Towards personalised intervention: A causal-dynamical framework to determine psychological treatment trajectories

Abstract: For approximately half of the individuals receiving mental health care, the results are suboptimal, even when treatments align with evidence-based guidelines. These limited effects may partly stem from how clinical decisions on treatment focus are made in mental health care. Typically, treatment strategy is guided by the diagnostic classification combined with the individualized case conceptualization. While standard, this approach may fall short for several reasons such as biases on the part of both the patient and therapist, and treatment guidelines being based on average effects that may not (exactly) suit the individual patient. To address these challenges, we propose a novel framework that reduces biases in clinical decision-making and makes it genuinely possible to tailor treatment focus to the individual patient. This framework involves (a) constructing causal graphs and estimating causal effects from intensively collected, longitudinal patient data, (b) simulating new time series based upon the causal relationships, and (c) using these simulations to identify the most effective treatment focus for the individual patient. By simulating and comparing different intervention strategies and examining both the estimated individual's responsiveness and its long-term effectiveness, this approach may generate useful insights to guide treatment focus and strategy, which can lead to a significant improvement of treatment outcomes in mental health care.