Kohne paper - Paradigm considerations in psychotherapy Flashcards
What is meant by Kohne when she says that “the categorical model seems to
be informed by an essentialist causal hypothesis”?
The categorical model understands mental disorders as a group of symptoms that originate from a biological cause or derive from an essence of some sort
What are the axioms of a categorical frame, according to Kohne? (3)
- An underlying cause explains the occurence of all symptoms of a cluster of symptoms
- Mental disorders are defined by a set of symptoms that are caused by essences
- Clusters of symptoms are independent of each other because they have a different cause
What is a problem with these essences assumed in the categorical frame? (Kohne)
Research has yet to find a single latent disease entity or etiological essence for the overwhelming majority
Why are schizophrenia bpd not good counterarguments against the problem with essences in categorical frames?
kohne
Because, despite MRI showing consistent brain alterations, it is still unknown if these are the cause or a consequence
What are problems with the current representation that there is of psychopathology? (3)
kohne
- Mental disorders may be unique in presentation and etiology from person to person
- “Symptom definition” is too superficial and narrow to represent mental disorders
- Symptoms could cause each other, and are not just caused by an underlying essence
What are two (philosophical) roots that Kohne sees present in the categorical frame of psychopathology?
Reductionism and essentialism
What is a critique Kohne has against the modern diagnostic routine and to what does she acredit this problem?
- It is not personalized enough (non-specific diagnoses & treatment, that tell you next to nothing about the client)
- Research has largely been based on DSM labels
Which is better, manualized or nonmanualized treatment, according to Kohne?
Neither has been shown to be better than the other
What is a problem Kohne has with “specialty treatments”?
That these show widespread diagnostic equivalence (i.e., they’re not really “specialty treatments”)
this seems to tie in with Kohne supporting common factors
Generally speaking, what does Kohne’s analysis support?
To move from a “general, static, categorical, disease model” towards a “symptom-transcending, complex, dynamix and personalized model” in our understanding of mental disorders
For what should the essentialist and reductionist frame of thought be abandoned, according to Kohne?
A relationalist turn
What is a related problem Kohne highlights to the categorical model?
That it dominates many parties/goals (e.g., treatment, research, policy making, etc.) and that having one model that represents all of these levels is problematic
Why is having only one domenating model for all parties/goals problematic, according to Kohne?
Some levels require:
- Simplification, others specificity
- Level of the population vs. the individual
In conclusion, practical, clinical and/or research ambitions may require different models
What is the idea behind dimensional trait models?
Psychopathology is to be thought of in continua (e.g., HiTOP)
What do dimensional trait models combine and how does it do so?
Personology and psychopathology: it combines a spectrum of personality traits (variants of normal personality) and its pathology (varying in severity) with an assumed underlying factor
How does a dimensional trait model account for anxiety/mood disorders?
By a common higher order dimension such as neuroticism or internalizing pathology (the latter having the underlying “P-factor”)
What is a problem with dimensional trait models?
Still that belief of the latent factor/marker, which has still yet to be supported by evidence (e.g., that of the internalizin spectra)
- I.e., the bottom-up method seems to still be biased by a top-down interpretation
Kohne says both dimensional and categorical models are still laden with essentialism, how do they differ in this?
- Categorical is informed by essentialism when it describes psychopathology
- Dimensional is informed by essentialism when it explains psychopathology
How does the network approach differ from both categorical and dimensional models?
- It categorized mental disorders as “problems of living” not as “disease concepts”
- Latent disease entity does not exist
What is the central principle of network theory?
Mental disorders are complex systems: multifactorial in constitution, etiology and causes background
What is a second principle of network theory?
Symptoms are a result of (bi)directional causal connections between symptoms
What is a third principle of network theory?
The covariance of mental symptoms follows a network structure (i.e., clusters of symptoms do exist and can be explained by strong causal relationships between the symptoms which forms a new homeostasis)
What is symptom centrality and hierarchy in network theory?
Symptoms with the strongest connections can be identified and targeted in psychotherapy to dismantle the network (hopefully)
What is the fourth principle of network theory?
Hysteresis (the trigger can subside, but the network stays as it has become self-sustaining)
What is the final (fifth) principle of network theory?
Symptom-component correspondence (network theorists don’t reify distinct categories, but have found common network structures of symptoms that more or less align with the categories within diagnostic manuals)
What problem arises with the network theory and in which of the principles is this especially evident?
Kohne
That reductionism/essentialism/disease concept slips in (as can be seen in the fifth principle)
What is the transdiagnostic approach aimed at?
The presence of similar cognitive/behavioural factors that are maintaining/risking factors prevalent in many/most mental disorders
Problematic about the transdiagnostic approach?
- There is no clear and coherent model for it as of yet
- This comes with the problem that the meaning of something being “transdiagnostic” is virtually unknown and vague
A core strength of the transdiagnostic approach?
It being bottom-up and having the possibility to broaden the symptom definition present now
Personalized approach became important why?
The discovery that what is working at the level of the group is not necessarily effective at the level of the individual (idiosyncratic level)
What are the main arguments Kohne makes against precision psychiatry (stratifiers as personalized treatment)? (4)
- The biomedical tests/stratifiers that can be used to inform clinical practice still remain unidentified
- Also the amount/complexity of them makes it difficult to know what should be “picked”
- Critiques against the complexity of such techniques as well as the costs associated with them
- Markers move away from personal contact/therapeutic relationships
What different type of personalized approach is there, next to precision psychiatry?
“n=1” aka everyone is different in their multitude of responses/presentations
What does the experience sampling method (ESM), together with technological advances allow for?
Kohne
Providing large data sets for the n=1 approach, making informed networks (both onset and recovery) for individuals
How does the n=1 approach different on three main grounds?
kohne
- Shift from syndrome to symptom
- group level to individual
- static notion to dynamic notion
Problems/critiques against the n=1 approach? (3)
Kohne
- The amount of complexity ultimately allowed (how would this translate in quantification)
- Requires especially motivated clients
- May not translate to group levels
Person-centred psychiatry/approach? What is it tied to?
- Tied to the humanistic/recovery movement
- The whole person and their context + needs should be the focus of clinical care
A problem with person-centred approach?
It may be so radically different, it may not allow for communication with other models (e.g., the categorical one) at all
Problems with the concepts used (specifically DSM diagnosis and diagnosis)?
Kohne
- Confusion between DSM diagnosis and diagnosis (used interchangeably, when they are quite different)
- Nomothetic and ideographic level are equated by the conflation of the words DSM diagnosis and diagnosis
I.e., DSM diagnoses should be called classifications, not diagnosis
Which three proposals are aimed at changing the current taxonomy? Viability?
Kohne
- HiTOP (strongest of three, decently viable if it hands in some of it’s strengths/principles to faccilitate communication)
- Transdiagnostic approach (unclear viability, could be either read as the “lumping method” or patient-oriented taxonomy)
- Abandom taxonomy completely (doesn’t seem viable as nomothetic level is required in at least some way for research/practical purposes)
Kohne’s proposal for a change in current diagnoses/individual level?
complex and precise n = 1 network architectures that embody highly subjective meaning that can be discovered in extremely effective therapeutic relationships
