complemented by routine process monitoring in psychotherapy and other health care settings. Various approaches to therapy feedback exist, differing in assessment frequency, integration into the therapeutic process, and degree of personalization. In this study, we will use a procedure of high-frequency assessment through daily self-ratings, a standard process questionnaire, alongside a personalized questionnaire derived from case formulation, and frequent feedback interviews using visual diagrams to mirror the ongoing therapeutic processes. Objective: This study aims to investigate the effectiveness of combining routine process monitoring with hypno-psychotherapy (autosystemic hypnotherapy) by comparing it to autosystemic hypnotherapy without process feedback in the outpatient treatment of mood disorders. It also seeks to examine process-outcome relationships and mechanisms of change through high-frequency self-assessments and session-based feedback. Methods: This study is a randomized controlled trial with 2 arms, using within-therapist randomization (ABAB design) in outpatient psychotherapy. Participants are recruited offline via routine intake procedures. A total of 100 patients will be randomly assigned to one of the two conditions following a waiting period. The inclusion criterion is the existence of any mood disorder (major depressive disorder or anxiety disorder), assessed via a clinical interview. Each therapist treats patients in both conditions. Outcomes will be measured at 4 time points: after diagnosis confirmation, postwaiting period, posttreatment, and a 6-month follow-up. Primary and secondary outcomes, including symptom severity, will be assessed using questionnaires. Data collection also includes patient and therapist session evaluations using the Bern Patient and Therapist Session Questionnaire. In the feedback condition, therapists conduct frequent interviews using time-series data generated from daily self-assessments using the synergetic navigation system, including the Therapy Process Questionnaire and an individualized measure based on case conceptualization. Results: While this study is ongoing, the primary aim is to assess the effects of the feedback condition on therapeutic outcomes, including symptom reduction and patient motivation. This study will also explore how dynamic monitoring and feedback influence the therapeutic alliance and session-level improvements. It is expected that the feedback condition will lead to improvements in symptom severity and therapeutic engagement compared to the nonfeedback condition. Recruitment is ongoing, with 22 participants enrolled. The training of therapists and the data collection began in 2022. Data collection will end and study findings will be published in 2027. The German Society for Auto-Systemic Hypnotherapy is funding these training courses. Conclusions: This study combines effect and process measures within a feedback condition, compared to a nonfeedback condition. It incorporates dynamic process assessment to explore change mechanisms by analyzing patterns of time-series data and session ratings by patients and therapists. The approach provides insights into how continuous feedback and tailored monitoring influence therapeutic progress and outcomes. Trial Registration: OSF Registries osf.io/z2efy; https://doi.org/10.17605/OSF.IO/Z2EFY International Registered Report Identifier (IRRID): DERR1-10.2196/78166

How can we understand today's mental health problems and challenges? The OMRA program's scientific monograph offers diverse perspectives on contemporary mental health issues and presents the impact of the program's implementation over the past three years. It brings together seventeen original and review articles that highlight the latest research, lessons learned and best practice - from the impact of the COVID-19 pandemic and demographic changes to the challenges of treating depression, anxiety, bipolar disorder and dementia. The authors emphasize the importance of raising awareness, reducing stigma and increasing mental health literacy, which has been shown to be a key factor in seeking professional help in a timely manner. Particular attention is paid to young adults, older people and vulnerable groups, as well as new forms of psychotherapeutic diagnosis and the use of digital technologies. The book shows that high-quality mental health care is only possible through the integration of disciplines, accessible psychoeducation and consideration of the broader context of the individual's life. The monograph is aimed at professionals, researchers, policy makers and anyone who wants to gain a deeper understanding of the challenges of modern times and help create a more compassionate and effective environment for mental health maintenance.

Introduction: Mental symptoms and disorders in competitive sports can reduce performance and may occur as sport-specific and non-specific disorders. Unrecognized or inadequately treated mental health symptoms and disorders in athletes can have serious health consequences. Methods: A review of the medical literature identified relevant publications on the topics of sports psychiatry and mental health in competitive athletes. A corresponding health concept was developed in this context. Results: The promotion of mental health is not yet an integral part of the care structures in competitive sports. Competitive success founds social status of athletes and contributes significantly to their self-esteem. In the case of participation loss or injury, the implicit or explicit pressure to restore function and performance quickly poses a particular challenge. Treatments under these conditions can differ from psychotherapeutic processes as usual. Apart from that, restoring health alone is not enough for athletes. The restoration of performance appears to be a decisive factor. The possibility of performance enhancement within the framework of care concepts is an attractive form of support for athletes. Conclusion: Performance serves to promote mental health and vice versa. The promotion of performance represents a fundamental shift in the paradigm of mental health care in sports. Promoting performance in the context of mental health care could help to ensure that more of the hard-to-reach group of elite athletes can be involved and, if necessary, receive early and professional treatment. Furthermore, a reduction in the stigmatization of mental disorders in sports could also be expected.

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BACKGROUND In recent years, routine outcome monitoring has been increasingly complemented by routine process monitoring in psychotherapy and other health care settings. Various approaches to therapy feedback exist, differing in assessment frequency, integration into the therapeutic process, and degree of personalization. In this study, we will use a procedure of high-frequency assessment through daily self-ratings, a standard process questionnaire, alongside a personalized questionnaire derived from case formulation, and frequent feedback interviews using visual diagrams to mirror the ongoing therapeutic processes. OBJECTIVE This study aims to investigate the effectiveness of combining routine process monitoring with hypno-psychotherapy (autosystemic hypnotherapy) by comparing it to autosystemic hypnotherapy without process feedback in the outpatient treatment of mood disorders. It also seeks to examine process-outcome relationships and mechanisms of change through high-frequency self-assessments and session-based feedback. METHODS This study is a randomized controlled trial with 2 arms, using within-therapist randomization (ABAB design) in outpatient psychotherapy. Participants are recruited offline via routine intake procedures. A total of 100 patients will be randomly assigned to one of the two conditions following a waiting period. The inclusion criterion is the existence of any mood disorder (major depressive disorder or anxiety disorder), assessed via a clinical interview. Each therapist treats patients in both conditions. Outcomes will be measured at 4 time points: after diagnosis confirmation, postwaiting period, posttreatment, and a 6-month follow-up. Primary and secondary outcomes, including symptom severity, will be assessed using questionnaires. Data collection also includes patient and therapist session evaluations using the Bern Patient and Therapist Session Questionnaire. In the feedback condition, therapists conduct frequent interviews using time-series data generated from daily self-assessments using the synergetic navigation system, including the Therapy Process Questionnaire and an individualized measure based on case conceptualization. RESULTS While this study is ongoing, the primary aim is to assess the effects of the feedback condition on therapeutic outcomes, including symptom reduction and patient motivation. This study will also explore how dynamic monitoring and feedback influence the therapeutic alliance and session-level improvements. It is expected that the feedback condition will lead to improvements in symptom severity and therapeutic engagement compared to the nonfeedback condition. Recruitment is ongoing, with 22 participants enrolled. The training of therapists and the data collection began in 2022. Data collection will end and study findings will be published in 2027. The German Society for Auto-Systemic Hypnotherapy is funding these training courses. CONCLUSIONS This study combines effect and process measures within a feedback condition, compared to a nonfeedback condition. It incorporates dynamic process assessment to explore change mechanisms by analyzing patterns of time-series data and session ratings by patients and therapists. The approach provides insights into how continuous feedback and tailored monitoring influence therapeutic progress and outcomes. CLINICALTRIAL OSF Registries osf.io/z2efy; https://doi.org/10.17605/OSF.IO/Z2EFY INTERNATIONAL REGISTERED REPORT DERR1-10.2196/78166