Transdiagnostic approach Flashcards
What is a transdiagnostic approach?
The transdiagnostic approach focuses on identifying the common and core maladaptive temperamental, psychological, cognitive, emotional, interpersonal and behavioural processes that underpin a broad array of diagnostic presentations
Simply = Identifying a mechanism which is present across disorders
What does ‘Transdiagnostic’ mean?
‘Transdiagnostic’ simply means ‘across diagnoses’
The term transdiagnostic was first applied (quite narrowly) to …..?
Cognitive therapy across eating disorders (e.g anorexia and bulimia)
True or False?
Nowadays a ‘full’ transdiagnostic approach applies to all mental health diagnoses not just various categories
True
What is the evidence for the transdiagnostic approach? List the 4 questions researchers ask when conducting a transdiagnostic approach
1) Are symptoms shared across disorders?
2) Are underlying mechanisms shared across disorders?
3) Is there a unified theory applicable across disorders?
4) Is there a single treatment applicable across disorders?
True or False?
Individuals with particular diagnoses might not have elevated rates of symptoms not related to their diagnosis
False
Individuals with particular diagnoses might have elevated rates of symptoms not related to their diagnosis
Post-traumatic stress disorder symptoms are present in ……. disorders
Personality
There are elevated rates of depression and anxiety in….? List 3 disorders
1) Psychotic disorders (Birchwood et al., 2000),
2) Eating disorders (Bulik et al., 1997)
3) Substance abuse disorders (Merikangase et al., 1998)
True or False?
There are decreased rates of psychotic symptoms in people with anxiety and depression when compared with a non-clinical sample
False
There are elevated rates of psychotic symptoms in people with anxiety and depression when compared with a non-clinical sample
Although individuals are diagnosed with one category, they score very high on symptom clusters related to other/individual categories in the classification system
What does this suggest?
These symptoms are more on a spectrum than being separate from each other
True or False?
The majority of people have not/do not meet the criteria for more than one disorder diagnosis
False
The majority of people have/meet the criteria for more than one disorder diagnosis
Kessler et al. (2005) more than …..% of people diagnosed with a disorder in a given year, meet the criteria for multiple disorders
50%
Who suggested that more than 50% of people diagnosed with a disorder in a given year, meet the criteria for multiple disorders?
Kessler et al. (2005)
Depending on the study, …..% - …….% of individuals with one disorder have another disorder that they qualify for
32% - 80%
Individuals with one disorder have another disorder that they qualify for
This is known as…?
(High Levels of) Comorbidity
There is a significant proportion of people whose diagnosis shifts/changes
This is known as…?
Instability of Diagnosis
Barca-Garcia et al. (2007) followed up 10,000 patients at ten-time points:
Only …..% of specific personality disorders were stable over time
……% of cases of schizophrenia were stable
Only 29% of specific personality disorders were stable over time
70% of cases of schizophrenia were stable
True or False?
There is a significant proportion of people whose diagnosis shifts/changes
True
People shift in their diagnosis over time
When does this mostly happen?
Early in life
Often the case with childhood disorders where is hard to pin down a specific diagnostic category
Why do people shift in their diagnosis mainly early on in life?
Because often the case with childhood disorders, it is hard to pin down a specific diagnostic category
Who followed up with 10,000 patients at ten-time points in life to investigate the stability of diagnosis?
Barca-Garcia et al. (2007)
Who conducted a birth cohort study in New Zealand that used over 1000 participants (assessed every 2 to 6 years)?
Caspi et al., 2013
Caspi et al., 2013 conducted a birth cohort study in New Zealand that used over 1000 participants, and assessed every…..?
2 to 6 years
What did Caspi et al. examine in their study?
They examined the structure of psychopathology, taking into account dimensionality, persistence, co-occurrence, and sequential comorbidity of mental disorders across 20 years, from adolescence to midlife
They assessed diagnostic symptoms for a wide range of disorders
Caspi et al. used factor analysis in their study. What was this for?
To explore inter-correlations between symptoms
What evidence did Caspi et al find in their study?
They found evidence pointing to one general underlying dimension that summarized individuals’ propensity to develop any and all forms of common psychopathologies.
Caspi et al. found evidence pointing to one general underlying dimension that summarized individuals’ propensity to develop any and all forms of common psychopathologies.
They called this the…?
P factor
What is the P factor?
One general underlying dimension that summarized individuals’ propensity to develop any and all forms of common psychopathologies
What does the p factor correlate with? List 3
1) Great life impairment
2) Great childhood maltreatment
3) Poorer brain function in early life (the higher the p score- the more impairment)
The higher the p score, the …… impairment
More
What does the p factor explain about finding causes and treatments for individual mental disorders?
The p factor explains why it is challenging to find causes, consequences, biomarkers, and treatments with specificity to individual mental disorders
The p factor explains why it is challenging to find causes, consequences, biomarkers, and treatments with specificity to individual mental disorders.
How can this be improved?
Conducting transdiagnostic approaches
What factors might be transdiagnostic? List 3
1) Biological
2) Social
3) Brain circuitry
What are biological factors?
Genetic factors
What are social factors?
Shared interpersonal factors/expressed emotion (such as hostility & criticism in family members)
What are brain circuitry factors?
Structure of the brain and functional patterns of the brain (assessing areas of the brain that are active and differentiate people with mental health difficulties)
Why might biological factors be transdiagnostic?
Many disorders have shared genetic factors/vulnerabilities, e.g. schizophrenia, bipolar disorder, ADHD & major depression
Why might social factors be transdiagnostic?
Predicts relapse in bipolar disorder, schizophrenia, anxiety, depression and others
Why might brain circuitry be transdiagnostic?
Structurally: Goodkind et al., 2015 study – in 15,892 patients they found that grey matter loss converged across diagnoses in 3 regions
Functional patterns: assessing areas of the brain that are active and differentiate people with mental health difficulties; they found overlapping areas across disorders – this led research councils to look at this more transdiagnostically- the human connectome
What did Goodkind et al find regarding the grey matter/brain structure of people with disorders?
Grey matter loss converged across diagnoses in 3 regions
When assessing areas of the brain that are active and differentiate people with mental health difficulties, what did researchers find?
They found overlapping areas across disorders
When assessing areas of the brain that are active and differentiate people with mental health difficulties, researchers found overlapping areas across disorders
What did this lead to?
This led research councils to look at this more transdiagnostically- the human connectome
Which research groups conducted the analysis of the brain circuitry involved in psychopathology?
Buckholtz & Meyer-Lidenberg, 2012
Goschke, 2014
What did research groups conducting analysis of the brain circuitry involved in psychopathology identify?
They identified 4 different brain circuits with different brain functions involved in psychopathology
There are 4 different brain circuits with different brain functions involved in psychopathology.
List the 4 brain circuits
- Frontal-parietal
- Default mode network (the way the brain is functioning at rest)
- Corticolimbic (amygdala)
- Frontal-striatal
What is the function of the frontal-parietal brain circuit in psychopathology?
Working memory & performance monitoring
What is the function of the default mode network (the way the brain is functioning at rest) brain circuit in psychopathology?
Theory of mind & perspective taking
What is the function of the Corticolimbic (amygdala) brain circuit in psychopathology?
Threat detection
What is the function of the frontal-striatal brain circuit in psychopathology?
Reward, decision making & motivation
Which brain circuit is responsible for this function involved in psychopathology?
Working memory & performance monitoring
Frontal-parietal
Which brain circuit is responsible for this function involved in psychopathology?
Theory of mind & perspective taking
Default mode network
Which brain circuit is responsible for this function involved in psychopathology?
Threat detection
Corticolimbic (amygdala)
Which brain circuit is responsible for this function involved in psychopathology?
Reward, decision making & motivation
Frontal-striatal
- Frontal-parietal
- Default mode network (the way the brain is functioning at rest)
- Corticolimbic (amygdala)
- Frontal-striatal
These are the 4 different brain circuits with different functions.
True or False?
These map onto specific disorders/ each network is specific to one disorder
False
These do not necessarily map onto specific disorders/No network is specific to one disorder
Each of these networks are involved in a transdiagnostic model
When exploring cognitive behavioural processes (brain function in different parts of the brain) researchers found that …..?
List 2 findings
1) Patterns of thinking and behaviour that maintain distress
2) Cognitive behavioural processes are all elevated across psychological disorders
Researchers found patterns of thinking and behaviour that maintain distress, such as ….?
List 3 patterns of thinking and behaviour.
1) Worry
2) Avoidance
3) Selectively attending to threats in the environment
Researchers found that patterns of thinking and behaviour are all elevated across psychological disorders
What does this represent?
Transdiagnostic factors
Who systematically surveyed the literature on transdiagnostic factors?
Harvey et al., 2004
What did Harvey et al., 2004 look at in their study?
Looked at various cognitive processes (attention, memory, thought, reasoning) as well as behaviour
What were the criteria of Harvey et al’s study? List 3
1) The process had to be identified in all disorders assessed
2) At least 4 disorders studied
3) They also looked at the methodology used in studies and ensured the evidence was at least of moderate quality
What were the findings of Harvey et al’s study? List 2
1) They found 12 different processes that
were ‘definitely’ transdiagnostic
2) At least 4 disorders showed these processes to be elevated compared to no clinical controls in well-designed studies
What was the initial assumption about psychological processes?
Psychological processes are specific to a particular disorder group (e.g anxiety)
What was the updated assumption about psychological processes?
Psychological processes can be elevated across the board
(e.g people with eating disorders BUT also people with psychosis have elevated detections of threat)
Psychological processes can be elevated across the board
(e.g people with eating disorders BUT also people with psychosis have elevated detections of threat)
What does this tell us? List 2 questions
1) Is there a problem with the psychiatric classification system (if what we are looking at is found across all these different groups)?
2) Is the classification system what we would expect it to be (by looking at other areas of science)?
Despite the validity of the classification system, Darwin showed that species ………. in characteristics over time
Change
Despite the validity of the classification system, Darwin identified huge ………… within a species
Individual variation
Despite the validity of the classification system, Darwin identified characteristics as …….. across categories (beak shape )
Continuous
Despite the validity of the classification system, Darwin identified the ……….. of characteristics
Functional properties
Despite the validity of the classification system, Darwin developed a ….. theory of change across all life, not specific categories of organisms
Unified theory
If we were to apply a similar approach to symptoms and disorders following Darwin’s theory, we can assume that:
People’s diagnosis ……… over time
Change
If we were to apply a similar approach to symptoms and disorders following Darwin’s theory, we can assume that:
There are huge individual ……… between people even with the same diagnosis
Variation/differences
If we were to apply a similar approach to symptoms and disorders following Darwin’s theory, we can assume that
There’s ……… (seen in those measures between categories where symptoms were elevated)
e.g psychotic symptoms in people with anxiety and depression
Continuity
If we were to apply a similar approach to symptoms and disorders following Darwin’s theory, we can assume that:
Some of these symptoms are actually ……..
(e.g. worry – things people do to try and cope)
Functional
What do researchers use to understand individuals’ lived experiences of mental health distress?
Qualitative interviews & analysis
True or False?
Qualitative interviews & analysis help to explore what mental health difficulties involve, how individuals get help and how they would describe their recovery process
True
What were the 5 studies which were looked at to explore what mental health difficulties involve, how individuals get help and how they would describe their recovery process?
1) University students -natural recovery across disorders
2) Primary care service
3) Bipolar disorder
4) Eating problems
5) The use of art in recovery
1) University students -natural recovery across disorders
2) Primary care service
3) Bipolar disorder
4) Eating problems
5) The use of art in recovery
These studies showed themes of…?
Loss of control – at the ‘rock bottom’ & regaining control as the process of recovery
Loss of control characterises the symptoms of a variety of disorders
List all 4 disorders
1) Panic attacks
2) Psychosis
3) Depression
4) Eating disorders
People with panic attacks lose control over what?
Lose control over behaviour/feelings during panic attacks
People with psychosis lose control over what?
Lose control over their minds and lose touch with reality
People with depression lose control over what?
Lose control over basic motivations to get up etc
People with eating disorders lose control over what?
Lose control over eating (binge-eating) or extreme control – restricting eating to regain the feeling of loss of control in other areas
What is one of the key issues at the heart of mental health problems?
Loss of control
Define cognitive theories
Theories focusing on individuals’ thinking
Define behavioural theories
Theories focusing on individuals’ behaviour
From a biological perspective, what is control?
Control is essential for sustaining life
Control keeps every single one of our cells alive; homeostasis
Homeostasis comes from Greek words meaning…?
“Same” and “Steady,”
This refers to any process that living things use to actively maintain fairly stable conditions necessary for survival
Define homeostasis
Any process that living things use to actively maintain fairly stable conditions necessary for survival
Any process that living things use to actively maintain fairly stable conditions necessary for survival
What is this?
Homeostasis
What homeostasis is evident in the body? List 2
1) Body temperature: kept at 37 degrees but
can increase to fight against infection
2) Blood sugar levels: diabetes - stable level is disrupted and needs to be corrected externally by using insulin
Control happens (sometimes/all the time) and happens (manually/automatically)
Control happens (all the time) and happens (automatically)
What do we need control for? List 4 everyday activities that need control
1) To balance (to keep stable, you move your arms and legs, your muscles are twitching, constantly adjusting )
2) To keep our heads upright – constant tension within our muscles
3) To maintain our posture – we might not be aware that we are ‘controlling’ but we are using all sorts of muscles to successfully maintain our posture
4) To talk - using muscles in our tongue, mouth and jaw
If you suddenly lost control and ability to go into your normal routine, it could be hugely distressing
True or False?
True
Who proposed the Perceptual Control Theory?
William T. Powers (medical physicist)
What does the Perceptual Control Theory explain?
How control works and is used more widely than just psychology (e.g in designing robotics systems)
What does the Perceptual Control Theory propose?
Proposes that psychological distress is the loss of control due to unresolved goal conflict
Various reasons for loss of control (injury, natural disasters, war etc)
Which theory proposed that psychological distress is the loss of control due to unresolved goal conflict?
Perceptual Control Theory
Which theory explains how the control works and is used more widely than just psychology?
Perceptual Control Theory
According to the Perceptual Control Theory, a loss of control (conflict) causes…?
Distress
According to the Perceptual Control Theory, a loss of control (conflict) causes distress
Why?
We all have internal standards, a sense of how we would like our experiences to be
We act on our environment to make these experiences match these standards
But conflict arises when we are unable to control important areas in our lives (conflicting goals)
How can conflict be resolved?
Through shifting and sustaining attention to the source of the conflict
It is likely to require flexible use of multiple brain networks
True or False?
Conflict can be intra personal only
False
Conflict can be intra personal or inter personal
What is Method of Levels therapy?
Talking therapy
The Method of Levels therapy is talking therapy based on the principles of…?
Perceptual Control Theory (PCT)
PCT proposes that individuals experience distress as a result of ….?
Reduced control over important goals in their lives
Method of Levels therapy directs an individual’s attention towards ….?
Identifying important goals and conflicting goals
Method of Levels therapy supports individuals to find ….?
Solutions to their own problems
What are the 2 main goals of therapy?
1) Keep the person talking about the problem
2) Notice disruptions
Which therapy helps individuals identify important goals and conflicting goals?
Method of Levels therapy
Which therapy supports individuals to find solutions to their own problems?
Method of Levels therapy
Which theory proposes that individuals experience distress as a result of reduced control over important goals in their lives?
Perceptual Control Theory (PCT)
Which therapy is based on the principles of Perceptual Control Theory (PCT)?
Method of Levels therapy
The client books their own appointment and talks about the problem of their choice
This is an example of…?
Method of Levels therapy
What are the distinctive features of the Method of Levels therapy? List 6 features
1) The client books their own appointment and talks about the problem of their choice
2) The counsellor/therapist is naturally curious, asking about the problem & the client’s experiences right now
3) In short, the counsellor/therapist keeps ‘out of the way’
4) Counsellor/therapist has goals but no specific techniques
5) Assumes that change happens spontaneously within the client
6) Assumes that the client knows when they no longer need MOL
True or False?
The evidence for shared factors across mental
health problems is weak
False
The evidence for shared factors across mental
health problems is robust
True or False?
The transdiagnostic approach to psychopathology has empirical support and is commonly used in everyday mental health services
False
The transdiagnostic approach to psychopathology has empirical support but is rarely used in everyday mental health services
True or False?
In science, classification is used to identify underlying elements
True
True or False?
Perceptual Control Theory put forward as a unifying framework
True
