18. psychological tx targeting mechanisms

Question 1

why target mechanisms?

Answer 1

• tx dev focused historically on reduction of psyc sx + remission of psyc disorders
• problem because based on DSM (arbitrary, inflex, lack of emp characterization)
• excessive co-occurence among psyc disorders - implication of common mech
• many risk + maintenance mechanisms are common to multiple psyc disorders

Question 2

what’s RDoC? what does it do? what’s the point?

Answer 2

• research domain criteria
• integrates many levels of info to explore basic dimensions of functioning that span the full range of behaviour (not all negative traits)
• move away from DSM dx to study mech that are common among disorders

Question 3

what’s the experimental therapeutics approach?

Answer 3

NIMH tx initiative
* translating understanding of factors that cause + sustain mental illness into new or improved approaches to prevention + tx
* identify malleable targets for novel interventon strategies that are potential mediators of sx improvement (not only testing, but whether it works through presumed mech)

Question 4

name some of the existing txs targeting mechanisms:
1. tx that target broad psyc mech underlying multiple disorders
2. “txs” that target narrow cog or behavioural mechanisms that may/not be transdiag

Answer 4

broad mech:
1. unified protocol for transdiagnostic treatment of emotional disorders (dep + anx)
2. transdiagnostic-group CBT (anx)
3. acceptance and commitment ther (transdiag)

narrow cog:
1. attention bias mod for anx
2. cognitive bias mod for depr
3. approach bias mod for SUD

Question 5

what’s the unified protocol?

Answer 5

• recognition of excessive co-occurence of mood + anx disorders
• tx target is what makes disorders similar (neur + emotional processes)
• goal to provoke emotional and expression (prevent letting emotions “take over”, tolerating anx than actual stim)

Question 6

core tx modules of unified protocol

there are 6 - mainly in order

Answer 6

1. understand emotions
2. increasing present-focused emotional awareness
3. increasing cognitive flexibility
4. identifying and preventing patterns of emotional avoidance and maladative emotion-driven behaviours
5. increasing awareness and tolerance of emotion-related physical sensations
6. interoceptive and situation-based emotion-focused exposure

Question 7

evidence for unified protocol

Answer 7

• UP improved sx for anx + depr, levels of neg and pos affect + sx interference in daily fucntioning
• effects maintained over 6 mo f-up

Question 8

limitations for unified protocol

Answer 8

• no comparison to dx-specific tx
• limited longitudinal follow-up data
• limited data in other pops w probems with emotional regulation (ED, BPD, SUD)

Question 9

what’s attention bias modification? what’s it for?

Answer 9

• for anx
• based on exp research on threat-related attention biases in anx
• use implicit tasks to modify these attentional biases + reduce anx
• most common: dot probe task
• bias awat from threat implicitly learned over 100, 1000 trials
• show to reduce AB in people with gad, sad, + sub clin anx
• evidence for causal effects of ABM on anx + potential preventitive use

Question 10

limitations of ABM

Answer 10

• maintenance of benefits over time
• generalizability of training to other threat stimuli
• determining optimal dose of training (not v engaging)
• might be just executive control of attention via top down rather than change via bottom up