 Research article
 Open Access
 Published:
Complexity in psychological selfratings: implications for research and practice
BMC Medicine volume 18, Article number: 317 (2020)
Abstract
Background
Psychopathology research is changing focus from groupbased “disease models” to a personalized approach inspired by complex systems theories. This approach, which has already produced novel and valuable insights into the complex nature of psychopathology, often relies on repeated selfratings of individual patients. So far, it has been unknown whether such selfratings, the presumed observables of the individual patient as a complex system, actually display complex dynamics. We examine this basic assumption of a complex systems approach to psychopathology by testing repeated selfratings for three markers of complexity: memory, the presence of (timevarying) short and longrange temporal correlations; regime shifts, transitions between different dynamic regimes; and sensitive dependence on initial conditions, also known as the “butterfly effect,” the divergence of initially similar trajectories.
Methods
We analyzed repeated selfratings (1476 time points) from a single patient for the three markers of complexity using Bartels rank test, (partial) autocorrelation functions, timevarying autoregression, a nonstationarity test, change point analysis, and the SugiharaMay algorithm.
Results
Selfratings concerning psychological states (e.g., the item “I feel down”) exhibited all complexity markers: timevarying short and longterm memory, multiple regime shifts, and sensitive dependence on initial conditions. Unexpectedly, selfratings concerning physical sensations (e.g., the item “I am hungry”) exhibited less complex dynamics and their behavior was more similar to random variables.
Conclusions
Psychological selfratings display complex dynamics. The presence of complexity in repeated selfratings means that we have to acknowledge that (1) repeated selfratings yield a complex pattern of data and not a set of (nearly) independent data points, (2) humans are “moving targets” whose selfratings display nonstationary change processes including regime shifts, and (3) longterm prediction of individual trajectories may be fundamentally impossible. These findings point to a limitation of popular statistical time series models whose assumptions are violated by the presence of these complexity markers. We conclude that a complex systems approach to mental health should appreciate complexity as a fundamental aspect of psychopathology research by adopting the models and methods of complexity science. Promising first steps in this direction, such as research on realtime process monitoring, shortterm prediction, and justintime interventions, are discussed.
Background
Complex systems approaches to mental health study psychopathology as a selforganized state emerging out of interdependent cognitive, affective, behavioral, and physiological processes [1,2,3]. This line of research has unarguably produced innovative and valuable insights into psychopathology, yet its most basic testable prediction has almost never been investigated: Do the observables of this complex system, i.e., psychological selfratings, actually display complex dynamics? This is an important question to resolve, as it directly affects the veracity of the claim that psychopathology should be regarded as a complex system state. In the present study, we address this question by identifying characteristic markers of complexity in the dynamics of psychological observables as measured by repeated selfratings of social, emotional, physiological, psychological, and behavioral states.
Recently, the mental health field is changing focus from groupbased “disease models” to more personalized models of psychopathology. Groupbased disease models view mental disorders as conditions in which a specific (biological or psychological) root cause leads to a set of observable symptoms [3]. In this view, knowledge about a population (e.g., people diagnosed with depression) can (at least to some extent) be generalized to an individual from that population. This assumption, however, does not hold when a population is heterogeneous (e.g., [4, 5]) or when processes are nonstationary (for example, when an individual’s mood is not stable over time) as is often the case in human sciences [6,7,8,9]. Because of the heterogeneity between patients and the intrinsic nonstationarity of clinical change processes, evidencebased practice guidelines based on grouplevel comparisons are only of limited use for the care of individual patients [10]. This is why scholars have called for a personalized approach to psychopathology, in which treatment is tailored to the specifics of the individual patient [11,12,13,14].
Recent advancements on the personalized approach to psychopathology pledge for a complex systems perspective on mental health [14,15,16,17]. This perspective has adopted metaphors and concepts from complexity science, a transdisciplinary research area originated in physics, mathematics, and biology [18,19,20]. The methods and analytic techniques of complexity science, however, are less commonly used in psychopathology research, although they have been used to study human behavior in the past [21,22,23,24,25]. Recent reviews of idiographic models and methods for psychopathology research did not include any of the available complexity methods [14, 26]. There thus appears to be a discrepancy between the assumed nature of the object under study (i.e., psychopathology as a state in a complex dynamical system) and the way it is scientifically studied.
In a complex dynamical system, the interdependencies between parts lead to the emergence of robust ordered states, or, patterns, at the level of the whole (see also [27, 28]). These patterns may function as attractors to the system, meaning that the system tends to maintain its current pattern despite perturbations from the internal or external environment (i.e., the system is attracted to a specific state). Several authors have proposed that psychopathological states function as attractors in a complex system comprising an individual in its environment [1, 2]. Such psychopathological attractors may be very entrenched, meaning that a patient is “stuck” in a particular state. The stability of attractors, however, can change over time, in which case alternative attractors become available to the system (i.e., multistability). Clinical improvement is then conceptualized as a socalled phase transition from a psychopathological towards a more healthy attractor state, while the onset of psychopathology is understood as the reverse. Recurrent depressive episodes may then for example be understood as phase transitions between a depressed and a healthy attractor.
Attractor states emerge through a process of selforganization: the direct interactions between the system parts with the internal or external environment (i.e., states emerge without a blueprint or latent cause [29, 30]). From a complex systems perspective, psychopathology is thus not a fixed condition with a root cause. Instead, it is a “softassembled,” selforganized, attractor state that arises out of—and is maintained by—the interactions between various component processes (e.g., biological, psychological, sociocultural processes) whose dynamics evolve on different temporal and spatial scales. The complex systems approach to psychopathology provides a set of descriptive principles (e.g., attractors, feedback loops, selforganization) that are assumed to apply to all psychopathological states, while acknowledging that the content of these states (e.g., in terms of symptom profiles [4]) is highly individual and context specific as it has emerged from a unique history of interaction events. A complex systems approach thus naturally combines nomothetic and idiographic aspects of psychopathology [2].
Probably due to their intuitive appeal, complex systems concepts, such as attractors, have since long been around in clinical psychology [31,32,33]. These concepts, however, have mostly been used metaphorically and not literally in the form of complexity analysis of time series data (but see for early applications [34,35,36]). This is probably due to the fact that complexity science’s analytic toolbox has been relatively unknown to clinical researchers. In addition, these analyses require data not commonly collected in clinical research: time series data. A time series is a record of intensive longitudinal measurements of a variable, which describes the temporal evolution of an observable of a specific system. Typically, complexity analyses require time series with many measurement points, which are easily collected for physiological signals (e.g., heart rate), but traditionally not for psychological signals (e.g., the evolution of mood over time [37]). The rise of smartphones now make it possible to collect multivariate time series of such psychological signals, using methods like ecological momentary assessment (EMA) or experience sampling [38]. Also, advances on complexity analysis have led to methods that can be applied to relatively short time series as well (e.g., [39]). Thus, the complex systems approach to psychopathology is at a cusp to move beyond metaphors and to build a genuine complexity science of personalized psychopathology. The first step in this direction is to test whether time series of psychological selfratings indeed exhibit characteristics of the dynamics of complex systems.
To answer this question, the present study will assess the presence of three characteristics of complex systems and their corresponding markers in time series data of psychological variables (see Table 1). First, complex systems develop over time and thus have memory. This means that the current state of a system depends on previous states. Rather than producing independent random fluctuations, observed values generated by a complex system are interdependent. Characteristic for complex selforganizing systems (such as humans) is that their memory is not limited to a short time scale (e.g., lag 1 or lag 2), but can in principle span any lag of time. Thus, longterm memory, identifiable as longrange temporal correlations and powerlaw scaling, is expected in the time series of a complex system as a sign of selforganized interactions across scales as has been evidenced in time series of human physiology and performance [40,41,42,43]. In a pioneering study, Delignières, Fortes, and Ninot [44] also found powerlaw scaling in bidaily selfratings of selfesteem and physical selfimage. Moreover, temporal correlations are expected to be nonstationary (i.e., timevarying) in complex systems, which is considered the strongest evidence for multiplicative interactions across different temporal scales [45].
Second, complex systems exhibit phase transitions between attractor states: qualitative changes in the state of the system that are reflected in time series as regime shifts and nonstationarity [23, 46]. Different regimes refer to different attractors (e.g., a state of psychopathology and a state of health) and may be characterized by different mean levels (e.g., of symptom severity), different variance levels (e.g., emotional inertia vs. mood swings), or differences in any other distributional characteristic. Complexity theory predicts that phase transitions from one attractor to another are preceded by a period of instability, which comes apparent as a temporary increase of variability and complexity in time series data, thereby providing another source of nonstationarity [39, 47]. The study of these regime shifts, or broader defined, phase transitions, is an important avenue for clinical science. Scholars have argued that many important clinical events such as the onset of psychopathology [48], relapse [49], suicide attempts [50], clinical improvement [51,52,53,54,55,56,57] and clinical deterioration [51, 52] may be instances of phase transitions. Also, the instability that precedes such transitions can be detected as socalled earlywarning signals (EWS) that may be used for shortterm prediction of clinical change [55, 58].
Third, complex systems can show a sensitive dependence on initial conditions, which leads to a limited predictive horizon [59, 60]. This means that it is possible to predict time series of a complex system a few time points ahead, but not in the far future. The predictive horizon of a time series can therefore be useful to distinguish complex systems (strong prediction decay) from random systems (which are never predictable) and simple deterministic systems (which are always predictable). A wellknown example of a complex system with a limited predictive horizon is the weather. Shortterm prediction is possible, but prediction becomes highly unreliable after a few days. A clinical example is provided by Tschacher et al. [35], who found that the evolution of schizophrenia symptoms for many patients in their study sample was predictable only in the short term, but not in the long term (see also [34, 61, 62]).
The present study examines whether selfratings collected with EMA exhibit the three signs of complexity introduced above: (1) timevarying short and longterm memory, (2) regime shifts, and (3) sensitive dependence on initial conditions. We analyzed the presence of these complexity markers in a singlecase dataset with long EMA time series (1476 time points) as a proofofprinciple.
Methods
Dataset
Publicly available EMA data from the study “Critical Slowing Down as a Personalized Early Warning Signal for Depression” were analyzed [63, 64]. The dataset contains 1476 selfratings over 239 consecutive days from a single individual. Data were collected during a doubleblind experiment in which the participant reduced his dosage of antidepressant medication. Twentynine items on momentary states of affect, symptoms, selfesteem, and physical sensations were rated on Likert and bipolar scales (ranging from 1 to 7 or from − 3 to + 3; items in Table 2). This was done multiple times per day during a baseline period, a period of dosage reduction, and after the dosage reduction. On average, the participant completed 6.2 (SD = 1.9) assessments per day. In addition, there were daily measures in the morning and evening regarding sleep and evaluation of the day, respectively. For a complete description of the dataset, see [63]. In the present study, we analyzed the twentynine items on momentary states. The time series of these items have 1476 observations per item. In total, 103 observations were missing, which is less than 1% of all observations (0.24%). The present dataset was chosen because of the long time series, which are necessary for several analysis techniques employed.
Data analysis
The time series were analyzed for markers of complexity using the methods and tests listed in Table 1. This was done twice: once for the full measurement period and once for the “baseline period” only, consisting of 292 assessments that were completed when the participant was not yet tapering medication. We analyzed the baseline period separately in order to examine to what extent the complexity markers were present when clinical change (relapse into depression) was presumably absent. Data analysis of both measurement periods was done with missing data excluded and with missing data imputed by a multivariate imputation algorithm using chained equations [65]. Results were highly similar, likely because of the low number of missing values. We report here on the analysis with missing observations excluded. Each marker was calculated for each time series separately. When a statistical test was used, we corrected for multiple testing with Bonferroni correction by dividing the conventional alpha level of .05 by the amount of items tested and rounding to 3 decimals. A result was therefore considered significant when p < .002. All analyses were performed in R [66]. The materials to reproduce the present analysis are available at the open science framework (https://osf.io/nca2u/). We elaborate on the specific tests in the “Results” section.
Results
Memory
Dependency
Memory in its most general form is reflected in time series as dependence on past values. Statistically, this means that time series generated by a complex system are nonrandom. We tested for randomness using Bartels rank test. In both the full measurement period and the baseline period, ~ 85% of the items were shown to be nonrandom (Table 2). The results showed that all measures of psychological variables were nonrandom. In contrast, for several measures of physical sensations, such as the item “I am hungry,” the null hypothesis of randomness was not rejected.
Longrange temporal correlations
We studied longterm memory by inspecting longrange temporal correlations. We plotted the autocorrelation function (ACF) for each item. The ACF shows the correlation of a time series with a lagged version of itself. The ACF can be visualized by plotting the correlation strength against the lag size (see Fig. 1 for an example; ACF plots for all items are available online at the open science framework). Visual inspection of the ACFs shows that both shortterm (e.g., lag 1, lag 2) and longterm memory are common in the present time series. There are, however, considerable differences in ACFs between items. For example, in Fig. 1, the ACF for a typical psychological variable (“I feel down”) can be compared to the ACF for “I am hungry.” While “I feel down” shows both shortterm and longterm memory, “I am hungry” shows little shortterm memory and no clear pattern of longterm correlations. To summarize the presence of longterm memory, we calculated the number of lags with significant partial autocorrelations per item (i.e., correlation estimates at higher lags are corrected for autocorrelation at lower lags). The partial autocorrelation function was calculated with the function pacf() as implemented in the stats package of R [66]. The significance threshold was based on a twotailed Z test with the time series length as number of observations. Results showed that all items had significant partial autocorrelations (Table 2). For each item, significant partial autocorrelations were also found at very high lags (i.e., > lag 200; Table 2).
Nonstationary temporal correlations
We tested nonstationarity in the lag 1 autocorrelation with a timevarying autoregressive (TVAR) model, using the Rpackage MGCV [67]. The TVAR model uses nonparametric smooth functions to model timevarying autoregressive coefficients at specific lags. We examined a TVAR model for lag 1, because it is the most examined lag in EMA research and often shows the strongest autocorrelation (e.g., [68]). Nonstationarity of the lag 1 autocorrelation was evaluated by the significance test of the TVAR (which tests whether the smoothing timevarying function is different from zero) and the effective degrees of freedom (EDF) of the smoothing function. The EDF indicates the number of parameters needed to represent the smoothing function [69]. An EDF of 2 indicates a linear trend of autocorrelation over time, which can either mean that the autocorrelation is not changing or changing linearly. An EDF higher than 2 indicates that the autocorrelation is definitely nonstationary. The results show that the lag 1 autocorrelation is often nonstationary (Table 2). Visual inspection of the fit of the TVAR model shows that items with an EDF of 2 often had a nonstationary (increasing or decreasing) lag 1 autocorrelation as well (see supplemental figures TVAR available at the open science framework). The autocorrelation function can also be nonstationary at different lags than 1. We explored this visually by plotting the autocorrelation function in a moving window of 492 time points. These plots show that the autocorrelation function is often nonstationary at many different lags (see Fig. 2 for an example; moving window ACF plots for all items are available online at the open science framework). We also visualized the variation of autocorrelation coefficients per lag (see Fig. 3 for an example; visualizations for all items are available online at the open science framework).
Regime shifts
Phase transitions can be reflected in time series data as regime shifts: distributional changes in the time series including changes in mean and variance. Statistically, this leads to nonstationarity. We tested the hypothesis that time series could be seen as stationary around a level using the KPSS test as available in the Rpackage tseries [70]. The alternative hypothesis of the test is the presence of a unit root: a systematic unpredictable pattern, indicating nonstationarity. Results are presented in Table 2. Nonstationarity was found in many items when tested over the whole measurement period and in few items for the baseline period. Additionally, we estimated the number of regime shifts with a change point analysis, specifically the e.divisive algorithm, available in the Rpackage epc [71], which identifies significant changes in the distribution of data points over time. E.divisive compares all possible data segments and tests significance differences using a permutation test. The results show that many items have multiple change points, especially when the full measurement period is considered. In the baseline period, one can see largely converging results from the nonstationarity test and the change point analysis.
Visual inspection of the results from the change point analysis suggests a relation between regime shifts in the time series of some items and the transition towards a depressive episode that the participant experienced. This is clearly illustrated for the item “I feel down” (Fig. 4) that was also found to be nonstationary (Table 1). One can see that the transition towards depression (Fig. 4; red line) is preceded by a period of instability in the time series, in which the item “I feel down” flickers between two regimes, one associated with lower scores and one with higher scores. After the transition towards the depressive episode, the time series settles in the regime with higher scores. Notably, the time series of the other items sometimes show regime shifts that seem related to the transition towards depression (as in Fig. 4), but there are also many regime shifts during presumably more stable periods in the participant’s mental state (figures of change points for all items are available online at the open science framework).
Sensitive dependence on initial conditions
Sensitive dependence on initial conditions means that an extremely small difference between two trajectories at present can lead to dramatically large differences in the future, i.e., a divergence of trajectories. This divergence is the result of nonlinearity, a property that is typical for complex systems. As a consequence of sensitive dependence on initial conditions, complex systems tend to produce trajectories that are predictable only on the short term. Predictability can therefore be used to distinguish between different types of systems. Random systems have no predictability at all, simple deterministic systems (e.g., a sine wave) are perfectly predictable both short and long term. Complex systems lie in between these extremes: the predictability of their trajectory quickly decays over time.
Phase space reconstruction
As a measure of predictability, we computed forecast skill using the procedure proposed by Sugihara and May [72] using the Rpackage rEDM [73]. First, time series are embedded in a reconstructed phase space in which timelagged copies of the time series are used as dimensions. The method of phase space reconstruction is based on Taken’s theorem [74]. This theorem entails that, under a limited set of assumptions, the state space dynamics of the system as a whole can be retrieved (under topological equivalence) from the observation of a single dimension of its state space: As long as the dimensions of the state space of a multidimensional dynamic system can be represented by coupled interdependent processes, its behavior can be reconstructed from a time series of only one observable dimension of that system. The state evolution of the system can be thought of as a trajectory through its state space. This trajectory is predicted by the SugiharaMay algorithm. The algorithm also imputed the few missing observations, as part of this specific analysis.
Procedure
The data were split in two parts. From the first 700 data points, the trajectory of each item in its reconstructed phase space was used to predict the trajectory of each item in a reconstructed phase space of the remaining measurement period. To create timelagged copies of the time series as surrogate dimensions, we used a time lag of 4, which was the median optimal time lag for all items. The determination of the time lag is an optimization procedure, but in principle, every time lag will do. We used 13 dimensions in the embedding procedure, as this was the maximum optimal embedding dimension for all items. Too few dimensions is problematic, because it can lead to false identifications of similar trajectories [75]. It is not problematic to have too many dimensions. A measure of predictability, forecast skill, is then computed as the Pearson correlation between values that are predicted by the SugiharaMay algorithm and the observed values.
Forecast skill
Forecast skill was compared at different time lags. A decrease in predictability over time lags is called a prediction decay. As a measure of prediction decay, we computed the slope of forecast skill over time within the first 5 lags (which was for most items a linear area in the forecast skill plots; see all forecast skill plots online at the open science framework). Our results show that for almost all items, forecast skill decreased over time (Fig. 5). However, there were interesting differences between items. Psychological items tended to show a clear decrease in predictability over time, suggesting that these time series indeed present the dynamics of a complex system. Items related to physical sensations, such as the item “I am hungry,” however, tended to show very low predictability both short and long term, suggesting that these time series are random. In Fig. 6, forecast skill is plotted against time for a typical affect item, a typical physical item, a sine wave, and random uniform noise. One can see that the predictability of “I feel down” decreases rapidly over time, as is expected for time series generated by complex systems. In contrast, “I am hungry” is never predictable and behaves as a random variable.
Discussion
The present study examined whether the dynamics of repeated selfratings are complex dynamics. We analyzed long psychological time series collected with EMA for three markers of complexity: (timevarying) short and longterm memory, regime shifts, and sensitive dependence on initial conditions. Results showed that the present selfratings were indeed complex: almost all items exhibited clear evidence for the three markers.
First, we found that the analyzed time series possessed memory: current values depended on past values. This was not restricted to shortterm memory in the form of a dependency on a previous assessment from hours or a day ago (e.g., lag 1, lag 2). Current values also correlated with values in the distant past that were assessed weeks or months ago (e.g., lag 200, lag 1000). These longrange temporal correlations are indicative of interactions across scales and selforganization in complex systems [43, 45]. Longrange temporal correlations can be understood as slow “waves” that are reflected by the time series [45, 76]. The present results align with the ever growing empirical record of studies that have evidenced the presence and characteristics of longrange correlations and fractal scaling (i.e., a specific pattern of longrange correlations associated with selforganization [42]) in time and trial series of human physiology and performance [40,41,42,43,44, 77,78,79,80,81,82,83,84,85,86]. Moreover, the temporal correlations changed over time, indicating multifractality, which is considered a strong indicator for multiplicative interactions across time scales as datagenerating process [45]. In sum, these results go against the notion that repeated selfratings are a collection of independent, memoryless [87], observations. Instead, repeated selfratings exhibit complex temporal patterns yielding timevarying short and longterm memory.
Second, about half of the time series were nonstationary and many time series exhibited multiple change points, indicating the presence of regime shifts. This reflects the occurrence of phase transitions: qualitative shifts from one attractor state to another. In the current dataset, the relapse of the participant towards a depressive state was an example of such a phase transition, which was related to a regime shift in weekly symptom scores in a previous study [64]. This phase transition has also led to nonstationarity and change points in EMA items (e.g., Fig. 4). Change point analysis showed, however, that many items had more than one change point, suggesting that multiple phase transitions occurred in the specific psychological processes that were measured with EMA (e.g., the flickering observed in Fig. 4). When stationarity and change points were only examined during the baseline period of the experiment in which medication was not yet being tapered, only few items showed evidence for regime shifts.
Third, the time series showed a limited predictive horizon, signaling the sensitive dependence on initial conditions that is typical for complex systems. The predictive horizon seemed to be limited to about 3 to 5 time points. The observed prediction decay indicates the presence of a butterfly effect: the trajectories of once closely located data points completely diverge over time. Thus, while shortterm prediction of these repeated selfratings is possible, these results suggest that longterm prediction may be fundamentally impossible. In the current analysis, trajectories were compared within the time series of the same person, but the butterfly effect applies equally well to trajectories of different persons. In a recent study by Rubel et al. [88], processoutcome relations in psychotherapy could not be reliably predicted on the basis of processoutcome relations from patients with highly similar pretreatment characteristics. A finding which may be explained by the presence of a butterfly effect (i.e., individual trajectories diverge over time; see also [61, 62]).
One interesting and unexpected result was the difference between selfratings of psychological states and physical sensations in the presence and strength of markers of complexity. All psychological states, such as “I feel down,” were found to be nonrandom in both the full dataset and the subset. In contrast, for physical sensations, such as “I am hungry,” the null hypothesis of randomness was often not rejected, at least not in the subset. Moreover, when looking at the predictive horizon in the forecast skill graphs, the psychological states all showed the typical prediction decay that characterizes complex systems, while the physical sensations showed a prediction horizon that more closely resembles that of a random variable. Physical sensations, such as hungriness, are of course not truly random processes. This result should thus be explained either by the appropriateness of the sampling rate in this study for the different variables or by the nature of the variables themselves (e.g., “I am hungry” may refer to an unambiguous identifiable internal state that can be thought of as being experienced at different orders of magnitude, “I feel suspicious,” much less so, see also [89]). Either way, the striking difference between the two types of items may be an important avenue for future research, with the potential to shed more light on the nature of psychological measurement.
In sum, the present study corroborates the assumption that selfratings of psychological states display complex behavior and support the proposal that a complex systems approach to psychopathology is warranted [1,2,3, 90, 91]. The present study is limited to a single case with long time series, which enabled us to thoroughly examine the dynamics and assess multiple markers with multiple techniques. The singlecase design, however, can by definition not be used to estimate the frequency of a phenomenon (in this case how many individuals will exhibit complex behavior in their psychological dynamics). Rather, the singlecase study shows the existence of a phenomenon. Thus, the results primarily indicate that complexity in psychological dynamics should be considered. However, given the strong theoretical arguments for humans to be complex (and not random or simple deterministic) systems [28] and the omnipresence of complexity in other humangenerated time series [43], we judge it unlikely that the complexity in the present dataset is a coincidence. Instead, the present results can be seen as illustrating the need for a complex systems approach to psychopathology that moves beyond metaphors and appreciates the scientific and clinical implications of complexity.
Scientific implications
First, the presence of both short and longterm memory has methodological implications. Widely applied statistical time series models of psychological dynamics, i.e., autoregressive (AR) models, do often not account for longterm memory [14, 26]. In these models, the current value of a variable is typically predicted by values in the near past (usually lag 1, or lag 2; e.g., [68]), but not in the distant past. Not taking into account longrange temporal correlations can “completely invalidate statistical inference” [92]. However, taking these longrange temporal correlations into account in a statistical model is far from straightforward. In the current study, we found for many items significant partial autocorrelations in as much as 20 different lags. In an AR model, these would be modeled as 20 independent, additive processes that influence the current state of the system. In other areas of psychological science, there is much debate about whether this is a sensible model to describe a time series [45, 93,94,95]. Proponents of AR models argue that the different autocorrelations represent distinct additive causal processes [95]. Complexity scientists argue that they do not, and propose the presence of longrange correlations to be a consequence of selforganized interactions between interdependent (i.e., nonadditive) causal processes at different temporal scales [96]. The latter argument is supported by the fact that longrange correlations are ubiquitous in nature, even when distinct additive causal processes are clearly absent (e.g., selforganization in a pile of sand [41]). Moreover, data with nonstationary autocorrelation functions, as we observed, cannot be generated by the most flexible AR model (i.e., the autoregressive fractally integrated moving average model [97]), but can be generated by models that feature interaction across scales (i.e., cascade models [45]). Thus, following a complex systems perspective that embraces selforganization as the causal mechanism, statistical models of time series can only be used descriptively and not as formal models of the underlying causal processes (see also [98]).
Vector autoregressive (VAR) models are time series models that include multiple variables that may predict themselves and each other at specific lags (often restricted to lag 1 in psychopathology research). VAR models are used to examine Granger causality [99]. Granger causality entails that if a variable X at one time point predicts a variable Y at a future time point beyond the autoregressive effect of Y (how Y predicts itself), X can be said to be Granger causal for Y. Although researchers using VAR models are careful in interpreting their models in causal terms, the general idea of these models is that they at least can give a hint of possible causal relations. Accordingly, variables that are Granger causal for many other variables are suggested as targets for treatment (e.g., [68]). This reasoning, however, is problematic under conditions of complexity. Due to the presence of short and longterm memory, time series are not stochastic beyond what is typically modeled by the VAR model, meaning that Granger causality does not apply [99]. Sugihara et al. [100] illustrate that the (lagged) correlations between variables in a complex (eco)system are indeed bad indicators for causality. Two variables that have a stable causal connection in a complex system may exhibit nonstationary correlation with each other, even to the point that the correlation coefficient switch signs [100]. In a simulation study on psychological dynamics, Haslbeck and Ryan [101] found that a VAR model cannot retrieve the complex systems model that generated the data. Sugihara et al. [100] propose convergent cross mapping as a possible alternative for Granger causality. Also, recurrencebased analysis, which requires no assumptions concerning the structure of the data, may be a promising approach to investigate the dynamics of EMA data [89, 102, 103]. Future research should further examine these techniques for psychological selfratings.
Second, complex systems exhibit phase transitions, which lead to regime shifts and thus nonstationarity in time series data. While regime shifts are generally undesirable in statistical approaches to psychological dynamics [26], they are an important research avenue in a complex systems approach. In the dynamic research strategy outlined by Thelen and Ulrich [23], phase transitions form the starting point for the study of developmental and also clinical change.

First, phase transitions differentiate between different attractor states that demand their own descriptions. For example, a depressed attractor state may yield a specific pattern of cognition, emotion, behavior, and physiology that is reflected in specific values of such variables (e.g., high negative emotions, high rumination) as well as the interrelations between them (e.g., a feedback loop between negative thoughts and negative feelings). A healthy attractor of the same person may in contrast be characterized by completely different values and interrelations of these variables [1]. Aggregation of a time series over different regimes should thus be avoided as this will give a misleading impression of the patient’s actual psychological states (e.g., emotions may appear neutral on average, while the patient actually experienced one period of negative emotions and one period of positive emotions). Future research should therefore explicitly examine possible different attractor states in time series (for example with change point analysis).

A second research avenue is the study of earlywarning signals (EWS) as precursors of upcoming phase transitions [104]. In a study on selfratings collected during psychotherapy, EWS were indeed shown to be predictive for upcoming regime shifts in symptom severity levels [52]. Such realtime prediction of transitions may be highly relevant for prevention and intervention in clinical practice. During periods of EWS, complex systems are more sensitive to external influences. Interventions, aimed at either eliciting positive change (e.g., sudden gains [52];) or preventing negative change (e.g., suicide attempts [50];), may thus be increasingly effective during periods of destabilization (see also [105]). Future research should test this hypothesis.

A third reason to study phase transitions is that these are the moments at which change mechanisms in complex systems may be revealed [23, 106]. Consider a simple example: the emergence of convection rolls when boiling water. At a critical temperature, where the body of water cannot dissipate its heat any more in a regular fashion, convection rolls emerge spontaneously. At the transition point, a change mechanism (a control parameter in complex systems terms) can be identified: the kinetic energy (i.e., heat) that is delivered to the pan. This sounds obvious but note that the heat may not have been identified as the control parameter if the water was only observed within a small temperature range that did not include the critical threshold, or the tipping point. Control parameters thus only become apparent as change mechanisms at the tipping points of transition. From this perspective, EMA research is thus especially interesting during a change process (e.g., therapy) and not during a baseline period in which the change mechanisms are likely to remain hidden. In psychopathology, control parameters will of course be harder to identify than in the example of convection rolls described above. Control parameters for clinical change are likely to be individual and contextualized. This makes control parameters an interesting avenue for applied idiographic research (for steps in this direction, see [107,108,109]).
Third, complex systems show sensitive dependence on initial conditions, which implies that psychological dynamics are predictable in the short term, but not in the long term. For clinical science, this means that longterm prediction of individual trajectories may be fundamentally impossible. Instead, researchers should aim at shortterm prediction and be careful in forecasting further in the future as predictions will become increasingly unreliable. Shortterm prediction is a promising future direction for intervention science, as it may enable justintime interventions (e.g., [110]). It should be noted, however, that advancements are made in deriving the governing equations of complex systems from time series data, in which case longterm prediction would in theory become possible (e.g., [111]). Future research could explore the possibility to derive such equations from EMA data.
Clinical implications
If we accept the three markers and their meaning in complex systems theories as fundamental aspects of psychopathology and clinical change, this has several implications for clinical practice and public health. Note that, in contrast to the scientific implications given above, these implications are more on a conceptual level, rather than a data level, and therefore arguably more speculative. Our primary aim is to illustrate how the clinical implications of a complex systems approach, as we and others have proposed elsewhere [1, 2, 90, 91], relate to the three characteristics that we examined.
First, our findings regarding memory support the assumption that psychopathology emerges from selforganized interactions between processes at different temporal scales [90]. Current psychopathology is then the result of a unique lifespan history of interaction events, which can explain why psychopathology is highly individualized [4, 14]. For clinical practice, this implies that classification is fundamentally limited for clinical case formulation (although it may fulfill a practical function). Instead, personalized case conceptualization should be preferred [12].
Second, our findings regarding regime shifts support the idea that clinical change represents a phase transition from one attractor to another (e.g., a transition into a depressive episode). Therapeutic change is then expected to be discontinuous and irregular rather than continuous and gradual. Also, this means that doseresponse relations in psychopathology will often be disproportional [112]: when a patient is in an entrenched psychopathological attractor, interventions will have very little effect, but if a patient is close to a tipping point, small interventions can have enormous effects. The hypothesis that treatment is increasingly effective during destabilization periods is an important avenue for future research. The generic principles of therapeutic change by Schiepek et al. [2] and the network destabilization and transition model by Hayes et al. [1] provide two (related) processoriented frameworks for how clinicians may support phase transitions towards clinical improvement in psychotherapy. Central to these approaches is that treatment does not follow a strict protocol, but is personalized to the dynamic state of the patient (e.g., in a stable attractor or a destabilization period).
Third, as exemplified by sensitive dependence on initial conditions, we expect clinical change processes to follow complex individual pathways that are very hard to predict based on baseline characteristics, rather than standard tracks [61]. On the individual level, clinical change processes are highly irregular and fluctuating, as comes apparent when enough measurements are taken. Too few measurements (e.g., only pre and post) can then be misleading, and frequent process monitoring (e.g., with daily selfratings) is essential for a valid measure of the change processes [113] (for an overview of all scientific and clinical implications, see Table 3).
Outlook
Last, we propose two (complementary) directions for future research: a nomothetic and an idiographic approach. First, the nomothetic approach to psychopathology research should aim at identifying and understanding general properties of clinical change based on the principles of complex systems (e.g., phase transitions). These general principles govern laws of withinsystem changes and thus cannot be derived from traditional grouplevel research but by drawing generalizations across cases, possibly in a multilevel framework ([9]; e.g., [52]). Research questions in this approach are as follows: how is destabilization related to clinical change? Can we predict phase transitions? Are interventions more effective during periods of destabilization?
Second, we propose an idiographic approach which, informed by nomothetic research, should aim at studying the manifestation of these general principles in single individuals, thereby providing individualized and contextualized content. Research questions in this approach are as follows: what does the psychopathological state of a patient entail? What feedback loops might play a role in maintaining this state? What might be possible control parameters that drive a client to its tipping point towards a more healthy psychological state? Such an idiographic approach, informed by general principles, provides an excellent starting point for applied clinical research which may directly inform clinical decisionmaking (for steps in this direction, see, e.g., [108, 110, 113]).
Conclusions
The present study illustrates that complexity should be considered in the study of psychological selfratings. This finding highlights the need to adopt principles of complex systems theory and methods into psychopathology research. As an outlook, we envision a complexity science of psychopathology that bridges the gap between nomothetic and idiographic research and between science and practice.
Availability of data and materials
The dataset analyzed during the current study is available at the open science framework repository [https://osf.io/j4fg8]. The open materials are available at the open science framework repository [https://doi.org/10.17605/OSF.IO/NCA2U; https://osf.io/nca2u/].
Abbreviations
 ACF:

Autocorrelation function
 AR:

Autoregressive
 EMA:

Ecological momentary assessment
 EWS:

Earlywarning signals
 TVAR:

Timevarying autoregressive
 VAR:

Vector autoregressive
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Acknowledgements
We would like to thank the members of the Complex Systems Group at Radboud University (https://www.ru.nl/bsi/research/grouppages/complexsystemsgroup/) for their input on the design of the study. The idea for this study was inspired by a blogpost by Fred Hasselman entitled “Testing assumptions of the datagenerating process underlying Experience Sampling” (https://antiismism.com/post/20170519testingassumptionsofthedatageneratingprocessunderlyingexperiencesampling/).
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MO formulated the research questions, designed and performed the data analysis, interpreted the results, and wrote the manuscript. FH formulated the research questions, designed the data analysis, interpreted the results, and revised the manuscript. ALA formulated the research questions, designed the data analysis, interpreted the results, and revised the manuscript. All authors approved the final version of the manuscript.
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Olthof, M., Hasselman, F. & LichtwarckAschoff, A. Complexity in psychological selfratings: implications for research and practice. BMC Med 18, 317 (2020). https://doi.org/10.1186/s12916020017272
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DOI: https://doi.org/10.1186/s12916020017272
Keywords
 Ecological momentary assessment
 Experience sampling method
 Complexity
 Complex system
 Psychopathology
 Mental health
 Time series
 Personalized medicine