Future Directions

Question 1

Of adults who have a psychological disorder-

Answer 1

75% had one as a child

Question 2

Homotypic continuity

Answer 2

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

Question 3

Heterotypic continuity

Answer 3

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

Question 4

Why childhood CD to adult MDD?

Answer 4

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

Question 5

Cumulative stress associated with CD

Answer 5

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

Question 6

Too late to change?

Answer 6

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

Question 7

Transdiagnostic processes

Answer 7

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

Question 8

Rumination

Answer 8

Perseverative repetitive thinking about causes and consequences of distress
Transdiagnostic process: associated with depression, disordered eating, substance use/abuse

Question 9

Co-Rumination

Answer 9

Effects and mechanisms of risks similar to rumination
Transdiagnostic process: associated with depression, anxiety disordered eating, substance use/abuse

Question 10

Rejection Sensitivity

Answer 10

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

Question 11

Negative Urgency

Answer 11

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

Question 12

Perfectionism

Answer 12

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

Question 13

Three components of perfectionism

Answer 13

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

Question 14

Emotional clarity

Answer 14

Difficulty identifying the emotions one is experiencing
Transdiagnostic process: low levels associated with depression, social anxiety, binge eating (but not restrictive eating), alcohol abuse

Question 15

Transdiagnostic processes characteristics

Answer 15

Normative- occur in people with or without psychopathology
Predict future onset of psychopathology, can exacerbate current episode of symptoms
They are malleable!

Question 16

Unified Protocol

Answer 16

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

Question 17

Transdiagnostic processes focus

Answer 17

Gives clear way to treat comorbidities without deciding which is more important

Question 18

Non-suicidal self-injury

Answer 18

Any act that deliberately harms or damages one’s body but without the explicit desire to commit suicide

Question 19

NSSI + adolescence

Answer 19

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

Question 20

Why do people self-harm?

Answer 20

Functional
- Alleviate negative emotions
- Self-punishment
- To “feel something”
- To influence others/communication
- To resist an urge to self-harm further

Question 21

Nock and Prinstein’s Functional Model

Answer 21

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

Question 22

NSSI function overall

Answer 22

Strategy to regulate emotion, do it because they can’t otherwise change how they are feeling, act of self-injury creates change

Question 23

Most people who self injure do it

Answer 23

Once, a minority self-injure repeatedly, for these people NSSI can be effective at alleviating negative emotions, so behavior is repeated

Question 24

How is pain processed in the brain?

Answer 24

• 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

Question 25

Pain and NSSI

Answer 25

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

Question 26

NSSI disorder currently

Answer 26

A disorder under consideration in DSM-5TR