Research

My research focuses on how people's depressive symptoms change (and improve) over time during psychological treatment. To get a better understanding of why people change, I focus on combining information from the micro-level (moment-to-moment) and macro-level (symptom questionnaires).

With a keen interest in methodological and statistical techniques, I am enthusiastic about translating clinically relevant questions into methodologically sound choices, and will just as happily be absorbed by analyzing data in R, discussing scientific ideas, or writing up findings in a manuscript.


Scientific publications


Open Science

Preregistration
Do early warning signals precede large symptom improvements in depression?

Preregistration of the analysis plan for the Transitions in Depression (TRANS-ID) Recovery project. A challenging preregistration as it does not fit neatly into either purely exploratory or confirmatory work.

Helmich, M. A., Smit, A. C., Snippe, E., & Wichers, M. (2020).
OSF link

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Preregistration

Brief background:

Early Warning Signals (EWS) are theoretical indicators of critical slowing down and low resilience in a complex dynamical system, where a rise in EWS indicates that the likelihood of an upcoming critical transition is higher. EWS have shown promise in anticipating large shifts in depressive symptoms in a few studies already. However, no study so far has tested whether rises in autocorrelation at lag-1 (AR(1)) and variance (SD) can be found within-persons prior to depressive symptom improvement.

Examining this is clinically and theoretically important, as it could provide patient and therapist valuable insight into whether the system is sensitive to positive changes (is destabilizing), and may be close to recovery, even if it may not be overtly noticeable in the symptoms yet. Moreover, it takes the next step from viewing mental disorder from a complex systems angle, to actually testing whether the principles of dynamical systems apply to transitions in psychological systems.

Research question:

Can we find indicators of critical slowing down (CSD) in the form of early warning signals (EWS) like increases in AR(1) and variance before transitions towards improvement in depressive symptoms?

Hypotheses:

  • Does the autoregressive coefficient at lag-1 (AR(1)), in moment-to-moment mood assessments, increase before a sudden shift in depressive symptoms on the SCL-90?

  • Does variability (SD), in momentary mood measurements, increase before a sudden shift in depressive symptoms on the SCL-90?

2021





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Early warning signals and critical transitions: Challenges and recommendations

Helmich, M. A., Olthof, M., Oldehinkel, A.J., Wichers, M., Bringmann, L.F., Smit, A.C. (2021) Early warning signals and critical transitions: Challenges and recommendations, Current Opinion in Psychology, In Press. DOI: 10.1016/j.copsyc.2021.02.008

Click for abstract

Abstract

Empirical evidence is mounting that monitoring momentary experiences for the presence of early warning signals (EWS) may allow for personalized predictions of meaningful symptom shifts in psychopathology. Studies aiming to detect EWS require intensive longitudinal measurement designs that center on individuals undergoing change. We recommend that researchers: (a) define criteria for relevant symptom shifts a priori to allow specific hypothesis testing; (b) balance the observation period length and high-frequency measurements with participant burden by testing ambitious designs with pilot studies; (c) choose variables that are meaningful to their patient group and facilitate replication by others. Thoroughly considered designs are necessary to assess the promise of EWS as a clinical tool to detect, prevent or encourage impending symptom changes in psychopathology.


Keywords: Psychopathology, ecological momentary assessment, symptom change, early warning signals, critical transitions

2020



Sudden Gains in Day-to-Day Change: Revealing Nonlinear Patterns of Individual Improvement in Depression

Helmich, M. A., Wichers, M., Olthof, M., Strunk, G., Aas, B., Aichhorn, W., Schiepek, G. & Snippe, E. (2020) Sudden Gains in Day-to-Day Change: Revealing Nonlinear Patterns of Individual Improvement in Depression, Journal of Consulting and Clinical Psychology, 88(2), p. 119-127. DOI: 10.1037/ccp0000469
Open access

Click for abstract

Abstract

OBJECTIVE: We examined individual overall trajectories of change and the occurrence of sudden gains in daily self-rated problem severity and the relation of these patterns to treatment response.

METHOD: Mood disorder patients (N = 329, mean age = 44, 55% women) completed daily self-ratings about the severity of their complaints as a standard part of treatment, using the Therapy Process Questionnaire (TPQ). Per individual, the best-fitting defined (linear, log-linear, 1-step) trajectory was tested for significance: for change over time, and for specificity of the best-fitting trajectory. Two-hundred and three cases had ICD-10 Symptom Rating (ISR) depression scores posttreatment: a score ≤1 identified 114 treatment responders. Relation to response was examined for sudden gains and type of change trajectory.

RESULTS: 138 cases (42%) had a significant decrease in problem severity, of which 54 cases (16%) had a defined trajectory: 50 cases with one-step improvement, and 4 with a linear improvement in daily problem severity. Sudden gains occurred in 28% of the total sample, and within 58% of improvement patterns. Specifically, sudden gains occurred in 68% of significant 1-step trajectories and 25% of the linear cases. Sudden gains and nonspecific change trajectories were significantly more frequent for treatment responders.

CONCLUSIONS: At the day-level, patterns of improvement are nonlinear for most patients. Sudden gains occur within various forms of overall change and are associated with treatment response. Clinically relevant improvements in depression occur both gradually and abruptly, and this finding allows for the possibility that the remission process functions according to dynamical systems principles.


Keywords: depression; treatment response; idiographic change pattern; sudden gains; daily assessment

Critical Fluctuations as an Early-Warning Signal for Sudden Gains and Losses in Patients Receiving Psychotherapy for Mood Disorders

Olthof, M., Hasselman, F., Strunk, G., van Rooij, M., Aas, B., Helmich, M. A., Schiepek, G., & Lichtwarck-Aschoff, A. (2020). Critical Fluctuations as an Early-Warning Signal for Sudden Gains and Losses in Patients Receiving Psychotherapy for Mood Disorders. Clinical Psychological Science, 8(1), 25–35. DOI: 10.1177/2167702619865969


Click for abstract

Abstract

Whereas sudden gains and losses (large shifts in symptom severity) in patients receiving psychotherapy appear abrupt and hence may seem unexpected, hypotheses from complex-systems theory suggest that sudden gains and losses are actually preceded by certain early-warning signals (EWSs). We tested whether EWSs in patients’ daily self-ratings of the psychotherapeutic process predicted future sudden gains and losses. Data were collected from 328 patients receiving psychotherapy for mood disorders who completed daily self-ratings about their therapeutic process using the Therapy Process Questionnaire (TPQ). Sudden gains and losses were classified from the Problem Intensity scale of the TPQ. The other items of the TPQ were used to compute the EWSs. EWSs predicted an increased probability for sudden gains and losses in a 4-day predictive window. These results show that EWSs can be used for real-time prediction of sudden gains and losses in clinical practice.

Keywords: early-warning signals, sudden gains, mood disorders, complex systems, psychotherapy, open materials, preregistered


Writing for a broader audience

Dutch / Nederlandstalig

Behandeling op maat: Kan je voorspellen welke behandeling welke depressieve persoon het best helpt?

Helmich, M.A. (2018)

Psyche & Brein, 02, p. 36-37.

Positief uit de put komen: Is herstel van depressie te herkennen aan een glimlach?

Helmich, M. A. (2018).

Tijdschrift voor Positieve Psychologie, 1 (feb), p. 28-31.



Courses & Conferences


2020

ESM Expert Network Meeting | Nov 26
Belgian-Dutch Network for ESM Research in Mental Health

Annual network meeting for experience sampling method (ESM) experts from Belgium and The Netherlands.

Online event

Celebrating Openness | Open Research Award | Oct 22
Online event

Event to celebrate the many ways in which academics make their research more accessible, transparent or reproducible.

Organised by University of Groningen Library (UB) and Open Science Community Groningen (OSCG)

Society for the Improvement of Psychological Science (SIPS) | June 22-23
Remote edition | online conference

An action-oriented psychology conference, aimed at initiating discussions, projects and participation in hack-a-thons, workshops and unconference sessions, where everyone is free to join or change sessions.

2019

SHARE Day | Nov 14, Groningen
Topic: Impact

Annual day of workshops, keynotes and lectures organised by the graduate school. Topics included the reproducibility crisis, Equivalence testing (Daniël Lakens), and multiverse analysis (Francis Tuerlinckx).

Organised by Research Insitute SHARE
Graduate School of Medical Sciences, University Medical Center Groningen

ESM Expert Network Meeting | Oct 15-16, Tilburg
Belgian-Dutch Network for ESM Research in Mental Health

Annual network meeting for experience sampling method (ESM) experts from Belgium and The Netherlands.

Organised by Tilburg Experience Sampling Center (TESC) | Tilburg University



Modeling the Dynamics of Intensive Longitudinal Data | Aug 19-23, Utrecht
Utrecht Summer School

A five-day course on how to study dynamics in intensive longitudinal data, such as ambulatory assessments (AA), experience sampling method (ESM) data, ecological momentary assessments (EMA), real time data capture, observational data or electronic daily diaries. The course provides a tour of diverse modeling approaches for such data and the philosophies behind them, as well as practical experience with these modeling techniques using different software packages (including R and Mplus).

Organised by Utrecht University | Faculty of Social and Behavioural Sciences
Course director: Prof. dr. Ellen Hamaker


Complexity Methods for Behavioural Science | July 8-12, Nijmegen
A toolbox for studying change
Radboud Summer School

A five-day course on research methods developed to study complex adaptive dynamical systems and networks, applied to the study of human behaviour. The idea behind many methods for studying the dynamics of complex systems is to exploit the fact that “everything is interacting” and quantify the degree of periodicity, nonlinearity, context sensitivity or resistance to perturbation (resilience) of system behaviour. The main focus of the course was hands-on data-analysis.

Organised by Radboud University Nijmegen | Behavioural Science Institute
Course leader: Fred Hasselman

Society for Ambulatory Assessment conference | June 19-22, Syracuse, NY, USA
Syracuse University

6th biennial conference. Topic: Understanding how persons change: from observations to intervention.

Conference program | Book of abstracts | My two presentations

2018

Rob Giel Onderzoekscentrum (RGOc) studiemiddag | Dec 11, Zuidlaren
Gepersonaliseerde zorg: geen woorden maar daden

Clinical conference.

Organised by University Medical Center Groningen, University Center Psychiatry and RGOc

My presentation (in Dutch)

Philosophical Issues in Psychiatry V | May 28-30, Copenhagen (DK)
University of Copenhagen

The problems of Multiple Levels, Explanatory Pluralism, Reduction and Emergence

This conference explored how the field of psychiatry incorporates a plethora of viable explanatory approaches (biology, neuroscience, clinical psychology, epidemiology, sociology, etc.) in an attempt to understand the causes of psychiatric illness.

Organised by Kenneth Kendler, Josef Parnas, Peter Zachar and the Mental Health Centre Glostrup and Center for Subjectivity Research, University of Copenhagen.

Conference programme and presentations.

ESM Expert Network Meeting | Nov 29-30, Heerlen
Belgian-Dutch Network for ESM Research in Mental Health

Annual network meeting for experience sampling method (ESM) experts from Belgium and The Netherlands.

Organised by Open University Heerlen & Maastricht University


Psychological Networks & Time Series Models | Sep 14, Groningen
Improving the analyses of complex clinical data

Meeting of researchers who work on psychological networks and time series models in psycho(patho)logy.

Organised by Laura Bringmann, Casper Albers, Angélique Cramer & Pia Tao

Society for Psychotherapy Research (SPR) conference | Jun 27-30, Amsterdam (NL)
Free University (VU) Amsterdam

49th International Annual Meeting

Predicting Transitions in Complex Systems | Apr 23-28, Dresden (DE)
Max Planck Institute for the Physics of Complex Systems

International Workshop

Complex dynamical systems can show sudden transitions to very diverse regimes. The workshop focused on new advances in data-driven approaches for identifying, characterizing and predicting regime transitions, and promoting cross-fertilization across disciplines.

Conference description| My poster presentation

2017

Clinical Relevance versus Statistical Significance | Dec 5-7, Groningen

Compared to statistical significance, little attention is paid to the importance of “clinical relevance” in scientific research. This short course dealt with the role clinical relevance plays in sample size determination (power), describing the results and statistical testing.

Course coordinator: Dr. Eric van Sonderen
Offered by Graduate School of Medical Sciences &
University Medical Center Groningen

ESM Expert Network Meeting | Nov 24, Groningen
Belgian-Dutch Network for ESM Research in Mental Health

Annual network meeting for experience sampling method (ESM) experts from Belgium and The Netherlands.

Organised by Interdisciplinary Center Psychopathology and Emotion Regulation,
University Medical Center Groningen

Advanced (non)linear regression techniques | Oct 30-Nov 11, Groningen

This statistics course offered an advanced introduction into Generalized Additive Modeling and (Logistic) Mixed-Effects Regression.

Course coordinator: Dr. Martijn Wieling
Offered by BCN &
University of Groningen

Society for Ambulatory Assessment conference | June 14-17, Esch-sur-Alzette (LU)
University of Luxembourg

5th biennial conference. Topic: Digital Health in Ambulatory Assessment

Conference program | Book of abstracts | My poster presentation






MINI SCAN certification | Feb 22 & Mar 1, Groningen
Training for MINI-SCAN diagnostic interview

Course coordinator: Drs. F. J. Nienhuis
Offered by Rob Giel Onderzoeks
centrum & University Medical Center Groningen

2016

ESM Expert Network Meeting | Nov 24, Leuven (BE)
Belgian-Dutch Network for ESM Research in Mental Health

First network meeting for experience sampling method (ESM) experts from Belgium and The Netherlands.

Organised by Center for Contextual Psychiatry | Catholic University Leuven