Lecture 11, Transdiagnostic Approaches

Question 1

Training Challenges

Answer 1

Dozens of different disorders exist in the population
Training therapists in different models for each disorder may not be feasible
Specialized therapists for each condition may not be practical

Question 2

Limited Number of Sessions

Answer 2

Average number of therapy sessions attended is around 5
Insufficient time for comprehensive treatment or significant progress
Limited sessions may hinder the effectiveness of disorder-based therapies

Question 3

Early Treatment Gains

Answer 3

Research indicates that significant treatment gains occur in the first therapy session
Subsequent sessions may have diminishing returns
Emphasizes the importance of optimizing early therapy stages

Question 4

Comorbidity Rates

Answer 4

30-80% of patients have comorbid disorders
Treating each disorder separately may not address complex interactions
Commonalities between different disorders need to be considered

Question 5

Lack of Standardized Diagnosis

Answer 5

Standardized diagnosis is not always conducted in psychology
Variability and inconsistencies in identifying and classifying disorders
Impacts the efficiency and reliability of disorder-based treatments

Question 6

Common Principles and Shared Factors

Answer 6

Disorders share key factors and underlying mechanisms
Historical perspectives from Freud, Rogers, and Ellis highlight common principles
Pivotal papers emphasize the transdiagnostic approach

Question 7

Transdiagnostic Processes

Answer 7

Transdiagnostic processes include attention, reasoning, behaviors, memory, and thinking
Examples include hypervigilance, avoidance, safety-seeking behaviors, and negative thinking
These processes cut across various disorders
These processes are present across multiple disorders
Advantages include generalizing models, understanding comorbidity, and informing transdiagnostic treatments

Question 8

Core Process Research

Answer 8

Research with a clinical sample reveals a factor analysis with one core process
Higher scores in clinical vs. non-clinical sample, regardless of diagnosis
Supports the existence of shared processes in predicting distress

Question 9

Qualitative Interviews and Analysis

Answer 9

Qualitative studies explore distress and recovery across disorders
Themes of loss of control at rock bottom and regaining control in the recovery process
Examples include natural recovery, primary care services, and bipolar disorder

Question 10

Homeostasis and Control

Answer 10

Control is essential for psychological distress and recovery
Homeostasis and control are vital for coordination and functioning
Dewey’s concept of control in the “reflex arc” reflects the importance of control in psychological processes

Question 11

Perceptual Control Theory

Answer 11

Historical context of Perceptual Control Theory by Powers et al.
Fits with the teleological approach of early psychology
Influenced therapies like Reality Therapy and Psychological Therapy, now influencing CBT

Question 12

Key Tenets of Perceptual Control Theory (PCT)

Answer 12

Control is fundamental to life: Closed-loop process of perceive, compare, and act.
Hierarchies: Control is organized in a hierarchy with long-term goals implemented through lower-level goals.
Conflict: Control conflicts arise when trying to control the same experience in opposing directions.
Reorganization: Control systems undergo trial-and-error learning to reduce conflict and optimize control.

Question 13

Example of Goal Conflicts in a Hierarchy

Answer 13

Goal conflicts occur when different levels of the hierarchy have opposing directions.
Effective therapy solutions accommodate both sides of the conflict.
Solutions are unpredictable, novel, and vary in the time taken to resolve conflicts.
Logical problem-solving and advice may have limited effectiveness.
Conflict formulation can be useful when therapy is less effective.

Question 14

Lack of Awareness of Goal Conflict - Core Process

Answer 14

Lack of awareness of goal conflict is the core process that maintains chronic disruption and psychological “disorders.”
Controlling experiences without considering the interference with important personal goals leads to goal conflict.
Shifting and sustaining awareness is essential for change and overcoming inflexible processes.

Question 15

Method of Levels (MOL) - Transdiagnostic Cognitive Therapy

Answer 15

MOL is a transdiagnostic cognitive therapy approach based on PCT principles.
Therapists use open-ended questions to focus on the control of perception and identify goal conflicts.
MOL helps shift awareness to long-term goals, values, and broader perspectives.
Promising findings from pragmatic case series and pilot randomized controlled trials in primary care.

Question 16

Resolving Goal Conflict as a Transdiagnostic Process of Change

Answer 16

Goal conflict maintains distress when kept outside awareness.
Writing about goal conflict reduces distress.
Interactive computer therapist using key term search and questions sustains attention on conflict and reduces distress.
Goal conflict resolution is a transdiagnostic process that can lead to positive outcomes in therapy.

Question 17

Therapy Manual and Practical Application

Answer 17

Therapy manual published for CBT across disorders using PCT and MOL.
Focus on managing “blocks” in therapy and adhering to PCT principles.
The manual provides theory, practice points, vignettes, and adherence measures for effective application.