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Slow down and be critical before using early warning signals in psychopathology

Nature Reviews Psychology volume 3, pages 767–780 (2024)Cite this article

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Abstract

Early warning signals are considered to be generic indicators of a system’s accumulating instability and ‘critical slowing down’ prior to substantial and abrupt transitions between stable states. In clinical psychology, these signals have been proposed to enable personalized predictions of the impending onset, recurrence and remission of mental health problems before changes in symptoms occur, thereby facilitating timely therapeutic interventions. In this Perspective, we question the idea that early warning signals in a person’s emotion time series can predict changes in mental health symptoms. Using the empirical findings to date and the theoretical and methodological limitations inherent in their application, we argue that there is little support for the use of early warning signals based on critical slowing down in clinical psychology. Deepening our knowledge of the theoretical foundations of these predictors and improving their measurement are key to clarifying the potential and boundaries for their use in psychopathology. It is necessary to build on the insights gained from early warning signal studies and to improve and evaluate alternative methods, keeping in mind that clinical applications require prospective, real-time predictions that not only indicate whether, but also when, a specific person is likely to experience changes in their mental health.

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Fig. 1: Changing system stability landscapes during critical slowing down.
Fig. 2: Example transitions in psychopathology.
Fig. 3: Statistical process control method.

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Acknowledgements

M.J.S. was funded by the Research Foundation — Flanders (FWO, grant number 12AVE24N).

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  1. These authors contributed equally: Marieke A. Helmich, Marieke J. Schreuder.

Authors and Affiliations

  1. Department of Psychology, University of Oslo, Oslo, Norway

    Marieke A. Helmich

  2. Quantitative Psychology and Individual Differences, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium

    Marieke J. Schreuder

  3. Department of Developmental Psychology, Tilburg University, Tilburg, The Netherlands

    Marieke J. Schreuder

  4. Department of Psychometrics and Statistics, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands

    Laura F. Bringmann

  5. Interdisciplinary Center Psychopathology and Emotion regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    Harriëtte Riese, Evelien Snippe & Arnout C. Smit

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M.A.H., M.J.S., E.S. and A.C.S. researched data and wrote the article. M.A.H., M.J.S., L.F.B., E.S. and A.C.S. contributed substantially to discussion of the content. All authors reviewed and/or edited the manuscript before submission.

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Helmich, M.A., Schreuder, M.J., Bringmann, L.F. et al. Slow down and be critical before using early warning signals in psychopathology. Nat Rev Psychol 3, 767–780 (2024). https://doi.org/10.1038/s44159-024-00369-y

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