Professor Ed Watkins

The Think-Tank seminar series

How can research into psychological mechanisms inform classification and treatment of emotional disorders? Evaluating a transdiagnostic mechanistic approach  

Facilitator

Professor Ed Watkins, Director of the Mood Disorders Centre and Sir Henry Wellcome Building, University of Exeter

Date and time

12:00 - 13:00, 12 April 2013

Abstract

A major theoretical challenge is how to conceptualize, classify, explain, and investigate emotional disorders to optimize our treatments. The conventional approach to understanding and treating emotional disorders is disorder-focused, based around distinct diagnostic categories (e.g., major depression), each defined to a precise set of atheoretical criteria (DSM-V, ICD-10). Although this approach has demonstrated good reliability, questions have been raised about its validity and utility. Limitations include: (a) it focuses on observed symptom clusters (symptomatic presentation) rather than on the underlying causal processes driving their expression; (b) there are very high rates of co-morbidity, raising questions about the core features of any specific diagnosis; (c) there is heterogeneity within diagnoses. An alternative approach is to uncouple “research efforts from clinically familiar categories to focus directly on fundamental mechanisms of psychopathology” (Sanislow et al., 2010, p. 631, Research Domain Criteria initiative, U.S. National Institute of Mental Health Strategy). Research into cognitive-behavioural, interpersonal, and biological mechanisms has suggested that there are processes that (a) are shared across multiple disorders and (b) causally contribute to the onset, maintenance, recurrence or recovery from disorders, leading to the hypothesis of transdiagnostic (cross-cutting) processes and mechanisms (Harvey et al., 2004). Candidate processes include negative and positive affect; avoidance; cognitive biases; and repetitive negative thinking (RNT; worry, rumination Ehring & Watkins, 2008; Watkins, 2008; Nolen-Hoeksema & Watkins, 2011). This mechanistic approach may provide an alternative or complementary adjunct to disorder-focused classification, particularly for predicting prognosis, distinguishing adaptive versus maladaptive processes, and matching of interventions to specific vulnerabilities.