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<title>Transdiagnostic process</title>

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<span id="openzim-page-title" class="mw-page-title-main"><span class="mw-page-title-main">Transdiagnostic process</span></span>

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<div id="mw-content-text" class="mw-body-content mw-content-ltr" lang="en" dir="ltr"><div class="mw-content-ltr mw-parser-output" lang="en" dir="ltr"><p>A <b>transdiagnostic process</b> is a proposed psychological <a href="Mechanism_(biology)" title="Mechanism (biology)">mechanism</a> underlying and connecting a group of <a href="Mental_disorder" title="Mental disorder">mental disorders</a>.

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<div class="mw-heading mw-heading2"><h2 id="History">History</h2></div>

<p>Over the last two centuries, western mental health science has focused on <a href="Nosology" title="Nosology">nosology</a> whereby panels of experts identify hypothetical sets of <a href="Signs_and_symptoms" title="Signs and symptoms">signs and symptoms</a>, label, and compile them into <a href="Taxonomy" title="Taxonomy">taxonomies</a> such as the <i><a href="Diagnostic_and_Statistical_Manual_of_Mental_Disorders" title="Diagnostic and Statistical Manual of Mental Disorders">Diagnostic and Statistical Manual of Mental Disorders</a></i>. While this is one of the approaches that has historically driven progress in <a href="Medicine" title="Medicine">medicine</a>, such taxonomies have long been controversial on grounds including <a href="Bias" title="Bias">bias</a>,<sup id="cite_ref-1" class="reference"><a href="#cite_note-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> <a href="Inter-rater_reliability" title="Inter-rater reliability">diagnostic reliability</a> and potential conflicts of interest amongst their promoters.<sup id="cite_ref-2" class="reference"><a href="#cite_note-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Greenberg_3-0" class="reference"><a href="#cite_note-Greenberg-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> 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.<sup id="cite_ref-4" class="reference"><a href="#cite_note-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-5" class="reference"><a href="#cite_note-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup>

</p><p>To date, no <a href="Biomarker" title="Biomarker">biological marker</a> or individual <a href="Cognition" title="Cognition">cognitive process</a> has been associated with a unique mental diagnosis<sup id="cite_ref-6" class="reference"><a href="#cite_note-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-7" class="reference"><a href="#cite_note-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> but rather such markers and processes seem implicated across many diagnostic categories.<sup id="cite_ref-8" class="reference"><a href="#cite_note-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> For these reasons, researchers have recently begun to investigate mechanisms through which environmental factors such as <a href="Poverty" title="Poverty">poverty</a>, <a href="Discrimination" title="Discrimination">discrimination</a>, <a href="Loneliness" title="Loneliness">loneliness</a>, <a href="Aversives" title="Aversives">aversive</a> <a href="Parenting" title="Parenting">parenting</a>, and childhood <a href="Psychological_trauma" title="Psychological trauma">trauma</a> 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 underlie multiple aspects of <a href="Cognition" title="Cognition">cognition</a> including <a href="Attention" title="Attention">attention</a>, <a href="Memory" title="Memory">memory</a>/imagery, <a href="Thought" title="Thought">thinking</a>, <a href="Reason" title="Reason">reasoning</a>, and <a href="Behavior" title="Behavior">behavior</a>.<sup id="cite_ref-9" class="reference"><a href="#cite_note-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup>

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<div class="mw-heading mw-heading2"><h2 id="Examples">Examples</h2></div>

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<div class="mw-heading mw-heading3"><h3 id="Transdiagnostic_processes_well-supported_by_evidence">Transdiagnostic processes well-supported by evidence</h3></div>

<p>While an exhaustive, confirmed list of transdiagnostic processes does not yet exist, relatively strong evidence exists for processes including:

</p>

<ul><li>Selective attention to external stimuli</li>

<li>Selective attention to internal stimuli <a rel="nofollow" class="external autonumber" href="https://www.researchgate.net/publication/328553766_A_systematic_review_of_the_relationship_between_rigidityflexibility_and_transdiagnostic_cognitive_and_behavioral_processes_that_maintain_psychopathology">[1]</a></li>

<li>Avoidance behavior: distracting ourselves or deliberately not entering feared situations, thereby blocking the opportunity to disconfirm negative beliefs.</li>

<li>Safety behavior: habitual behaviors 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)</li>

<li>Experiential avoidance</li>

<li>Explicit selective memory</li>

<li>Recurrent memory</li>

<li>Interpretation reasoning: how we reach conclusions regarding the meaning of ambiguous or open-ended situations.</li>

<li>Expectancy reasoning: predicting likely future events and outcomes that may follow specific actions or situations.</li>

<li>Emotional reasoning</li>

<li>Recurrent thinking</li>

<li>Positive and negative <a href="Metacognitive" class="mw-redirect" title="Metacognitive">metacognitive</a> beliefs: beliefs we have about our own thinking processes.</li></ul>

<div class="mw-heading mw-heading3"><h3 id="Possible_additional_transdiagnostic_processes">Possible additional transdiagnostic processes</h3></div>

<p>Processes supported by growing evidence include:

</p>

<ul><li>Implicit selective memory</li>

<li>Overgeneral memory</li>

<li>Avoidant encoding and retrieval</li>

<li>Attributions: inferring causes for the outcomes we perceive</li>

<li>Detecting covariation: detecting events that tend to co-occur regularly and consistently</li>

<li>Hypothesis testing and data gathering: evaluating if currently held explanations and beliefs seem accurate or need revision</li>

<li>Recurrent negative thinking: <a href="Worry" title="Worry">worry</a> and <a href="Rumination_(psychology)" title="Rumination (psychology)">rumination</a> that dwells on <a href="Intrusive_thought" title="Intrusive thought">intrusive thoughts</a> in an effort to work through or resolve them.</li>

<li>Thought suppression: deliberately trying to block or remove specific intrusive <a href="Mental_images" class="mw-redirect" title="Mental images">mental images</a> or urges from entering consciousness, which may have the paradoxical effect of sustaining the thought.</li></ul>

<div class="mw-heading mw-heading2"><h2 id="Implications">Implications</h2></div>

<p>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.<sup id="cite_ref-10" class="reference"><a href="#cite_note-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> 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.<sup id="cite_ref-dalgleishetal_11-0" class="reference"><a href="#cite_note-dalgleishetal-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup>

</p><p>Transdiagnostic processes also suggest mechanisms through which <a href="Delusion" title="Delusion">delusions</a> and <a href="Cognitive_bias" title="Cognitive bias">cognitive biases</a> 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 <a href="Confirmation_bias" title="Confirmation bias">confirmation bias</a>, meaning existing beliefs are not updated in the light of conflicting new information.<sup id="cite_ref-12" class="reference"><a href="#cite_note-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup>

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<ul><li><a href="Cognitive_behavioral_therapy#Unified_Protocol" title="Cognitive behavioral therapy">Cognitive behavioral therapy § Unified Protocol</a></li>

<li><a href="Common_factors_theory" title="Common factors theory">Common factors theory</a> – common principles among different psychotherapies</li></ul>

<div class="mw-heading mw-heading2"><h2 id="References">References</h2></div>

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<li id="cite_note-dalgleishetal-11"><span class="mw-cite-backlink"><b><a href="#cite_ref-dalgleishetal_11-0">^</a></b></span> <span class="reference-text"><cite id="CITEREFDalgleishBlack2020" class="citation journal cs1">Dalgleish, Tim; Black, Melissa (2020). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7027356">"Transdiagnostic approaches to mental health problems: current status and future directions"</a>. <i><a href="Journal_of_Consulting_and_Clinical_Psychology" title="Journal of Consulting and Clinical Psychology">Journal of Consulting and Clinical Psychology</a></i>. <b>88</b> (3): <span class="nowrap">179–</span>195. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1037%2Fccp0000482">10.1037/ccp0000482</a>. <a href="PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7027356">7027356</a></span>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/32068421">32068421</a>.</cite></span>

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<li id="cite_note-12"><span class="mw-cite-backlink"><b><a href="#cite_ref-12">^</a></b></span> <span class="reference-text"><cite id="CITEREFPolettiaSambataro2013" class="citation journal cs1">Polettia, Michele; Sambataro, Fabio (2013). "The development of delusion revisited: A transdiagnostic framework". <i>Psychiatry Research</i>. <b>210</b> (3): <span class="nowrap">1245–</span>1259. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fj.psychres.2013.07.032">10.1016/j.psychres.2013.07.032</a>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/23978732">23978732</a>. <a href="S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:30537221">30537221</a>.</cite></span>

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