Week 11 Lecture 11 - Transdiagnostic approach Flashcards
Harvey, Watkins, Mansell & Shafran (2004) conducted Systematic review of cognitive & behavioural processes in Adult Axis 1 Disorders
What was found?
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
Harvey, Watkins, Mansell & Shafran (2004) conducted Systematic review of cognitive & behavioural processes in Adult Axis 1 Disorders
What advantages were highlighted?
- generalise models across disorders;
- understand comorbidity;
- inform transdiagnostic treatments
What are the 5 groups of processes found in the transdiagnostic approach?
- attention
- memory
- reasoning
- thinking
- behaviours
5 realms were identified in the transdiagnostic approach
What processes come under attention?
Hypervigilance to external threat
Attentional avoidance of external threat
Hypervigilance to internal experiences
5 realms were identified in the transdiagnostic approach
What processes come under memory?
Recurrent intrusive memories
Selective memory
(Overgeneral memory) –> narrower in applicability
5 realms were identified in the transdiagnostic approach
What processes come under reasoning?
Interpretational bias
Expectancy bias
Emotional reasoning
5 realms were identified in the transdiagnostic approach
What processes come under thinking?
Recurrent negative thinking
Metacognitive beliefs
(Thought suppression) –> narrower in applicability
5 realms were identified in the transdiagnostic approach
What processes come under behaviours?
Avoidance
Safety-seeking behaviours
Experiential Avoidance
Core Process Research in a Clinical Sample
What was the method?
146 patients of different diagnoses
Scale of 15 different transdiagnostic processes
Factor Analysis
Core Process Research in a Clinical Sample
What was found?
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)
Separate processes vs core process in predicting distress in students & in chronic physical illness
What was the method?
- 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?
Separate processes vs core process in predicting distress in students & in chronic physical illness
What was found?
- greater correlation for core process model
- 1 factor is beneath these 3 separate dimensions (worry, thought suppression and avoidance)
To understand the core process….What does psychological distress and recovery involve?
What was the method?
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)
To understand the core process….What does psychological distress and recovery involve?
What was found?
Themes of loss of control at the ‘rock bottom’ & regaining control as the process of recovery
Fits with wider literature
What is control and why is it important?
Homeostasis is control; this is essential for life
Now: temperature; balance; blood sugar
Co-ordination & movement for any activity relies on control
What is the historical context of Perceptual control theory?
- 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
What is a negative feedback loop?
see summary sheet
What are the Key tenets of PCT?
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.
What is the Why, What, How hierarchy in PCT?
see summary sheet
Implications from PCT on what is effective about therapy?
- 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
What maintains goal conflict?
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’
What can shifting and sustaining awareness achieve?
Enable change in systems that regulate inflexible processes; ‘metacognitive’
Help shift awareness to long term goals, values & broader perspectives
What is Method of Levels?
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
Pilot RCT in Primary Care –> MOL
What was the method?
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
Pilot RCT in Primary Care –> MOL
What was found?
Significantly greater change in MOL group on anxiety & depression
Resolving goal conflict as a transdiagnostic process of change?
What was the hypothesis?
Goal conflict maintains distress through loss of control when kept outside awareness by these processes
Resolving goal conflict as a transdiagnostic process of change?
What was the preliminary findings?
Writing about goal conflict reduces distress about the conflict (Kelly et al., 2011)
Interactive computer therapist (Gaffney et al., 2014)
Searches participant text for key terms
Asks questions to sustain attention on them
What was found?
Awareness of conflict correlated with reduction in distress & mediated the effect of positive expectancy
