The long road from person-specific models to personalized mental health treatment
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COMMENTARY
Open Access
The long road from person-specific models to personalized mental health treatment Thomas L. Rodebaugh1*, Madelyn R. Frumkin1 and Marilyn L. Piccirillo2
Keywords: Idiographic modeling, Personalized medicine, Mental health, Treatment, Psychotherapy
Background Idiographic (or person-specific) methods that examine longitudinal relationships within a single individual have become increasingly available and have generated much enthusiasm. These methods have the potential to resolve the dilemma that occurs when a treatment provider is tasked with making treatment decisions for an individual patient or client based on group-level findings (referred to in the psychological literature as the therapist’s dilemma [1, 2]). The hope is that such idiographic methods would allow the determination of the best course of treatment, by taking what is already known about the efficacy of interventions and adding knowledge about associations between a specific individual’s symptoms. For example, a clinician who is choosing between two or more treatments might find it helpful to know how symptoms are related for the individual they are preparing to treat. Person specific networks (PSNs) and psychological treatment The authors of the current article [3] advance the argument that clinicians can use idiographic techniques productively and responsibly in the context of psychotherapy. Although we share this general goal, we provide further context for the challenges that currently limit its implementation. We have advocated for the use of idiographic models [1, 2], have employed them in a research context [4], This comment refers to the article available at https://doi.org/10.1186/ s12916-020-01818-0. * Correspondence: [email protected] 1 Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, USA Full list of author information is available at the end of the article
and have pilot tested their use in our clinic [5]. Our experience thus far is that both researchers and clinicians find it challenging to understand, fit, and interpret idiographic models, whether they are handled as PSNs or in one of the other frameworks available [2]. We found that, even in a clinic of student therapists who have seen repeated presentations about idiographic modeling, fewer than half thought the PSNs of their clients would inform their treatment [5]. This is in keeping with previous research evaluating the implementation of idiographic models [6] and of treatmentbased algorithms more broadly [7]. Further cause for pessimism is the finding that researchers who specialize in this kind of modeling show very little agreement on how to analyze or interpret even one individual’s data [8]. This is at least in part because there are several distinct ways of analyzing idiographic data, not all of which result in PSNs per se. Of course, this does not mean that clinicians cannot use these models, or that treatment will not benefit from them. However, it does reduce our optimism regarding how widely clinic
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