Alberto Jover Martínez, PhD student within NSMD, gave an interview to the Dutch Association for Behavioural and Cognitive Therapies (VGCT). On 15 November, it was published on their Knowledge Network. 

In the name of science, 300 college students have been subjected to answer 35 questions, nine times a day, for four weeks. This Student Mapping Study is recently finished and it is the starting point for the first study involving a clinical sample for the New Science of Mental Disorders (NSMD) consortium, led by Anita Jansen (recipient of the NWO Zwaartekracht grant, Maastricht University). PhD student Alberto Jover Martínez is excited to talk about the theory behind the first study and will share a glimpse of the preliminary findings. 

DSM categorizations still reign in the clinical practice, stemming from the medical model. Although these labels can be quite useful, psychological problems cannot be compared to a virus that can be clearly located in the body. Instead of the medical focus and labeling of psychological problems, Jover Martínez likes to refer to scientist Denny Borsboom, who coins them  ‘problems of life’. He illustrates: “when someone is fired, for example, it gives rise to doubt about your own competences. It reduces your self-esteem which makes you sad, because you don’t want to feel incompetent. These feelings of sadness cause a loss of energy and you might stop doing things that you otherwise would enjoy. Consequently, your life doesn’t feel as fulfilling, triggering negative thoughts, which causes sleep problems at night making you even more tired. You get stuck in a vicious cycle. This is the core of mental disorders according to the network approach: it is a psychological chain of events that happens because something triggers one of them. When you connect all those events in the cycle, it looks like a network and our network approach of mental disorders is based upon this idea”. 

Endless combinations

Although the network approach is the start of a new direction for the treatment of mental disorders, Jover Martínez emphasizes that the labels used now, based on the DSM, are not useless. In his view, the labels are a way of communicating among clinicians and between clinician and patient. “The more pressing questions would be: are these labels the best representation of the problems people experience? And second, since long-term treatment effects for psychological disorders are not that good, should these labels be used to guide treatment?”, Jover Martínez wonders. “Take a look at the label major depression disorder, for example. Based on the different criteria for this disorder and the amount of different combinations, you can essentially have more that 10.000 different profiles of depression with the same label. And these people would all be treated the same way. That doesn’t seem optimal.”

First steps with students

What should one imagine about such a network? The network approach makes it possible to represent the exact problems for each individual, based on connections between different nodes in an individual network. The nodes can be all kinds of relevant variables that make up the network, such as positive affect and negative affect. That’s all good and well, but the network approach needs empirical support. To this end, Jover Martínez conducted a first study with 300 college students who were assessed multiple times per day for a month about all kinds of psychological phenomena such as self-esteem, anxiety, worries and thoughts. Because the assessments were so frequent, the changes from one timepoint to the next one can be captured. “For example, if this person is alone at one timepoint, does it mean that at the next timepoint this person will have a worse mood or feel less hopeful?”, Jover Martínez illustrates. 
The sample of students was divided into people with relatively low and high psychopathology (based on scores on the Brief Symptom Inventory; BSI), to compare their networks and the connections among the nodes. Jover Martínez explains: “What was interesting: the negative nodes were more strongly connected for people with high psychopathology compared to people with low psychopathology. For example, connections are strong between impulsivity and craving food, and there are far fewer connections between the positive variables such as enjoying activities and positive affect.” For people with low psychopathology, the positive nodes are more strongly connected. Jover Martínez is excited: “The good news is that we are able to differentiate between the networks of people with high and low psychopathology. Eventually, we would like to make precise distinctions to know which type of people need which treatment based on their network profile. That would be the point of this whole project in the long run.” As a next step, a similar study is planned with 600 clinical patients with all types of psychopathology. 

Alberto Jover Martinez haarlem.jpg

A look into the future

What will the future hold for this network approach in daily clinical practice? Jover Martínez suggests an efficient way to work with this new model: “waiting periods in the clinical practice could be used for patients to fill out questionnaires. Professionals can analyze that data and determine a profile based on an individual network of nodes. Based on empirical evidence, the clinician can choose a treatment that responds well to the particular profile”. 
The Student Mapping Study is a first step to determine if a network approach is actually useful, and many more studies will follow. Jover Martínez wants to share his mindset about the promise of the network approach with clinicians: “The clinical world was developed by using the DSM, but there may be other ways that can be useful. We are increasingly moving towards a data driven world. We should consider and use all those data tools we have for the benefit of the people who need help. When these tools will become available, keep an open mind and consider taking a different approach”. 

About NSMD

New Science of Mental Disorders (NSMD) is the consortium led by Prof Anita Jansen of Maastricht University. It focuses on the network approach to mental disorders.
The symptoms of a mental disorder often differ per individual, even if people share the same diagnosis. In doing so, symptoms influence each other, which can worsen or diminish symptoms. NSMD, with the help of a ‘Zwaartekracht’ grant from NWO and the Ministry of Education, Culture and Science, is investigating whether treatment based on an individual network is more effective than current treatments based on DSM diagnoses. Over 30 researchers from seven Dutch universities are affiliated to NSMD, and dozens of PhD students will be trained in the coming years. The project will run until 2030. 

Author: Maria Bekendam, VGCT