Conceptual Rationale for the Development of a Transdiagnostic Group for Common Mental Health Problems

View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Frontiers - Publisher Connector REVIEW published: 10 February 2016 doi: 10.3389/fpsyg.2016.00099 The Take Control Course: Conceptual Rationale for the Development of a Transdiagnostic Group for Common Mental Health Problems Lydia Morris 1*, Warren Mansell 1 and Phil McEvoy 2 1 School of Psychological Sciences, University of Manchester, Manchester, UK, 2 Six Degrees Social Enterprise, CIC, The Angel Centre, Salford, UK Background: Increasingly, research supports the utility of a transdiagnostic understanding of psychopathology. However, there is no consensus regarding the theoretical approach that best explains this. Transdiagnostic interventions can offer service delivery advantages; this is explored in the current review, focusing on group modalities and primary care settings. Objective: This review seeks to explore whether a Perceptual Control Theory (PCT) explanation of psychopathology across disorders is a valid one. Further, this review illustrates the process of developing a novel transdiagnostic intervention (Take Control Edited by: Gian Mauro Manzoni, Course; TCC) from a PCT theory of functioning. eCampus University, Italy Method: Narrative review. Reviewed by: Juan Ramos Cejudo, Results and Conclusions: Considerable evidence supports key tenets of PCT. Further, Complutense University of Madrid, PCT offers a novel perspective regarding the mechanisms by which a number of familiar Spain Kristine Rømer Thomsen, techniques, such as exposure and awareness, are effective. However, additional research Aarhus University, Denmark is required to directly test the relative contribution of some PCT mechanisms predicted *Correspondence: to underlie psychopathology. Directions for future research are considered. Lydia Morris [email protected] Keywords: transdiagnostic, group intervention, anxiety, depression, primary care, control theory Specialty section: This article was submitted to Cognitive Behavioral Therapy (CBT) offers a range of highly efficacious treatment protocols Psychology for Clinical Settings, targeting specific disorders, as evidenced by a substantial number of RCTs (Butler et al., 2006; a section of the journal Hofmann et al., 2012). However, significant numbers of people do not receive evidence-based Frontiers in Psychology psychological interventions for psychological problems (Shafran et al., 2009; Castelnuovo, 2010; Received: 04 November 2015 Hofmann, 2013); a “gap” between research findings and clinical practice (Shafran et al., 2009). Accepted: 18 January 2016 Various explanations for this gap have been considered including: clinician beliefs that manualized Published: 10 February 2016 treatments are not sufficiently flexible for routine practice; insufficient funding for training and Citation: interventions; and lack of knowledge of how to best convey and assess CBT skills (Shafran et al., Morris L, Mansell W and McEvoy P 2009; Dobson and Beshai, 2013). (2016) The Take Control Course: The plurality of disorder-specific protocols within the “CBT family” can provide challenges Conceptual Rationale for the Development of a Transdiagnostic in disseminating CBT and could contribute to the gap between research findings and practice Group for Common Mental Health (Mansell, 2008; Dobson and Beshai, 2013; Hofmann, 2013). This provides an ongoing imperative Problems. Front. Psychol. 7:99. for the development of interventions that develop generalizable clinician skills and are effective for doi: 10.3389/fpsyg.2016.00099 clients with comorbid problems (Shafran et al., 2009; McHugh and Barlow, 2010). Transdiagnostic Frontiers in Psychology | www.frontiersin.org 1 February 2016 | Volume 7 | Article 99 Morris et al. Transdiagnostic Group, Rationale, and Development interventions may facilitate this process by providing 2009; Pierre, 2010; Nolen-Hoeksema and Watkins, 2011). interventions that are empirically grounded, but flexible to Convergent evidence from neurobiological and cognitive- deliver and disseminate (McHugh et al., 2009; Wilamowska et al., behavioral research suggests that current diagnostic categories 2010). do not precisely specify the factors that cause and maintain Firstly, this paper briefly reviews the rationale and empirical psychopathology (Morris and Cuthbert, 2012). For example, basis for a transdiagnostic approach. Secondly, Perceptual research has indicated that “genetic and environmental Control Theory (PCT; Powers, 1973) is detailed. PCT offers a risk factors for mental illness induce susceptibility to broad conceptual underpinning for transdiagnostic CBT interventions domains of psychopathology, rather than discrete categorical (Mansell et al., 2012). Thirdly, the PCT basis of a new group- disorders, because they disrupt core connectivity circuits in based intervention (Take Control Course; TCC) is presented, ways that necessarily produce transdiagnostic symptoms” including a PCT understanding of exposure and awareness (Buckholtz and Meyer-Lindenberg, 2012, p. 990). This techniques. The TCC targets transdiagnostic processes and has resulted in an increased drive for understandings of therefore contributes to emerging research regarding how a psychopathology based on mechanistic empirical data (e.g., transdiagnostic theory can inform effective interventions. Initial Research Domain Criteria project; Cuthbert, 2015). The effectiveness data for the TCC is reported in full elsewhere emphasis on understanding mechanisms that underline (Morris et al., 2015) and a RCT is currently underway. Both the psychology seems a vital one in order to explain the converging initial feasibility study and the RCT recruit from primary care empirical evidence. psychological services. There is growing empirical support for the presence of common maintenance processes, but there is much less understanding regarding which theoretical account best explains A TRANSDIAGNOSTIC APPROACH how and why these processes maintain psychological distress (Harvey et al., 2004; Mansell et al., 2009; Nolen-Hoeksema and Considerable research has identified transdiagnostic Watkins, 2011). Traditional CBT accounts have been adapted maintenance processes across numerous disorders (Mansell, to focus on targeting processes across disorders (Norton, 2008; 2011; Nolen-Hoeksema and Watkins, 2011)1. Deficits in Forgeard et al., 2011). However, it is argued that other accounts executive control, such as difficulties disengaging from a current (such as PCT) could also offer a useful understanding of task, are also found across a range of disorders (Schultz and how and why numerous transdiagnostic processes maintain Searleman, 2002; Fernández-Serrano et al., 2011). See Nolen- psychological distress across disorders. For example, PCT was Hoeksema and Watkins (2011) for a more detailed summary of initially conceptualized as transdiagnostic because it was founded transdiagnostic processes. as a framework for understanding psychological functioning Some interesting and promising transdiagnostic groups have as a whole and so the suggested mechanisms apply across already been developed; for example, Barlow and colleagues all disorders (Alsawy et al., 2014). It provides a functional Unified Protocol has recently been delivered in a group-format model of how psychopathology arises and how recovery can and Norton’s transdiagnostic anxiety groups are well-established be facilitated (Powers, 1973). PCT is described as “functional” (Norton, 2008; Wilamowska et al., 2010; Bullis et al., 2014); because PCT is a theory from which actual working systems can see Newby et al. (2015) for a meta-analysis of transdiagnostic be constructed (see Carey, 2011, for greater theoretical discussion interventions. However, these differ from the TCC in a number of this and http://www.perceptualrobots.com for some practical ways. A key difference is that none of the previous transdiagnostic examples). PCT will be described in more detail in the upcoming interventions draw on PCT. It is advantageous to develop sections. interventions from different theoretical perspectives so that Further, PCT is a core process account; core process mechanisms of change can be compared and understood (Follette accounts suggest that there are a few universal processes and Beitz, 2003; Rosen and Davison, 2003). Other differences are that underlie psychopathology (Ingram, 1990; Mansell et al., described in Morris et al. (2015) in summary: 2009). One of the challenges to transdiagnostic theories is The features of TCC, that differentiate it from pre-existing parsimoniously explaining why a plethora of maintenance interventions are: (a) basis in PCT; (b) no explicit emphasis processes, such as repetitive negative thinking, perfectionism, are on challenging the content of cognitions; (c) briefer group- associated with psychopathology. Core process accounts provide based format; (d) explicitly flexible delivery mode; (e) a parsimonious way of integrating the relationships between broadly transdiagnostic focus that targets generic mechanisms these processes (see Mansell et al., 2009, for a discussion of (maladaptive/inflexible control and goal conflict). (p. 3). other theoretical accounts that could integrate such findings). Empirical evidence that there are universal processes that One potential advantage of a transdiagnostic approach is the underlie psychological dysfunction across disorders is currently potential to bring us closer to understanding the mechanisms small, but is increasing (Field and Cartwright-Hatton, 2008; that

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