Week 11 Lecture 11 - Transdiagnostic approach

Question 1

Harvey, Watkins, Mansell & Shafran (2004) conducted Systematic review of cognitive & behavioural processes in Adult Axis 1 Disorders

What was found?

Answer 1

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

• 12 ‘definite’ Transdiagnostic processes + 3 ‘possible

Question 2

Harvey, Watkins, Mansell & Shafran (2004) conducted Systematic review of cognitive & behavioural processes in Adult Axis 1 Disorders

What advantages were highlighted?

Answer 2

• generalise models across disorders;
• understand comorbidity;
• inform transdiagnostic treatments

Question 3

What are the 5 groups of processes found in the transdiagnostic approach?

Answer 3

• attention
• memory
• reasoning
• thinking
• behaviours

Question 4

5 realms were identified in the transdiagnostic approach

What processes come under attention?

Answer 4

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

Question 5

5 realms were identified in the transdiagnostic approach

What processes come under memory?

Answer 5

Recurrent intrusive memories
Selective memory
(Overgeneral memory) –> narrower in applicability

Question 6

5 realms were identified in the transdiagnostic approach

What processes come under reasoning?

Answer 6

Interpretational bias
Expectancy bias
Emotional reasoning

Question 7

5 realms were identified in the transdiagnostic approach

What processes come under thinking?

Answer 7

Recurrent negative thinking
Metacognitive beliefs
(Thought suppression) –> narrower in applicability

Question 8

5 realms were identified in the transdiagnostic approach

What processes come under behaviours?

Answer 8

Avoidance
Safety-seeking behaviours
Experiential Avoidance

Question 9

Core Process Research in a Clinical Sample

What was the method?

Answer 9

146 patients of different diagnoses
Scale of 15 different transdiagnostic processes
Factor Analysis

Question 10

Core Process Research in a Clinical Sample

What was found?

Answer 10

One Factor Solution, 13 items r >.4

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

Higher scores in clinical vs. non-clinical sample,p < .001
No differences based on diagnosis
(anxiety/mood/eating/psychosis/ somatoform)

Question 11

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

What was the method?

Answer 11

• compared separate processes and core processes model
• how was do separate processes (worry, thought suppression and avoidance) predict DASS?
• how well does this compare to a single core process that has all these 3 things in common?

Question 12

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

What was found?

Answer 12

• greater correlation for core process model
• 1 factor is beneath these 3 separate dimensions (worry, thought suppression and avoidance)

Question 13

To understand the core process….What does psychological distress and recovery involve?

What was the method?

Answer 13

Qualitative Interviews & Analysis

• 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)

Question 14

To understand the core process….What does psychological distress and recovery involve?

What was found?

Answer 14

Themes of loss of control at the ‘rock bottom’ & regaining control as the process of recovery

Fits with wider literature

Question 15

What is control and why is it important?

Answer 15

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

Question 16

What is the historical context of Perceptual control theory?

Answer 16

• Fits with the teleological approach of early psychology
• Fits with importance of unconscious conflict
• Powers was a control system engineer who developed the theory through the 1950s & 60s
• Encountered cybernetics
• Influenced William Glasser’s Reality Therapy; Klaus Grawe’s Psychological Therapy; now influencing the development of CBT

Question 17

What is a negative feedback loop?

Answer 17

see summary sheet

Question 18

What are the Key tenets of PCT?

Answer 18

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

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

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

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

Question 19

What is the Why, What, How hierarchy in PCT?

Answer 19

see summary sheet

Question 20

Implications from PCT on what is effective about therapy?

Answer 20

• 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

Question 21

What maintains goal conflict?

Answer 21

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’

Question 22

What can shifting and sustaining awareness achieve?

Answer 22

Enable change in systems that regulate inflexible processes; ‘metacognitive’

Help shift awareness to long term goals, values & broader perspectives

Question 23

What is Method of Levels?

Answer 23

Transdiagnostic cognitive therapy from PCT (Carey, 2006; Powers, 1973)
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

Question 24

Pilot RCT in Primary Care –> MOL

What was the method?

Answer 24

N=29 (out of 55)
17 MOL (up to 8 sessions; M = 5)
12 Contact Service with treatment-as-usual (M = 4 sessions of CBT)
Intention-to-treat analysis

Question 25

Pilot RCT in Primary Care –> MOL

What was found?

Answer 25

Significantly greater change in MOL group on anxiety & depression

Question 26

Resolving goal conflict as a transdiagnostic process of change?

What was the hypothesis?

Answer 26

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

Question 27

Resolving goal conflict as a transdiagnostic process of change?

What was the preliminary findings?

Answer 27

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

Question 28

Interactive computer therapist (Gaffney et al., 2014)
Searches participant text for key terms
Asks questions to sustain attention on them

What was found?

Answer 28

Awareness of conflict correlated with reduction in distress & mediated the effect of positive expectancy