Head: Univ.-Prof. Dr. Günter Schiepek

On 1 June 2009, what had previously been a program for research in synergetics, neuroscience, and therapy research, achieved official recognition as a research institute at the Paracelsus Medical University Salzburg and is now known as the Institute of Synergetics and Psychotherapy Reserach. It is attached to the University Clinic for Psychiatry and Psychotherapy I (Head: Univ.-Prof. Dr. Christoph Stuppäck) of the University Hospital Salzburg.

The Institute is lead by Univ.-Prof. Dr. Günter Schiepek. Management positions within the Institute are held as follows: Univ.-Doz. Dr. Wolfgang Aichhorn (clinic and research), Prim HR Univ.-Doz. Dr. Reinhold Fartacek (research in suicide prevention), Univ.-Doz. Dr. Stefan Golaszewski (research with a focus on functional imaging), MR Dr. Wilfried Leeb (training and clinics with a focus on SNS), Dr. Markus Schwarz (economics and management).

Doctoral students, postdoctoral associates and research associates are currently: Mag. Elisabeth Adleff (PhD student), Prof. Dr. Wolfgang Eberling, Dr. Heiko Eckert, Mag. Clemens Fartacek (PhD student), Dr. Karl Kralovec, Dr. Manfred Lambertz, Mag. Mag. Gabriele Maurer (PhD student), Mag. Josef Sturm (PhD student).


                                                      

Objectives and Profile

• The Institute is involved in process and outcome research in psychotherapy, rehabilitation and other forms of therapy in the field of psychiatric and psychosomatic disorders and psychosocial stress. It also covers research in the fields of education and training, supervision and coaching, as well as the dynamics of health institutions (e.g. employee health projects, organizational development in hospitals and health facilities).
   
• The scientific paradigm is committed to the theory and methodology of complex, dynamic systems. The self-organization of complex systems plays a significant role, i.e. the collection and modeling of dynamic processes of complex systems and their change (order transitions), in particular as to how they are theoretically defined by synergetics and modeled mathematically. The Institute uses methods of linear and non-linear time series analysis, connectivity and synchronization analysis of system components or sub-systems, but also classical statistics (e.g. for purposes of treatment evaluation). The Institute is active in the development and application of theories and methods aswell as in the transfer of methods (e.g., from physics to human sciences).
   
• The Institute is committed to a bio-psycho-social approach. This involves understanding biological (especially neurobiological), psychological and social processes and its interrelations. This includes quantitative and qualitative data collection (measurement), processing and analysis, visualization, and theoretical modeling of data (e.g. by computer simulation). Functional imaging of neuronal self-organization processes plays an important role in psychotherapy.
   
• The Institute is working on the development of methods. It sets itself the task of developing and applying innovative methods of data collection and data analysis for the purpose of basic research in psychology, psychiatry and psychotherapy. One example is the Synergetic Navigation System, which is exhaustively tested in practical and scientific implementations and is also further developed and modified to applications in new fields (e.g., suicide prevention, internet therapy, couple and family therapy). The Institute serves as a coordination center for national and international projects in psychotherapy research. A database and a network of experts will be made available for the purpose of research in the area of the SNS ("The Human Change Project"). Meetings, conferences and seminars are organized.  
  
  
• The Institute pursues objectives in the field of basic research, i.e. theory development, theory evaluation and research, as well as in the field of application and technology transfer. It offers education and training programs for doctors and psychotherapists, which includes training for users of the Synergetic Navigation System. The main target is to offer a complete training in psychotherapy (scientist-practitioner model) with a focus on synergetics and neuroscience, resulting in a recognized professional qualification.

Research Projects

Process Monitoring and Feedback Using Synergetic Navigation System in Inpatient Psychotherapy
In addition to being applied in different diagnostic areas (depression, anxiety disorders, personality disorders, PTSD) the SNS is being tested as a feedback tool in the psychological and medical treatment of patients. It explores the best way in which data-based therapy management can be carried out in practice. Database: Daily input of data from the Therapy Process Questionnaire and written comments. Outcome measurements (pre-post comparisons or weekly evaluations, e.g. by ICD-10-based symptom rating [ISR]) or (Depression Anxiety Stress Scale 21 [DASS 21]). Further measurements are currently implementet to the SNS.

By drawing on procedural characteristics, therapeutic effects can be seen (the process patterns include: change of motivation, emotional experience, stability before and during critical instabilities, extent of local (i.e. temporary) instabilities during therapeutic order transitions, and others). To predict the outcome (criterion) variables CHAID analysis and multiple linear and non-linear regression models are used. Head: Univ.-Doz. Dr. Wolfgang Aichhorn, MR Dr. Leeb Wilfried, Univ.-Prof. Dr. Günter Schiepek

Development of the SNS and the Development of the IA-Matrix
Within a new development step of the SNS, additional features of the system are implemented (permutation entropy, upgraded and improved imaging, traffic light function for generic principles, enhanced synopsis, accelerated performance, simplified using, further outcome questionnaires, free configuration of additional items to the TPQ, etc.)

An internet-based interaction pattern analysis system is developed for applications in couple therapy, family therapy, team development, organizational analysis, etc.

Neurobiology of non-linear processes in the psychotherapy of obsessive-compulsive disorder - Repeated functional imaging (fMRI) and Computer-Process Monitoring
The project started in November 2005 and has now completed its data collection phase. We included 9 patients and 9 healthy controls matched by sex, age, and education level. Patients were diagnosed as Obesessive-Compulsive Disorder (OCD) of the subtype "washing / contamination fear" without co-morbidity and medication. A single case study hase already been published in the World Journal of Biological Psychiatry. An overall evaluation of the data is currently taking place. The project is supported by a grant from the Austrian National Bank with 65,000 Euro and the German Society of Systemic and Family Therapy.

Research questions and hypotheses are:

1. Can the finding that psychotherapy is characterized by non-linear processes with discontinuous transitions between dynamic patterns (process models) and by critical instabilities during transitions be replicated in the treatment of OCD? Are there any correlations between these procedural characteristics and the outcome of treatment?
2. Do the expected destabilization processes correspond to certain neural correlates? In particular: Are there differences between phases of instability and stability in brain dynamics? (Data basis: repeated fMRI scans during the course of treatment) 
3. Does successful treatment correspond to changing neuronal activation patterns? (Database: fMRI measurements at the beginning and end of treatment)

Critical instabilities manifest themselves in an increase of chaotic patterns in the system dynamics (increased high-entropic but coherent fluctuations). The construct of instability is measured on the basis of daily self-ratings (real-time monitoring) and is measured by an increase in frequency and amplitude of the resulting time series, as well as by the broader distribution of ratings on the scale range.

Based on information from the SNS, repeated (i.e. 3-4) fMRI scans were realized during the course of treatment. The involvement of other brain regions is expected to occur during phases of critical instability, as this takes place during stable manifestations of the disorder. If increased motivation for change, as well as processes of cognitive-emotional re-evaluation and the occurrence of ambiguity are expected during periods of instability, activations in the anterior cingulated cortex (ACC), in the nucleus accumbens, possibly also in the prefrontal cortex, in the insula, in the amygdala, as well as in cortical parietal regions should be recognizable in addition to the neuronal activity specific to the disorder itself (e.g. striato-fronto-thalamo-frontal feedback loops). The stimulation paradigm (visual symptom provocation) consisted of the presentation of 30 digital images of individual objects and situations provoking compulsive thoughts and behavior, compared to 30 standardized disgust provoking pictures (taken from the IAPS), and to 30 standardized neutral pictures (from the IAPS).

The project is being implemented in collaboration with the University Clinic of Psychiatry and Psychotherapy (Ludwig-Maximilians-University Munich, Dr. Susanne Karch, Univ.-Doz. Dr. Oliver Pogarell), the Psychosomatic Clinic Windach (Univ.-Prof. Dr. Michael Zaudig, Dr. Igor Tominschek) and the Medical University of Vienna (Department of Psychiatry, AO. Univ.-Prof. Dr. Martin Aigner, Dr. Markus Dold, Dr. Annemarie Unger, Univ.-Prof. Gerhard Lenz] and the Center of Excellence for High-Field MR [Univ.-Prof. Dr. Ewald Moser, Dr. Christian Windischberger).

Suicide Prevention and Dynamic Analysis of Chronical Suicidality of Patients after Hospital Discharge using an internet-based Method (SNS)
The patients of the Special Assignment Unit (Sonderauftrag) for Suicide Prevention of the Christian Doppler University Clinic Salzburg, are continuing with the collection of internet-based data beyond their inpatient stay. SNS-based data collection enables modeling of chronic suicidality as a dynamic disease. The SNS is used as a diagnostic tool for determining the patient’s state of mental health and risk of suicide. It is accompanied by repeated telephone contacts with the patients.

Subproject 1: Assessment of the dynamics of suicidality in high-risk patients
Subproject 2: Suicide prevention through mountaineering.

Head: Prim. HR Univ.-Doz. Dr. Reinhold Fartacek. Involved: Mag. Clemens Fartacek, Dr. Karl Královec, Dr. Martin Plöderl, Mag. Josef Sturm, Univ.-Prof. Dr. Günter Schiepek.

Projects in Planning:

Process Monitoring and Repeated fMRI of Psychotherapy in Depressed Patients under Additional Consideration of the Neuro-plasticity (Gene Marker CREB)

This project uses the experiences of the project for process-monitoring and repeated functional brain imaging in obsessive-compulsive disorders. The plan is to include 20 patients diagnosed with "major depression" undergoing inpatient psychotherapeutic treatment, and 20 matched healthy control subjects. In addition to repeated outcome measurements (e.g. weekly DASS 21) and pre-post evaluation, including 1-year follow-up (ISR, SCL-90, Inconsistency-Questionnaire, PHQ, quality of life and resources evaluation), daily patient process monitoring (Therapy Process Questionnaire) will be performed. In addition to pre-post measurements by fMRI, at least two additional fMRI scans will be carried out relating to specific stable or unstable phases of the therapeutic activity (as with control subjects at identical time intervals). Stimulation paradigm: Script driven or pictures following individual scheme analysis or OPD, representing self-related contents.

The project will comprise two further characteristics: Markers of neuronal gene expression (CREB) are collected on a weekly basis, which should indicate the specific neuronal plasticity during the treatment process. This technology is based on studies of the reserach group of Univ.-Prof. Dr. Aldenhoff (Kiel).

In addition, the fMRI data should not only to be processed within a localization paradigm, but in view of the involved networks between relevant brain regions and their system dynamics (effective connectivity). Dynamic Causal Modeling (DCM) analysis is used here.

The hypotheses to be tested relate to the connection between therapeutic effects and (a) the subjective therapy dynamics and their nonlinear properties, in particular the patients’ self-related experiences, (b) the dynamics of neural systems in the course of therapy (DCM of repeated fMRI measurements), and (c) the changes in gene expression (CREB).

Univ.-Prof. Dr. Günter Schiepek, Univ.-Doz. Dr. Stephan Golaszewski, Prim. Univ.-Doz. Dr. Wolfgang Aichhorn, MR Dr. Wilfried Leeb. Cooperation with the work group of Univ.-Prof. Dr. Josef Aldenhoff at the University Clinic of Psychiatry in Kiel, and Univ.-Prof. Dr. Georg Northoff (Brain Research Center Ottawa, Canada).

The Human Change Project
The application of the Synergetic Navigation System in cooperation with different treatment centers and hospitals opens up new opportunities for coordinated research on how psychotherapy works. Process and outcome data are routinely collected in various facilities, thus providing comprehensive data of frequent monitoring of a distinct variety of disturbances, which ultimately result in a multitude of treatment scenarios within a short period of time. These records are of course anonymous (in accordance with data protection act) and will be systemized, stored and made available for further scientific analysis (secondary analysis).

Process Diagnostics for Internet Therapies
International experience shows that internet therapies are (a) easily accessible for therapy-seekers, thus playing an important role in early treatment and subsequent prevention of chronic mental illness, and (b) are effective. The SNS contains a blogging function within which internet-therapy can be carried out. Specific frequently recurring topics and current content of the patients’ entries (diary function of the SNS) are analyzed. The SNS offers an ideal opportunity for process-oriented diagnostics accompanying internet- therapy, which therapists and patients alike can access during chats on the computer.

Psychotherapy Sciences Course
This planned degree course is conceptualized as a consecutive master’s degree, meaning a bachelor’s degree followed by a master’s degree. The qualification gained also counts as a professional qualification in psychotherapy. Owing to this, the course fulfils the Austrian criteria required by the preparatory course (Propädeutikum) and spezialization (Fachspezifikum).

• Annual conference "Obsessive-Compulsive Disorder" at the LMU Munich, September 2009
  The Institute is co-organizer of the next annual conference in research and treatment of obsessive-compulsive disorders. The conference will be held annually by the German Society of Obsessive-Compulsive Disorders. In 2009, the conference will be held by the Psychosomatic Clinic Windach (Univ.-Prof. Dr. Michael Zaudig) together with the LMU Munich (University Clinic for Psychiatry and Psychotherapy) and the German Tourette's Society at the University Clinic of Munich (Nussbaumstr. 7).  

Synergetic Navigation System 

The Synergetic Navigation System (SNS) is an internet-based method for mapping processes of change. It enables the collection, visualization and analysis of data recorded during ongoing psychotherapy processes. The method also allows for the collection of data from other processes such as social or medical rehabilitation, training and skills learning, counseling and supervision, the effects of medication and the development of health care and team dynamics.

The temporal resolution of data (possible with any PC or handy with internet access), as well as the implemented questionnaires can be selected by users. Daily assessments have proven to be very useful in psychotherapy. A special questionnaire investigating the therapy procedure has been developed for both inpatients and outpatients (Therapy Process Questionnaire). In addition to quantitative data, short notes (diary entries) may also be collected. The combination of qualitative and quantitative data yields complex and comprehensive results.

Some examples:

• Presentation of an item on a 7-step Likert-scale
• Presentation of an item on a visual analogue scale. The SNS enables process feedback at the time of the activity. It is a real-time monitoring, which enables evidence-based treatments and therapies.
• Presentation of raw scores in a window also featuring entry date and personal comments. The analysis methods implemented by the SNS have been specifically developed to assess the features of self-organization processes, i.e. transitions of patterns and attractors in complex systems, critical instabilities, changes in synchronization between subsystems, and other features.
• Complexity resonance diagram This shows when transitions occur and what aspects of experience (i.e. subscales of the questionnaire) are involved. Items are color-coded (blue = 0, red = maximum value) and plotted according to dynamic complexity. Yellow to red areas represent high fluctuations in the respective time series.
• Variable synchronization pattern. This presents color-coded visualizations of correlations between survey items in a particular time frame or between different persons involved in a system.
• Synopsis of recurrence plot (above picture), complexity resonance diagram (middle picture) and synchronization course (picture below) of a psychotherapeutic process. All three processes give different methodological perspectives and results regarding transitions during therapy. Changes can be more easily generated in areas of pronounced instability. Destabilization must always be offset by stability. (picture in progress:)

The SNS offers further features in addition to real-time analysis:

• Electronic patient records and basic documentation for psychotherapy
• Effect and outcome measurement (DASS 21, ISR, Y-BOCS, symptom rating based on TPQ)
• Blogging. This is a closed chat room, which enables therapists to remain in contact with their patients when they are not in inpatient care and facilitates communication between therapy sessions. Blogging is also a practical form of communication for project partners and intervision activities.

• Schiepek G, Eckert H, Bauhofer C, Weihrauch S (2008). Diagnostik dynamischer Systeme. In Röhrle B, Caspar F, Schlottke PF (Hrsg). Lehrbuch der klinisch-psychologischen Diagnostik (S. 201-223). Stuttgart: Kohlhammer.
• Schiepek G (2008). Psychotherapy as evidence-based process management: a contribution to professionalism beyond the standard model. Kairos – The Slovenian Journal of Psychotherapy, 2(1-2), 9-21.
• Schiepek G (2008). Integration in der Psychotherapie – Was kann die Neurobiologie leisten? Welche Kriterien sollte eine Integration erfüllen? Wie sieht eine Integration auf der Basis der Synergetik aus? Integrative Therapie, 34(1/2), 77-98.
• Schiepek G, Rufer M (2008). Systemische Therapie – eine wissenschaftliche, evidenzbasierte und bio-psycho-soziale Methodologie. Familiendynamik, 33(4), 353-356.
• Schiepek G, Tominschek I, Karch S, Lutz J, Mulert C, Meindl T, Pogarell O (e-published Sept 2008; print journal in press). A controlled single case study with repeated fMRI measures during the treatment of a patient with obsessive-compulsive disorder: Testing the nonlinear dynamics approach to psychotherapy. World Journal of Biological Psychiatry, DOI: 10.1080/15622970802311829
• Tominschek I, Schiepek G, Mehl C, Maier K, Heinzel S, Bauhofer C, Berbic B, Zaudig M (2008). Real-Time Monitoring in der Behandlung von Zwangsstörungen: Technologie und Fallbeispiel. Verhaltenstherapie, 18(3), 146-152.
• Schiepek G. Psychotherapie als evidenzbasiertes Prozessmanagement. Ein Beitrag zur Professionalisierung jenseits des Standardmodells. Nervenheilkunde, 27(12), 1138-1146.
• Schiepek, G. (2009). Systemische Neurowissenschaften und systemische Therapie. In R. Hanswille (Hrsg.), Systemische Hirngespinste (S. 34-62). Göttingen: Vandenhoeck & Ruprecht.
• Schiepek, G. (2009). Complexity and Nonlinear Dynamics in Psychotherapy. European Review, 17(2), 331-356.
• Schiepek, G. & Perlitz, V. (in press). Self-organization in clinical psychology. In R.A. Meyers (Ed.) Encyclopedia of Complexity and Systems Science. Heidelberg New York: Springer
  Walter S, Schiepek G, Schneider S, Strunk G, Kaimer P, Mergenthaler E (in press). The synchronization of plan activations and emotion-abstraction-patterns in the process of psychotherapy. A single case study. Psychotherapy Research
• Schiepek, G. & Strunk, G. (submitted). The identification of critical fluctuations and phase transitions in short term and coarse-grained time series – a method for the real-time monitoring of human change processes. Biological Cybernetics
• Dold M, Unger A, Demel U, Lenz G, Schiepek G, Aigner M, Laurenceau, JP, Hayes AM (submitted). Internet-based real-time monitoring in the psychotherapy of OCD – a nonlinear dynamic systems approach. Journal of Consulting and Clinical Psychology
• Golaszewski S, Höller Y, Klein S, Krombichler M, Schiepek G (submitted). FMRT in der Psychiatrie. Ein Review. Neuropsychiatrie
• Heinzel S, Schiepek G, Tominschek I (in prep.). Revisiting the role of flooding: Order transitions and critical instabilities during psychotherapy of obsessive compulsive disorder. J Exp Psychiatry

Recent book publications

• Haken H, Schiepek G. Synergetik in der Psychologie. Selbstorganisation verstehen und gestalten. Göttingen: Hogrefe, 2006.
• Strunk G, Schiepek G. Systemische Psychologie. Einführung in die komplexen Grundlagen menschlichen Verhaltens. Heidelberg: Spektrum Akademischer Verlag, 2006.
• Tominschek I, Schiepek G. Zwangsstörungen. Ein systemisch-integratives Behandlungskonzept. Göttingen: Hogrefe, 2007.

Available for download:

• Schiepek, G. (2009). Complexity and Nonlinear Dynamics in Psychotherapy. European Review, 17(2), 331-356.
• Schiepek G. Psychotherapie als evidenzbasiertes Prozessmanagement. Ein Beitrag zur Professionalisierung jenseits des Standardmodells. Nervenheilkunde, 27(12), 1138-1146.
• Perlitza, V., Cotuk, B., Lambertz, M., Grebe, R., Schiepek, G., Petzold, E. R., Schmid-Schönbein, H., Flatten, G.. Coordination dynamics of circulatory and respiratory rhythms during psychomotor drive reduction. Autonomic Neuroscience: Basic and Clinical 115 (2004) 82– 93.
• Schiepek, G., Tominschek, I., Karch, S., Mulert, C., Pogarell, O. Neurobiologische Korrelate der Zwangsstörungen  - Aktuelle Befunde zur funktionellen Bildgebung. Neuroimaging and the Neurobiology of Obsessive−Compulsive Disorder. Psychother Psych Med (2006).
• Schiepek G, Tominschek I, Karch S, Lutz J, Mulert C, Meindl T, Pogarell O (e-published Sept 2008; print journal in press). A controlled single case study with repeated fMRI measures during the treatment of a patient with obsessive-compulsive disorder: Testing the nonlinear dynamics approach to psychotherapy. World Journal of Biological Psychiatry, DOI: 10.1080/15622970802311829
• Schiepek, G. Die neuronale Selbstorganisation des Selbst. Ein Beitrag zum Verhältnis von neuronalen und mentalen Prozessen aus Sicht der Synergetik

An extensive text book entitled Neurobiology of Psychotherapy (ed. G. Schiepek Schattauer Verlag Stuttgart ) is in preparation.

• In 2006, a research application to the Jubilee Fund of the Austrian National Bank the amount of 65,000 Euros was granted. Funding will serve the project "Neurobiology and Nonlinear Dynamics of Psychotherapeutic Processes on the Example of Obsessive Compulsive Disorder"
• Applications to the Dt. Gesellschaft für Familientherapie and Systemische Therapie (DGSF) amounting to 15,000 Euros in the years 2008 and 2009, were approved.
• EU application: A personal health system for people suffering from Seasonal Affective Disorder (SAD). Seventh Framework Program Call FP7-ICT-2009-4, in cooperation with Bartenbach Lichtlabor (Oetz, Austria), Medical University Vienna (Austria), Conrad Caine Media Applications (Germany), National Institute for Health and Welfare (Finland)
• RISE and individual applications to the PMU are being worked on. A combined FFW and DFG application is also planned.