Resumo
A abordagem de rede oferece alternativa à concepção de transtornos psicológicos como doença latente. Transtornos psicológicos são então, conceitualizados como redes de interação causal de sintomas. A análise de rede permite uma visão única do sistema do indivíduo, obtida a partir de dados, em vez de categorização. Permite focar em intervenções específicas para relações de sintomas específicos, em vez de abordagens protocolares. Com o objetivo de oferecer um panorama atual sobre os estudos da abordagem de rede e apresentar as possíveis implicações na prática clínica, foi realizada uma revisão narrativa da literatura a partir das bases de dados Scopus e PubMed. Estudos buscaram construir redes de sintomas usando métodos de coleta de dados transversais e séries-temporais, permitindo analisar a centralidade do sintoma na rede inter/intra-individual, possibilitando elaborar intervenções específicas para cada paciente. Pesquisas sugerem que mudanças na conectividade dos sintomas, e a demora da reestabilização da rede de um indivíduo após uma perturbação, leva à mudança de um estado-saudável para um estado-patológico. Monitorar a dinâmica da rede pode antever recaídas, permitindo intervenção precoce nos sintomas-centrais. Em conclusão, as redes podem fornecer informações sobre mecanismos psicológicos específicos subjacentes ao desenvolvimento de transtornos psicológicos. Todavia, as pesquisas são preliminares e um consenso sobre o modelo de análise é necessário. Também precisa-se considerar quais tipos de variáveis devem ser incluídas nas redes psicopatológicas.
Referências
Anderson, T., Lunnen, K. M., & Ogles, B. M. (2010). Putting models and techniques in context. In B. L. Duncan, S. D. Miller, B. E. Wampold, & M. A. Hubble (Eds.), The heart and soul of change: Delivering what works in therapy (pp. 143–166). American Psychological Association. https://doi.org/10.1037/12075-005
Alvarenga, M. A. S., Flores-Mendoza, C. E., & Gontijo, D. F. (2009). Evolução do DSM quanto ao critério categorial de diagnóstico para o distúrbio da personalidade antissocial. Jornal Brasileiro de Psiquiatria, 58(4). https://doi.org/10.1590/S0047-20852009000400007
American Psychiatric Association. (2014). DSM-5: Manual diagnóstico e estatístico de transtornos mentais. Artmed Editora.
American Psychiatric Association. (1980). Diagnostic and Statistical Manual of Mental Disorders [3rd ed.]. American Psychiatric Association.
Barlow, D. H., Farchione, T. J., Bullis, J. R., Gallagher, M. W., Murray-Latin, H., Sauer-Zavala, S., ... & Ametaj, A. (2017). The unified protocol for transdiagnostic treatment of emotional disorders compared with diagnosis-specific protocols for anxiety disorders: A randomized clinical trial. JAMA psychiatry, 74(9), 875-884. https://doi.org/10.1001/jamapsychiatry.2017.2164
Borsboom, D., & Cramer, A. O. (2013). Network analysis: an integrative approach to the structure of psychopathology. Annual Review of Clinical Psychology, 9, 91-121. https://doi.org/10.1146/annurev-clinpsy-050212-185608
Borsboom, D. (2017). A network theory of mental disorders. World Psychiatry, 16(1), 5-13. https://doi.org/10.1002/wps.20375
Campbell, D. G., Felker, B. L., Liu, C. F., Yano, E. M., Kirchner, J. E., Chan, D., Rubenstein, L. V., & Chaney, E. F. (2007). Prevalence of depression-PTSD comorbidity: implications for clinical practice guidelines and primary care-based interventions. Journal of general internal medicine, 22(6), 711–718. https://doi.org/10.1007/s11606-006-0101-4
Chorpita, B. F., Daleiden, E. L., & Weisz, J. R. (2005). Identifying and selecting the common elements of evidence based interventions: A distillation and matching model. Mental health services research, 7(1), 5-20. https://doi.org/10.1007/s11020-005-1962-6
Easden, M. H., & Kazantzis, N. (2018). Case conceptualization research in cognitive behavior therapy: A state of the science review. Journal of clinical psychology, 74(3), 356-384. https://doi.org/10.1002/jclp.2251
Epskamp, S., Waldorp, L. J., Mõttus, R., & Borsboom, D. (2018). The Gaussian graphical model in cross-sectional and time-series data. Multivariate behavioral research, 53(4), 453-480. https://doi.org/10.1080/00273171.2018.1454823
Epskamp, S., van Borkulo, C. D., van der Veen, D. C., Servaas, M. N., Isvoranu, A. M., Riese, H., & Cramer, A. O. (2018). Personalized network modeling in psychopathology: The importance of contemporaneous and temporal connections. Clinical Psychological Science, 6(3), 416-427. https://doi.org/10.1177/2167702617744325
Flory, J. D., & Yehuda, R. (2015). Comorbidity between post-traumatic stress disorder and major depressive disorder: alternative explanations and treatment considerations. Dialogues in clinical neuroscience, 17(2), 141–150. https://doi.org/10.31887/DCNS.2015.17.2/jflory
Fried, E. I., van Borkulo, C. D., Cramer, A. O., Boschloo, L., Schoevers, R. A., & Borsboom, D. (2017). Mental disorders as networks of problems: a review of recent insights. Social Psychiatry and Psychiatric Epidemiology, 52(1), 1-10. https://doi.org/10.1007/s00127-016-1319-z
Fried, E. I., Eidhof, M. B., Palic, S., Costantini, G., Huisman-van Dijk, H. M., Bockting, C. L., ... & Karstoft, K. I. (2018). Replicability and generalizability of posttraumatic stress disorder (PTSD) networks: a cross-cultural multisite study of PTSD symptoms in four trauma patient samples. Clinical Psychological Science, 6(3), 335-351. https://doi.org/10.1177/2167702617745092
Guloksuz, S., Pries, L. K., & van Os, J. (2017). Application of network methods for understanding mental disorders: pitfalls and promise. Psychological Medicine, 47(16), 2743-2752. https://doi.org/10.1017/S0033291717001350
Hayes, S. C., Hofmann, S. G., Stanton, C. E., Carpenter, J. K., Sanford, B. T., Curtiss, J. E., & Ciarrochi, J. (2019). The role of the individual in the coming era of process-based therapy. Behaviour Research and Therapy, 117, 40-53. https://doi.org/10.1016/j.brat.2018.10.005
Hayes, S. C., & Hofmann, S. G. (Eds.). (2018). Process-based CBT: The science and core clinical competencies of cognitive behavioral therapy. New Harbinger Publications.
Hektner, J. M., Schmidt, J. A., & Csikszentmihalyi, M. (2007). Experience sampling method: Measuring the quality of everyday life. Sage Publications, Inc.
Hofmann, S. G., & Curtiss, J. (2018). A complex network approach to clinical science. European Journal of Clinical Investigation, 48(8), e12986. https://doi.org/10.1111/eci.12986
Hofmann, S. G., Curtiss, J., & McNally, R. J. (2016). A complex network perspective on clinical science. Perspectives on Psychological Science, 11(5), 597-605. https://doi.org/10.1177/1745691616639283
Insel, T., Cuthbert, B., Garvey, M., Heinssen, R., Pine, D. S., Quinn, K., ... & Wang, P. (2010). Research domain criteria (RDoC): toward a new classification framework for research on mental disorders. The American Journal of Psychiatric, 167(7), 748-751. https://doi.org/10.1176/appi.ajp.2010.09091379
Kuyken, W. (2006). Evidence-based case formulation: Is the emperor clothed? In N. Tarrier (Ed.), Case formulation in cognitive behavior therapy: The treatment of challenging and complex clinical cases (pp. 12–35). Brunner-Routledge.
Kuyken, W., Padesky, C. A., & Dudley, R. (2008). The science and practice of case conceptualization. Behavioural and Cognitive Psychotherapy, 36(6), 757-768. https://doi.org/10.1017/S1352465808004815
Langer, J. K., Tonge, N. A., Piccirillo, M., Rodebaugh, T. L., Thompson, R. J., & Gotlib, I. H. (2019). Symptoms of social anxiety disorder and major depressive disorder: A network perspective. Journal of Affective Disorders, 243, 531-538. https://doi.org/10.1016/j.jad.2018.09.078
Larson, R., & Csikszentmihalyi, M. (2014). The experience sampling method. In Flow and the foundations of positive psychology (pp. 21-34). Springer, Dordrecht.
Lutz, W., Schwartz, B., Hofmann, S. G., Fisher, A. J., Husen, K., & Rubel, J. A. (2018). Using network analysis for the prediction of treatment dropout in patients with mood and anxiety disorders: A methodological proof-of-concept study. Scientific Reports, 8(1), 7819. https://doi.org/10.1038/s41598-018-25953-0
Lyon, A. R., Lau, A. S., McCauley, E., Vander Stoep, A., & Chorpita, B. F. (2014). A case for modular design: Implications for implementing evidence-based interventions with culturally diverse youth. Professional Psychology: Research and Practice, 45(1), 57–66. https://doi.org/10.1037/a0035301
Martín-Brufau, R., Suso-Ribera, C., & Corbalán, J. (2020) Emotion Network Analysis During COVID-19 Quarantine ‐ A Longitudinal Study. Front. Psychol. 11, 559572. https://doi.org/10.3389/fpsyg.2020.559572
McNally, R. J. (2016). Can network analysis transform psychopathology? Behaviour Research and Therapy, 86, 95-104. https://doi.org/10.1016/j.brat.2016.06.006
Myin-Germeys, I., Kasanova, Z., Vaessen, T., Vachon, H., Kirtley, O., Viechtbauer, W., & Reininghaus, U. (2018). Experience sampling methodology in mental health research: new insights and technical developments. World Psychiatry, 17(2), 123-132. https://doi.org/10.1002/wps.20513
Nuijten, M. B., Deserno, M. K., Cramer, A. O. J., & Borsboom, D. (2016). Mental disorders as complex networks: An introduction and overview of a network approach to psychopathology. Clinical Neuropsychiatry: Journal of Treatment Evaluation, 13(4-5), 68–76.
Organização Mundial da Saúde. (1994). CID-10: Classificação Estatística Internacional de Doenças com disquete Vol. 1. Edusp.
Richetin, J., Preti, E., Costantini, G., & De Panfilis, C. (2017). The centrality of affective instability and identity in Borderline Personality Disorder: Evidence from network analysis. PloS one, 12(10), e0186695. https://doi.org/10.1371/journal.pone.0186695
Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: The evidence for what makes psychotherapy work. Routledge.
Wichers, M., Wigman, J. T., Bringmann, L. F., & de Jonge, P. (2017). Mental disorders as networks: some cautionary reflections on a promising approach. Social Psychiatry and Psychiatric Epidemiology, 52(2), 143-145. https://doi.org/10.1007/s00127-016-1335-z
Este trabalho está licenciado sob uma licença Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright (c) 2022 Gabriel Talask, Vinicius Lemos, Rafael da Costa, Antonio Egidio Nardi, Marcele de Carvalho