Transdiagnostic process

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A transdiagnostic process is a proposed psychological mechanism underlying and connecting a group of mental disorders.

History

Example of differential diagnosis
Example of differential diagnosis

Over the last two centuries, western mental health science has focused on nosology whereby panels of experts identify hypothetical sets of signs and symptoms, label, and compile them into taxonomies such as the Diagnostic and Statistical Manual of Mental Disorders. While this is one of the approaches that has historically driven progress in medicine, such taxonomies have long been controversial on grounds including bias,[1] diagnostic reliability and potential conflicts of interest amongst their promoters.[2][3] Over-reliance on taxonomy may have created a situation where its benefits are now outweighed by the fragmentation and constraints it has caused in the training of mental health practitioners, the range of treatments they can provide under insurance cover, and the scope of new research.[4][5]

To date, no biological marker or individual cognitive process has been associated with a unique mental diagnosis[6][page needed][7] but rather such markers and processes seem implicated across many diagnostic categories.[8] For these reasons, researchers have recently begun to investigate mechanisms through which environmental factors such as poverty, discrimination, loneliness, aversive parenting, and childhood trauma or maltreatment might act as causes of many disorders and which therefore might point towards interventions that could help many people affected by them. Research suggests that transdiagnostic processes may underlie multiple aspects of cognition including attention, memory/imagery, thinking, reasoning, and behavior.[9]

Examples

Transdiagnostic processes well-supported by evidence

While an exhaustive, confirmed list of transdiagnostic processes does not yet exist, relatively strong evidence exists for processes including:

  • Selective attention to external stimuli
  • Selective attention to internal stimuli [1]
  • Avoidance behavior: distracting ourselves or deliberately not entering feared situations, thereby blocking the opportunity to disconfirm negative beliefs.
  • Safety behavior: habitual behaviors we execute because we believe they will help us to avoid something we fear (for example, vomiting, dieting or excessive exercise to avoid weight gain)
  • Experiential avoidance
  • Explicit selective memory
  • Recurrent memory
  • Interpretation reasoning: how we reach conclusions regarding the meaning of ambiguous or open-ended situations.
  • Expectancy reasoning: predicting likely future events and outcomes that may follow specific actions or situations.
  • Emotional reasoning
  • Recurrent thinking
  • Positive and negative metacognitive beliefs: beliefs we have about our own thinking processes.

Possible additional transdiagnostic processes

Processes supported by growing evidence include:

  • Implicit selective memory
  • Overgeneral memory
  • Avoidant encoding and retrieval
  • Attributions: inferring causes for the outcomes we perceive
  • Detecting covariation: detecting events that tend to co-occur regularly and consistently
  • Hypothesis testing and data gathering: evaluating if currently held explanations and beliefs seem accurate or need revision
  • Recurrent negative thinking: worry and rumination that dwells on intrusive thoughts in an effort to work through or resolve them.
  • Thought suppression: deliberately trying to block or remove specific intrusive mental images or urges from entering consciousness, which may have the paradoxical effect of sustaining the thought.

Implications

Transdiagnostic processes suggest interventions to help people suffering from mental disorders. For example, helping someone to view thoughts as mental events in a wider context of awareness, rather than as expressions of external reality, may enable someone to step back from those thoughts and to see them as ideas to be tested rather than unchangeable facts.[10] If research can identity a relatively limited number of transdiagnostic processes, people facing a wide range of mental difficulties might be helped by practitioners trained to master a relatively limited number of techniques corresponding to those underlying processes, rather than requiring many specialists who are each expert in treating a single specific disorder.[11]

Transdiagnostic processes also suggest mechanisms through which delusions and cognitive biases may be understood. For example, the process of detecting covariation can lead to illusory correlations between unrelated stimuli, and the process of hypothesis testing and data gathering is generally subject to confirmation bias, meaning existing beliefs are not updated in the light of conflicting new information.[12]

See also

References

  1. ^ Gorwitz, Kurt (March–April 1974). "Census enumeration of the mentally ill and the mentally retarded in the nineteenth century". Health Services Reports. 89 (2): 180–187. doi:10.2307/4595007. JSTOR 4595007. PMC 1616226. PMID 4274650.
  2. ^ Bradshaw, James (2006-11-01). "Glasser headlines psychotherapy conference". The National Psychologist. Archived from the original on 2011-10-14. Retrieved 2022-08-20.
  3. ^ Greenberg, Gary (January 29, 2012). "The D.S.M.'s troubled revision". The New York Times. The article's closing words: "it [the APA] will be laughing all the way to the bank."
  4. ^ Fusar-Poli, Paolo (2019). "Transdiagnostic psychiatry: a systematic review". World Psychiatry. 18 (2): 192–207. doi:10.1002/wps.20631. PMC 6502428. PMID 31059629.
  5. ^ Hyman, Steven E. (2010). "The diagnosis of mental disorders: the problem of reification". Annual Review of Clinical Psychology. 6: 155–179. doi:10.1146/annurev.clinpsy.3.022806.091532. PMID 17716032. S2CID 52850745. Retrieved 2022-08-20.
  6. ^ Kupfer, David J.; First, Michael B.; Regier, Darrel A, eds. (2002). A research agenda for DSM-V. Washington, DC: American Psychiatric Association. ISBN 0890422923. OCLC 49518977.
  7. ^ Widiger, Thomas A.; Samuel, Douglas B. (2005). "Diagnostic categories or dimensions? A question for the Diagnostic and Statistical Manual of Mental Disorders—5th edition". Journal of Abnormal Psychology. 114 (4): 494–504. doi:10.1037/0021-843X.114.4.494. PMID 16351373. Retrieved 2022-08-20.
  8. ^ Buckholtz, Joshua W.; Meyer-Lindenberg, Andreas (2012). "Psychopathology and the human connectome: toward a transdiagnostic model of risk for mental illness". Neuron. 74 (6): 990–1046. doi:10.1016/j.neuron.2012.06.002. PMID 22726830.
  9. ^ Harvey, A. G.; Watkins, E.; Mansell, W.; Shafran, R. (2004). Cognitive behavioural processes across psychological disorders: A transdiagnostic approach to research and treatment. USA: Oxford University Press. ISBN 9780198528876.
  10. ^ Teasdale, J. D.; Moore, R. G. (2002). "Metacognitive awareness and prevention of relapse in depression: Empirical evidence". Journal of Consulting and Clinical Psychology. 70 (2): 275–287. doi:10.1037/0022-006X.70.2.275. PMID 11952186.
  11. ^ Dalgleish, Tim; Black, Melissa (2020). "Transdiagnostic approaches to mental health problems: current status and future directions". Journal of Consulting and Clinical Psychology. 88 (3): 179–195. doi:10.1037/ccp0000482. PMC 7027356. PMID 32068421.
  12. ^ Polettia, Michele; Sambataro, Fabio (2013). "The development of delusion revisited: A transdiagnostic framework". Psychiatry Research. 210 (3): 1245–1259. doi:10.1016/j.psychres.2013.07.032. PMID 23978732. S2CID 30537221.


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