Week 7: Transdiagnostic Approaches Flashcards
6 criticisms of the DSM-5 and ICD-11
- Categorical system: Disorders are separate entities
- High comorbidity: non-specific symptoms, processes, vulnerabilities etc.
- A-theoretical approach (no theoretical background of the ones developing the DSM-V has played a role in developing the DSM) and descriptive.
-No statements about aetiology (except for PTSD) - gap between research and clinical practice: Treatment in clinical practice according to case formulation
- Influential: all patients need to be linked to the DSM-5 to be reimbursed for treatment
- Overly reliant on expert opinion
What is the basic idea of the transdiagnostic approach?
Focus on processes within the disorder
2 groups for transdiagnostic treatment
Type A
* Suitable for a large group of patients
* Focus on a small number of important processes/symptoms that all related disorders benefit from
– Reduction of complexity compared to disorder specific approach
Type B
* Highly individualized process-focused treatment
* Focus on selection of large amount of specific processes
* Individual diagnostic and case formulation: Increase of complexity relative to disorder specific approach
Compared to the transdiagnostic approach, how is a disorder specific treatment plan characterized? (5)
- Apply sequentially evidence-based treatment protocols, based on individual case formulation
- Problem: Possibly not the most efficient approach
-Comorbid complaints without actual focus could interfere with treatment
- Not all problems are covered by the diagnoses/ thus will be focused on in treatment
- Not the favourite approach of therapists
Compared to disorder specific, how is a transdiagnostic treatment plan characterized? (4)
- Individualised treatment based on individual case formulation -> often used in clinical practice (e.g. focus on repetitive negative thinking/ rumination, emotion regulation)
- Problem: No evidence-based decision rules/ low reliability of individual case formulation
- No evidence-based treatments for processes available
-Clinical literature is not adapted or organized to this way (treatment protocols are disorder specific and do not focus on changing processes)
Criticism of the transdiagnostic approach (2)
- not yet evidence based
- stay using disorder specific interventions with high effectivity
What is a major implication of the transdiagnostic approach?
Same treatment interventions effective for different disorders
Criticisms of the Dimensional Approach: Hierarchical Taxonomy of Psychopathology (3)
Criticism:
categorical distinctions
does not capture heterogeneity of mental disorders
overly reliant on experts
3 Components of Network Analysis?
- Mental disorders arise from interaction of symptoms rather than underlying causes
- Identify critical symptoms to be targeted in treatment
- Network can help identify potential comorbidities
3 criticisms of network analysis?
- Oversimplifying mental disorders
- Contextual and environmental factors are not included
- Personality disorders cannot be well explained as it concerns stable and enduring patterns
3 basic assumptions about psychopathology, according to RDoC
1) Psychiatric disorders are disorders of the brain (Is this always true?)
2) Psychiatric disorders can be identified in brain circuits with technic from neuroscience
3) Certain biological signatures can do individual predictions on the nature of the disorder and the prognostic of the treatment
5 Domains of RDoC
1) Negative valence systems
2) Positive valence systems
3) Cognitive systems
4) Social processes
5) Arousal and regulatory systems
Describe the difference between mechanistically transdiagnostic and descriptively transdiagnostic
Descriptively transdiagnostic
Processes that are present in a range of disorders
construct is present in range of disorders, without regard to how or why
Mechanistically transdiagnostic
Processes that reflect a causal, functional mechanism for co-occurrence
this reflects a causal relationship to range of psychopathology
For example:
Low-self esteem is present in many orders (descriptive), but targeting low self-esteem will not lead to alleviation of psychopathological processes which maintain symptoms
3 categories of transdiagnosis, as proposed by Sauer-Zavala et al. (2017)
- Universally applied Therapeutic principles
a guiding therapeutic strategy is universally applied across the range of presenting disorders - Modular Approach
A clinician chooses from an assembled bank of discrete strategies to create a treatment that maps onto any patient’s problems, regardless of diagnosis - Shared Mechanisms
Interventions that explicitly target shared mechanisms implicated in the development and maintenance of certain classes of psychopathology
Qualities of a Universally Applied Therapeutic Principles approach: (4)
Emanate from a school or identifiable type of psychotherapy (humanistic, psychodynamic)
Contain strategies that are universally applied to a broad range of psychopathology.
Theory-based to guide accounts of how therapy should be conducted
“Top-down” efforts to apply an existing therapeutic technique to multiple disorders without explicit consideration whether all disorder treated with that technique are maintained by the similar process.
