How Developmental Psychopathology Theory and Research Can Inform the Research Domain Criteria (RDoC) Project

The recently proposed Research Domain Criteria (RDoC) project has the potential to stimulate new research and overcome many of the limitations of the Diagnostic and Statistical Manual of Mental Disorders taxonomy. In the present article we focus, in three main sections, on how theory and research from developmental psychopathology can inform RDoC. First, we discuss the ontology of mental illness and the potential advantages of the RDoC approach to understanding the nature of mental illness. Second, we note potential issues to consider when implementing the RDoC framework, including (a) integrating developmental processes, (b) classifying mental illness within a dimensional approach, and (c) avoiding problems associated with biological reductionism. Third, we describe how a developmental psychopathology perspective may inform each of these potential issues within RDoC. Finally, we highlight the study of emotion and the centrality of affective processes within the RDoC framework. Specifically, we describe how constructionist models of emotion are consistent with developmental psychopathology and how this perspective on emotion can help to guide RDoC research.     

Introduction to the Special Issue: Toward Implementing Physiological Measures in Clinical Child and Adolescent Assessments

The National Institute of Mental Health recently launched the Research Domain Criteria (RDoC). The RDoC is an initiative to improve classification of mental health concerns by promoting research on the brain mechanisms underlying these concerns, with the ultimate goal of developing interventions that target these brain mechanisms. A key focus of RDoC involves opening new lines of research examining patients' responses on biological measures. The RDoC presents unique challenges to mental health professionals who work with children and adolescents. Indeed, mental health professionals rarely integrate biological measures into clinical assessments. Thus, RDoC's ability to improve patient care rests, in part, on the development of strategies for implementing biological measures within mental health assessments. Further, mental health professionals already carry out comprehensive assessments that frequently yield inconsistent findings. These inconsistencies have historically posed challenges to interpreting research findings as well as assessment outcomes in practice settings. In this introductory article, we review key issues that informed the development of a special issue of articles demonstrating methods for implementing low-cost measures of physiological functioning in clinical child and adolescent assessments. We also outline a conceptual framework, informed by theoretical work on using and interpreting multiple informants' clinical reports (De Los Reyes, Thomas, Goodman, & Kundey, 2013 De Los Reyes , A. , Thomas , S. A. , Goodman , K. L. , & Kundey , S. M. A. ( 2013 ). Principles underlying the use of multiple informants' reports . Annual Review of Clinical Psychology , 9 , 123 – 149 . doi: 10.1146/annurev-clinpsy-050212-185617 [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]), to guide hypothesis testing when using physiological measures within clinical child and adolescent assessments. This special issue and the conceptual model described in this article may open up new lines of research testing paradigms for implementing clinically feasible physiological measures in clinical child and adolescent assessments.     

A Tale of Two Paradigms

The articles in this special issue of Clinical Psychology: Science and Practice address topics that may improve the flow of knowledge from research to clinical practice settings. In this commentary, these topics are viewed from the perspective of an efficacy researcher. Progress in the treatment for mental disorders depends on the bidirectional flow of knowledge between researchers and practitioners. Evidence-based practice is possible for most mental disorders (i.e., schizophrenia, bipolar affective disorder, major depressive disorder, the full range of anxiety disorders, and alcoholism and the other chemical dependence disorders), yet there is strong evidence that many (if not most) sufferers do not receive treatments that are known to be effective. Therefore, there is at least a partial disconnect between the processes that result in discovery and confirmation of novel therapeutics and implementation of new approaches to treatment in day-to-day practice settings.     

Illness and symptom perception: a theoretical approach towards an integrative measurement model

Several models have been proposed to conceptualize psychological representations of health, illness, and bodily sensations. These models differ as to the cognitive and affective components they include, whether they study the interaction of these components, and whether associations between psychological representations of bodily states and affective and behavioral reactions to these representations are considered conditional. These different conceptualizations and corresponding measurement approaches exist in parallel without resulting in synergistic effects or theoretical advancements within the field. In this paper, we review theoretical models on perception and attitudes and construct an integrative theoretical framework on psychological representation of bodily symptoms as well as more abstract representations of health and disease. The aim of this combination of approaches is to unify the strengths of different research domains in the conceptualization and measurement of mental representations of bodily states. Furthermore, the aim is to specify new, testable predictions and implications about the (conditional) relationship of these mental representations and affective and behavioral consequences. A core element in this integrative model is comparison. We review how comparison processes can change the cognitive and affective reference frame for illness and symptom perception and in turn affective and behavioral reactions. We discuss implications for measurement of illness and symptom representations as well as implications for clinical practice. Finally, we make suggestions for a research agenda to validate the proposed model as well as to address new questions derived from it.     

Don't Mourn: Organize. Reviving Mental Health Services Research for Healthcare Quality Improvement

The structure, organization, management, and design of the mental health system are changing profoundly as new healthcare policies reshape its configurations. This special issue is a call to action for the mental health services research field. The articles represent an important attempt to identify specific concepts, constructs, and findings from psychosocial treatment research about fidelity and integrity of treatment and align them with healthcare quality. However, the current structure and processes for deriving quality indicators place other demands on the extant research base. These will challenge this migration unless changes are made in leadership around consistent measurement strategies, payment mechanisms to support quality, and attention to technological infrastructure development. The mental health services research field should be proactive. Pediatric issues need special attention, especially as applied to community‐based services for children and their families.     

Future Directions in Research on Racism-Related Stress and Racial-Ethnic Protective Factors for Black Youth

Research on racism-related stress and racial-ethnic protective factors represents an important enterprise for optimizing the mental health of African American and other racial and ethnic minority youth. However, there has been a relative dearth of work on these factors in the clinical psychology research literature, and more work is needed in outlets such as these. To this end, the current article adopts a developmental psychopathology framework and uses recent empirical findings to outline our current understanding of racism-related stress and racial-ethnic protective factors (i.e., racial identity, racial socialization, Africentric worldview) for African American youth. We then provide nine recommendations—across basic, applied, and broader/cross-cutting research lines—that we prioritize as essential to advancing the future scientific investigation of this crucial research agenda. Within and across these recommendations, we issue a charge to researchers and clinicians alike, with the ultimate goal of alleviating the negative mental health impact that racism-related stress can have on the well-being and mental health of African American and other racial and ethnic minority youth.     

Integrating Decision Making and Mental Health Interventions Research: Research Directions

The importance of incorporating patient and provider decision-making processes is in the forefront of the National Institute of Mental Health (NIMH) agenda for improving mental health interventions and services. Key concepts in patient decision making are highlighted within a simplified model of patient decision making that links patient-level/"micro" variables to services-level/"macro" variables via the decision-making process that is a target for interventions. The prospective agenda for incorporating decision-making concepts in mental health research includes (a) improved measures for characterizing decision-making processes that are matched to study populations, complexity, and types of decision making; (b) testing decision aids in effectiveness research for diverse populations and clinical settings; and (c) improving the understanding and incorporation of preference concepts in enhanced intervention designs.     

Clinical utility of cognitive‐behavioural treatment for panic disorder. results obtained in different settings: a research centre and a public mental health care unit

Cognitive‐Behavioural programmes have become the treatment of choice for Panic Disorder (PD). However, although its effectiveness has been widely demonstrated, there are still some limitations regarding the possibility of offering this type of treatment to all panic sufferers. Some researchers are studying ways to make these programmes more available. This study deals with the application and testing of treatment programmes for PD in sites where patients usually look for help for their psychological problems, i.e. mental health care centres. Our work follows a strategy of benchmarking, and the results obtained after applying the treatment in habitual clinical contexts are compared with the results obtained after applying it in research contexts. In the present work, we analyse the possibility of ‘transporting’ a group cognitive‐behavioural programme for PD, developed in a research context, to a more natural setting, a public mental health unit. In this work we present data, using a benchmarking strategy, on one hand, on the differential effectiveness of a group cognitive‐behavioural treatment for PD applied in two different settings: a research setting—a clinical unit at the university; and a natural setting—a public mental health unit. On the other hand, we compare our results with those achieved by other studies carried out in research settings in different countries and a study carried out in a natural setting. Results indicated that our treatment was equally effective in both settings and that effectiveness was comparable to that achieved by the other studies in research and natural settings. Copyright © 2002 John Wiley & Sons, Ltd.     

Current Directions in Videoconferencing Tele-Mental Health Research

The provision of mental health services via videoconferencing tele-mental health has become an increasingly routine component of mental health service delivery throughout the world. Emphasizing the research literature since 2003, we examine (a) the extent to which the field of tele-mental health has advanced the research agenda previously suggested and (b) implications for tele-mental healthcare delivery for special clinical populations. Previous findings have demonstrated that tele-mental health services are satisfactory to patients, improve outcomes, and are probably cost effective. In the very small number of randomized controlled studies that have been conducted to date, tele-mental health has demonstrated equivalent efficacy compared to face-to-face care in a variety of clinical settings and with specific patient populations. However, methodologically flawed or limited research studies are the norm, and thus the research agenda for tele-mental health has not been fully maximized. Implications for future research and practice are discussed.     

Examining Psychotherapy Processes in a Services Research Context

Interdisciplinary research efforts integrating services and interventions research methodologies are needed to improve the "real-world" clinical utility and impact of youth mental health research. "Hybrid" services and interventions research efforts can capitalize on the methodologic strengths of each research tradition in order to more rigorously examine and affect therapy processes in usual care youth mental health service settings. The goals of this article are to (a) identify the need for hybrid practice research on youth mental health care; (b) present a "case example" of a hybrid study, where child and family therapy processes are being examined in a usual care, practice-based context by a team of services researchers; (c) address the potential advantages and challenges of hybrid research; and (d) suggest promising areas for future hybrid research in youth mental health care.     

Seasonal Affective Disorder

The widespread effect of seasonal affective disorder (SAD) in clinical settings as well as other sectors of public health has drawn much research attention lately, which has raised in the field many contentious issues about this condition. This article reviews current literature on SAD, presenting the historical background, diagnostic criteria, epidemiological data, clinical features, treatment, and possible etiological mecrtanism(s) of SAD. The issue of whether SAD is a distinct clinical entity is discussed.     

Promise of Interventions and Services Research: Can It Transform Practice?

This special issue grapples with how best to use science to encourage the use of evidence-based practices. We use this commentary to respond to this broad theme. We emphasize that (a) concerns about gaps between the promise of science and implementation are not unique to mental health, but mental health conditions should be included in national efforts to address the overall quality gap; (b) advances are needed in implementing evidence-based psychotherapy and in creating efficiencies in therapy protocols across multiple disorders; (c) research as well as practice should become more responsive to the values of clients and communities; and (d) leadership is needed across these areas to transform science advances into practice solutions.     

The quality of mental disorder information websites: A review

Objective

This paper reviews studies assessing the quality of websites providing information about mental disorders.

Methods

The review included 31 articles identified by searching research databases in March 2010. Topics covered included affective disorders, anxiety disorders, eating disorders, substance use disorders and schizophrenia/psychosis.

Results

The largest number of articles (13) reported studies assessing affective disorder information quality. Methodologies varied in site selection and rating methods, with some of limited validity. Most concluded that quality was poor, although quality of affective disorder sites may be improving.

Conclusion

There is currently very little understanding of the influence of website quality on user behaviour. Future quality assessments might use the criteria informed by key behaviour change theories.

Practice implications

A possible approach to research on websites and user behaviour might be to develop an evaluation framework incorporating strategies from behaviour change models, key mental health literacy elements and health outcomes relevant to mental health promotion.     

Conducting Psychopathology Prevention Research in the RDoC Era

The Research Domain Criteria (RDoC) initiative promoted by the National Institute of Mental Health emphasizes a dimensional approach to psychopathology that is agnostic to DSM diagnosis. The RDoC project offers exciting possibilities for advancing research aimed at preventing psychopathology. However, prevention has historically been defined using diagnostic status, requiring the field to redefine what constitutes prevention using an RDoC approach. This article outlines new criteria for prevention in the RDoC context and provides guidance for implementing these criteria. We also describe the role of prevention‐mechanism trials that examine whether preventive interventions change proximal etiological mechanisms known to be associated with psychopathology. We hope that these modified criteria and recommendations will stimulate new possibilities for prevention research that will advance the field.     

Theory and concepts of prevention science as applied to clinical psychology.

This article provides an overview for this special issue on prevention science in clinical psychology. A brief historical perspective on prevention in clinical psychology is presented. An even greater emphasis on prevention in the future is related to changes in the current health-care system and their likely impact on psychological practice as we move into the next century. Conceptual and theoretical models of the prevention enterprise are addressed with a distinction drawn between health promotion and disease prevention in the areas of mental disorders and general physical health. The classification of preventive interventions is discussed and methodological challenges to outcomes research are outlined. The article concludes with a discussion of training and public policy implications and a brief overview of the other articles included in this special issue on prevention science.     

The role of health care communication in the development of complementary and integrative medicine

In recent years, complementary medicine (CM) approaches are integrated within a growing number of health care services worldwide. Implementation of CM within primary, secondary and tertiary settings of health care requires attention to a variety of communication challenges. In this special issue of Patient Education and Counseling 23 articles are presented about the patient–provider communication on complementary approaches, and the implementation and integration of CM in health care. Parallel to CM integration in the clinical arena, this special issue emphasizes the importance of two complementary axes: in medical education and in research, particularly on management of chronic illness and life-threatening diseases. The three legs of the integrative stool – research, education, and clinical practice – are perceived in the light of open, non-judgmental patient–health care provider–CM practitioner communication and a patient-centered bio-psycho-social–cultural–spiritual agenda.     

Introduction to the Special Issue on Psychopathological Posttraumatic Reactions

Research over the past 30 years has changed the landscape of trauma and general stress studies, leading to the new conceptual and clinical questions regarding the nature of psychopathological reactions to trauma. In this introduction to this special issue, we review several well‐documented scientific findings that continue to surprise laypeople and mental health experts alike. The articles in this special issue will further our understanding of modern psychological responses to adversity.     

Current progress and future plans for developing effective treatments: Comments and perspectives

Examined the conclusions and implications of article, in this special issue. Treatments can be differentiated on their empirical basis and, for the problems reviewed, one can identify treatments of choice. To build on the documented advances, we provide a blueprint for progress in treatment research. The blueprint focuses on a series of steps that involve conceptualization of clinical dysfunction and treatment, supportive research on these conceptual views, careful specification of treatment, evaluation of treatment outcome, and tests of mediators and moderators of treatment. To improve research, we recommend expanding assessment, addressing a broad range of questions about treatment, attending to measures of clinical significance, replicating key findings, and investigating the transportability of the findings to service-oriented clinical settings.     

The role of health care communication in the development of complementary and integrative medicine

In recent years, complementary medicine (CM) approaches are integrated within a growing number of health care services worldwide. Implementation of CM within primary, secondary and tertiary settings of health care requires attention to a variety of communication challenges. In this special issue of Patient Education and Counseling 23 articles are presented about the patient–provider communication on complementary approaches, and the implementation and integration of CM in health care. Parallel to CM integration in the clinical arena, this special issue emphasizes the importance of two complementary axes: in medical education and in research, particularly on management of chronic illness and life-threatening diseases. The three legs of the integrative stool – research, education, and clinical practice – are perceived in the light of open, non-judgmental patient–health care provider–CM practitioner communication and a patient-centered bio-psycho-social–cultural–spiritual agenda.     

Clinical Psychologists in Departments of Psychiatry: Current Issues and a Look to the Future

The aim of this article is to discuss issues facing psychologists who work in departments of psychiatry. The authors both have experience in such settings and address relationships between psychologists and psychiatrists, the differences in training backgrounds and approaches to understanding and treating mental health disorders, and issues related to productivity. In many departments, clinical psychologists do not have equal standing with psychiatrists when it comes to compensation, competition for resources, and administrative representation. Nevertheless, when calls for increasingly multimodal research and treatment approaches are considered along with the requirement that psychiatry residency training programs require instruction in empirically supported psychological treatments, one recognizes that psychologists will continue to fill important roles in departments of psychiatry for the foreseeable future.