Dimensional models of psychopathology: research agenda and clinical utility

This commentary emphasizes the implications for a mental health research agenda that stem from the papers in this special section on dimensional models of psychopathology. These include the need to extend dimensional models to a wider range of psychopathology; the relationship of the dimensions described in these papers, largely based on symptom and self-report measures, to findings from current research in genetics, neuroimaging, and other domains of neuroscience; the need for new scales that can assess the entire range of relevant dimensions with modern psychometric techniques; and ways to employ these dimensions in applied clinical situations. It is concluded that hierarchical dimensional models offer powerful ways of organizing our thinking about psychopathology and will serve to guide many promising avenues of future research.     

Symptom modelling can be influenced by psychiatric categories: choices for research domain criteria (RDoC)

Psychiatric researchers typically assume that the modelling of psychiatric symptoms is not influenced by psychiatric categories; symptoms are modelled and then grouped into a psychiatric category. I highlight this primarily through analysing research domain criteria (RDoC). RDoC’s importance makes it worth scrutinizing, and this assessment also serves as a case study with relevance for other areas of psychiatry. RDoC takes inadequacies of existing psychiatric categories as holding back causal investigation. Consequently, RDoC aims to circumnavigate existing psychiatric categories by directly investigating the causal basis of symptoms. The unique methodological approach of RDoC exploits the supposed lack of influence of psychiatric categories on symptom modelling, taking psychiatric symptoms as the same regardless of which psychiatric category is employed or if no psychiatric category is employed. But this supposition is not always true. I will show how psychiatric categories can influence symptom modelling, whereby identical behaviours can be considered as different symptoms based on an individual’s psychiatric diagnosis. If the modelling of symptoms is influenced by psychiatric categories, then psychiatric categories will still play a role, a situation which RDoC researchers explicitly aim to avoid. I discuss four ways RDoC could address this issue. This issue also has important implications for factor analysis, cluster analysis, modifying psychiatric categories, and symptom based approaches.     

A scoping review on the extent and nature of anxiety-related research within the research domain criteria (RDoC) framework: Limited coverage using non-disorder-specific search terms

The need for research on modifiable risk factors in anxiety has been highlighted in previous reviews synthesizing literature on the etiology and maintenance of anxiety. The Research Domain Criteria (RDoC) provides a useful framework to lead this body of work. A scoping review was conducted to examine the extent and nature of research evidence on each RDoC domain as they have been investigated in anxiety via relevant correlates, with the end goal of informing future research priorities. The coverage of this review was limited to search terms bound within non-disorder-specific anxious pathology. The adopted selection criteria resulted in 170 cases (across 94 studies) where RDoC-relevant correlates of anxiety were studied. Results highlight disparate research focus across domains (limited research on processes within the Positive Valence Systems, Systems for Social Processes, and Arousal/Regulatory Systems), inconsistent findings within domains (Cognitive Systems), and a lack of research on cross-domain interactions.     

Is the Divide a Chasm?: Bridging Affective Science with Clinical Practice

This special section endeavors to facilitate the integration of biologically-based assessments of emotion into the clinical setting. This goal is consistent with the Research Domain Criteria (RDoC) initiative, which aims to identify transdiagnostic biobehavioral mechanisms that underlie mental disorders. We focus on four challenges to applying biologically-informed research on emotion and emotion regulation to clinical contexts: (1) How do we assess emotion in an RDoC framework? (2) How do we integrate measures of emotion with other systems in a wider context? (3) What do physiological indices of emotion tell us about clinical phenomena? and (4) How do we integrate physiological assessments into clinical practice? Throughout this comment, we refer to the articles in this special section to make our points, and, when possible, offer suggestions for future work to continue to address these challenges.     

Contextualizing neuroticism in the Hierarchical Taxonomy of Psychopathology

Neuroticism is the personality trait most consistently and strongly connected to psychopathology. The majority of research on the relationship between traits and mental illness has focused on neuroticism’s connection with broad psychopathology spectra or discrete disorders. However, both personality and psychopathology are hierarchically-organized domains that may be examined at multiple levels of fidelity and bandwidth from very specific thoughts, feelings, and behaviors (i.e., nuance traits or symptoms) to very broad patterns indexing many interrelated tendencies (i.e., general factors). The Hierarchical Taxonomy of Psychopathology (HiTOP) is a recently proposed nosologic framework for psychopathology symptoms and domains that accounts for this tiered organization. Here, we illustrate how neuroticism-psychopathology relationships—both what is known and unknown—may be elucidated through the HiTOP system.     

心理病理学网络理论、方法与挑战

对于精神障碍这一概念的理解, 传统DSM-ICD分类诊断系统和研究领域标准RDoC均基于潜变量视角, 认为精神障碍的症状由其潜在共同原因所致。这2种观点都忽略了症状间的相互作用。不同于分类和维度视角, Borsboom在2008年对精神障碍的概念化提出了的全新视角——心理病理学网络理论。此理论的核心观点是症状之间的动态因果关系构成了精神障碍。基于心理病理学网络理论的网络分析方法, 主要以结合EBIC的glasso算法估计症状间的偏相关网络, 并通过网络中节点中心性与网络连接性等指标, 来考查精神障碍症状的不同特性。近几年来, 研究者发现心理病理学网络分析方法在对症状间因果关系的推断、核心症状的识别和网络结构的可靠性与可重复性方面仍面临一些挑战。这些挑战为心理病理学网络理论与方法指明了未来可能的发展方向。     

Risk-factor research and prevention programs for anxiety disorders: a translational research framework

The aim of the present essay is to discuss the interconnection between risk-factor research and prevention program development for panic-spectrum psychopathology. We argue that prevention of panic-spectrum psychopathology specifically, and anxiety disorders more generally, is likely to be best advanced through active, systematic translation of basic, risk-factor research. After operationalizing key terminology, we present some exemplar risk-factor candidates for panic-spectrum psychopathology, summarize research related to their role as risk-factors for panic problems, and link this discussion to risk-factor nomenclature. We then present a translational framework for extrapolating extant knowledge on these and other potential risk-factors for panic-spectrum psychopathology with respect to the development of preventative interventions. The proposed translational framework is intended to describe a forward-feeding process by which risk-factor research could be used by clinical researchers to inform prevention programs; and reciprocally, how such prevention knowledge could be most effectively utilized to drive new, clinically focused risk-factor research.     

In search of the unifying principles of psychotherapy: conceptual, empirical, and clinical convergence

The search for the principles of unified psychotherapy is an important stage in the advancement of the field. Converging evidence from various streams of clinical science allows the identification of some of the major domains of human functioning, adaptation, and dysfunction. These principles, supported by animal modeling, neuroscience, and developmental psychopathology, along with new theoretical constructs, are demonstrating that human functioning is best conceptualized as holistic and highly interrelated at all domain levels of the total ecological system. Incorporating these findings with evidence accrued over the past century of psychotherapy practice and study allows psychologists to begin to explore the development of a unified system of psychotherapy that is rooted in the clinical sciences. One such attempt to develop a unified framework is presented as a starting point. ((c) 2006 APA, all rights reserved).     

Toward a Cognitive-Behavioral Classification System for Mental Disorders

As is true for its predecessors, the recently published DSM-5 uses arbitrary criteria and cutoffs to define categories of mental disorders that are of questionable validity and that provide no guidance for treatment. Recently, the NIMH introduced an alternative classification system, the Research Domain Criteria (RDoC). Both the DSM-5 and the RDoC initiative make the strong assumption that psychological problems are expressions of specific latent disease entities. In contrast, the complex causal network approach conceptualizes psychological problems as mutually interacting, often reciprocally reinforcing, elements of a complex causal network. The cognitive behavioral model offers a classification framework that is compatible with the complex causal network approach and provides a treatment-relevant alternative to the latent disease model that is the basis for the DSM-5 and the RDoC initiative.     

Culture and education: new frontiers in brain plasticity

Cognitive neuroscience has started to probe cross-cultural differences in the neuronal mechanisms underlying cognitive, perceptual and social domains. Moreover, brain imaging has revealed how education changes the brain. Such research opens up a new frontier in brain plasticity research, breaking down the boundaries between neuroscience and other traditionally non-biological disciplines, resulting in many conceptual and practical implications.     

Mind and muscle: the cognitive-affective neuroscience of exercise

There is growing basic-science interest in the mechanisms underpinning the positive effects of exercise on brain function and cognitive-affective performance. There is also increasing clinical evidence that exercise may prevent and treat various neuropsychiatric disorders. At the same time, there is growing awareness that athletic performance is mediated in crucial ways by central nervous system mechanisms. The relevant mechanisms in all these cases requires further exploration, but likely includes neurotrophic, neuroendocrine, and neurotransmitter systems, which in turn are crucial mediators of psychopathology and resilience. The hypothesis that Homo sapiens evolved as a specialist endurance runner provides an intriguing context against which to research the proximal mechanisms relevant to a cognitive-affective neuroscience of exercise.     

Developmental Psychopathology: Reactions, Reflections, Projections

In this paper, I describe the field of developmental psychopathology, discuss its major tenets, and delineate its boundaries with other disciplines with an eye toward the future. I articulate how I envision those aspects of developmental psychopathology that I view as central to the discipline affecting the field and evolving over time. The current status and suggested directions for a number of issues are discussed, including: the interface between normal and abnormal development; developmental mechanisms and processes across the life span; the need for an interdisciplinary approach; prevention and intervention; and training. I believe that a continued and expanded interface between the study of normal and atypical development will span the dualisms that exist between the clinical study of and research into disorders of childhood and adulthood, between basic and applied research, and between psychology and biology. If fostered, I envision an exciting new era of theoretical and empirical work in the developmental sciences.     

情绪障碍及其干预:心理表象的视角

心理表象在多种情绪障碍中均表现出病理性特点。研究者基于心理表象主要对创伤后应激障碍、抑郁心境、双相障碍情绪和社交焦虑进行了心理病理学解释,尤其关注闪回和过度概化记忆等两种典型症状,并且重视心理表象在情绪症状维持中的作用。概括而言,研究者强调记忆形成与提取过程的异常、认知与行为的保护性策略的负强化、对事件及自我的认知偏差等三类因素对情绪障碍的致病作用。目前,针对或运用心理表象的干预与训练方法包括减少消极表象、改变消极表象内容、提高积极表象能力、提高记忆的具体性等四类。未来应注重侵入性表象的功能分析以及相关的心理病理学模型研究,并拓展干预与训练研究。     

Developmental psychopathology. Current research, issues, and directions

Developmental psychopathology refers to the study of clinical dysfunction in the context of maturational and developmental processes. Although the field encompasses the entire life span, the present focus is on childhood. Special characteristics make the study of childhood dysfunction somewhat unique, including the emergence, evolution, and attenuation of seemingly problematic behaviors over the course of development; the manner in which children are referred for clinical evaluation; and complexities in identifying the appropriate foci for clinical intervention. Notwithstanding these obstacles, recent work has advanced considerably in diagnosis, assessment, and treatment of childhood disorders. The present article highlights recent advances in these areas and promising extensions in current research. Many advances have relied heavily on the extension of paradigms developed in research with adults. Additional research is needed that draws on and integrates conceptual and empirical work from developmental psychology.     

The illusion of reality: a review and integration of psychological research on hallucinations

Hallucinations are among the most severe and puzzling forms of psychopathology. Although usually regarded as first-rank symptoms of schizophrenia, they are found in a wide range of medical and psychiatric conditions. Moreover, a substantial minority of otherwise normal individuals report hallucinatory experiences. The purpose of this article is to review the considerable research into the cognitive mechanisms underlying (particularly psychotic) hallucinations that has been carried out and to integrate this research within a general framework. The available evidence suggests that hallucinations result from a failure of the metacognitive skills involved in discriminating between self-generated and external sources of information. It is likely that different aspects of these skills are implicated in different types of hallucinatory experiences. Further research should focus on specific metacognitive deficits associated with different types of hallucinations and on treatment strategies designed to train hallucinators to reattribute thoughts to themselves.     

Understanding youth antisocial behavior using neuroscience through a developmental psychopathology lens: Review,integration, and directions for research

Youth antisocial behavior (AB) is an important public health concern impacting perpetrators, victims, and society. Functional neuroimaging is becoming a more common and useful modality for understanding neural correlates of youth AB. Although there has been a recent increase in neuroimaging studies of youth AB and corresponding theoretical articles on the neurobiology of AB, there has been little work critically examining the strengths and weaknesses of individual studies and using this knowledge to inform the design of future studies. Additionally, research on neuroimaging and youth AB has not been integrated within the broader framework of developmental psychopathology. Thus, this paper provides an in-depth review of the youth AB functional neuroimaging literature with the following goals: (1) to evaluate how this literature has informed our understanding of youth AB, (2) to evaluate current neuroimaging studies of youth AB from a developmental psychopathology perspective with a focus on integrating research from neuroscience and developmental psychopathology, as well as placing this research in the context of other related areas (e.g., psychopathy, molecular genetics), and (3) to examine strengths and weaknesses of neuroimaging and behavioral studies of youth AB to suggest how future studies can develop a more informed and integrated understanding of youth AB.     

Cortical electrophysiological network dynamics of feedback learning

Understanding the neurophysiological mechanisms of learning is important for both fundamental and clinical neuroscience. We present a neurophysiologically inspired framework for understanding cortical mechanisms of feedback-guided learning. This framework is based on dynamic changes in systems-level oscillatory synchronization, reflecting changes in synaptic plasticity between stimulus-processing and motor areas that are modulated in a top-down fashion by different areas of the prefrontal cortex. We make new and testable predictions for how large-scale cortical networks support learning from feedback. Testing these predictions may provide new insights into the basic mechanisms underlying learning and how these mechanisms may be impaired in clinical disorders in which feedback learning is compromised.     

Gratitude and Subjective Wellbeing: A Proposal of Two Causal Frameworks

Gratitude, the experience of appreciating the positive aspects in life, has been associated with increased subjective wellbeing (SWB). This paper proposes two causal frameworks (i.e., a cognitive and a psycho-social framework) that highlight the possible mechanisms by which gratitude influences SWB. This paper provides support for these two frameworks by reviewing research conducted to date on the relationship between the experience of gratitude and SWB, in terms of reduced symptoms of psychopathology, better interpersonal relationships, and improved physical health. In addition, the promising potential of gratitude interventions to improve SWB in healthy individuals and those with symptoms of psychopathology are reviewed. While gratitude interventions represent a relatively new approach, the limited evidence suggests that they may eventually provide an effective form of intervention that can be used to complement current therapy aprroaches for improving SWB. Therefore its potential application in clinical populations and the underlying mechanisms that might be driving the positive effects of gratitude interventions in improving SWB deserve further research attention.     

Does neuroscience hold promise for the further development of behavior therapy? The case of emotional change after exposure in anxiety and depression

Over the last few years, the integration of biological and psychological models has become increasingly important in clinical psychology. This paper presents a neurobiological framework for exploring how neuroscience research may be valuable in the context of new developments in behavior therapy. The importance of the cortical-subcortical circuitry of emotion processing for investigating the working mechanisms of exposure therapy is illustrated by current neuroimaging research. The implication is that during exposure therapy the focus of attention must be fully directed towards the emotional content of the threatening situation to facilitate prefrontal control over the amygdala and that new contextual information, of emotional salience, must be added to create inhibitory projections from the hippocampus. In addition, some possible mechanisms of action for different therapeutic approaches to both anxiety and depression and the role of neuroimaging techniques in predicting treatment outcome are discussed.