Transdiagnostic therapy Flashcards
Pros and Cons of the unified protocol for emotional disorders
Transdiagnostic processes: similarities between disorders
- Attention
- Reasoning
- Thinking style
- Memory processes
- Behavioral processes
PROS
- Co-morbidity
- Encourage greater transfer of theoretical and treatment advances between disorders
- Might help explain interesting findings
- Within a category: prevention & treatment
- Across categories: treatment of negative affect syndrome
- Perspective on how to help more patients with better results, what works for whom
CONS
- Can not explain why people present psychopathology so differently
How does the unified protocol for emotional disorders differs from disorder-specific interventions
Negative Affective Syndrome (NAS): transdiagnostic view on emotional disorders
- Emotion Regulation; maladaptive strategies, positive emotions
- Anxiety sensitivity
- Attentional Bias
- Distress tolerance
- Intolerance of uncertainty
- Perceived control
- Shame
- Repetitive negative thinking
- Thought-action-fusion (with OCD)
UNIFIED PROTOCOL
- Individual treatment
- Max 18 sessions
- Limited evidence yet, helpful
- Importance: application more likely, more patients profit, co-morbidity
Transdiagnostic group CBT (T-GCBT)
12 weekly 2 hour sessions
Schedule
Sessions 1-2: psycho-education
Session 3: cognitive restructuring
Sessions 4-9:exposure and cognitive restructuring
Sessions 10-11: global, schema restructuring
Session 12: relapse prevention
Includes: CBT; lots of treatment protocols, ACT
Proven to be similarly effective
But maybe individual differences of suitable approaches
Transdiagnostic group CBT (T-GCBT)
12 weekly 2 hour sessions
Schedule
- Sessions 1-2: psycho-education
- Session 3: cognitive restructuring
- Sessions 4-9:exposure and cognitive restructuring
- Sessions 10-11: global, schema restructuring
- Session 12: relapse prevention
- Includes: CBT; lots of treatment protocols, ACT
- Proven to be similarly effective
- But maybe individual differences of suitable approaches
Feeding and Eating disorders
- Pica and Rumination Disorder
- Avoidant-Restrictive Food Intake Disorder
- Anorexia Nervosa
(Active maintenance of unhealthy low body weight
Overvaluation of shape, and weight, and their control) - Bulimia Nervosa
(Recurrent binge eating (objectively large amount of food and a sense of loss of control)
Extreme weight-control behavior
Overvaluation of shape, and weight, and their control) - Binge-eating Disorder
(Recurrent binge eating (objectively large amount of food and a sense of loss of control)
NOT Overvaluation of shape, and weight, and their control (no compensation)) - Other Specified F & E D
(No diagnostic criteria
Residual category for eating disorders of clinical severity
That do not meet the diagnostic criteria for AN or BN) - Unspecified F & E D
=> similar almost same psychopathology is seen across the eating disorders
=> severity is almost the same
=> migration of diagnoses
Core/Transdiagnostic psychopathology of eating disorders
Overvaluation of shape, and weight, and their control
- peculiar to eating disorders
- uncommon in the general population
Transdiagnostic processes in eating disorders
Attention:
- Body -> negative aspects own body, positive aspects others
Reasoning:
- Expectancy that negative outcomes will occur as a consequence of their weight and shape
- Eating helps negative moods and boredom (BN)
- Thinness will lead to positive outcomes (AN)
- I will be happy and successful when i have a certain weight
Thinking style:
- concerns about body shape, weight, food,
- negative self-esteem
Memory processes:
- eating disorder patients: moreover general memories
Behavioral processes
- Avoidance: eating fat food -> looking at food/drinks, situations where they can not control their food, no weighing or weighing excessively, mirrors
- Safety behavior: strict rules, repeat checking of body
Transdiagnostic theory of eating disorders
Core psychopathology: overweight of concerns of body shape and weight
4 additional mechanisms:
- Extreme perfectionism
- Low self-esteem
- Mood intolerance
- Interpersonal problems
importance of a transdiagnostic approach to eating disorders in clinical practice
Treatment
- CBT: 20 sessions (in extreme cases: CBT-enhanced -> 40)
- Look at it as a house of cards (which mechanism is underlying the eating disorder)
- Assessment:
Patient (eating disorder examination), important other people, Co-morbidity, Physical situation
- Individual maintaining processes: concerns, avoidance, safety behaviors
- Motivate: why do they seek help, what do they want to change, barriers?, consequences of their disorder
- Personalized theory
CBT - enhanced:
agenda-setting, socratic motivation
- Phase 1: Quick changes, Diet management
- Phase 2: Short, Motivation, what is a barrier to change, what helps
- Phase 3: cognitions, behavioral experiments, exposure
- Phase 4: patient becomes therapist, prevention of relapse
Therapy
- Treatment protocol: “fix what is wrong/disorder”
- Resilience: daily life, meaning, positive psychology “build what is strong”
=> 2 pathways to change the overvaluation of weight, body shape and
their control
How to organize health care
- Low motivation for seeking help
- Different diagnoses
- Same maintaining processes
- Migration of diagnoses
- One treatment center (online, outpatient, clinical ward)
the importance of a transdiagnostic approach in the context of the prevention of eating disorders
Prevention
- High prevalence of overweight, binge eating, extreme weight control behavior
- Shared risk and protective factors? -> to develop prevention interventions
Project EAT 1 and 2
- Shared risk factors:
weight-related pressure in the social environment, personal weight and body concerns, dieting and unhealthy weight control behaviors
- Protective for girls: frequent meals and positive atmosphere at meals
Transdiagnostic processes and clinical practice
Refugees and migrants
from WHO
Problem Management Plus (PM+)
- 5 sessions 90 minutes
- Suitable for: High levels of anxiety and depression and less functioning
- Adjustment to culture
- Factors: problem-solving, stress management, behavioral activation, access to social support
