L4 The Transdiagnostic Approach

What does "transdiagnostic" mean?

It means "across diagnoses"

What does a ‘full’ transdiagnostic approach apply to

all mental health diagnoses (not just various categories)

3 issues with DSM and MH diagnoses

elevated rates of non-diagnostic symptoms, high levels of comorbidity, and instability of diagnosis

Explain the issue of ‘elevated rates of non-diagnostic symptoms’

individuals with particular diagnoses might have elevated rates of symptoms not related to their diagnosis

What disorder are PTSD symptoms often elevated in

personality disorders

What 3 MH conditions are depression and anxiety elevated in (1 severe, 2 others)

psychotic disorders, eating disorders and substance abuse disorders

Why is a consequence of elevated rates of non-diagnostic symptoms

make treatment consideration difficult

Why might it indicate if individuals are diagnosed with one condition but score high on symptom clusters related to other classifications

symptoms are more on a spectrum than being distinct from each other

What is comorbidity?

The presence of two or more mental health disorders in one individual

According to Kessler et al, what % of people meet the criteria for multiple disorders

more than 50%

2 ways in which diagnosis is unstable

people can recover or individual’s diagnosis can shift over time

After following up with patients at 10 time points, what % of cases of schizophrenia were stable (Barca-Garcia et al)

70%

What time point is difficult to pin down specific diagnostic category

childhood disorders

What does Caspi et al’s "p factor" indicate?

A person’s overall likelihood to develop any and all forms of common psychopathologies

What 3 things does the p factor correlate with

great life impairment, great childhood maltreatment and poorer brain function in early life

What did Caspi claim the p factor helped to explain

why it is challenging to find causes, consequences, biomarkers and treatments with specificity to individual mental disorders

What approach may improve research due to findings related to p factor

transdiagnostic approaches

4 factors that might be transdiagnostic

biological, social, brain circuitry and cognitive behavioural processes

What biological factors are transdiagnostic?

Shared genetic vulnerabilities in disorders like schizophrenia, bipolar disorder, ADHD, and depression.

What social factors are transdiagnostic?

shared interpersonal factors and expressed emotion predict relapse across multiple disorders

Structurally, what specific brain circuitry findings support a transdiagnostic view?

Grey matter loss is seen across multiple disorders

While assessing functional patterns, what was consistent across disorders

overlapping areas

What cognitive behavioural processes are elevated across psychological disorders

patterns of thinking and behaviour e.g. worry, avoidance and selectively attending to threat in environment

What did Harvey et al. (2004) conclude about generalisation of psychological processes?

Thought patterns once thought specific to a disorder are actually common across many disorders

What common theme emerged in qualitative research on mental health distress?

Loss of control

Why is control biologically important?

essential for sustaining life e.g. homeostasis- body temperature and blood sugar

What 4 everyday body movements require control?

Balance, posture, speech and head upright

What is the significance of losing control considering all the things it is necessary for

could be hugely distressing

Name a theory of control that can contribute to understanding mental health difficulties

Perceptual Control Theory (PCT)

Who developed PCT

Powers

How does PCT explain psychological distress?

as a result of loss of control due to unresolved goal conflict

How are goals structured in PCT?

Hierarchically

What do lower goals relate to

‘how’ we want/need things

What do higher goals relate to

‘why’ we want things in a certain way

What is the nature of the control systems

to constantly reduce error

What is error in the control systems

when preferred states do not match experienced states

Why does goal conflict occur

inevitable consequence of controlling numerous goals simultaneously e.g. pursuing two or more incompatible goals/preferred states

What happens when goals conflict remains unresolved?

leads to loss of control and psychological distress

How is conflict resolved

reorganisation

What is the process of reorganization in PCT?

A trial-and-error learning process to resolve goal conflicts

What 2 things needs to occur during reorganisation

a) focus reorganisation on the right place, b) keep it focused so that spontaneous changes take place

2 natures of conflict

can be intra personal or inter personal

Name a talking theory, based on the principles of PCT

Method of Levels therapy

According to the Method of Levels, how is conflict resolved

through shifting and sustaining attention to the source of the conflict

What 2 things does the Method of Levels therapy help individuals identify

important goals and conflicting goals

What are the 2 main goals of MOL therapy?

keep the person talking about the problem and notice disruptions

What is a key aspect of the therapist in MOL therapy?

The therapist remains curious but does not lead the conversation, allowing the client to explore their own experiences.

What is a unique aspect of MOL therapy appointments?

Clients book their own appointments and choose what problem to discuss.