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Mental Health and Wellbeing > transdiagnostic approach > Flashcards

transdiagnostic approach Flashcards

1
Q

limitations of disorder based therapies

A
  • There are dozens of different disorders in the population
  • Are we really going to train therapists different models for different psychiatric disorders?
  • Average no. sessions attended is around five (Hansen et al. 2002)
  • Greatest treatment gains in the first session (Lambert et al. 2001)
  • 30-80% of patients have comorbid disorders
  • Standardised diagnosis is not conducted (c.90mins)

Therefore we need a universal flexible therapy that can be started early on

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2
Q

is classification valid but not always useful?

A

yes it is efficient but not necessry for treatment in psychology

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3
Q

key factors are shared across disorders

distress irrespective of any particular diagnostic category

A

Pivotal papers: e.g. Ingram (1990); Persons (1991); Hayes et al. (1996)

‘Transdiagnostic’ CBT for Eating Disorders (Fairburn, Shafran & Cooper, 2003)

Biology (e.g. COMT gene) - OCD, schizophrenia, bipolar disorder, anorexia nervosa, phobias

Social Factors (e.g. Expressed Emotion) : Schizophrenia, mood disorders, anxiety disorders, eating disorders

So, what is the evidence that the ‘mechanisms’ maintaining disorders might be shared?

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4
Q

what are the criteria for transdiagnostic processes

A

Criteria for a transdiagnostic process
Strong methodology (e.g. valid measure; control group)
Present in ALL disorders & over 4 disorders

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5
Q

what are the advantages of transdiagnosti approaches

A

generalise models across disorders
understand comorbidity
inform transdiagnostic treatments

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6
Q

what are the transdiagnostic processes

A 
attention
reasoning
behaviours
memory
thinking
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7
Q

what is attention

A

Hypervigilance to external threat
Attentional avoidance of external threat
Hypervigilance to internal experiences

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8
Q

what is memory

A

Recurrent intrusive memories
Selective memory
(Overgeneral memory)

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9
Q

reasoning

A

Interpretational bias
Expectancy bias
Emotional reasoning

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10
Q

thinking

A

Recurrent negative thinking
Metacognitive beliefs
(Thought suppression)

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11
Q

behaviours

A

Avoidance
Safety-seeking behaviours
Experiential Avoidance

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12
Q

what are the core processes

A

Anxiety , depression Standardised measures of thought suppression, worry & experiential avoidance
r = .5 to .7

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13
Q

Separate processes vs core process in predicting distress in students & in chronic physical illness

A

worry thought suppression and experiential avoidance

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14
Q

What does psychological distress and recovery involve?

A
  • Qualitative Interviews & Analysis
  • Themes of loss of control at the ‘rock bottom’ & regaining control as the process of recovery •Fits with wider literature
  • Natural recovery across disorders (Higginson & Mansell, 2008)
  • Primary care service (McEvoy et al., 2012)
  • Bipolar disorder (Mansell et al., 2010)
  • Eating problems (Alsawy & Mansell, 2013)
  • Use of art in recovery (Stevenson-Taylor & Mansell, 2012)
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15
Q

what is control and why is it important

A
  • Homeostasis is control; this is essential for life
  • Now: temperature; balance; blood sugar
  • Co-ordination & movement for any activity relies on control
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16
Q

The historical context of Perceptual Control Theory

A
  • Fits with the teleological approach of early psychology (e.g. William James, John Dewey)
  • Fits with importance of unconscious conlict (Freud, Horney)
  • Powers was a control system engineer who developed the theory through the 1950s & 60s
  • Encountered cybernetics (e.g. Wiener; Ashby)
  • Inluenced William Glasser’s Reality Therapy; Klaus Grawe’s Psychological Therapy; now inluencing the development of CBT (Mansell, 2005)
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17
Q

what is the negative feedback loop

A 
percieve
compare
act
controlled variables
disturbance
18
Q

key principles of perceptual control theory

A

control
hierarchies
conflict
reorganisation

19
Q

what is control

A

Control is fundamental to life.We control our experiences. This is
achieved by a closed-loop process of perceive, compare and act

20
Q

what is hierarchies

A

Hierarchies - Control is organised in a hierarchy whereby long term goals and
principles are implemented by setting goals for lower level systems

21
Q

what is conflict

A

Conflict - When a person tries to control the same experience in opposing directions, conflict occurs and chronic conflict disrupts control

22
Q

what is reorganisation

A

Reorganisation - The properties of control systems are changed through a
trial-and-error learning process to reduce conflict and optimise control.
Reorganisation follows awareness.

23
Q

why?

A

Relates to individual values/ principles about the self, world and others

24
Q

what?

A

Experience being discussed

25
Q

how?

A

Relates to speciic control processes/ acions/ short term experiences

26
Q

Implications from PCT on what is effective about therapy…

A
  • Solutions will be successful when both sides of the conflict are accommodated
  • Solutions will be unpredictable and novel
  • Time taken to resolve a conflict will vary
  • Logical problem solving might be ineffective
  • Advice will be of limited value
  • “Resistant” clients might be operating from one side of a conflict
  • When therapy is less than effective a conflict formulation might be useful
27
Q

what maintains goal conflict

A

•“Controlling an experience without regard to, or an awareness of, the important personal goals that it interferes with” – this creates & maintains goal conflict

Not just a form of avoidance (e.g. pursuing drugs; ‘hyping self up’; avoidance can be helpful, e.g. real danger; in work settings)

• It is interference with people’s goals that leads to the chronic disruption in
functioning - the key criterion of a psychological ‘disorder’

28
Q

what is the core process

A

It is the lack of awareness of goal conlict that is the core process…
•Person controls an experience despite the conflict it causes with control of ‘higher level’ experiences

29
Q

shifting and sustaining awareness

A
  • Enable change in systems that regulate inflexible processes; ‘metacognitive’
  • Help shift awareness to long term goals, values & broader perspectives

• e.g. realising that a good working life is more important than not feeling anxious all the time &
therefore experiment with ‘exposure’ to anxiety
• e.g. exploring conflict: the need to ‘speak up at work’ vs. the need ‘not to be rejected’ - in the long term to‘be accepted for who I am’

30
Q

what is Method of levels (MOL)

A

Transdiagnostic cognitive therapy from PCT

31
Q

what are the goals of MOL

A
  • Every therapist statement is an open question
  • GOAL ONE: To help the client talk about the problem
  • GOAL TWO: To ask about present moment disruptions
  • focuses on the process of control of perception
  • catches possible conflict
  • identifies higher level goals
  • Iterative procedure; open-ended
  • Promising findings in several pragmatic case series in primary care
32
Q

what body language focus on in MOL

A

indicators of background thoughts
emphasising certain words smiling catch potential conflict
not given a fixed number of sessions

33
Q

does method of levels work

A

significantl greater change in MOL group on anxiety and depression compared to TAU

34
Q

what is the hypothesis of Resolving goal conlict as a transdiagnostic process of change

A

Goal conflict maintains distress through loss of control when kept outside awareness by these processes

35
Q

preliminary findings of transdiagnostic process of change

A

• Writing about goal conflict reduces distress about the conflict (Kelly et al., 2011)

• Interactive computer therapist (Gafney et al., 2014)
• Searches participant text for key terms
• Asks questions to sustain attention on them
• Awareness of conlict correlated with reduction in distress & mediated the effect of positive expectancy
emulating same questions in methods of levels and asking question to help them notice their conflicts and sustain awareness of it

36
Q

therapy manual

A

CBT across disorders
managing blocks in therapy
using PCT and method of levels

37
Q

is the transdiagnostic approach empirically supported

A

yes

38
Q

what does Overlaps between constructs indicate

A

Overlaps between constructs indicate that an integrative theoretical approach and therapy is required

39
Q

what does PCT provide

A

• PCT provides an alternative psychological perspective – ‘behaviour is the control of perception’

Control at heart of health. Unresolved goal conflict undermines control
Perceptual control theory

40
Q

what does PCT propose

A

• PCT proposes that mental health problems are chronic loss of control caused by unresolved goal conflict

41
Q

what is method of levels

A

Method of Levels designed to shift and sustain awareness to higher levels to resolve goal conflict

Mental Health and Wellbeing (11 decks)

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