As we’ve been discussing over the last few weeks, current trends are shifting away from a symptom-based, disorder-specific approach that prescribes different treatment interventions for separate disorders. Instead, there is increasing interest in and support for an approach that focuses on the common psychological processes underlying presenting symptoms of different disorders that contribute to mental health problems. This transdiagnostic perspective is particularly relevant in addressing psychiatric comorbidities, and is based on distilling principles of treatment rather than developing new therapy prototypes (Barlow et al., 2004; S. C. Hayes et al., 1996).
More importantly, perhaps, a transdiagnostic approach is one that transcends the limits of categorical classification, such as that in the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013), and helps group commonalities across the theoretical constructs underlying treatment models and diagnoses together into a coherent, integrative, and efficient system (e.g., Barlow et al., 2011; S. C. Hayes et al., 2012) which can potentially lead to a more expedient, practical, and efficacious treatment of psychopathology in general (D. A. Clark, 2009; Craske, 2012; Egan et al., 2012).
Ingram (1990) was an early pioneer of transdiagnostic processes, identifying self-focused attention (i.e., heightened and often inflexible awareness of internal stimuli) as a common maintaining variable across a wide range of disorders that distinguished adaptive from maladaptive functioning.
Even prior to the current concept of transdiagnostic processes, Aaron Beck (1976) recognized that his cognitive theory and treatment of depression could also be applied successfully to anxiety disorders. Subsequent studies have examined other psychological mechanisms that are shared across diagnostic categories and have a critical role in maintaining psychopathological functioning. For example, repetitive negative thinking (e.g., rumination, worry) has been linked to increased depression and anxiety across a range of psychological disorders including major depression, social anxiety disorder, generalized anxiety disorder, and PTSD. Similarly, experiential avoidance has been identified as a principal factor in maintaining subjective distress across multiple disorders (S.C. Hayes et al., 1996).
Gilbert and Irons (2004) identified self-attacking as an underlying process that maintains psychopathological symptoms and maladaptive functioning across mood, anxiety, and trauma-related disorders, and created treatment interventions focused on experiential techniques for self-soothing and self-compassion as a means of tackling this mechanism. That same year, Harvey and colleagues (2004) identified twelve transdiagnostic processes within the domans of attention, memory, reasoning, thought, and behavior that seem responsible for causing and/or maintaining psychopathology across diagnostic categories.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA.
Barlow, D. H., Allen, L. B., & Choate, M. L. (2004). Toward a unified treatment for emotional disorders. Behavior Therapy, 35, 205–230.
Barlow, D. H., Farchione, T. J., Fairholme, C. P., et al. (2011). Unified protocol for transdiagnostic treatment of emotional disorders. New York: Oxford University Press.
Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York: International Universities Press.
Clark, D. A. (2009). Cognitive behavioral therapy for anxiety and depression: Possibilities and limitations of a transdiagnostic perspective. Cognitive Behaviour Therapy, 38, 29–34.
Craske, M. G. (2012). Transdiagnostic treatment for anxiety and depression. Depression and Anxiety, 29, 749–753.
Egan, S. J., Wade, T. D., & Shafran, R. (2012). The transdiagnostic process of perfectionism. Revista de Psicopatologia y Psicologia Clinica, 17, 279–294.
Gilbert, P., & Irons, C. (2005). Focused therapies and compassionate mind training for shame and self-attacking. In P. Gilbert (Ed.), Compassion. London: Brunner-Routledge.
Harvey, A. G., Watkins, E. R., Mansell, W., et al. (2004). Cognitive behavioural processes across psychological disorders. Oxford: Oxford University Press.
Hayes, S. C., Wilson, K. G., Gifford, E. V., et al. (1996). Emotional avoidance and behavioral disorders. Journal of Consulting and Clinical Psychology, 64, 1152–1168.
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy (2nd ed.). New York: Guilford.
Ingram, R. E. (1990). Self-focused attention in clinical disorders. Psychological Bulletin, 109, 156–176.