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SEM 2 Mental Health and Distress > Transdiagnostic approach > Flashcards

Transdiagnostic approach Flashcards

1
Q

What is a transdiagnostic approach?

A

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

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2
Q

What does ‘Transdiagnostic’ mean?

A

‘Transdiagnostic’ simply means ‘across diagnoses’

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3
Q

The term transdiagnostic was first applied (quite narrowly) to …..?

A

Cognitive therapy across eating disorders (e.g anorexia and bulimia)

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4
Q

True or False?

Nowadays a ‘full’ transdiagnostic approach applies to all mental health diagnoses not just various categories

A

True

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5
Q

What is the evidence for the transdiagnostic approach? List the 4 questions researchers ask when conducting a transdiagnostic approach

A

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?

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6
Q

True or False?

Individuals with particular diagnoses might not have elevated rates of symptoms not related to their diagnosis

A

False

Individuals with particular diagnoses might have elevated rates of symptoms not related to their diagnosis

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7
Q

Post-traumatic stress disorder symptoms are present in ……. disorders

A

Personality

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8
Q

There are elevated rates of depression and anxiety in….? List 3 disorders

A

1) Psychotic disorders (Birchwood et al., 2000),

2) Eating disorders (Bulik et al., 1997)

3) Substance abuse disorders (Merikangase et al., 1998)

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9
Q

True or False?

There are decreased rates of psychotic symptoms in people with anxiety and depression when compared with a non-clinical sample

A

False

There are elevated rates of psychotic symptoms in people with anxiety and depression when compared with a non-clinical sample

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10
Q

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?

A

These symptoms are more on a spectrum than being separate from each other

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11
Q

True or False?

The majority of people have not/do not meet the criteria for more than one disorder diagnosis

A

False

The majority of people have/meet the criteria for more than one disorder diagnosis

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12
Q

Kessler et al. (2005) more than …..% of people diagnosed with a disorder in a given year, meet the criteria for multiple disorders

A

50%

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13
Q

Who suggested that more than 50% of people diagnosed with a disorder in a given year, meet the criteria for multiple disorders?

A

Kessler et al. (2005)

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14
Q

Depending on the study, …..% - …….% of individuals with one disorder have another disorder that they qualify for

A

32% - 80%

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15
Q

Individuals with one disorder have another disorder that they qualify for

This is known as…?

A

(High Levels of) Comorbidity

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16
Q

There is a significant proportion of people whose diagnosis shifts/changes

This is known as…?

A

Instability of Diagnosis

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17
Q

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

A

Only 29% of specific personality disorders were stable over time

70% of cases of schizophrenia were stable

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18
Q

True or False?

There is a significant proportion of people whose diagnosis shifts/changes

A

True

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19
Q

People shift in their diagnosis over time

When does this mostly happen?

A

Early in life

Often the case with childhood disorders where is hard to pin down a specific diagnostic category

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20
Q

Why do people shift in their diagnosis mainly early on in life?

A

Because often the case with childhood disorders, it is hard to pin down a specific diagnostic category

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21
Q

Who followed up with 10,000 patients at ten-time points in life to investigate the stability of diagnosis?

A

Barca-Garcia et al. (2007)

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22
Q

Who conducted a birth cohort study in New Zealand that used over 1000 participants (assessed every 2 to 6 years)?

A

Caspi et al., 2013

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23
Q

Caspi et al., 2013 conducted a birth cohort study in New Zealand that used over 1000 participants, and assessed every…..?

A

2 to 6 years

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24
Q

What did Caspi et al. examine in their study?

A

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

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25
Q

Caspi et al. used factor analysis in their study. What was this for?

A

To explore inter-correlations between symptoms

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26
Q

What evidence did Caspi et al find in their study?

A

They found evidence pointing to one general underlying dimension that summarized individuals’ propensity to develop any and all forms of common psychopathologies.

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27
Q

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…?

A

P factor

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28
Q

What is the P factor?

A

One general underlying dimension that summarized individuals’ propensity to develop any and all forms of common psychopathologies

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29
Q

What does the p factor correlate with? List 3

A

1) Great life impairment

2) Great childhood maltreatment

3) Poorer brain function in early life (the higher the p score- the more impairment)

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30
Q

The higher the p score, the …… impairment

A

More

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31
Q

What does the p factor explain about finding causes and treatments for individual mental disorders?

A

The p factor explains why it is challenging to find causes, consequences, biomarkers, and treatments with specificity to individual mental disorders

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32
Q

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?

A

Conducting transdiagnostic approaches

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33
Q

What factors might be transdiagnostic? List 3

A

1) Biological
2) Social
3) Brain circuitry

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34
Q

What are biological factors?

A

Genetic factors

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35
Q

What are social factors?

A

Shared interpersonal factors/expressed emotion (such as hostility & criticism in family members)

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36
Q

What are brain circuitry factors?

A

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)

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37
Q

Why might biological factors be transdiagnostic?

A

Many disorders have shared genetic factors/vulnerabilities, e.g. schizophrenia, bipolar disorder, ADHD & major depression

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38
Q

Why might social factors be transdiagnostic?

A

Predicts relapse in bipolar disorder, schizophrenia, anxiety, depression and others

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39
Q

Why might brain circuitry be transdiagnostic?

A

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

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40
Q

What did Goodkind et al find regarding the grey matter/brain structure of people with disorders?

A

Grey matter loss converged across diagnoses in 3 regions

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41
Q

When assessing areas of the brain that are active and differentiate people with mental health difficulties, what did researchers find?

A

They found overlapping areas across disorders

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42
Q

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?

A

This led research councils to look at this more transdiagnostically- the human connectome

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43
Q

Which research groups conducted the analysis of the brain circuitry involved in psychopathology?

A

Buckholtz & Meyer-Lidenberg, 2012
Goschke, 2014

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44
Q

What did research groups conducting analysis of the brain circuitry involved in psychopathology identify?

A

They identified 4 different brain circuits with different brain functions involved in psychopathology

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45
Q

There are 4 different brain circuits with different brain functions involved in psychopathology.

List the 4 brain circuits

A
  1. Frontal-parietal
  2. Default mode network (the way the brain is functioning at rest)
  3. Corticolimbic (amygdala)
  4. Frontal-striatal
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46
Q

What is the function of the frontal-parietal brain circuit in psychopathology?

A

Working memory & performance monitoring

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47
Q

What is the function of the default mode network (the way the brain is functioning at rest) brain circuit in psychopathology?

A

Theory of mind & perspective taking

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48
Q

What is the function of the Corticolimbic (amygdala) brain circuit in psychopathology?

A

Threat detection

49
Q

What is the function of the frontal-striatal brain circuit in psychopathology?

A

Reward, decision making & motivation

50
Q

Which brain circuit is responsible for this function involved in psychopathology?

Working memory & performance monitoring

A

Frontal-parietal

51
Q

Which brain circuit is responsible for this function involved in psychopathology?

Theory of mind & perspective taking

A

Default mode network

52
Q

Which brain circuit is responsible for this function involved in psychopathology?

Threat detection

A

Corticolimbic (amygdala)

53
Q

Which brain circuit is responsible for this function involved in psychopathology?

Reward, decision making & motivation

A

Frontal-striatal

54
Q
  1. Frontal-parietal
  2. Default mode network (the way the brain is functioning at rest)
  3. Corticolimbic (amygdala)
  4. 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

A

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

55
Q

When exploring cognitive behavioural processes (brain function in different parts of the brain) researchers found that …..?

List 2 findings

A

1) Patterns of thinking and behaviour that maintain distress

2) Cognitive behavioural processes are all elevated across psychological disorders

56
Q

Researchers found patterns of thinking and behaviour that maintain distress, such as ….?

List 3 patterns of thinking and behaviour.

A

1) Worry
2) Avoidance
3) Selectively attending to threats in the environment

57
Q

Researchers found that patterns of thinking and behaviour are all elevated across psychological disorders

What does this represent?

A

Transdiagnostic factors

58
Q

Who systematically surveyed the literature on transdiagnostic factors?

A

Harvey et al., 2004

59
Q

What did Harvey et al., 2004 look at in their study?

A

Looked at various cognitive processes (attention, memory, thought, reasoning) as well as behaviour

60
Q

What were the criteria of Harvey et al’s study? List 3

A

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

61
Q

What were the findings of Harvey et al’s study? List 2

A

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

62
Q

What was the initial assumption about psychological processes?

A

Psychological processes are specific to a particular disorder group (e.g anxiety)

63
Q

What was the updated assumption about psychological processes?

A

Psychological processes can be elevated across the board

(e.g people with eating disorders BUT also people with psychosis have elevated detections of threat)

64
Q

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

A

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)?

65
Q

Despite the validity of the classification system, Darwin showed that species ………. in characteristics over time

A

Change

66
Q

Despite the validity of the classification system, Darwin identified huge ………… within a species

A

Individual variation

67
Q

Despite the validity of the classification system, Darwin identified characteristics as …….. across categories (beak shape )

A

Continuous

68
Q

Despite the validity of the classification system, Darwin identified the ……….. of characteristics

A

Functional properties

69
Q

Despite the validity of the classification system, Darwin developed a ….. theory of change across all life, not specific categories of organisms

A

Unified theory

70
Q

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

A

Change

71
Q

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

A

Variation/differences

72
Q

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

A

Continuity

73
Q

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)

A

Functional

74
Q

What do researchers use to understand individuals’ lived experiences of mental health distress?

A

Qualitative interviews & analysis

75
Q

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

A

True

76
Q

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?

A

1) University students -natural recovery across disorders

2) Primary care service

3) Bipolar disorder

4) Eating problems

5) The use of art in recovery

77
Q

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…?

A

Loss of control – at the ‘rock bottom’ & regaining control as the process of recovery

78
Q

Loss of control characterises the symptoms of a variety of disorders

List all 4 disorders

A

1) Panic attacks
2) Psychosis
3) Depression
4) Eating disorders

79
Q

People with panic attacks lose control over what?

A

Lose control over behaviour/feelings during panic attacks

80
Q

People with psychosis lose control over what?

A

Lose control over their minds and lose touch with reality

81
Q

People with depression lose control over what?

A

Lose control over basic motivations to get up etc

82
Q

People with eating disorders lose control over what?

A

Lose control over eating (binge-eating) or extreme control – restricting eating to regain the feeling of loss of control in other areas

83
Q

What is one of the key issues at the heart of mental health problems?

A

Loss of control

84
Q

Define cognitive theories

A

Theories focusing on individuals’ thinking

85
Q

Define behavioural theories

A

Theories focusing on individuals’ behaviour

86
Q

From a biological perspective, what is control?

A

Control is essential for sustaining life

Control keeps every single one of our cells alive; homeostasis

87
Q

Homeostasis comes from Greek words meaning…?

A

“Same” and “Steady,”

This refers to any process that living things use to actively maintain fairly stable conditions necessary for survival

88
Q

Define homeostasis

A

Any process that living things use to actively maintain fairly stable conditions necessary for survival

89
Q

Any process that living things use to actively maintain fairly stable conditions necessary for survival

What is this?

A

Homeostasis

90
Q

What homeostasis is evident in the body? List 2

A

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

91
Q

Control happens (sometimes/all the time) and happens (manually/automatically)

A

Control happens (all the time) and happens (automatically)

92
Q

What do we need control for? List 4 everyday activities that need control

A

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

93
Q

If you suddenly lost control and ability to go into your normal routine, it could be hugely distressing

True or False?

A

True

94
Q

Who proposed the Perceptual Control Theory?

A

William T. Powers (medical physicist)

95
Q

What does the Perceptual Control Theory explain?

A

How control works and is used more widely than just psychology (e.g in designing robotics systems)

96
Q

What does the Perceptual Control Theory propose?

A

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)

97
Q

Which theory proposed that psychological distress is the loss of control due to unresolved goal conflict?

A

Perceptual Control Theory

98
Q

Which theory explains how the control works and is used more widely than just psychology?

A

Perceptual Control Theory

99
Q

According to the Perceptual Control Theory, a loss of control (conflict) causes…?

A

Distress

100
Q

According to the Perceptual Control Theory, a loss of control (conflict) causes distress

Why?

A

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)

101
Q

How can conflict be resolved?

A

Through shifting and sustaining attention to the source of the conflict

It is likely to require flexible use of multiple brain networks

102
Q

True or False?

Conflict can be intra personal only

A

False

Conflict can be intra personal or inter personal

103
Q

What is Method of Levels therapy?

A

Talking therapy

104
Q

The Method of Levels therapy is talking therapy based on the principles of…?

A

Perceptual Control Theory (PCT)

105
Q

PCT proposes that individuals experience distress as a result of ….?

A

Reduced control over important goals in their lives

106
Q

Method of Levels therapy directs an individual’s attention towards ….?

A

Identifying important goals and conflicting goals

107
Q

Method of Levels therapy supports individuals to find ….?

A

Solutions to their own problems

108
Q

What are the 2 main goals of therapy?

A

1) Keep the person talking about the problem
2) Notice disruptions

109
Q

Which therapy helps individuals identify important goals and conflicting goals?

A

Method of Levels therapy

110
Q

Which therapy supports individuals to find solutions to their own problems?

A

Method of Levels therapy

111
Q

Which theory proposes that individuals experience distress as a result of reduced control over important goals in their lives?

A

Perceptual Control Theory (PCT)

112
Q

Which therapy is based on the principles of Perceptual Control Theory (PCT)?

A

Method of Levels therapy

113
Q

The client books their own appointment and talks about the problem of their choice

This is an example of…?

A

Method of Levels therapy

114
Q

What are the distinctive features of the Method of Levels therapy? List 6 features

A

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

115
Q

True or False?

The evidence for shared factors across mental
health problems is weak

A

False

The evidence for shared factors across mental
health problems is robust

116
Q

True or False?

The transdiagnostic approach to psychopathology has empirical support and is commonly used in everyday mental health services

A

False

The transdiagnostic approach to psychopathology has empirical support but is rarely used in everyday mental health services

117
Q

True or False?

In science, classification is used to identify underlying elements

A

True

118
Q

True or False?

Perceptual Control Theory put forward as a unifying framework

A

True

SEM 2 Mental Health and Distress (10 decks)

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