Importance Conceptualizing mental disorders as latent entities has been challenged by the network theory of mental disorders, which states that psychological problems are constituted by a network of mutually interacting symptoms. While the implications of the network approach for planning and evaluating treatments have been intensively discussed, empirical support for the claims of the network theory regarding treatment effects is lacking. Objective To assess the extent to which specific hypotheses derived from the network theory regarding the (interindividual) changeability of symptom dynamics in response to treatment align with empirical data. Design, Setting, and Participants This secondary analysis entails data from a multisite randomized clinical trial, in which 254 patients with chronic depression reported on their depressive symptoms at every treatment session. Data collection was conducted between March 5, 2010, and October 14, 2013, and this analysis was conducted between November 1, 2021, and May 31, 2022. Intervention Thirty-two sessions of either disorder-specific or nonspecific psychotherapy for chronic depression. Main Outcomes and Measures Longitudinal associations of depressive symptoms with each other and change of these associations through treatment estimated by a time-varying longitudinal network model. Results In a sample of 254 participants (166 [65.4%] women; mean [SD] age, 44.9 [11.9] years), symptom interactions changed through treatment, and this change varied across treatments and individuals. The mean absolute (ie, valence-ignorant) strength of symptom interactions (logarithmic odds ratio scale) increased from 0.40 (95% CI, 0.36-0.44) to 0.60 (95% CI, 0.52-0.70) during nonspecific psychotherapy and to 0.56 (95% CI, 0.48-0.64) during disorder-specific psychotherapy. In contrast, the mean raw (ie, valence-sensitive) strength of symptom interactions decreased from 0.32 (95% CI, 0.28-0.36) to 0.26 (95% CI, 0.20-0.32) and to 0.09 (95% CI, 0.02-0.16), respectively. Changing symptom severity could be explained to a large extent by symptom interactions. Conclusions and Relevance These findings suggest that specific treatment-related hypotheses of the network theory align well with empirical data. Conceptualizing mental disorders as symptom networks and treatments as measures that aim to change these networks is expected to give further insights into the working mechanisms of mental health treatments, leading to the improvement of current and the development of new treatments. Trial Registration ClinicalTrials.gov Identifier: NCT00970437.

中文翻译：

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网络理论对精神障碍治疗的启示：随机临床试验的二次分析。

将精神障碍概念化为潜在实体受到了精神障碍网络理论的挑战，该理论认为心理问题是由相互相互作用的症状网络构成的。虽然网络方法对规划和评估治疗的影响已经得到深入讨论，但网络理论关于治疗效果的主张缺乏实证支持。目的 评估从网络理论得出的有关治疗反应症状动态（个体间）可变性的具体假设与经验数据的一致程度。设计、环境和参与者 这项二次分析需要来自多中心随机临床试验的数据，其中 254 名慢性抑郁症患者在每次治疗期间报告了他们的抑郁症状。数据收集是在2010年3月5日至2013年10月14日之间进行的，该分析是在2021年11月1日至2022年5月31日之间进行的。 干预 针对慢性抑郁症进行32次针对障碍的特异性或非特异性心理治疗。主要结果和措施抑郁症状相互之间的纵向关联以及通过时变纵向网络模型估计的治疗改变这些关联。结果 在 254 名参与者（166 [65.4%] 女性；平均 [SD] 年龄，44.9 [11.9] 岁）的样本中，症状相互作用因治疗而发生变化，并且这种变化因治疗和个体而异。在非特异性心理治疗期间，症状相互作用的平均绝对（即价无知）强度（对数比值比量表）从 0.40（95% CI，0.36-0.44）增加到 0.60（95% CI，0.52-0.70），并增加到 0.56（ 95% CI, 0.48-0.64) 在针对特定疾病的心理治疗期间。相比之下，症状相互作用的平均原始（即效价敏感）强度从 0.32 (95% CI, 0.28-0.36) 下降至 0.26 (95% CI, 0.20-0.32) 和 0.09 (95% CI, 0.02-0.36)。 0.16），分别。症状严重程度的变化在很大程度上可以通过症状相互作用来解释。结论和相关性这些研究结果表明，网络理论的特定治疗相关假设与经验数据非常吻合。将精神障碍概念化为症状网络，将治疗概念化为旨在改变这些网络的措施，有望进一步深入了解精神健康治疗的工作机制，从而改进现有治疗方法并开发新的治疗方法。试验注册 ClinicalTrials.gov 标识符：NCT00970437。