Ambulatory assessment (AA; also known as ecological momentary assessment) has enjoyed enthusiastic implementation in psychological research. The ability to assess thoughts, feelings, behavior, ...physiology, and context intensively and repeatedly in the moment in an individual's natural ecology affords access to data that can answer exciting questions about sequences of events and dynamic processes in daily life. AA also holds unique promise for developing personalized models of individuals (i.e., precision or person-specific assessment) that might be transformative for applied settings such as clinical practice. However, successfully translating AA from bench to bedside is challenging because of the inherent tension between idiographic and nomothetic principles of measurement. We argue that the value of applied AA will be most fully realized by balancing the ability to develop personalized models with ensuring comparability among individuals.
Public Significance Statement
Psychological research is increasingly measuring human functioning in life as it is lived, by assessing thoughts, feelings, behavior, physiology, and context using tools like smartphones and other mobile sensors. This article proposes some basic principles for adapting these research tools for applied clinical settings.
Advances in methods for longitudinal data collection and analysis have prompted a surge of research on psychological processes. However, decisions about how to time assessments are often not ...explicitly tethered to theories about psychological processes but are instead justified on methodological (e.g., power) or practical (e.g., feasibility) grounds. In many cases, methodological decisions are not explicitly justified at all. The disconnect between theories about processes and the timing of assessments in longitudinal research has contributed to misspecified models, interpretive errors, mixed findings, and nonspecific conclusions. In this article, we argue that higher demands should be placed on researchers to connect theories to methods in longitudinal research. We review instances of this disconnect and offer potential solutions as they pertain to four general questions for longitudinal researchers: how time should be scaled, how many assessments are needed, how frequently assessments should occur, and when assessments should happen.
Personalized Models of Psychopathology Wright, Aidan G.C; Woods, William C
Annual review of clinical psychology,
05/2020, Volume:
16, Issue:
1
Journal Article
Peer reviewed
Open access
The personalized approach to psychopathology conceptualizes mental disorder as a complex system of contextualized dynamic processes that is nontrivially specific to each individual, and it seeks to ...develop formal idiographic statistical models to represent these individual processes. Although the personalized approach draws on long-standing influences in clinical psychology, there has been an explosion of research in recent years following the development of intensive longitudinal data capture and statistical techniques that facilitate modeling of the dynamic processes of each individual's pathology. Advances are also making idiographic analyses scalable and generalizable. We review emerging research using the personalized approach in descriptive psychopathology, precision assessment, and treatment selection and tailoring, and we identify future challenges and areas in need of additional research. The personalized approach to psychopathology holds promise to resolve thorny diagnostic issues, generate novel insights, and improve the timing and efficacy of interventions.
The construct of narcissism is inconsistently defined across clinical theory, social-personality psychology, and psychiatric diagnosis. Two problems were identified that impede integration of ...research and clinical findings regarding narcissistic personality pathology: (a) ambiguity regarding the assessment of pathological narcissism vs. normal narcissism and (b) insufficient scope of existing narcissism measures. Four studies are presented documenting the initial derivation and validation of the Pathological Narcissism Inventory (PNI). The PNI is a 52-item self-report measure assessing 7 dimensions of pathological narcissism spanning problems with narcissistic grandiosity (Entitlement Rage, Exploitativeness, Grandiose Fantasy, Self-sacrificing Self-enhancement) and narcissistic vulnerability (Contingent Self-esteem, Hiding the Self, Devaluing). The PNI structure was validated via confirmatory factor analysis. The PNI correlated negatively with self-esteem and empathy, and positively with shame, interpersonal distress, aggression, and borderline personality organization. Grandiose PNI scales were associated with vindictive, domineering, intrusive, and overly-nurturant interpersonal problems, and vulnerable PNI scales were associated with cold, socially avoidant, and exploitable interpersonal problems. In a small clinical sample, PNI scales exhibited significant associations with parasuicidal behavior, suicide attempts, homicidal ideation, and several aspects of psychotherapy utilization.
The Hierarchical Taxonomy of Psychopathology (HiTOP) is a scientific effort to address shortcomings of traditional mental disorder diagnoses, which suffer from arbitrary boundaries between ...psychopathology and normality, frequent disorder co‐occurrence, heterogeneity within disorders, and diagnostic instability. This paper synthesizes evidence on the validity and utility of the thought disorder and detachment spectra of HiTOP. These spectra are composed of symptoms and maladaptive traits currently subsumed within schizophrenia, other psychotic disorders, and schizotypal, paranoid and schizoid personality disorders. Thought disorder ranges from normal reality testing, to maladaptive trait psychoticism, to hallucinations and delusions. Detachment ranges from introversion, to maladaptive detachment, to blunted affect and avolition. Extensive evidence supports the validity of thought disorder and detachment spectra, as each spectrum reflects common genetics, environmental risk factors, childhood antecedents, cognitive abnormalities, neural alterations, biomarkers, and treatment response. Some of these characteristics are specific to one spectrum and others are shared, suggesting the existence of an overarching psychosis superspectrum. Further research is needed to extend this model, such as clarifying whether mania and dissociation belong to thought disorder, and explicating processes that drive development of the spectra and their subdimensions. Compared to traditional diagnoses, the thought disorder and detachment spectra demonstrated substantially improved utility: greater reliability, larger explanatory and predictive power, and higher acceptability to clinicians. Validated measures are available to implement the system in practice. The more informative, reliable and valid characterization of psychosis‐related psychopathology offered by HiTOP can make diagnosis more useful for research and clinical care.
Continuous measurement systems provide a means of measuring dynamic behavioral and experiential processes as they play out over time. DARMA is a modernized continuous measurement system that ...synchronizes media playback and the continuous recording of two-dimensional measurements. These measurements can be observational or self-reported and are provided in real-time through the manipulation of a computer joystick. DARMA also provides tools for reviewing and comparing collected measurements and for customizing various settings. DARMA is a domain-independent software tool that was designed to aid researchers who are interested in gaining a deeper understanding of behavior and experience. It is especially well-suited to the study of affective and interpersonal processes, such as the perception and expression of emotional states and the communication of social signals. DARMA is open-source using the GNU General Public License (GPL) and is available for free download from
http://darma.jmgirard.com
.
Theories of narcissism emphasize the dynamic processes within and between grandiosity and vulnerability. Research seeking to address this has either not studied grandiosity and vulnerability together ...or has used dispositional measures to assess what are considered to be momentary states. Emerging models of narcissism suggest grandiosity and vulnerability can further be differentiated into a three-factor structure-Exhibitionistic Grandiosity, Entitlement, and Vulnerability. Research in other areas of maladaptive personality (e.g., borderline personality disorder) has made headway in engaging data collection and analytic methods that are specifically meant to examine such questions. The present study took an exploratory approach to studying fluctuations within and between grandiose and vulnerable states. Fluctuations-operationalized as gross variability, instability, and lagged effects-were examined across three samples (two undergraduate and a community sample oversampled for narcissistic features; total person N = 862, total observation N = 36,631). Results suggest variability in narcissistic states from moment to moment is moderately associated with dispositional assessments of narcissism. Specifically, individuals who are dispositionally grandiose express both grandiosity and vulnerability, and vary in their overall levels of grandiosity and vulnerability over time. On the other hand, dispositionally vulnerable individuals tend to have high levels of vulnerability and low levels of grandiosity. Entitlement plays a key role in the processes that underlie narcissism and narcissistic processes appear unique to the construct and not reflective of broader psychological processes (e.g., self-esteem). Future research should consider using similar methods and statistical techniques on different timescales to study dynamics within narcissism.
Narcissism Today: What We Know and What We Need to Learn Miller, Joshua D.; Back, Mitja D.; Lynam, Donald R. ...
Current directions in psychological science : a journal of the American Psychological Society,
12/2021, Volume:
30, Issue:
6
Journal Article
Peer reviewed
Narcissism is of great interest to behavioral scientists and the lay public. Research across the past 20 years has led to substantial progress in the conceptualization, measurement, and study of ...narcissism. This article reviews the current state of the field, identifying recent advances and outlining future directions. Advances include hierarchical conceptualizations of narcissism across one-factor (narcissism), two-factor (grandiose vs. vulnerable narcissism), and three-factor (agentic extraversion, antagonism, narcissistic neuroticism) levels; the development of measures to assess the components of narcissism; clarification of the relations between narcissism and self-esteem; an understanding of the behavioral and motivational dynamics underlying narcissistic actions and social outcomes; and insight regarding potential fluctuations between narcissistic states. Future directions point in general to increased research using the lower levels of the narcissism hierarchy, especially the three-factor level. At this level, more research on the etiology, heritability, stability, and centrality of the three components is required.
Objective: Mindfulness interventions have been shown to reduce stress; however, the mechanisms driving stress resilience effects are not known. Mindfulness interventions aim to teach individuals how ...to: (a) use attention to monitor present moment experiences; with (b) an attitude of acceptance and equanimity. A randomized controlled dismantling trial (RCT) was conducted to test the prediction that the removal of acceptance skills training would eliminate stress-reduction benefits of a mindfulness intervention. Method: This preregistered RCT randomly assigned stressed community adults to 1 of 3 conditions: (a) Monitor and Accept (MA) mindfulness training, a standard 8-week Mindfulness-Based Stress Reduction (MBSR) intervention that provided explicit instruction in developing both monitoring and acceptance skills; (b) Monitor Only (MO) mindfulness training, a well-matched 8-week MBSR intervention that taught monitoring skills only; or (c) No Treatment (NT) control. Stress and nonjudgment were measured using ecological momentary assessment (EMA) for 3 days at baseline and 3 days at postintervention. Results: Consistent with predictions, MA participants increased in nonjudgment and decreased in both stress ratings and the proportion of assessments that they reported experiencing feelings of stress in daily life, relative to both MO and NT participants. Conclusions: This RCT provides one of the first experimental tests of the mechanisms linking mindfulness interventions with stress resilience. These findings suggest that acceptance skills training may be a necessary active ingredient and support the value of integrating acceptance skills training into stress-reduction interventions.
Traditional diagnostic systems went beyond empirical evidence on the structure of mental health. Consequently, these diagnoses do not depict psychopathology accurately, and their validity in research ...and utility in clinicalpractice are therefore limited. The Hierarchical Taxonomy of Psychopathology (HiTOP) consortium proposed a model based on structural evidence. It addresses problems of diagnostic heterogeneity, comorbidity, and unreliability. We review the HiTOP model, supporting evidence, and conceptualization of psychopathology in this hierarchical dimensional framework. The system is not yet comprehensive, and we describe the processes for improving and expanding it. We summarize data on the ability of HiTOP to predict and explain etiology (genetic, environmental, and neurobiological), risk factors, outcomes, and treatment response. We describe progress in the development of HiTOP-based measures and in clinical implementation of the system. Finally, we review outstanding challenges and the research agenda. HiTOP is of practical utility already, and its ongoing development will produce a transformative map of psychopathology.
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