Exploring the Impact of Perceived Causal Symptom Networks on Adolescents’ Experience and Coping with Depression: A Qualitative Study

Background: Network theory conceptualizes psychopathology as dynamic systems of interacting symptoms and represents a promising framework for personalized psychotherapy, including in child and adolescent mental health. Person-specific symptom networks offer an individualized map of maintaining processes and may provide an ideal basis for tailoring interventions to central and causally relevant symptoms. However, little is known about whether the mere process of collaboratively constructing such personalized networks already exerts measurable effects on adolescents’ everyday experiences, symptom understanding, and behavior. The present study therefore examined the short-term impact of creating a PErceived CAusal Symptom Network for Children and Adolescents (PECAN-CA) on daily-life functioning and illness representations in adolescents with depression. Methods: Ten adolescents aged 14–17 years who met DSM-5 criteria for Major Depressive Disorder participated in a qualitative exploratory study supplemented by supportive quantitative measures. In a structured PECAN-CA session, each adolescent collaboratively constructed an individualized perceived causal symptom network. Two weeks later, semi-structured interviews assessed how the network influenced daily-life experiences, symptom monitoring, coping strategies, behavioral choices, and communication about depression. Depressive symptoms (PHQ-9-A), guilt perceptions, and illness perceptions (IPQ-R subscales) were assessed pre- and post-intervention. Qualitative data were analyzed using inductive qualitative content analysis. Results: Adolescents frequently reported revisiting their network during moments of distress or reflection, suggesting integration into everyday cognitive processing. The visualization appeared to increase meta-cognitive awareness of symptom interactions, clarify perceived maintaining cycles, and facilitate communication with others. Seven participants described deliberate attempts to modify behaviors targeting central network nodes (e.g., sleep difficulties, social withdrawal, interpersonal emotion regulation patterns). All adolescents who attempted behavioral changes reported perceived downstream improvements in related symptoms. Quantitative measures indicated trends toward improved illness coherence and reduced maladaptive guilt attributions. Conclusion: Beyond its potential as a tool for treatment planning, the collaborative creation of a person-specific symptom network may itself function as an active psychoeducational and self-regulatory intervention. Constructing individualized causal diagrams appeared to influence adolescents’ daily-life appraisals, coping behavior, and intentional change efforts within a short time frame. These findings highlight the possibility that idiographic network construction represents not only a diagnostic or planning instrument, but a mechanism-relevant intervention component in personalized psychotherapy for adolescent depression. Trial Registration This study was preregistered on the Open Science Framework (https//osf.io/egmb3). Ethical approval was granted by the Ethics Committee of the Faculty of Psychology and Human Movement Science at the University of Hamburg.