Claudia van Borkulo

University of Amsterdam | UVA · Department of Psychology

Exposure and response prevention is the gold-standard treatment for obsessive compulsive disorder (OCD), yet up to half of patients do not adequately respond. Thus, different approaches to identifying and intervening with non-responders are badly needed. One approach would be to better understand the functional connections among aspects of OCD symp...

Resilience refers to the ability to return to normal psychological functioning despite facing adversity. It remains an open question how to anticipate and study resilience, due to its dynamic and multifactorial nature. This paper presents a novel formalized simulation framework for studying resilience from a complex systems perspective. From this v...

Network approaches to psychometric constructs, in which constructs are modeled in terms of interactions between their constituent factors, have rapidly gained popularity in psychology. Applications of such network approaches to various psychological constructs have recently moved from a descriptive stance, in which the goal is to estimate the netwo...

Identifying the different influences of symptoms in dynamic psychopathology models may hold promise for increasing treatment efficacy in clinical applications. Dynamic psychopathology models study the behavioral patterns of symptom networks, where symptoms mutually enforce each other. Interventions could be tailored to specific symptoms that are mo...

Urbanisation and common mental disorders (CMDs; ie, depressive, anxiety, and substance use disorders) are increasing worldwide. In this Review, we discuss how urbanicity and risk of CMDs relate to each other and call for a complexity science approach to advance understanding of this interrelationship. We did an ecological analysis using data on urb...

In recent years, network analysis has been applied to identify and analyse patterns of statistical association in multivariate psychological data. In these approaches, network nodes represent variables in a data set, and edges represent pairwise conditional associations between variables in the data, while conditioning on the remaining variables. T...

Identifying the different influences of symptoms in dynamic psychopathology models may hold promise for increasing treatment efficacy in clinical applications. Dynamic psychopathology models study the behavioral patterns of symptom networks, where symptoms mutually enforce each other. Interventions could be tailored to specific symptoms that are mo...

Background : Major depression (MD) is a heterogeneous disorder in terms of its symptoms. Symptoms vary by presence of risk factors such as female sex, familial risk, and environmental adversity. However, it is unclear if these factors also influence interactions between symptoms. This study investigates if symptom networks diverge across sex, famil...

Background There has been increasing interest in classifying inflammatory phenotypes of depression. Most investigations into inflammatory phenotypes only have tested whether elevated inflammation is associated with elevated levels of depression symptoms, or risk for a diagnosis. This study expanded the definition of phenotype to include the structu...

Inspired by modeling approaches from the ecosystems literature, in this paper, we expand the network approach to psychopathology with risk and protective factors to arrive at an integrated analysis of resilience. We take a complexity approach to investigate the multifactorial nature of resilience and present a system in which a network of interacti...

There has been increasing interest in classifying inflammatory phenotypes of depression. Most investigations into inflammatory phenotypes solely have tested whether increased inflammation is associated with increased depression. This study expanded the definition of phenotype to include the structure of depression as a function of inflammation. Net...

In "The Neuroimmunology of Depression: Beyond Diagnoses" chaired by myself and Carmine Pariante. Recording: https://www.youtube.com/watch?v=xHSIJUW8E98&list=PL9oMEuQcUyCzoe2p5pyQqBed2SrnyYCe6&index=6&t=0s

Network theories have been put forward for psychopathology (in which mental disorders originate from causal relations between symptoms) and for personality (in which personality factors originate from coupled equilibria of cognitions, affect states, behaviours, and environments). Here, we connect these theoretical strands in an over-arching persona...

In their recent paper, Forbes et al. (2019; FWMK) evaluate the replicability of network models in two studies. They identify considerable replicability issues, concluding that “current ‘state-of-the-art’ methods in the psychopathology network literature […] are not well-suited to analyzing the structure of the relationships between individual sympt...

Background There is increasing interest in day-to-day affect fluctuations of patients with depressive and anxiety disorders. Few studies have compared repeated assessments of positive affect (PA) and negative affect (NA) across diagnostic groups, and fluctuation patterns were not uniformly defined. The aim of this study is to compare affect fluctua...

Background: Childhood adversity (CA) is strongly associated with mental health problems. Resilience factors (RFs) reduce mental health problems following CA. Yet, knowledge on the nature of RFs is scarce. Therefore, we examined RF mean levels, RF interrelations, RF-distress pathways, and their changes between early (age 14) and later adolescence (...

It is well-established that the symptomatology of depressed patients is dynamic; symptoms are not continuously present or absent, but instead show patterns of change over time. Here, we present a dynamic network account of these changes in symptomatology. This dynamic network account is based on models to describe the spread of a virus across a pop...

Patients with a current disorder have higher moment-to-moment instability (RMSSD) of negative (NA) and positive affect (PA) than remitted patients and controls. Especially with regard to NA, this could be interpreted as patients with a current disorder being more sensitive to internal and external stressors and having suboptimal affect regulation.

Supplemental materials containing additional information and analyses (e.g., analyses with RMSSD corrected for the mean, within-person variance, autocorrelation, etc.).

R code to address the issue of comparing network structures of groups with a difference in severity by partialling out an external measure of severity before estimating network structures. The following is from the Supplementary Information to: Van Borkulo et al., 2015. Association of symptom network structure with the course of depression. JAMA Ps...

(For an interactive summary of the paper, see our web app: https://gabylunansky.shinyapps.io/PRPmodel/). Network theories have been put forward for psychopathology (in which mental disorders originate from causal relations between symptoms) and for personality (in which personality factors originate from coupled equilibria of cognitions, affect s...

The spiritual successor of this project, "Inflammatory Phenotype of Depression Symptom Structure: A Network Perspective" has been accepted for publication at Brain, Behavior, and Immunity. Please see the corresponding ResearchGate page. A comparison of depression and anxiety symptom networks in individuals with elevated vs. non-elevated CRP.

Background: Childhood adversity (CA), such as trauma or long-lasting stress, is strongly associated with mental health problems. Resilience factors (RFs) reduce the liability for mental health problems subsequent to CA. As mental health levels change over time, RFs may also change. Yet, knowledge on the latter is scarce. Therefore, we examined whet...

Steinley, Hoffman, Brusco, and Sher (2017) proposed a new method for evaluating the performance of psychological network models: fixed-margin sampling. The authors investigated LASSO regularized Ising models (eLasso) by generating random datasets with the same margins as the original binary dataset, and concluded that many estimated eLasso paramete...

Background: A history of self-harm is a major risk factor for suicide. Some patients are more likely than others to repeat suicidal behaviour after an episode of self-harm. Insight in the relation between current thoughts of self-harm, motives for the self-harm episode and perceived problems may improve prevention strategies. Network analysis allo...

Background: Suicide is one of the leading causes of death in young individuals. Timely and adequate identification of individuals with suicidal ideation could prevent from suicidal behavior. Psychotic experiences (PE) have been shown to increase levels of suicidal ideation (SI) in the general population. Therefore, detailed investigation of the re...

Background Suicide is the second cause one of the leading causes of death in young individuals. Timely and adequate identification of individuals with suicidal ideation could prevent from suicidal behavior. Psychotic experiences (PE) have been shown to increase levels of suicidal ideation (SI) in the general population. Therefore, detailed investig...

The network approach to clinical psychology is a relatively new approach and diverges on various aspects from existing models and theories. The hallmark of the theory is that there is no common cause that underlies a set of symptoms. Instead, the network approach starts out by assuming that symptoms causally interact with each other. In this chapte...

Recent literature has introduced (a) the network perspective to psychology and (b) collection of time series data to capture symptom fluctuations and other time varying factors in daily life. Combining these trends allows for the estimation of intraindividual network structures. We argue that these networks can be directly applied in clinical resea...

This tutorial is part (as an appendix) of a doctoral thesis and is based on the initial NCT() function. Meanwhile, the package has been developed and updated. You can now use NCT in combination with estimateNetwork() function of the bootnet package. This enables using network estimation methods such as mgm. Also, you can find example code for asses...

According to the network perspective on psychopathology, mental disorders can be viewed as a network of causally interacting symptoms. With the network approach in mind, hypotheses can be formulated about psychopathology and treatment. The starting point of Claudia van Borkulo’s thesis is based on two central questions: “Why do some people develop...

One in four depressed adolescents does not respond favourably to treatment.1 Prognostic markers to identify this non-responder group are lacking and urgently needed.2 It has been suggested that the network structure of depressive symptoms (i.e. group-level covariance or connectivity between symptoms) may be informative in this regard. Intuitively,...

Steinley, Hoffman, Brusco and Sher (2017) proposed a new method for evaluating the performance of psychological network models: fixed-margin sampling. The authors investigated LASSO regularized Ising models (eLasso) by generating random datasets with the same margins as the original binary dataset, and concluded that many estimated eLasso parameter...

One in 4 adolescents with depression does not respond favorably to treatment.¹ Prognostic markers to identify this nonresponder group are lacking and urgently needed.² It has been suggested that the network structure of depressive symptoms (ie, group-level covariance or connectivity between symptoms) may be informative in this regard.³ Intuitively,...

Background: Genetic risk and environmental adversity-both important risk factors for major depression (MD)-are thought to differentially impact on depressive symptom types and associations. Does heterogeneity in these risk factors result in different depressive symptom networks in patients with MD? Methods: A clinical sample of 5784 Han Chinese...

Forbes, Wright, Markon, and Krueger (2017) stated that “psychopathology networks have limited replicability” (p. 1011) and that “popular network analysis methods produce unreliable results” (p. 1011). These conclusions are based on an assessment of the replicability of four different network models for symptoms of major depression and generalized a...

Recent literature has introduced (1) the network perspective to psychology, and (2) collection of time-series data in order to capture symptom fluctuations and other time varying factors in daily life. Combining these trends allows for the estimation of intra-individual network structures. We argue that these networks can be directly applied in cli...

Forbes, Wright, Markon, and Krueger (2017) state that “psychopathology networks have limited replicability” and that “popular network analysis methods produce unreliable results”. These conclusions are based on an assessment of the replicability of four different network models for symptoms of major depression and generalized anxiety across two sam...

Background Suicidal behaviour is the end result of the complex relation between many factors which are biological, psychological and environmental in nature. Network analysis is a novel method that may help us better understand the complex association between different factors. Aims To examine the relationship between suicidal symptoms as assessed...

Stress plays a central role in the development and persistence of psychosis. Network analysis may help to reveal mechanisms at the level of the micro-dynamic effects between stress, other daily experiences and symptomatology. This is the first study to examine time-lagged networks of the relations between minor daily stress, momentary affect/though...

This is the pre-print. The peer-reviewed, published version is also available!

Current diagnostic systems mainly focus on symptoms needed to classify patients with a specific mental disorder and do not take into account the variation in co-occurring symptoms and the interaction between the symptoms themselves. The innovative network approach aims to further our understanding of mental disorders by focusing on meaningful conne...

Purpose: The network perspective on psychopathology understands mental disorders as complex networks of interacting symptoms. Despite its recent debut, with conceptual foundations in 2008 and empirical foundations in 2010, the framework has received considerable attention and recognition in the last years. Methods: This paper provides a review of...

Recent literature has introduced (1) the network perspective to psychology, and (2) collection of time-series data in order to capture symptom fluctuations and other time varying factors in daily life. Combining these trends allows for the estimation of intra-individual network structures. We argue that these networks can be directly applied in cli...

In this paper, we characterize major depression (MD) as a complex dynamic system in which symptoms (e.g., insomnia and fatigue) are directly connected to one another in a network structure. We hypothesize that individuals can be characterized by their own network with unique architecture and resulting dynamics. With respect to architecture, we show...

Background: Major depressive disorder (MDD) and generalized anxiety disorder (GAD) often co-occur with somatic symptomatology. Little is known about the contributions of individual symptoms to this association and more insight into their relationships could help to identify symptoms that are central in the processes behind the co-occurrence. This...

Aims: Depressive and anxiety symptoms often co-occur with somatic symptoms. Although individual symptoms in this association have varying characteristics and are likely to be differentially related to one another, little is known about their roles. This study explores associations between individual depressive/anxiety and somatic symptoms by using...

In this paper, we characterize major depression (MD) as a complex dynamic system in which symptoms (e.g., insomnia and fatigue) are directly connected to one another in a network structure. We hypothesize that individuals can be characterized by their own network with unique architecture and resulting dynamics. With respect to architecture, we show...

Childhood trauma (CT) has been identified as a potential risk factor for the onset of psychotic disorders. However, to date, there is limited consensus with respect to which symptoms may ensue after exposure to trauma in early life, and whether specific pathways may account for these associations. The aim of the present study was to use the novel n...

Psychopathology is often classified according to diagnostic categories or scale scores. These ignore potentially important information about associations between specific symptoms and, consequently, lead to heterogeneous constructs that may mask relevant individual differences. Network analyses focus on these specific symptom associations, providin...

In Reply In our publication in JAMA Psychiatry,1 we reported that the structure of symptom networks is related to the course of depression. Our findings are based on a between-patients design. Although we agree with Bos and Wanders that this has implications for the interpretation of our results, we do not think their conclusions are warranted.Bos...

In depression research, symptoms are routinely assessed via rating scales and added to construct sum-scores. These scores are used as a proxy for depression severity in cross-sectional research, and differences in sum-scores over time are taken to reflect changes in an underlying depression construct. To allow for such interpretations, rating scale...