Week 11 - transdiagnostic approach Flashcards
What are the benefits to a Disorder-Specific Treatment?
- Can prioritise main presenting problem
- Avoids ‘diluting’ treatment: ‘more of less’ rather than ‘less of more’
- Evidence that treating principal disorder has positive impacts on comorbidities
- Simpler and enhances group cohesion
- They are highly effective!
- Pragmatics
- Generates research
- Attracts funding
- Leads to fame and fortune!
What are the limitations to a Disorder-Specific Treatment?
- Comorbidity: absence of an evidence-base that addresses each and every combination of comorbid-presentations
- Where to start?
- Is there a common lynchpin(s)?
- What about people who don’t meet formal diagnostic criteria?
- Diagnosis-specific protocols can generalise to non-treated disorders, suggesting they might be acting on transdiagnostic processes. Is generalisation impeded by the focus on one disorder?
- Diagnosis-specific CBT manuals look strikingly similar
What are the benefits to a Transdiagnostic Approach?
- Help us understand comorbidity by focusing on processes that are common across disorders and that causally contribute to symptoms
- Comorbidity is the norm
- Stability of diagnoses within individuals is low
- More parsimonious assessment and training than a large number of discrete disorders
- Link to aetiological and maintaining mechanisms better than descriptive diagnostic labels
What are the areas that Transdiagnostic processes currently approach?
- Repetitive Negative Thought – worry, rumination, obsession
- Intolerance of Uncertainty
- Avoidance
- Interpersonal problems
- Negative meta-cognitive beliefs
- Attention bias
What are some common elements in the environment of individuals with disorders
- Low levels of positive reinforcement
- High levels of punishment
- Low levels of support
- Many external stressors
- Conflict in interpersonal relationships
What is part of the opportunities for emotional regulation?
(antecedent focused)
- situation selection
- situation modification
- attention deployment
- cognitive change
- emotion
(response focused)
- response modulation
Functional analysis is very important, as you many have therapeutic strategies but they must be based on a therapeutic model. What makes up a transdiagnostic functional analysis?
- Action (target behaviour)
- Setting (internal and external factors surrounding the behaviour)
- Trigger (events immediately prior to behaviour)
- Result (what happened – positive and negative reinforcement)
One transdiagnostic model is the model of emotion generation, which involves our emotional tendencies (behavioural, experiential and physiological tendencies) being fed into by antecedents (emotional cues/evaluation) and causing an emotional response which can be modulated. Define emotional regulation…
• “the processes by which individuals influence which emotions they have,
when they have them, and how they experience and express these
emotions” (Gross, 1998)
• Can be automatic or controlled
• Can be conscious or unconscious
• Can be effective at various points in the emotion generative process
What is response modulation?
Modulation = Directly influencing physiological,
experiential, or behavioural
responding
What are unhelpful and alternative responses?
Unhelpful responses =
• Suppression (numbing, dissociating, cutting, drinking, drugs, food)
• Avoidance (of activities, places, people, relationships, conversations that produce uncomfortable emotions)
• Escalation (e.g. ruminating, attacking)
• Repeatedly acting on emotional urges, and then regretting the consequences
Alternative responses =
• Highly dependent on individual difficulties, situations and the client’s goals/ values
• Change or distract from the emotion in a “healthy” non-destructive way, e.g.
- distress tolerance skills (DBT): Distract, Improve the Moment, Self Soothe
- Cognitive Challenging
- Change attention focus
• Experiencing the emotion without trying to change or suppress it, e.g. using mindfulness skills
• Choosing behavioural response based on values + goals, as opposed to action-urge
“Chilled plus” transdiagnostic treatment for adolescents has 4 components. what are they?
Contents
- Motivation and goal setting
- Goal directed action to overcome avoidance
- Developing more realistic thinking
- Building emotional awareness and distress tolerance
Transdiagnostic therapy can occur on 3 levels. What is L1: meta level?
L1: meta level • Beliefs and issues around a problem • Conceptual level • Possible approaches: - Externalising (Narrative) - Emotional Schemas (CBT, Leahy) - Education (DBT) - Motivational interviewing (MI) - Metacognitive work (MCT) - Values clarification (ACT)
Beliefs about emotion
2 fundamental coping pathways:
1. Attending to and labelling emotions in a manner that accepts and
normalises them
2. Pathologising some emotional experiences - leads to attempts to distort
or avoid them, and secondary emotions e.g. guilt, shame
• Influenced by family, culture, experience of trauma
EMOTIONS HAVE FUNCTIONS (E.G. survival, inforamtion, communication, motivation, socialising, etc)
KEY TARGETS: 1. Increase motivation and readiness 2. Reduce investment 3. Reduce strong self-doubt 4. Identify potential barriers EMPHASIS: Exploring and shifting beliefs and attitudes around problem
Transdiagnostic therapy can occur on 3 levels. What is L2: present focused level?
(deals with cognitions, behaviours, emotions and physical sensations). • Actual process of worry and anxiety • Experiential Level • Interventions: - Behaviour therapy - Cognitive therapy - Affect/emotions
TARGETS: 1. Reduce avoidance of affect 2. Ability to slow down & work through worry thinking 3. Ability to regulate affect adaptively 4. Acceptance towards residual anxiety EMPHASIS: Exposure to affect and developing adaptive responses to affect
Transdiagnostic therapy can occur on 3 levels. What is L3: Schematic level?
• Underlying schematic issues • Core beliefs about self, others and world • Optional • Interventions - Schema therapy - Imaginal exposure - Imagery rescripting - Develop New System (Padesky)
KEY TARGETS:
1. Create new understanding and perspective of
past experience
2. Shift in key cognitions and emotions associated
with past memory
3. New way of relating to internal and external
experiences
EMPHASIS: Use of affect and imagery to change perspectives relating to
schemas and developing new ways of interacting with life
