Nolen- Hoeksema & Watkins (2011)

23 important questions on Nolen- Hoeksema & Watkins (2011)

What do transdiagnostic models of psychopathology seek to identify?

Fundamental processes underlying multiple, usually comorbid psychopathologies

hold several theoretical and clinical advantages over disorder specific models.

Approaches focused on transdiagnostic processes have several theoretical and clinical advantages over disorder-specific approaches:

- there is growing agreement that the heterogeneous disorders in our current diagnostic system are each made up of dysfunctional versions of processes that vary along continua in the general population, which means that the same dysfunctional processes are seen in several different disorders

- helps us understand the comorbidity between disorders.

- treatments that remediate a transdiagnostic factor could affect all the disorders it is related to

To which concept does transdiagnostic processes have similarities with

To the concepts of intermediate phenotypes and endophenotypes in psychiatric research
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Whereas mental disorders are heterogeneous clusters of symptoms, what do intermediate phenotypes have

Are conceived as neurocognitive and affective processes, such as learning and memory, causally linked to the development of symptoms

Which limitations exist in current transdiagnostic models

- transdiagnostic processes generally have not addressed phenotypic plasticity, wherein the pattern of symptoms morphs across the life course, often unpredictably

- transdiagnostic models do a better job explaining multifinality than divergent trajectories

What is the difference between distal risk factors and proximal risk factors

Distal; environmental context factors or congenital biological characteristics that cause psychopathology only via mediating proximal risk factors.  tend to be difficult to control or modify

proximal; within person variables that mediate the relationship between distal risk factors and symptoms

What is the critical distinction between distal and proximal factors

How close the causal connection is between the risk factor and psychopathology; distal risk factors lead to psychopathology only via mediating proximal risk factors, whereas proximal risk factors directly cause psychopathology

How do we conceive distal transdiagnostic risk factors

As experiences or characteristics that are usually independent of any actions of the individual - they happen to an individual
they set the stage for proximal risk factors that more directly lead to psychopathology

We suggest that it is useful to confine distal risk factors into two categories. Which two?

- environmental context factors (such as parental psychopathology and traumatic events)

- congenital biological abnormalities

Which two differrent kind of stressors do we have in environmental context factors

- independent stressors; not caused by the individual experiencing them

- dependent stressors; which the individual may have played a role in creating

Why should we consider trauma a distal risk factor?

Because it sets the conditions for the development of symptoms. (not always > because it does not always lead to PTSD or acute stress disorder)

What are proximal transdiagnostic risk factors

Within person variables that have been linked more directly to disorders via specific mechanisms

How are proximal risk factors operationalized?

As those intrapersonal risk factors that
a) directly precede symptoms
b) directly influence symptoms

Proximal risk factors fall into three categories, which can be interrelated:

- biological factors leading to potentially maladaptive emotional, cognitive or behavioral tendencies

- fundamental cognitive deficits or biases in information processing

- stable psychological individual difference factors reflect the tendency to respond to situations

How can distal risk factors lead to proximal risk factors

- distal risk factors may shape responses to the environment. Congential biological abnormalities may also shape individuals responses to the environment, creating proximal risk factors

- distal factors could shape individuals beliefs, schemas and self-images to create proximal factors

- classical and operant conditioning, modelling and observational learning are likely to play rols in linking distal and proximal risk factors

False or true

it is likely true that having more than one proximal transdiagnostic risk factor or combination of proximal and distal risk factors increases one's vulnerability to given psychopathology more than having only one proximal risk factor

True

What is the difference between how distal risk factors and moderators exert their causal effects

Moderators have their effects by interacting with and acting on existing proximal risk factors and thus follow them in time or are concurrent with them; however, moderators precede and have causal effects on psychopathology

Give the difference between proximal risk factors and moderators explained

Proximal risk factors explain comorbidity and multifinality , that is the mechanisms by which one process leads to multiple comorbid disorders

moderators explain how individuals with that proximal risk factor develop specific disorders, that is their divergent trajectories

Applying the heuristic; rumination as a transdiagnostic factor.

what is rumination

Rumination refers to the tendency to repetitively analyze one's problems, concerns and feelings of distress without taking action to make positive changes.

Which distal risk factors and mechanisms are there linking them to rumination

Childhood sexual and emotional abuse > may develop dysregulated stress responses > more challenging to engage in efficacious behavioral responses to new stressors and thys may fall into ruminative pattern.

overcontrolling parents > rumination in children by undermining children's sense of self efficacy

Which mechanisms are there linking rumination to depression

Experimental studies indicate that rumination exacerbates existing dysphoric mood and leads to people in a depressed mood to have more negative thoughts about the past present and future making it more likely that people will use these negative thoughts to understand current circumstances

What can the heuristic do for future directions

- guide a deeper and more systematic exploration of the mechanisms by which transdiagnostic risk factors have their effects and create comorbidity among disorders

- guide the search for moderators that determine what specific symptoms individuals who carry transdiagnostic risk factors will develop.

What is a limitation of this heuristic

That it is new and has not been directly tested.

too simplistic > reduced risk factors to two levels distal and proximal but likely more levels

heuristic has not specified the potential role of developmental factors in the effects of risk factors and moderators although we believe that developmental processes are important

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