Future Directions Flashcards
Of adults who have a psychological disorder-
75% had one as a child
Homotypic continuity
Adult disorders are preceded by childhood and adolescent difficulties which are similar in kind
More common
For ex: lifecourse persistent externalizing: ODD to CD to ASPD
or anxiety disorders and eating disorders- ie separation anxiety in childhood, remits with treatment, panic disorder in adulthood
Heterotypic continuity
Adult disorders are preceded by childhood and adolescent difficulties which have a very different symptom presentation
For ex:
Children with conduct disorder are substantially at risk for major depressive disorder in adulthood
Why childhood CD to adult MDD?
Experiencing one disorder contributes to risk for another
Childhood CD selects individuals into adverse physical and relational environments later in the life course which increase stress exposure and depression risk
Cumulative stress associated with CD
School failure/drop out
Lack of employment options
Few friends
Limited social support
High conflict partnerships
Poor family relationships
Early child-bearing- added responsibilities at a young age
Too late to change?
Limit to ability to change external environmental circumstances
But people’s emotions change naturally as they age
Emotional reactivity goes down over the lifecourse
People naturally become calmer and more able to handle negative emotions as they age
Transdiagnostic processes
Cognitive, emotional, and behavioral processes characteristic of multiple disorders
Helpful in explaining comorbidity and trajectories over time
Believed to be mechanistic- produce symptoms of psychopathology
underlying pattern that produces symptoms for lots of different disorders in different ways
Rumination
Perseverative repetitive thinking about causes and consequences of distress
Transdiagnostic process: associated with depression, disordered eating, substance use/abuse
Co-Rumination
Effects and mechanisms of risks similar to rumination
Transdiagnostic process: associated with depression, anxiety disordered eating, substance use/abuse
Rejection Sensitivity
Tendency to expect, perceive, and overreact to experiences of social rejection or potential social rejection
Transdiagnostic process: associated with depression, anxiety, violent and nonviolent aggressive behavior
Negative Urgency
Tendency towards rash, impulsive behaviors when experiencing negative emotions, particular motivation to try to feel better quickly but make rash decisions that have a short term benefit and then backfire
Transdiagnostic process: associated with depression, bulimia, substance use, externalizing
Perfectionism
Setting unrealistically high standards for achievement, paired with criticism for not meeting standards and a high degree of concern over mistakes
Transdiagnostic process: associated with depression, anxiety, eating disorders esp AN, OCD
Three components of perfectionism
Self-oriented: setting unrealistically high standards for oneself
Other-oriented: setting unrealistically high standards for other people (esp loved ones and family members)
Socially prescribed: perceiving one’s social world as to be full of high expectations and unrealistic standards
Emotional clarity
Difficulty identifying the emotions one is experiencing
Transdiagnostic process: low levels associated with depression, social anxiety, binge eating (but not restrictive eating), alcohol abuse
Transdiagnostic processes characteristics
Normative- occur in people with or without psychopathology
Predict future onset of psychopathology, can exacerbate current episode of symptoms
They are malleable!
Unified Protocol
Specifically designed to treat underlying transdiagnostic processes versus symptoms of a disorder
Core components:
- Emotional awareness
- Linking thoughts and emotions
- Learning about avoidance of emotional responses (negative urgency)
- Confronting strong emotions through exposures
- Increasing awareness and tolerance of physical sensations
Enrolls participants with a very wide range of disorders and comorbidities
Improves both primary presenting problem as well as comorbid conditions
Treatment gains maintained 12-18 months later
Compared to CBT protocols that target a single disorder, equally efficacious and works on same time frame
Some studies suggest a lower drop out rate
Adult protocol and adolescent and children as young as 7
Transdiagnostic processes focus
Gives clear way to treat comorbidities without deciding which is more important
Non-suicidal self-injury
Any act that deliberately harms or damages one’s body but without the explicit desire to commit suicide
NSSI + adolescence
Adolescent phenomenon
1-4% of adults engage, 15% of adolescents do
Average age of first NSSI is 12-15, 98% of NSSI start before adulthood
Why do people self-harm?
Functional
- Alleviate negative emotions
- Self-punishment
- To “feel something”
- To influence others/communication
- To resist an urge to self-harm further
Nock and Prinstein’s Functional Model
All NSSI fulfills 1 of 2 conditions, all reinforcement based:
Automatic: gain reinforcement by producing a change/accomplishing something within oneself
Social: gain reinforcement by accomplishing something in relation to another person
Automatic Positive Reinforcement: to feel something- feeling generation
Automatic Negative Reinforcement: to alleviate negative and intense emotions overwhelmingly most common function of NSSI
Social Positive Reinforcement: to obtain a response from someone
Social Negative Reinforcement: to remove interpersonal demands or feared reactions from other people/the world
NSSI function overall
Strategy to regulate emotion, do it because they can’t otherwise change how they are feeling, act of self-injury creates change
Most people who self injure do it
Once, a minority self-injure repeatedly, for these people NSSI can be effective at alleviating negative emotions, so behavior is repeated
How is pain processed in the brain?
- Anterior cingulate cortex acts as alarm system, appraises problems
- Insula perceives degree of problem
- Physical pain activates ACC and insula
- People who are more sensitive to pain show greater activations of ACC and insula
- Socially painful experiences activate ACC and insula
- Same brain regions are responsible for sensation of physical pain and processing emotional pain
Pain and NSSI
Chronic NSSI users show differences in processing and experiencing pain
Majority of adolescents who use NSSI report little pain at time of injury
In these people, with physical pain exposure, decreased activations in ACC and insula, effect accentuated if first induce distress
This matches with self report- NSSI alleviates pain for these people, perhaps because of overlapping neural systems for physical and emotional pain
NSSI disorder currently
A disorder under consideration in DSM-5TR
