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Summary all articles Cog. Beh. processes across disorders
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Summary all articles Cog. Beh. processes across disorders. Includes images and explanations.
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Lecture 1: AvoidanceArticle 1: Experiential avoidance and behavioral disorders: A functional
dimensional approach to diagnosis and treatment.
Syndromal classification is in many ways foreign to psychology, because it
tends to ignore the developmental, functional, contextual approach to behavior
that is characteristic of much of our discipline in favor of a more object like,
pathological, medical approach.
Functional diagnostic dimensions present an alternative, of which emotional
avoidance is just one example (other possible dimensions might include such
examples as poor rule generation, inappropriate rule following, or socially
impoverished repertoires, although defense of these dimensions awaits
another day). Functional diagnostic dimensions are not traditional disorders,
nor are they well-worked-out etiological theories. They are dimensional
processes, not all-or-nothing categories that suggest psychological processes
relevant to etiology that make coherent many topographical forms under a
single functional process and that can be readily linked to treatment. As such
they provide a kind of functional middle ground between mere psychological
topography on the one hand or well-developed and functional psychological
theories of psychopathology on the other.
Functional diagnostic dimensions focus directly and nonprejudicially on the
behavior of interest. This allows research from many areas of our disparate
field to proceed but in a manner that is more fitting with psychology and its
traditions than the psychiatric nosology that we have imported.
Comparing Syndromal and Functional Classification
Although there are many purposes to diagnostic classification, most
researchers seem to agree that the ultimate goal is the development of classes,
dimensions, or relational categories that can be empirically wedded to
treatment strategies. Syndromal classification—whether dimensional or
categorical is as old as scientific psychology itself. Syndromal classification
starts with constellations of signs and symptoms to identify the disease entities
that are presumed to give rise to these constellations. Syndromal
classification thus starts with structure and, it is hoped, ends with
utility. The attempt in functional classification, conversely, is to start with
utility by identifying functional processes with clear treatment implications. It
then works backward and returns to the issue of identifiable signs and
symptoms that reflect these processes. These differences are fundamental.
, Syndromal Classification
The immediate goal of syndromal classification is to identify collections of
signs (what one sees) and symptoms (what the client's complaint is). The hope
is that these syndromes will lead to the identification of disorders with a
known etiology, course, and response to treatment. When this has been
achieved, we are no longer speaking of syndromes but of diseases. Because the
construct of disease involves etiology and response to treatment, these
classifications are ultimately a kind of functional unit. Thus, the syndromal
classification approach is a topographically oriented classification strategy for
the identification of functional units of abnormal behavior.
In the absence of progress toward true functional entities, syndromal
classification of psychopathology has several down sides. Symptoms are
virtually nonfalsifiable, because they depend only on certain formal features.
Syndromal categories tend to evolve—changing their names frequently and
splitting into ever finer subcategories but they rarely simply disappear. As a
result, the number of syndromes within the DSM system has increased
exponentially.
In physical medicine, syndromes regularly disappear into disease categories. A
wide variety of symptoms can be caused by a single disease, or a common
symptom can be explained by very different diseases entities. These etiological
factors have very different treatment implications. Note that the reliability of
symptom detection is not what is at issue. .In the same way, the increasing
reliability of DSM diagnoses is of little consolation in and of itself.
The DSM system specifically eschews the primary importance of functional
processes. For example, the link between syndromal categories and biological
markers or change processes has been consistently disappointing. To date,
compellingly sensitive and specific physiological markers have not been
identified for any psychiatric syndrome. Similarly, the link between syndromes
and differential treatment has long been known to be weak. Without attention
to etiology, treatment utility, and pathological process, the current syndromal
system seems unlikely to evolve rapidly into a functional, theoretically relevant
system.
Functional Classification
In a functional approach to classification, the topographical characteristics of
any particular individual's behavior is not the basis for classification; instead,
behaviors and sets of behaviors are organized by the functional processes that
are thought to have produced and maintained them. This functional method is
inherently less direct and naive than a syndromal approach, as it requires the
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