Transdiagnostic Phenomenon Research Articles

Psychotherapy in Dark Times: The Role of Moral Injury

Psychotherapy in Dark Times: The Role of Moral Injury

Assessment of self‐contempt in psychotherapy: A neurobehavioural perspective

AbstractObjectiveThe aim of this methodological paper was to present self‐contempt, and its assessment, in a broad transdiagnostic framework of psychopathology and related to change in psychotherapy. Self‐contempt may be a central phenomenon in many psychological disorders. We outline methodological recommendations for the study of complex transdiagnostic phenomena which involve multilevel biobehavioural responses.MethodWe illustrate the assessment of self‐contempt as a complex transdiagnostic phenomenon with a study in which emotion‐eliciting two‐chair dialogues focused on the elaboration of self‐criticism, and an observer‐rated system was applied to assess each client's expressed self‐contempt at the moment of enacted self‐criticism. The client's own self‐contemptuous words were extracted from this self‐critical dialogue and then later presented as part of a functional magnetic resonance imaging paradigm.ResultsThis assessment paradigm was applied to a brief treatment for clients with borderline personality disorder, and the results of pre–post change over time in markers of self‐contempt are presented.ConclusionsThe importance of the assessment of self‐contempt in an ecologically valid manner, by using individualised stimuli and taking into account multilevel activations, is discussed in the context of a transdiagnostic conception of psychopathology and in the context of change in psychotherapy.

Sleep disturbances in schizophrenia spectrum and bipolar disorders – a transdiagnostic perspective

BackgroundSleep disturbances are prevalent in severe mental disorders but their type and frequency across diagnostic categories has not been investigated in large scale studies. MethodsParticipants with Schizophrenia spectrum disorders (SCZ, (N = 617)), Bipolar disorders (BD, (N = 440)), and Healthy Controls (HC, (N = 173)) were included in the study. Sleep disturbances (insomnia, hypersomnia and delayed sleep phase) were identified based on items from the Inventory of Depressive Symptoms – Clinician rated scale. Clinical symptoms were assessed with the Positive and Negative Syndrome scale and level of functioning with the Global assessment of Functioning scale. ResultsThe rate of any sleep disturbance was 78% in SZ, 69% in BD and 39% in HC. Insomnia was the most frequently reported sleep disturbance across all groups. Both diagnostic groups reported significantly more of any sleep disturbances than HC (P < 0.001). Having a sleep disturbance was associated with more severe negative and depressive symptoms and with lower functioning across diagnostic groups (P < 0.001, η2 = 0.0071). Hypersomnia was the only sleep disturbance associated with previous treatment history. ConclusionSleep disturbances, including insomnia, hypersomnia and delayed sleep phase, are frequent in SCZ and BD, and associated with more severe clinical symptomatology across diagnostic groups. This suggests that sleep disturbance is a clinically relevant transdiagnostic phenomenon.

Maladaptive repetitive thought as a transdiagnostic phenomenon and treatment target: An integrative review.

Maladaptive repetitive thought (RT), the frequent and repetitive revisiting of thoughts or internal experiences, is associated with a range of psychopathological processes and disorders. We present a synthesis of prior research on maladaptive RT and develop a framework for elucidating and distinguishing between five forms of maladaptive RT. In addition to the previously studied maladaptive RT (worry, rumination, and obsession), this framework is used to identify two additional forms of maladaptive RT (yearning and interoceptive RT). We then present a review of extant psychotherapy intervention research targeting maladaptive RT, focusing both on specific empirically based treatment strategies, and also constructs within treatments that impact maladaptive RT. The paper concludes with recommendations for future basic and intervention research on maladaptive RT and related psychopathologies.

The polluted mind: Understanding mental contamination as a transdiagnostic phenomenon

The transdiagnostic approach to conceptualizing anxiety disorders posits that (a) these conditions have more similarities than differences and (b) treatments for clinical anxiety are improved by greater understanding of mechanisms shared among the anxiety disorders. Accordingly, researchers have sought to examine psychological phenomena relevant to multiple anxiety-related conditions. One such phenomenon is mental contamination: the syndrome whereby an individual feels “dirty” or “impure” in the absence of direct contact with a contaminated stimulus. Despite theoretical and empirical support for the notion that mental contamination is related to multiple anxiety problems, mental contamination is most often studied in the context of obsessive-compulsive disorder only. The aim of the special issue is to highlight innovative research examining mental contamination as a potential transdiagnostic construct. Studies examining mental contamination in multiple contexts are presented in this special issue, which concludes with a summary and discussion of future research directions.

Influence of Weight on Shared Core Symptoms in Eating Disorders: Support or Challenge for a Transdiagnostic Perspective?

In terms of the transdiagnostic model of eating disorders, Anorexia Nervosa (AN), Bulimia Nervosa (BN), and Binge Eating Disorder (BED) share the same distinctive psychopathology. However, empirical evidence showing similarities between these eating disorder diagnoses for core symptoms is scarce, and the role of weight status is unclear. Data from a total of 168 female participants were collected between April 2004 and April 2008, at an outpatient unit specialized in eating disorder treatment. Core symptoms of eating disorders were measured via self-report questionnaires. In particular, women with BED and BN showed similar patterns of core symptomatology compared with AN. However, when body mass index (BMI) was considered in the analyses, there were no differences between the three diagnostic groups in relation to body image. Differences in eating behavior are not solely triggered by weight differences, whereas body image disturbances are a transdiagnostic phenomenon among EDs and should also be considered in the treatment of BED.

Psychosis as a transdiagnostic and extended phenotype in the general population.

A large body of research indicates that weak expressions of positive psychotic symptoms ("psychotic experiences") can be measured in the general population, and likely represent the behavioural manifestation of distributed multifactorial (genetic and non-genetic) risk for psychosis. Psychotic experiences are a transdiagnostic phenomenon: the majority of individuals with these experiences have a diagnosis of non-psychotic disorder, particularly common mental disorder, in which psychotic experiences predict greater illness severity and poorer treatment response. Some of the people with common mental disorder and psychotic experiences will present to mental health services meeting criteria for "clinical high risk". Treatment of the transdiagnostic dimension of psychosis in individuals with common mental disorder who meet "clinical high risk" criteria thus may improve outcome (which cannot be interpreted as prevention of "schizophrenia"). Subthreshold psychotic experiences are transitory in about 80% of individuals, while around 20% go on to develop persistent psychotic experiences and 7% a psychotic disorder, with an annual transition rate of 0.5-1%. Persistence is associated, on the one hand, with environmental exposures, particularly childhood trauma, and, on the other, with network-type dynamic interactions between psychotic experiences themselves (e.g., interactions between hallucinatory experiences and delusional ideation) and between symptom dimensions (e.g., interactions between affective symptoms and psychotic experiences, or interactions between subthreshold negative symptoms and psychotic experiences). The study of psychotic experiences is helping to elucidate the mechanisms by which environmental and genetic influences shape the transdiagnostic expression of psychosis proneness, that is mostly transitory but may first become persistent over time and eventually give rise to transition to a psychotic disorder.

Repetitive Negative Thinking: A Transdiagnostic Correlate of Affective Disorders

Recent research suggests that repetitive negative thinking is a transdiagnostic phenomenon that is present across affective disorders. Notably, multiple measures of repetitive negative thinking exist, including some that are disorder-specific and others that are transdiagnostic. To date, no studies have examined whether these measures are captured by a latent Repetitive Negative Thinking factor or how these measures are differentially associated with symptoms of affective disorders, including mood, anxiety, and obsessive-compulsive spectrum disorders. Across two separate studies, Mechanical Turk participants completed measures of rumination, post-event processing, dampening of positive affect, and two transdiagnostic measures of repetitive thinking, as well as measures of depression, physiological anxiety, social anxiety, obsessive-compulsive disorder, and body dysmorphic disorder. Using structural equation modeling, evidence of a single Repetitive Negative Thinking latent factor was found. Moreover, positive associations emerged between the latent factor and all five clinical symptom measures. Notably, few differences emerged in the magnitude of the associations between measures of repetitive negative thinking and psychological symptoms. Together, findings support a transdiagnostic conceptualization of repetitive negative thinking.

Me, myself, and I: self-referent word use as an indicator of self-focused attention in relation to depression and anxiety.

Self-focused attention (SFA) is considered a cognitive bias that is closely related to depression. However, it is not yet well understood whether it represents a disorder-specific or a trans-diagnostic phenomenon and which role the valence of a given context is playing in this regard. Computerized quantitative text-analysis offers an integrative psycho-linguistic approach that may help to provide new insights into these complex relationships. The relative frequency of first-person singular pronouns in natural language is regarded as an objective, linguistic marker of SFA. Here we present two studies that examined the associations between SFA and symptoms of depression and anxiety in two different contexts (positive vs. negative valence), as well as the convergence between pronoun-use and self-reported aspects of SFA. In the first study, we found that the use of first-person singular pronouns during negative but not during positive memory recall was positively related to symptoms of depression and anxiety in patients with anorexia nervosa with varying levels of co-morbid depression and anxiety. In the second study, we found the same pattern of results in non-depressed individuals. In addition, use of first-person singular pronouns during negative memory recall was positively related to brooding (i.e., the assumed maladaptive sub-component of rumination) but not to reflection. These findings could not be replicated in two samples of depressed patients. However, non-chronically depressed patients used more first-person singular pronouns than healthy controls, irrespective of context. Taken together, the findings lend partial support to theoretical models that emphasize the effects of context on self-focus and consider SFA as a relevant trans-diagnostic phenomenon. In addition, the present findings point to the construct validity of pronoun-use as a linguistic marker of maladaptive self-focus.

Rumination in bipolar disorder: a systematic review.

To conduct a systematic review of the literature about the symptom of rumination in bipolar disorder (BD). We searched the MEDLINE (PubMed), ISI Web of Knowledge, PsycINFO, and SciELO databases using the descriptors "rumination" and "bipolar disorder" and no time limits. This strategy yielded 105 references, of which 74 were selected. Inclusion criteria were studies involving patients with BD and the use of at least one validated scale for the assessment of rumination. Review articles were excluded. Seventeen articles were ultimately analyzed and included in the review. Rumination is present in all BD phases, is a stable interepisodic symptom, is associated with symptoms of depression, anxiety, and hypomania, and may occur in response to both positive and negative affect. There is no research on rumination and neurobiological findings in patients with BD. Rumination seems to be independent of mood state, but shows close relationship with it. It is possible that rumination has a negative impact on cognitive and executive functions, particularly inhibitory control. Finally, rumination is an important symptom in both phases of BD, and, therefore, may be a useful target for further exploration as a dimensional domain and a transdiagnostic phenomenon in Research Domain Criteria (RDoC) projects.

Repetitive Negative Thinking and Psychological Distress in Fibromyalgia

Excessive and repetitive negative thinking (RTN) about past experiences or worries about the future is present across a large range of psychological disorders and appears to be involved in the maintenance of emotional problems. Studies have supported that RNT is characterized by the same process across disorders and can be reliably distinguished from other forms of recurrent cognitions and functional forms of repeated thinking, leading Harvey and colleagues (2004) to propose it as a definite transdiagnostic process. As a transdiagnostic phenomenon, RNT is underexplored in fibromyalgia (FM), a highly prevalent syndrome characterized by chronic, medically unexplained widespread musculoskeletal pain that causes significant disability. FM is associated with a high prevalence of psychiatric co-morbidity, mostly anxiety and depression, and a large variety of psychological processes. In these patients, cognitive processes and cognitions may play an important role as mediating mechanisms between FM and psychological distress. The content of RNT in patients with FM may be related with excessive monitorization of pain and other physical signs, leading to higher pain intensity and more pain-related fear-avoidance behaviour. In this way, persistence on RNT works as a maladapative coping strategy, impairing emotional regulation and perpetuating psychological distress. Improvement in the understanding of the cognitive processes implicated in FM that could be targeted in cognitive interventions may have positive results in reducing the burden of the syndrome.

Repetitive Negative Thinking in Anticipation of a Stressor

Repetitive negative thinking (RNT) has been confirmed as a transdiagnostic phenomenon, but most measures of RNT are contaminated with diagnosis-specific content. The first aim of this study was to examine the structure of an anticipatory version of the Repetitive Thinking Questionnaire (RTQ-Ant) as a trans-emotional measure of anticipatory RNT. The original RTQ was completed with reference to a past stressor, whereas the RTQ-Ant instructs respondents to link their responses to a future stressor. The second aim was to test if the associations between a range of emotions (anxiety, depression, shame, anger, general distress) and the original post-stressor version of the RTQ would be replicated. Undergraduates (N = 175, 61% women) completed the RTQ-Ant, along with measures of various emotions, with reference to upcoming university exams. Principal axis factor analysis yielded many similarities between the original post-event RTQ and the RTQ-Ant, and some differences. The RTQ-Ant was comprised of two subscales: the RNT subscale measures engagement in repetitive thinking, negative thoughts about oneself, and ‘why’ questions; and the Isolated Contemplation (IC) subscale included items referring to isolating oneself and reflecting on negative thoughts, feelings, loneliness, and listening to sad music. RNT was more strongly related to negative emotions than IC. The RTQ-Ant appears to be a reliable measure of anticipatory RNT that is associated with a broad array of emotions.

The transdiagnostic phenomenon of self-criticism.

Three interventions used to assist highly self-critical patients develop self-compassion are described and illustrated with case material. Theoretical background, assumed mechanism of change, and research evidence for each intervention is presented.

Are worry, rumination, and post-event processing one and the same?: Development of the repetitive thinking questionnaire

Accumulating evidence suggests that repetitive negative thinking (RNT) is a transdiagnostic phenomenon. However, various forms of RNT such as worry, rumination, and post-event processing have been assessed using separate measures and have almost exclusively been examined within the anxiety, depression, and social phobia literatures, respectively. A single transdiagnostic measure of RNT would facilitate the identification of transdiagnostic maintaining factors of RNT, and would be more efficient than administering separate measures for each disorder. Items from three existing measures of RNT were modified to remove diagnosis-specific content and administered to a sample of undergraduate students ( N = 284). Exploratory factor analysis yielded two factors labeled Repetitive Negative Thinking and Absence of Repetitive Thinking (ART). The RNT scale demonstrated high internal reliability and was associated with anxiety, depression, anger, shame, and general distress. Moreover, the RNT scale was associated with constructs that are theoretically related to engagement in RNT, including positive and negative metacognitions, cognitive avoidance, thought suppression, and thought control strategies. The ART scale had little predictive utility. Theoretical and clinical implications are discussed.