The Mind 4 Life Programme – Information for Clinicians
Over the past decade, there has been a major shift in the conceptualisation of depression and anxiety disorders, away from a single-diagnosis approach and in favour of a transdiagnostic model. The transdiagnostic approach to assessment, theory and treatment of depression and anxiety focuses on identifying the common and core problematic psychological, cognitive, emotional, interpersonal and behavioural processes that cut across disorders. This approach has the potential to advance existing theories and treatments for depression and anxiety. In particular, it has the potential to improve the efficacy and efficiency in the way we deliver treatment to people with depression and anxiety.
We have developed a new psychological treatment for adult depression and anxiety disorders. This treatment focuses on the symptoms that are common to depression and anxiety, and incorporates the best available techniques from existing manual-based treatments into the one treatment package. This treatment expands beyond interventions grounded in a sole treatment paradigm (e.g., CBT) towards a theory-driven approach that utilises efficacious techniques translated from basic science alongside components drawn from a wide range of evidence-based psychological treatments (e.g., Mindfulness-based interventions, Acceptance and Commitment Therapy, Behavioural Activation and Dialectical Behaviour Therapy).
This treatment protocol also changes the way that standardised manual-based treatments are delivered. Rather than using integral interventions (where all patients receive the same relatively fixed, complete protocol), we created a modular intervention, whereby the assessment of core problematic areas of emotional, cognitive, interpersonal and behavioural processes informs the selection of treatment modules targeted at specific problem areas for patients. This modular approach allows for standardised, yet flexible treatment that is personalised to the individual concerns, problems and goals for the patient. This treatment also expands beyond interventions that typically focus on alleviating negative symptomatology (e.g., negative thoughts, excessive negative emotions) and incorporates interventions designed to increase positive emotions, capture strengths, and enhance resilience for sustained recovery.
HARMONIC comprises a set of 10 stand-alone modules. All clients receive modules 1 and 2 and then collaborative formulation between client and therapist is used to select the order and content of additional modules (with no fixed number being prescribed) based on the client’s strengths and difficulties. The treatment modules comprise:
Getting Acquainted – Protocol introduction, collaborative case conceptualisation, and motivational enhancement. This module focuses on helping the client understand depression and anxiety, get acquainted with treatment, and set individualised goals for treatment.
Understanding Emotions – Training in experiential and emotional awareness. This module focuses on helping clients develop an understanding of the adaptive role of emotions, and identify the core components of emotion as well fostering non-judgmental awareness of thoughts, feelings, bodily sensations and their inter-relationships.
Managing and Tolerating Emotions – Training in emotion regulation and distress tolerance. In this module clients learn core emotion regulation and distress tolerance skills, including relaxation, the use of exercise, distraction and social support.
Behavioural activation. For clients whose behavioural profile minimises their interaction with affirming and positively reinforcing activities, and/or for whom essential life routines have become disrupted, this module focuses on skills to re-establish routines and of activity monitoring and scheduling to augment rewarding and positive experiences. This draws on concepts and techniques from behavioural activation for depression.
Tackling Avoidance – Exposure to internal or external affective triggers. This module involves exposure to specific interoceptive and/or situational contexts that evoke intense distress, promoting affect tolerance and emotion regulation skills. This module incorporates the key component of graded exposure and response prevention (where necessary), and allows for flexible use of graded exposure to tackle avoidance of situations, sensations, emotions, imagery, thoughts, memories and other feared triggers.
Tackling unhelpful thinking – Cognitive appraisal and reappraisal. This module instantiates the central components of cognitive therapy.
Tackling unhelpful habits – Countering emotion-driven behavioural habits. This module addresses maladaptive behavioural patterns, particularly avoidant behaviours and unhelpful intrapersonal and interpersonal behaviours such as reassurance-seeking, unhelpful emotion-driven communication, and compulsive behaviours.
Overcoming Repetitive Thinking – Monitoring, controlling and changing maladaptive repetitive thought. While traditional CBT focuses on thought content, this module focuses on the process of thinking by training clients to shift from a maladaptive ruminative and worry style to an adaptive style of thinking focused on the specifics of the situation, and on the present moment.
Managing Upsetting Memories and Images – Monitoring, controlling and changing traumatic or intrusive memories. Difficulties in regulating the distressing and intrusive recollection of past upsetting events, are common across the majority of depression and anxiety disorders. This module comprises therapeutic exercises targeted at changing key distressing intrusive memories.
Augmenting positivity, building resilience, and relapse prevention – Reduced emotional response to positive stimuli (anhedonia) is a robust finding in depression and some anxiety disorders, and predicts poor prognosis. This module teaches range of skills to augment beneficial emotional sensitivity and responsiveness to positive events.
The Emotion Model
The treatment is based around the emotion model and aims to develop an understanding of this model as well as a number of core skills in individuals so that they can better manage their emotions, responses to stressors and their maladaptive behaviours.