lecture 11

Question 1

Limitations of disorder-based therapies

Answer 1

Average no. sessions attended is around five
Greatest treatment gains in the first session
30-80% of patients have comorbid disorders
Standardised diagnosis is not conducted

Question 2

Harvey, Watkins, Mansell & Shafran (2004)

Answer 2

Systematic review of cognitive & behavioural processes in Adult Axis 1 Disorders

many of these are traditionally regarded as ‘symptoms’ e.g. worry, avoidance – i.e. symptoms have a function
Criteria for a transdiagnostic process

Present in ALL disorders & over 4 disorders
12 ‘definite’ Transdiagnostic processes + 3 ‘possible
Advantages: generalise models across disorders; understand comorbidity; inform transdiagnostic treatments

Question 3

the Transdiagnostic Processes - attention

Answer 3

Attention
Hypervigilance to external threat
Attentional avoidance of external threat
Hypervigilance to internal experiences

Question 4

reasoning (bias)

Answer 4

Interpretational bias
Expectancy bias
Emotional reasoning

Question 5

memory

Answer 5

Recurrent intrusive memories
Selective memory
(Overgeneral memory)

Question 6

behaviours

Answer 6

Avoidance
Safety-seeking behaviours
Experiential Avoidance

Question 7

thinking

Answer 7

Recurrent negative thinking
Metacognitive beliefs
(Thought suppression)

Question 8

Core Process Research in a Clinical Sample

Answer 8

factor analysis:
1 factor solution, 13 items
Anxiety , depression, Standardised measures of thought suppression, worry & experiential avoidance
No differences based on diagnosis

Question 9

To understand the core process….What does psychological distress and recovery involve

Answer 9

Themes of loss of control at the ‘rock bottom’ & regaining control as the process of recovery

Question 10

whats control and why important

Answer 10

Homeostasis is control; this is essential for life
Now: temperature; balance; blood sugar
Co-ordination & movement for any activity relies on control

Question 11

The historical context of Perceptual Control Theory (Powers et al., 1960; Powers, 1973, 2005)

Answer 11

Fits with the teleological approach of early psychology
Fits with importance of unconscious conflict (Freud)

Question 12

The Negative Feedback Loop
*image

Answer 12

Fundamental to all biopsychosocial systems?

Question 13

Key Tenets of PCT

Answer 13

Control - Control is fundamental to life.We control our experiences. This is achieved by a closed-loop process of perceive, compare and act
Hierarchies - Control is organised in a hierarchy whereby long term goals and principles are implemented by setting goals for lower level systems
Conflict - When a person tries to control the same experience in opposing directions, conflict occurs and chronic conflict disrupts control
Reorganisation - The properties of control systems are changed through a trial-and-error learning process to reduce conflict and optimise control. Reorganisation follows awareness.

Question 14

what why how

Answer 14

why - Relates to individual values/ principles about the self, world and others
what - expereince being discussed
how - Relates to specific control processes/ actions/ short term experiences

Question 15

Implications from PCT on what is effective about therapy….

Answer 15

Solutions will be successful when both sides of the conflict are accommodated
Solutions will be unpredictable and novel
Time taken to resolve a conflict will vary
Logical problem solving might be ineffective
Advice will be of limited value
“Resistant” clients might be operating from one side of a conflict
When therapy is less than effective a conflict formulation might be useful

Question 16

What maintains goal conflict?

Answer 16

Controlling an experience without regard/ awareness of the important personal goals that it interferes with”
Not just a form of avoidance
It is interference with people’s goals that leads to the chronic disruption in functioning

Question 17

It is the lack of awareness of goal conflict that is the core process…

Answer 17

Person controls an experience despite the conflict it causes with control of ‘higher level’ experiences

Question 18

Shifting & sustaining awareness

Answer 18

Enable change in systems that regulate inflexible processes; ‘metacognitive’
Help shift awareness to long term goals, values & broader perspectives

Question 19

Method of Levels (MOL)

Answer 19

Transdiagnostic cognitive therapy from PCT (Carey, 2006; Powers, 1973
Every therapist statement is an open question
GOAL ONE: To help the client talk about the problem
GOAL TWO: To ask about present moment disruptions
focuses on the process of control of perception
catches possible conflict/identifies higher level goals
Iterative procedure; open-ended

Question 20

Pilot RCT in Primary Care Bird, Tai Hamilton & Mansell, in prep

Answer 20

17 MOL (up to 8 sessions; M = 5)
12 Contact Service with treatment-as-usual
Intention-to-treat analysis
Significantly greater change in MOL group on anxiety & depression

Question 21

Resolving goal conflict as a transdiagnostic process of change?
+ 2 findings

Answer 21

Hypothesis: Goal conflict maintains distress through loss of control when kept outside awareness by these processes
Preliminary Findings:
Writing about goal conflict reduces distress about the conflict (Kelly et al., 2011)
Interactive computer therapist (Gaffney et al., 2014) - Awareness of conflict correlated with reduction in distress & mediated the effect of positive expectancy