A transdiagnostic process is a proposed psychological mechanism underlying and connecting a group of

mental disorder A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitti ...

History

Over the last two centuries, western mental health science has focused on

nosology Nosology () is the branch of medical science that deals with the classification of diseases. Fully classifying a medical condition requires knowing its cause (and that there is only one cause), the effects it has on the body, the symptoms that ...

whereby panels of experts identify hypothetical sets of

signs and symptoms Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressure or an abnormality showi ...

, label, and compile them into taxonomies such as the '' Diagnostic and Statistical Manual of Mental Disorders''. While this is one of the approaches that has historically driven progress in

medicine Medicine is the science and Praxis (process), practice of caring for a patient, managing the diagnosis, prognosis, Preventive medicine, prevention, therapy, treatment, Palliative care, palliation of their injury or disease, and Health promotion ...

, such taxonomies have long been controversial on grounds including

bias Bias is a disproportionate weight ''in favor of'' or ''against'' an idea or thing, usually in a way that is closed-minded, prejudicial, or unfair. Biases can be innate or learned. People may develop biases for or against an individual, a group ...

, diagnostic reliability and potential conflicts of interest amongst their promoters. The article's closing words: "it he APAwill be laughing all the way to the bank." Over-reliance on taxonomy may have created a situation where its benefits are now outweighed by the fragmentation and constraints it has caused in the training of mental health practitioners, the range of treatments they can provide under insurance cover, and the scope of new research. To date, no biological marker or individual

cognitive process Cognition refers to "the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses". It encompasses all aspects of intellectual functions and processes such as: perception, attention, thought, ...

has been associated with a unique mental diagnosis but rather such markers and processes seem implicated across many diagnostic categories. For these reasons, researchers have recently begun to investigate mechanisms through which environmental factors such as

poverty Poverty is the state of having few material possessions or little income. Poverty can have diverse < ...

, discrimination,

loneliness Loneliness is an unpleasant emotional response to perceived isolation. Loneliness is also described as social paina psychological mechanism which motivates individuals to seek social connections. It is often associated with a perceived lack ...

, aversive

parenting Parenting or child rearing promotes and supports the physical, emotional, social, spiritual and intellectual development of a child from infancy to adulthood. Parenting refers to the intricacies of raising a child and not exclusively for a b ...

, and childhood trauma or maltreatment might act as causes of many disorders and which therefore might point towards interventions that could help many people affected by them. Research suggests that transdiagnostic processes may underly multiple aspects of

cognition Cognition refers to "the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses". It encompasses all aspects of intellectual functions and processes such as: perception, attention, thoug ...

including

attention Attention is the behavioral and cognitive process of selectively concentrating on a discrete aspect of information, whether considered subjective or objective, while ignoring other perceivable information. William James (1890) wrote that "Att ...

memory Memory is the faculty of the mind by which data or information is encoded, stored, and retrieved when needed. It is the retention of information over time for the purpose of influencing future action. If past events could not be remembered ...

/imagery,

thinking In their most common sense, the terms thought and thinking refer to conscious cognitive processes that can happen independently of sensory stimulation. Their most paradigmatic forms are judging, reasoning, concept formation, problem solving, an ...

reason Reason is the capacity of Consciousness, consciously applying logic by Logical consequence, drawing conclusions from new or existing information, with the aim of seeking the truth. It is closely associated with such characteristically human activ ...

ing, and

behavior Behavior (American English) or behaviour ( British English) is the range of actions and mannerisms made by individuals, organisms, systems or artificial entities in some environment. These systems can include other systems or organisms as w ...

Examples

Transdiagnostic processes well-supported by evidence

While an exhaustive, confirmed list of transdiagnostic processes does not yet exist, relatively strong evidence exists for processes including: * Selective attention to external stimuli * Selective attention to internal stimuli * Avoidance behaviour: distracting ourselves or deliberately not entering feared situations, thereby blocking the opportunity to disconfirm negative beliefs. * Safety behaviour: habitual behaviours we execute because we believe they will help us to avoid something we fear (for example, vomiting, dieting or excessive exercise to avoid weight gain) * Experiential avoidance * Explicit selective memory * Recurrent memory * Interpretation reasoning: how we reach conclusions regarding the meaning of ambiguous or open-ended situations. * Expectancy reasoning: predicting likely future events and outcomes that may follow specific actions or situations. * Emotional reasoning * Recurrent thinking * Positive and negative metacognitive beliefs: beliefs we have about our own thinking processes.

Possible additional transdiagnostic processes

Processes supported by growing evidence include: * Implicit selective memory * Overgeneral memory * Avoidant encoding and retrieval * Attributions: inferring causes for the outcomes we perceive * Detecting covariation: detecting events that tend to co-occur regularly and consistently * Hypothesis testing and data gathering: evaluating if currently held explanations and beliefs seem accurate or need revision * Recurrent negative thinking:

worry Worry refers to the thoughts, images, emotions, and actions of a negative nature in a repetitive, uncontrollable manner that results from a proactive cognitive risk analysis made to avoid or solve anticipated potential threats and their pote ...

and rumination that dwells on intrusive thoughts in an effort to work through or resolve them. * Thought suppression: deliberately trying to block or remove specific intrusive

mental images Mental Images GmbH (stylized as mental images) was a German computer generated imagery (CGI) software firm based in Berlin, Germany, and was acquired by Nvidia in 2007, then rebranded as Nvidia Advanced Rendering Center (ARC), and is still prov ...

or urges from entering consciousness, which may have the paradoxical effect of sustaining the thought.

Implications

Transdiagnostic processes suggest interventions to help people suffering from mental disorders. For example, helping someone to view thoughts as mental events in a wider context of awareness, rather than as expressions of external reality, may enable someone to step back from those thoughts and to see them as ideas to be tested rather than unchangeable facts. If research can identity a relatively limited number of transdiagnostic processes, people facing a wide range of mental difficulties might be helped by practitioners trained to master a relatively limited number of techniques corresponding to those underlying processes, rather than requiring many specialists who are each expert in treating a single specific disorder. Transdiagnostic processes also suggest mechanisms through which

delusion A delusion is a false fixed belief that is not amenable to change in light of conflicting evidence. As a pathology, it is distinct from a belief based on false or incomplete information, confabulation, dogma, illusion, hallucination, or some o ...

s and

cognitive bias A cognitive bias is a systematic pattern of deviation from norm or rationality in judgment. Individuals create their own "subjective reality" from their perception of the input. An individual's construction of reality, not the objective input, ...

es may be understood. For example, the process of detecting covariation can lead to illusory correlations between unrelated stimuli, and the process of hypothesis testing and data gathering is generally subject to

confirmation bias Confirmation bias is the tendency to search for, interpret, favor, and recall information in a way that confirms or supports one's prior beliefs or values. People display this bias when they select information that supports their views, ignorin ...

, meaning existing beliefs are not updated in the light of conflicting new information.

References