WEEK 3 - Predicting Psychopathology

Diathesis-stress models definition

Emphasize disorders emerge when pre-dispositional vulnerabilities are activated by environmental demands

resilience models

considers strengths, but must these be considered alongside risks

resilience

the process and outcome of successfully adapting to difficult or challenging life experiences, especially through mental, emotional, and behavioural flexibility and adjustment to external and internal demands

several factors contribute, a) the ways in which individuals view and engage with the world, b) the availability and quality of social resources, c) specific [behavioural] coping strategies

research demonstrates that the resources and skills associated with more positive adaptation (greater resilience) can be cultivated and practiced

emphasizes both a process and outcome, highlighting adaptability and flexibility

resilience measurement

requires experiencing an adverse effect that impair the ability to achieve a positive outcome and return to normal functioning

just because you are resilient to one stressor, does not mean you will be resilient to the next

there is no reliable way to assess one’s resilience level

one can recover without having been able to sustain themselves through the stressor. equally, it is possible to have grown from a stressor but never recover fully

Connor-Davidson Resilience Scale

measures adaptability, persistence and confidence

Brief Resilience Scale

measures resilience recovery

Ecological Momentary Assessment

captures dynamic daily resilience

proposed resilience factor framework

psychological: self-efficacy, self-image, control, optimism

processes: anticipation, adaptability, and reactivity

outcomes: positive reintegration / bouncing back

resilience implications

a multi-component system and existing scales each capture only a slice of this system

every psychological item and factor from all scales mapped onto the unified construct, suggesting it is capturing holistic resilience

this integrates trait-like capacities, dynamic processes, and end-state outcomes. it is the first attempt to standardize resilience factors

youth resilience key findings

pre-pandemic resilience predicts better overall mental health, but most resilience factors did not buffer COVIDs mental health impact

family-level resilience showed the most consistent protective effects, but individual-level resilience showed mixed results

youth resilience implications

resilience is not a universal. it is context-dependent: stressor, developmental stage, relationships and environment

youth with stronger pre-pandemic resilience generally had better mental health, but most resilience factors did not buffer the specific mental health impacts of COVID-19

family systems appear to be the most stable resilience anchor during crises and emerged as the most reliable and protective domain

COVID-19 stressors like isolation, school closures, uncertainty, may have overwhelmed typical resilience resources

diathesis stress model explanation

everyone has a threshold for developing psychopathology that is dependent on interactions between vulnerability and stress, this hypothesis seems helpful for predicting who will develop psychopathology and who wont

however, the way theorists quantify relationships varies:

additive: linear dose-response

ipsative: inverse relationship, high stress requires lowers diathesis

threshold: additional interaction between vulnerability and stress predicts a tipping point at which psychopathology is developed

diathesis stress model clinical implications

cognitive models agree with the ipsative and threshold approach as does the data on recurrent MDD: repeat episodes = stronger schema, requires less stress for activation

PTSD epidemiology points to an ipsative model: the greater the trauma, the less diathesis needed to trigger psychopathology

diathesis stress factors

vulnerability measurement: there is no strict measurement for vulnerability, but there are dozens of instruments that measure constructs that serve as vulnerability factors

social: indices of poverty, discrimination and trauma exposure; can be measured by trauma exposure checklists (Childhood Trauma Questionnaire)

psychological: link between adverse childhood experiences and adult PTSD was best explained by cognitive mediators. cognition is important vulnerability and intervention target

biological: genetic liability, HPA axis-dysregulation, cortisol reactivity

diathesis stress measurements

life event scale (Holmes and Rahe)

perceived stress scale (cohen, kamarch and mermelstein)

ecological momentary assessment (shiffman et al)

cortisol and HPA axis biomarkers

risk factors

the bridge between etiology and intevention, included in formulation and explain why disorders develop, persist and reoccur

trauma impacts neurobiological development through epigenetic changes, HPA axis dysregulation, and altered neural connectivity

diagnosis

the identification of the nature of an illness or other problem by examination of the symptoms; helps to understand vulnerability

formulation

a collaborative, evidence-based hypothesis that explains the origin, development and maintenance of a person’s mental health difficulties; helps mapping risk + resilience for the individual

treatment

evidence-based therapeutic approaches designed to reduce, manage, or eliminate mental health symptoms, dysfunction and distress; helps targeting modifiable risks

statistical relationships between potential risk factors and psychopathology development

correlate: association with no temporal precedence - meaning no evidence or causality

risk factor: precedes outcome - temporal precedence

causal risk factor: precedes an outcome, and manipulating it affects the outcome

moderator

fixed variable that set conditions; sets the conditions for a disorder to occur (risk) and can be treated in therapy; early experiences act as these within psychopathology, setting the conditions for future pathology to occur

mediator

intervening variables that transmit effects (eg, maladaptive schemas); actively maintain the disordered state. the main intervention target

biological risk factor

genetic liability, neurobiology, HPA axis dysregulation

cognitive risk factor

maladaptive conditions, rumination, attributional style

behavioural risk factors

dysfunctional coping strategies, avoidance, withdrawal

environmental risk factors

trauma, poverty, discrimination, family dysfunction

cultural risk factors

stigma, minority stress, digital-age stressors

psychological trauma

chronic stress can lead to epigenetic changes that affect the homeostasis of the HPA axis. changes in the brain also have an adaptive side; enhancing hypervigilance to danger to protect from further trauma

the diathesis stress gene x environment interaction is moderated by epigenetic processes with genetic overlap for schizophrenia, MDD and PTSD

epigenetic

the study of how behaviours and environmental factors, such as diet, stress and toxics, cause changes that affect how genes work without changing the underlying DNA sequence

cognitive mediators

cognitive factors mediate the relationship between adverse childhood experiences and adult psychopathology; cognitive factors are transdiagnostic intervention targets

transdiagnostic

a mental health approach focusing on core, underlying processes and mechanisms that cause or maintain multiple psychological disorders, rather than focusing on single, discrete diagnosis

p-factor

proposed general liability underlying comorbidity across psychiatric disorders, analogous to “g” in intelligence - a single dimension explaining variance across multiple domains

predicts broad impairment, self-harm, poor functioning and therefore some general liability

is a statistical phenomenon, but should not be treated like a real entity yet as it risks ignoring environmental factors

comorbidity

a simultaneous presence of two or more medical conditions or diseases in a patient, occurring alongside a primary diagnosis

dispositional negative emotionality (DNE)

based on a spectral model of personality and psychopathology suggesting a shared origin stable and robust personality disposition

impulsive responsivity to emotion (IRE)

A trait linked to internalizing and externalizing factors in that the strategy they use is a reaction to internal distress. tied to deficits in response inhibition which link to intrusions seen in multiple disorders

low cognitive functioning

high levels of p generate distress which impacts cognitive functioning across many intelligence domains. cognitive deficits in individuals with high p were observed long before psychopathology emerged

thought dysfunction

individuals with high levels of p may experience psychotic processes regardless of diagnosis. this also includes intrusion, trauma re-experiencing. TD loads highest on to p and in some cases is p itself. loads higher than internalizing and externalizing

internalizing

related to the p-factor, is a category of psychopathology that divides the study into broad categories: this category covers fear, distress, anxiety and depression

is presented inwardly in coping mechanisms

externalizing

related to the p-factor, is a category of psychopathology that divides the study into broad categories: this category covers substance abuse, ADHD symptoms, etc

is presented outwardly in coping mechanisms

p-factor limitations

bifactor models fit well, but statistical fit does not guarantee construct validity

single + bifactor models share similar correlation strengths for p, and these have high criterion validity for a range of issues

treating p as a latent “cause” may risk ignoring external determinants such as poverty, discrimination or trauma

p may be a statistical artefact of symptom overlap, not a true concept; may simply index overall impairment and correlate strongly with only negative outcomes

overemphasis on p may obscure disorder-specific mechanisms