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A transdiagnostic model

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1 A transdiagnostic model
MOOD-AS-INPUT THEORY A transdiagnostic model Today I’m going to talk about the mood as input model and discuss it’s potential as a model of transdiagnostic processes in psychopathology. We have been examining mood-as-input theory as a model of task perseveration for about the last 12 years at Sussex Uni Dr Frances Meeten University of Sussex

2 University of Sussex Jason Chan Suzanne Dash Jack Hawksley
Professor Graham Davey University of Sussex Jason Chan Suzanne Dash Jack Hawksley Dr Benie MacDonald Dr Helen Startup Mood as input research at Sussex has been supervised over the last 12 years by Prof G – and along the ways others too…. I would also like to acknowlege colleagues past and present who’s work I am going to draw upon today. TALK OUTLINE Perseveration as a transdiagnostic process The mood-as-input model Experimental evidence Future directions

3 Transdiagnostic approach
Mood-as-input model as applied to perseveration in psychological disorders Data from a mood-as-input based intervention Future directions Transdiagnostic approach to research and treatment – and why it’s important Examine the MAI model as applied to perseveration in psychological disorders I imagine a lot of you are thinking well you’ve spent a decade looking at mechanisms, but how does this affect treatment…so I’ve got a little bit of outcome data from a recent MAI based trial for anxiety Then I’ll look at future directions – hopefully something for everyone in there…

4 The transdiagnostic approach
Transdiagnostic thought processes (Harvey, Watkins, Mansell, & Shafran, 2006) Positive and negative metacognitive beliefs Recurrent thinking Transdiagnostic constructs A transdiagnostic examination of intolerance of uncertainty across anxiety and depressive disorders (Mahoney & McEvoy, 2012) Depressive rumination and co-morbidity: Evidence for brooding as a transdiagnostic process (Watkins, 2009) Rumination as a transdiagnostic factor in depression and anxiety (McLaughlin & Nolen-Hoeksema, 2011) Perfectionism as a transdiagnostic process: A clinical review (Egan, Wade, & Shafran, 2011) In the last few years the transdiagnositc approach to research and treatment has received considerable interest. Harvey and colleagues propose that positive and neg metacog beliefs and recurrent thinking are both transdiagnostic thoguht processes. - THERE are a number of recent papers looking at transdiagnostic constructs : here are just a few examples Of course one reason that the transdiagnostic app has receievd so much interest is that it helps to explain high co-morbidity observed among many psychological disorders. Furthermore it FORMALISES some interesting treatment approaches which focus ion addressing underlying mechanisms or processes common to a number of psychological disorders.

5 Depressive rumination
(Nolen-Hoeksema, 1991; Watkins, 2008 ) Catastrophising (Davey & Levy 1998) PERSEVERATION Negative mood Negative mood Repetitive and persistent thought or behavior, which the individual finds difficult to control (Davey, 2006) The transdiagnostic process that I am going to discuss today is perseveration. Perseveration can be defined as….. and there are a number of psychopathologies which often have shared characteristics of repetitive and persistent thought or behaviour and negative affect (Davey, 2006a) for example…. Depressive rumination Catastrophsing in GAD Obsessions & Compulsions in OCD In almost all examples of these psychopathologies the perseveration is viewed as excessive, out of proportion to the functional purpose that it serves, and a source of emotional discomfort for the individual concerned – thus individuals also experience high levels of concurrent negative mood -The mood as input model attempts to provide an explanation of these common elements by looking at the dynamic interactions beetwen the goals or ‘stop rules applied to open ended tasks such as worrying, checking, or ruminating – and negative mood. Obsessions (Brown, Moras, Zinbarg & Barlow, 1993) Compulsions (Tallis & de Silva, 1992)

6 What is mood-as-input? Model of task perseveration
(Martin, Ward, Achee, & Wyer, 1993) Q: Why do people persevere at a task for longer than is useful? i.e. worrying, checking… Use mood to gauge if completed task goals Positive moods = Progression Negative mood = Lack of achievement Example: Negative and positive mood in different contexts The mood-as-input model proposed by Leonard Martin and colleagues is a model of task perseveration from the social psychology literature -rather than assuming that there is an inherent relations between mood and processing – the model assumes that mood only influences task perseveration depending upon the content or ‘stop rule’ applied to the task. -

7 Mood-as-input and task perseveration
(Martin, Achee, Ward, & Wyer, 1993) Prediction: The informative properties of mood will change with the context Gave people a task, but asked them to approach it in 2 different ways – either to do complete the task unitl they had done as much as they could, or to to complete the task until they no longer felt like continuing – this is the context! REASON FOR THIS EFFECT i.e if you have an AMA stop rule – when in a neg mood (and explicitly or impliclty ask ‘have I done as much as I can?’, your mood signals a lack of progress or achievement at task so you continue – pos mood signals progress or satisfaction.

8 Stop Rules When we start an open-ended task we have ‘goals’
‘I must do this as well as I can’(performance focused) OR ‘I will do this until I no longer feel like continuing’(task focused) ‘As Many as Can’ (AMA) OR ‘Feel Like Continuing’ (FL) Typically, when you start an open-ended task you have a goal for the task – the goal Stop rules refer to the criteria we apply to an open –ended task when we consider whether to continue or stop Broadly speaking, there are two ways we can approach an open-ended task – either task focused or performance focused. Task focused is when one engages in a task that is either enjoyable, or where there is no concern about evaluation. Here the motivation is to continue with the task as long as it is enjoyable (e.g. Hirt et al., 1996; Martin et al., 1993) However, when the focus is on meeting a certain standard, or level of performance, motivation for the task is performance focused. Thus we are more likely to continue with the task until we have done enough to meet the task requirements To examine these two different approachs MAI literature has commonly focused on two stop rules the AMA and FL – of course there may be more nuanced ways of conceptualising task motivation – but with a view to experiemtnally testing the MAI model these 2 stop rules have provided a useful conceptulaisation of performance and – as I will go on to discuss in a moment – we have good reason to believe that the AMA stop rule is a fairly useful analogue representation of a perseverative approach to task completion that we can apply to clinical paradigms.

9 AMA stop rules in psychopathology
Why AMA? Individuals with common perseverative psychopathologies experience dispositional characteristics that are likely to give rise to the deployment of AMA stop rules E.g. Inflated responsibility Intolerance of uncertainty Clinical perfectionism Poor problem solving confidence Metacognitive beliefs about the benefits of worrying, or checking etc. Now – look little bit more closely at AMA SR in psyvhopathology. Much of the work we will look at today is most interested in what happens when people are applying an AMA stop rule to an open-ended task. . MAI focuses on the AMA stop rule because we believe this approach to pathological worry

10 Predictions from the MAI model
Psychopathology-relevant tasks are often conducted under conditions of ‘as many as can’ stop rules and negative mood Mood-as-input as applied to the generation of perseverative disorders Say prediction – TAKE HOME MESSAGE FOR THIS PART OF THE TALK MAI model provides a mechanism whoich may explain a process common across a number of disorders GENERATION – MAI model explains generation/aquisiton of perseverative thougths or behaviors – not so much engrained rituals/neutralising behaviorus etc.

11 Experimental work Open-ended laboratory-based perseverative tasks
Catastrophic worry Perseverative checking Depressive rumination Remove this one…?

12 Open-ended catastrophising task
Mood-as-input and perseverative worry Startup & Davey (2001) Open-ended catastrophising task * High vs. low worriers ‘As many as’ vs. ‘Feel like’ Also add in that neg mood and ama stop rule results in perseveration in compulsive checking tasks and depressive rumination – so robust Why would low worries worry more when in FL?? HIGHLIGHT clinical significance here – you can actually change the amount of time high and low worries spend generating cat outcomes – so this indictaes that worriers don’t hold a disposiotnal ‘worry style’ but that worrying is malleable thoguh tackling of SR * p = < .05

13 Mood-as-input and perseverative checking
MacDonald & Davey (2005): Overall number of checks in an open-ended checking task when in a positive or negative mood using an AMA or FL stop rule ** See similar pattern in number of lines re-checked and total time spent checking ** p = < .001

14 Mood-as-input and depressive rumination
Hawksley & Davey (2010): Number of rumination steps in an open-ended rumination task when in a positive or negative mood using an AMA or FL stop rule * Also done this with a clinical population – talk about Chan paper When this is applied clinically -Depressed pateints undertook the dep rumination task twice once when using AMA and once when using FL -Depression group produced sig more ruminaiton steps using AMA than when using the FL stop rule – CONFIRMS relevance of MAI hyp to ruminaiton in a clinically depressed sample – maniplulting stop rules within treatement may be a practical way of reducing rumination. * p = < .05

15 Chan, Davey, & Brewin (under review): Number of rumination steps in an open-ended rumination task using an AMA or FL stop rule Within subs! When depressed individuals changed stop rule their rumination perseveration changed.

16 Davey et al, 2007: Worriers shift from AMA to FL
Common questions How do people ever stop? Davey et al, 2007: Worriers shift from AMA to FL Is mood always used as a source of information? Discounting hypothesis High level of expertise Individuals disengage from unachieved goal – but only temporarily If mood is discounted not used as info If individuals have high level of expertise tend not to use mood – but this isn’t clinically relevant when people perceive they are bad problem solvers or have low tolerance of uncertainty

17 Summary of findings Mood interacts with stop rules to generate
perseveration at a number of psychopathology relevant tasks Dispositional characteristics of those who experience anxious psychopathologies indicate a likelihood to adopt AMA stop rule use Transdiagnostic mechanism? Negative mood and stop rule interaction reliably demonstrates task perseveration TAKE HOME MESSAGE OF THIS SECTION OF THE TALK After last point – we believe the MAI model has most utility in defining the circumstances under which dysfunctional perseveraiton first occurs – there is good evidence to suggest that mood and stop rule are not entirly independent of each other – for example low mood is likely to link to feelings of personal inadaquecy – poor preception in abiliyt to solve problems – and personal inadequecy – all of which wld lead people to take an AMA approach. Once this mood stop rule link is manifest – there are most likely other factors that come into play in maintenance of the disorder such as neutralising strategies – avoidance – and rituals. Want more? Meeten, F. & Davey, G. C. L. (2011). Mood-as-input hypothesis and perseverative psychopathologies. Clinical Psychology Review, 31,

18 Mood-as-input based intervention
(Dash, Meeten, Davey, & Jones, in prep) Socialisation to the mood-as-input model as a method for reducing worry A brief 4-session experiment with high worriers (PSWQ > 62) Primary outcome measure: Penn State Worry Questionnaire Predictions Socialisation to the model would improve worry as compared to controls Applying techniques based on mood-as-input theory would reduce worry Talk about study Remember to say we had other outcome measures – just going to talk about main outcome measure

19 N = 39 Intervention method Mood-as-input sessions
Baseline measures Session Outcome measures 4-week follow-up outcome measures 1 2 3 4 Group 1 Socialization to MAI model MAI technique (mood) MAI technique (decision rule) Group 2 Group 3 Befriending Group 4 Mood-as-input sessions Session 1 and 2: Socialisation to the model (1) and relating model to personal worry topic (2) Session 3 and 4 : Specific components of the model looking at how mood and stop rules affect worry Where’s the clinical impact…? Homework Lifting mood and changing decision rule homework sheet All groups completed a worry diary throughout the study

20 Primary outcome measure difference scores
Difference scores between Time 1 PSWQ scores and Time 6 PSWQ scores. Positive values indicate a decrease in PSWQ scores and negative values an increase in PSWQ scores. Interesting primary measure outcomes – shows promise Difference scores show that learning about the model is enough to sig. reduce worry relative to befriending. Possible that a higher ‘dose’ or more refined mood and stop rule information is needed – only dod this over 2 half hr sessions! Feasibility study – think about refining the intervention and possibly trialling as a low intensity option looking at importance of socialisation to the model. Follow-up with future work

21 Future directions Application to other areas of psychopathology
A transdiagnostic mechanism of perseveration generation? Implications for treatment One size is never going to fit all Addressing common underlying mechanisms is a useful tool in a treatment package New projects i.e. essentially MAI could be apllied to a wide-range of psychopathologies where the individual commences a goal directed activity in a negative mood and is driven to acheive the goal deploying AMA stop rules. i.e. binge eating or gambling – for example in gambling it is well established that gambling often occurs in a negative mood state and gamblers in a negative mood tend to gamble of rlonger and faster than those in a positive mood – pathological gambling is also comorbid with OCD and other persevertaive psycjopathologies, so possible that MAI processes may provide memchansism common to all these disorders inc. gambling Model is most likely explanation perseveraiton generation. If – as the data suggests this mechanism explains perseveraiton in a number of circumstances – this may provide a useful treatment in low intensity services (other term?) DISCLAIMER – one size is never going to fit all – Addressing common underlying mechanisms is a useful tool in both research and a treatment package ….The mood-as-input model has the potential as a transdiagnostic mechansim to explain the dev. Of persevraiton and its comorbidity acorss a number of disorders.

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