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Every action we perform, no matter how simple or complex, has a cognitive representation. It is commonly assumed that these are organized hierarchically. Thus, the representation of a complex action consists of multiple simpler actions. The representation of a simple action, in turn, consists of stimulus, response, and effect features. These are integrated into one representation upon the execution of an action and can be retrieved if a feature is repeated. Depending on whether retrieved features match or only partially match the current action episode, this might benefit or impair the execution of a subsequent action. This pattern of costs and benefits results in binding effects that indicate the strength of common representation between features. Binding effects occur also in more complex actions: Multiple simple actions seem to form representations on a higher level through the integration and retrieval of sequentially given responses, resulting in so-called response-response binding effects. This dissertation aimed to investigate what factors determine whether simple actions form more complex representations. The first line of research (Articles 1-3) focused on dissecting the internal structure of simple actions. Specifically, I investigated whether the spatial relation of stimuli, responses, or effects, that are part of two different simple actions, influenced whether these simple actions are represented as one more complex action. The second line of research (Articles 2, 4, and 5) investigated the role of context on the formation and strength of more complex action representations. Results suggest that spatial separation of responses as well as context might affect the strength of more complex action representations. In sum, findings help to specify assumptions on the structure of complex action representations. However, it may be important to distinguish factors that influence the strength and structure of action representations from factors that terminate action representations.
There is no longer any doubt about the general effectiveness of psychotherapy. However, up to 40% of patients do not respond to treatment. Despite efforts to develop new treatments, overall effectiveness has not improved. Consequently, practice-oriented research has emerged to make research results more relevant to practitioners. Within this context, patient-focused research (PFR) focuses on the question of whether a particular treatment works for a specific patient. Finally, PFR gave rise to the precision mental health research movement that is trying to tailor treatments to individual patients by making data-driven and algorithm-based predictions. These predictions are intended to support therapists in their clinical decisions, such as the selection of treatment strategies and adaptation of treatment. The present work summarizes three studies that aim to generate different prediction models for treatment personalization that can be applied to practice. The goal of Study I was to develop a model for dropout prediction using data assessed prior to the first session (N = 2543). The usefulness of various machine learning (ML) algorithms and ensembles was assessed. The best model was an ensemble utilizing random forest and nearest neighbor modeling. It significantly outperformed generalized linear modeling, correctly identifying 63.4% of all cases and uncovering seven key predictors. The findings illustrated the potential of ML to enhance dropout predictions, but also highlighted that not all ML algorithms are equally suitable for this purpose. Study II utilized Study I’s findings to enhance the prediction of dropout rates. Data from the initial two sessions and observer ratings of therapist interventions and skills were employed to develop a model using an elastic net (EN) algorithm. The findings demonstrated that the model was significantly more effective at predicting dropout when using observer ratings with a Cohen’s d of up to .65 and more effective than the model in Study I, despite the smaller sample (N = 259). These results indicated that generating models could be improved by employing various data sources, which provide better foundations for model development. Finally, Study III generated a model to predict therapy outcome after a sudden gain (SG) in order to identify crucial predictors of the upward spiral. EN was used to generate the model using data from 794 cases that experienced a SG. A control group of the same size was also used to quantify and relativize the identified predictors by their general influence on therapy outcomes. The results indicated that there are seven key predictors that have varying effect sizes on therapy outcome, with Cohen's d ranging from 1.08 to 12.48. The findings suggested that a directive approach is more likely to lead to better outcomes after an SG, and that alliance ruptures can be effectively compensated for. However, these effects
were reversed in the control group. The results of the three studies are discussed regarding their usefulness to support clinical decision-making and their implications for the implementation of precision mental health.