Presentation on theme: "A transdiagnostic model"— Presentation transcript:
1A transdiagnostic model MOOD-AS-INPUT THEORYA transdiagnostic modelToday 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 UniDr Frances MeetenUniversity of Sussex
2University of Sussex Jason Chan Suzanne Dash Jack Hawksley Professor Graham DaveyUniversity of SussexJason ChanSuzanne DashJack HawksleyDr Benie MacDonaldDr Helen StartupMood 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 OUTLINEPerseveration as a transdiagnostic processThe mood-as-input modelExperimental evidenceFuture directions
3Transdiagnostic approach Mood-as-input model as applied to perseveration in psychological disordersData from a mood-as-input based interventionFuture directionsTransdiagnostic approach to research and treatment – and why it’s importantExamine the MAI model as applied to perseveration in psychological disordersI 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 anxietyThen I’ll look at future directions – hopefully something for everyone in there…
4The transdiagnostic approach Transdiagnostic thought processes (Harvey, Watkins, Mansell, & Shafran, 2006)Positive and negative metacognitive beliefsRecurrent thinkingTransdiagnostic constructsA 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 examplesOf 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.
5Depressive rumination (Nolen-Hoeksema, 1991;Watkins, 2008 )Catastrophising(Davey & Levy 1998)PERSEVERATIONNegativemoodNegativemoodRepetitive 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 ruminationCatastrophsing in GADObsessions & Compulsions in OCDIn 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)
6What 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 goalsPositive moods = ProgressionNegative mood = Lack of achievementExample: Negative and positive mood in different contextsThe 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.-
7Mood-as-input and task perseveration (Martin, Achee, Ward, & Wyer, 1993)Prediction: The informative properties of mood will change with the contextGave 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.
8Stop 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 goalStop rules refer to the criteria we apply to an open –ended task when we consider whether to continue or stopBroadly 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 requirementsTo 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.
9AMA 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 rulesE.g.Inflated responsibilityIntolerance of uncertaintyClinical perfectionismPoor problem solving confidenceMetacognitive 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
10Predictions from the MAI model Psychopathology-relevant tasks are often conducted under conditions of ‘as many as can’ stop rules and negative moodMood-as-input as applied to the generation of perseverative disordersSay prediction – TAKE HOME MESSAGE FOR THIS PART OF THE TALKMAI model provides a mechanism whoich may explain a process common across a number of disordersGENERATION – MAI model explains generation/aquisiton of perseverative thougths or behaviors – not so much engrained rituals/neutralising behaviorus etc.
11Experimental work Open-ended laboratory-based perseverative tasks Catastrophic worryPerseverative checkingDepressive ruminationRemove this one…?
12Open-ended catastrophising task Mood-as-input and perseverative worryStartup & 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 robustWhy 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
13Mood-as-input and perseverative checking MacDonald & Davey (2005): Overall number of checks in an open-ended checkingtask 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
14Mood-as-input and depressive rumination Hawksley & Davey (2010): Number of rumination steps in an open-ended ruminationtask when in a positive or negative mood using an AMA or FL stop rule*Also done this with a clinical population – talk about Chan paperWhen 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
15Chan, Davey, & Brewin (under review): Number of rumination steps in an open-ended rumination task using an AMA or FL stop ruleWithin subs!When depressed individuals changed stop rule their rumination perseveration changed.
16Davey et al, 2007: Worriers shift from AMA to FL Common questionsHow do people ever stop?Davey et al, 2007: Worriers shift from AMA to FLIs mood always used as a source of information?Discounting hypothesisHigh level of expertiseIndividuals disengage from unachieved goal – but only temporarilyIf mood is discounted not used as infoIf 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
17Summary of findings Mood interacts with stop rules to generate perseveration at a number of psychopathologyrelevant tasksDispositional characteristics of those whoexperience anxious psychopathologiesindicate a likelihood to adopt AMA stop rule useTransdiagnostic mechanism? Negative moodand stop rule interaction reliably demonstratestask perseverationTAKE 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,
18Mood-as-input based intervention (Dash, Meeten, Davey, & Jones, in prep)Socialisation to the mood-as-input model as a method for reducing worryA brief 4-session experiment with high worriers (PSWQ > 62)Primary outcome measure: Penn State Worry QuestionnairePredictionsSocialisation to the model would improve worry as compared to controlsApplying techniques based on mood-as-input theory would reduce worryTalk about studyRemember to say we had other outcome measures – just going to talk about main outcome measure
19N = 39 Intervention method Mood-as-input sessions Baseline measuresSessionOutcome measures4-week follow-up outcome measures1234Group 1Socialization to MAI modelMAI technique (mood)MAI technique (decision rule)Group 2Group 3BefriendingGroup 4Mood-as-input sessionsSession 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 worryWhere’s the clinical impact…?HomeworkLifting mood and changing decision rule homework sheetAll groups completed a worry diary throughout the study
20Primary 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 promiseDifference 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
21Future directions Application to other areas of psychopathology A transdiagnostic mechanism of perseveration generation?Implications for treatmentOne size is never going to fit allAddressing common underlying mechanisms is a useful tool in a treatment packageNew 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. gamblingModel 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.