Transdiagnostic process

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

Contents

History

Example of differential diagnosis AIR criteria differential diagnosis.png
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:

Possible additional transdiagnostic processes

Processes supported by growing evidence include:

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

Related Research Articles

<span class="mw-page-title-main">Cognitive behavioral therapy</span> Type of therapy to improve mental health

Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. Cognitive behavioral therapy is one of the most effective means of treatment for substance abuse and co-occurring mental health disorders. CBT focuses on challenging and changing cognitive distortions and their associated behaviors to improve emotional regulation and develop personal coping strategies that target solving current problems. Though it was originally designed to treat depression, its uses have been expanded to include many issues and the treatment of many mental health conditions, including anxiety, substance use disorders, marital problems, ADHD, and eating disorders. CBT includes a number of cognitive or behavioral psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.

Cognitive psychology is the scientific study of mental processes such as attention, language use, memory, perception, problem solving, creativity, and reasoning.

<span class="mw-page-title-main">Cognitive bias</span> Systematic pattern of deviation from norm or rationality in judgment

A cognitive bias is a systematic pattern of deviation from norm or rationality in judgment. Individuals create their own "subjective reality" from their perception of the input. An individual's construction of reality, not the objective input, may dictate their behavior in the world. Thus, cognitive biases may sometimes lead to perceptual distortion, inaccurate judgment, illogical interpretation, and irrationality.

<span class="mw-page-title-main">Cognition</span> Act or process of knowing

Cognition is the "mental action or process of acquiring knowledge and understanding through thought, experience, and the senses". It encompasses all aspects of intellectual functions and processes such as: perception, attention, thought, imagination, intelligence, the formation of knowledge, memory and working memory, judgment and evaluation, reasoning and computation, problem-solving and decision-making, comprehension and production of language. Cognitive processes use existing knowledge and discover new knowledge.

<span class="mw-page-title-main">Thought disorder</span> Disorder of thought form, content or stream

A thought disorder (TD) is a disturbance in cognition which affects language, thought and communication. Psychiatric and psychological glossaries in 2015 and 2017 identified thought disorders as encompassing poverty of ideas, neologisms, paralogia, word salad, and delusions—all disturbances of thought content and form. Two specific terms have been suggested—content thought disorder (CTD) and formal thought disorder (FTD). CTD has been defined as a thought disturbance characterized by multiple fragmented delusions, and the term thought disorder is often used to refer to an FTD: a disruption of the form of thought. Also known as disorganized thinking, FTD results in disorganized speech and is recognized as a major feature of schizophrenia and other psychoses. Disorganized speech leads to an inference of disorganized thought. Thought disorders include derailment, pressured speech, poverty of speech, tangentiality, verbigeration, and thought blocking. One of the first known cases of thought disorders, or specifically OCD as it is known today, was in 1691. John Moore, who was a bishop, had a speech in front of Queen Mary II, about "religious melancholy."

Social cognition is a topic within psychology that focuses on how people process, store, and apply information about other people and social situations. It focuses on the role that cognitive processes play in social interactions.

Cognitive restructuring (CR) is a psychotherapeutic process of learning to identify and dispute irrational or maladaptive thoughts known as cognitive distortions, such as all-or-nothing thinking (splitting), magical thinking, overgeneralization, magnification, and emotional reasoning, which are commonly associated with many mental health disorders. CR employs many strategies, such as Socratic questioning, thought recording, and guided imagery, and is used in many types of therapies, including cognitive behavioral therapy (CBT) and rational emotive behaviour therapy (REBT). A number of studies demonstrate considerable efficacy in using CR-based therapies.

Metacognition is an awareness of one's thought processes and an understanding of the patterns behind them. The term comes from the root word meta, meaning "beyond", or "on top of". Metacognition can take many forms, such as reflecting on one's ways of thinking and knowing when and how to use particular strategies for problem-solving. There are generally two components of metacognition: (1) knowledge about cognition and (2) regulation of cognition. A metacognitive model differs from other scientific models in that the creator of the model is per definition also enclosed within it. Scientific models are often prone to distancing the observer from the object or field of study whereas a metacognitive model in general tries to include the observer in the model.

Irritability is the excitatory ability that living organisms have to respond to changes in their environment. The term is used for both the physiological reaction to stimuli and for the pathological, abnormal or excessive sensitivity to stimuli.

<span class="mw-page-title-main">Executive functions</span> Cognitive processes necessary for control of behavior

In cognitive science and neuropsychology, executive functions are a set of cognitive processes that are necessary for the cognitive control of behavior: selecting and successfully monitoring behaviors that facilitate the attainment of chosen goals. Executive functions include basic cognitive processes such as attentional control, cognitive inhibition, inhibitory control, working memory, and cognitive flexibility. Higher-order executive functions require the simultaneous use of multiple basic executive functions and include planning and fluid intelligence.

In psychology, a dual process theory provides an account of how thought can arise in two different ways, or as a result of two different processes. Often, the two processes consist of an implicit (automatic), unconscious process and an explicit (controlled), conscious process. Verbalized explicit processes or attitudes and actions may change with persuasion or education; though implicit process or attitudes usually take a long amount of time to change with the forming of new habits. Dual process theories can be found in social, personality, cognitive, and clinical psychology. It has also been linked with economics via prospect theory and behavioral economics, and increasingly in sociology through cultural analysis.

<span class="mw-page-title-main">Grandiose delusions</span> Subtype of delusion

Grandiose delusions (GDs), also known as delusions of grandeur or expansive delusions, are a subtype of delusion characterized by extraordinary belief that one is famous, omnipotent, wealthy, or otherwise very powerful. Grandiose delusions often have a religious, science fictional, or supernatural theme. Examples include the extraordinary belief that one is a deity or celebrity, or that one possesses extraordinary talents, accomplishments, or superpowers.

<span class="mw-page-title-main">Rumination (psychology)</span> Focused attention

Rumination is the focused attention on the symptoms of one's mental distress, and on its possible causes and consequences, as opposed to its solutions, according to the Response Styles Theory proposed by Nolen-Hoeksema in 1998.

Neurodevelopmental framework for learning, like all frameworks, is an organizing structure through which learners and learning can be understood. Intelligence theories and neuropsychology inform many of them. The framework described below is a neurodevelopmental framework for learning. The neurodevelopmental framework was developed by the All Kinds of Minds Institute in collaboration with Dr. Mel Levine and the University of North Carolina's Clinical Center for the Study of Development and Learning. It is similar to other neuropsychological frameworks, including Alexander Luria's cultural-historical psychology and psychological activity theory, but also draws from disciplines such as speech-language pathology, occupational therapy, and physical therapy. It also shares components with other frameworks, some of which are listed below. However, it does not include a general intelligence factor, since the framework is used to describe learners in terms of profiles of strengths and weaknesses, as opposed to using labels, diagnoses, or broad ability levels. This framework was also developed to link with academic skills, such as reading and writing. Implications for education are discussed below as well as the connections to and compatibilities with several major educational policy issues.

In psychology and neuroscience, executive dysfunction, or executive function deficit, is a disruption to the efficacy of the executive functions, which is a group of cognitive processes that regulate, control, and manage other cognitive processes. Executive dysfunction can refer to both neurocognitive deficits and behavioural symptoms. It is implicated in numerous psychopathologies and mental disorders, as well as short-term and long-term changes in non-clinical executive control. Executive dysfunction is the mechanism underlying ADHD Paralysis, and in a broader context, it can encompass other cognitive difficulties like planning, organizing, initiating tasks and regulating emotions. It is a core characteristic of ADHD and can elucidate numerous other recognized symptoms.

<span class="mw-page-title-main">Inhibitory control</span> Cognitive process

Inhibitory control, also known as response inhibition, is a cognitive process – and, more specifically, an executive function – that permits an individual to inhibit their impulses and natural, habitual, or dominant behavioral responses to stimuli in order to select a more appropriate behavior that is consistent with completing their goals. Self-control is an important aspect of inhibitory control. For example, successfully suppressing the natural behavioral response to eat cake when one is craving it while dieting requires the use of inhibitory control.

Cognitive inhibition refers to the mind's ability to tune out stimuli that are irrelevant to the task/process at hand or to the mind's current state. Additionally, it can be done either in whole or in part, intentionally or otherwise. Cognitive inhibition in particular can be observed in many instances throughout specific areas of cognitive science.

Metacognitive therapy (MCT) is a psychotherapy focused on modifying metacognitive beliefs that perpetuate states of worry, rumination and attention fixation. It was created by Adrian Wells based on an information processing model by Wells and Gerald Matthews. It is supported by scientific evidence from a large number of studies.

Metacognitive training (MCT) is an approach for treating the symptoms of psychosis in schizophrenia, especially delusions, which has been adapted for other disorders such as depression, obsessive–compulsive disorder and borderline over the years. It was developed by Steffen Moritz and Todd Woodward. The intervention is based on the theoretical principles of cognitive behavioral therapy, but focuses in particular on problematic thinking styles that are associated with the development and maintenance of positive symptoms, e.g. overconfidence in errors and jumping to conclusions. Metacognitive training exists as a group training (MCT) and as an individualized intervention (MCT+).

Association splitting is a self-help technique for people with obsessive-compulsive disorder (OCD).

References

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