Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-18T18:10:52.014Z Has data issue: false hasContentIssue false
  • English
  • Français

Effectiveness of Transdiagnostic Cognitive Behaviour Therapy for Anxiety and Depression in Adults: A Systematic Review and Meta-analysis

Published online by Cambridge University Press:  15 June 2016

Philip Andersen Open the ORCID record for Philip Andersen [Opens in a new window] ,
Paul Toner ,
Martin Bland  and
Dean McMillan
Philip Andersen
Affiliation:
University of York, UK
Paul Toner
Affiliation:
University of York, UK
Martin Bland
Affiliation:
University of York, UK
Dean McMillan*
Affiliation:
University of York, and Hull York Medical School, UK
*
Correspondence to Dean McMillan, Hull York Medical School and Department of Health Sciences, Room ARC/205, University of York, York YO10 5DD, UK. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Transdiagnostic Cognitive Behaviour Therapy (CBT) seeks to identify core cognitive-behavioural processes hypothesized to be important across a range of disorders and to develop a treatment that targets these. This contrasts with standard CBT approaches that are disorder-specific. Proponents of transdiagnostic CBT suggest that it may offer advantages over disorder-specific CBT, but little is known about the effectiveness of this approach. Aims: The review aimed to summarize trial-based clinical and cost-effectiveness data on transdiagnostic CBT for anxiety and depression. Method: A systematic review of electronic databases, including peer-reviewed and grey literature sources, was conducted (n = 1167 unique citations). Results: Eight trials were eligible for inclusion in the review. There was evidence of an effect for transdiagnostic CBT when compared to a control condition. There were no differences between transdiagnostic CBT and active treatments in two studies. We found no evidence of cost-effectiveness data. Conclusions: Quality assessment of the primary studies indicated a number of methodological concerns that may serve to inflate the observed effects of transdiagnostic approaches. Although there are positive signs of the value of transdiagnostic CBT, there is as yet insufficient evidence to recommend its use in place of disorder-specific CBT.

Keywords

Transdiagnosticcognitive behaviour therapysystematic reviewmeta-analysismethodological qualityevidence-base
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 44 , Issue 6 , November 2016 , pp. 673 - 690
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Beck, A. T. and Steer, R. A. (1990). The Beck Anxiety Inventory Manual. San Antonio, TX: Psychological Corporation.Google Scholar
Beck, A. T., Steer, R. A. and Brown, G. K. (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.Google Scholar
Borkovec, T. D., Abel, J. L. and Newman, H. (1995). Effects of psychotherapy on comorbid conditions in generalized anxiety disorder. Journal of Consulting and Clinical Psychology, 63, 479–83.Google Scholar
Butler, A. C., Chapman, J. E., Forman, E. M. and Beck, A. T. (2006). The empirical status of cognitive–behavioral therapy: a review of meta–analyses. Clinical Psychology Review, 26, 17–31.Google Scholar
Centre for Reviews and Dissemination (2009). Systematic Reviews: CRD's guidance for undertaking reviews in health care. York: Centre for Reviews and Dissemination, University of York.Google Scholar
Cochrane Collaboration (2012). Review Manager (RevMan) [computer program]. Version 5.2. Copenhagen: The Nordic Cochrane Centre.Google Scholar
Craske, M. G., Farchione, T. J., Allen, L. B., Barrios, V., Stoyanova, M. and Rose, R. (2007). Cognitive behavioral therapy for panic disorder and comorbidity: more of the same or less of more? Behaviour Research and Therapy, 45, 1095–1109.CrossRefGoogle ScholarPubMed
Das-Munshi, J., Goldberg, D., Bebbington, P. E., Bhugra, D. K., Brugha, T. S., Dewey, M. E., et al. (2008). Public health significance of mixed anxiety and depression: beyond current classification. British Journal of Psychiatry, 192, 171–77.CrossRefGoogle ScholarPubMed
Dwan, K., Altman, D. G., Arnaiz, J. A., Bloom, J., Chan, A.-W., Cronin, E., et al. (2008). Systematic review of the empirical evidence of study publication bias and outcome reporting bias. PLoS ONE, 3, e3081.Google Scholar
Erickson, D. H., Janeck, A. S. and Tallman, K. (2007). A cognitive-behavioral group for patients with various anxiety disorders. Psychiatric Services, 58, 1205–1211.Google Scholar
Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L., Thompson-Hollands, J., Carl, J. R., et al. (2012). Unified protocol for transdiagnostic treatment of emotional disorders: a randomized controlled trial. Behavior Therapy, 43, 666–678.CrossRefGoogle ScholarPubMed
Fleming, T. R., Odem-Davis, K., Rothmann, M. D. and Shen, Y. L. (2011). Some essential considerations in the design and conduct of non-inferiority trials. Clinical Trials, 8, 432–439.CrossRefGoogle ScholarPubMed
Guy, W. (1976). ECDEU Assessment Manual for Psychopharmacology. Rockville, MD: U.S. Department of Health, Education, and Welfare.Google Scholar
Hamilton, M. (1959). The assessment of anxiety states by rating. British Journal of Medical Psychology, 32, 50–55.Google Scholar
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 56–62.Google Scholar
Haslam, C., Atkinson, S., Brown, S. S. and Haslam, R. A. (2005). Anxiety and depression in the workplace: effects on the individual and organisation (a focus group investigation). Journal of Affective Disorders, 88, 209–215.Google Scholar
Health and Safety Executive (2012). Health and Safety Executive Annual Statistics Report 2011/12. London: Health and Safety Executive (HSE).Google Scholar
Hedges, L. V. (1981). Distribution theory for Glass's estimator of effect size and related estimators. Journal of Educational and Behavioral Statistics, 6, 107–128.Google Scholar
Higgins, J. P. T., Altman, D. G., Gøtzsche, P. C., Jüni, P., Moher, D., Oxman, A. D., et al. (2011). The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ, 343, 1–9.Google Scholar
Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T. and Fang, A. (2012). The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cognitive Therapy and Research, 36, 427–440.CrossRefGoogle ScholarPubMed
Hollon, S. D., Stewart, M. O. and Strunk, D. (2006). Enduring effects for cognitive behavior therapy in the treatment of depression and anxiety. Annual Review of Psychology, 57, 285–315.CrossRefGoogle ScholarPubMed
Johnston, L., Titov, N., Andrews, G., Spence, J. and Dear, B. F. (2011). A RCT of a transdiagnostic internet-delivered treatment for three anxiety disorders: examination of support roles and disorder-specific outcomes. PLoS ONE, 6, e28079.Google Scholar
Kessler, R. C., Chiu, W. T., Demler, O., Merikangas, K. R. and Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 62, 617–627.Google Scholar
Kroenke, K., Spitzer, R. L. and Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.Google Scholar
Leykin, Y. and DeRubeis, R. J. (2009). Allegiance in psychotherapy outcome research: separating association from bias. Clinical Psychology: Science and Practice, 16, 54–65.Google Scholar
Lovibond, S. H. and Lovibond, P. F. (1995). Manual for the Depression Anxiety Stress Scales (2nd ed.). Sydney, Australia: Psychology Foundation.Google Scholar
Luborsky, L., Diguer, L., Seligman, D. A., Rosenthal, R., Krause, E. D., Johnson, S., et al. (1999). The researcher's own therapy allegiances: a “wild card” in comparisons of treatment efficacy. Clinical Psychology: Science and Practice, 6, 95–106.Google Scholar
McEvoy, P. M., Nathan, P. and Norton, P. J. (2009). Efficacy of transdiagnostic treatments: a review of published outcome studies and future research directions. Journal of Cognitive Psychotherapy, 23, 20–33.Google Scholar
McManus, S., Meltzer, H., Brugha, T., Bebbington, P. and Jenkins, R. (2009). Adult Psychiatric Morbidity in England, 2007: results of a household survey. Leeds: The NHS Information Centre for Health and Social Care.Google Scholar
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G. and The PRISMA Group (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Annals of Internal Medicine, 151, 264–269.Google Scholar
Munder, T., Brütsch, O., Leonhart, R., Gerger, H. and Barth, J. (2013). Researcher allegiance in psychotherapy outcome research: an overview of reviews. Clinical Psychology Review, 33, 501–511.Google Scholar
NICE (2011). Common Mental Health Disorders: identification and pathways to care. Leicester and London: The British Psychological Society and The Royal College of Psychiatrists.Google Scholar
Norton, P. J. (2012). A randomized clinical trial of transdiagnostic cognitve-behavioral treatments for anxiety disorder by comparison to relaxation training. Behavior Therapy, 43, 506–517.CrossRefGoogle ScholarPubMed
Norton, P. J. and Barrera, T. L. (2012). Transdiagnostic versus diagnosis-specific CBT for anxiety disorders: a preliminary randomized controlled noninferiority trial. Depression and Anxiety, 29, 874–882.CrossRefGoogle ScholarPubMed
Norton, P. J., Hayes, S. A. and Hope, D. A. (2004). Effects of a transdiagnostic group treatment for anxiety on secondary depression. Depression and Anxiety, 20, 198–202.CrossRefGoogle ScholarPubMed
Norton, P. J. and Hope, D. A. (2005). Preliminary evaluation of a broad-spectrum cognitive-behavioral group therapy for anxiety. Journal of Behavior Therapy and Experimental Psychiatry, 36, 79–97.Google Scholar
Norton, P. J. and Philipp, L. M. (2008). Transdiagnostic approaches to the treatment of anxiety disorders: a quantitative review. Psychotherapy: Theory, Research, Practice, Training, 45, 214–226.CrossRefGoogle Scholar
Olatunji, B. O., Cisler, J. M. and Deacon, B. J. (2010). Efficacy of cognitive behavioral therapy for anxiety disorders: a review of meta-analytic findings. Psychiatric Clinics of North America, 33, 557–577.Google Scholar
Otte, C. (2011). Cognitive behavioral therapy in anxiety disorders: current state of the evidence. Dialogues in Clinical Neuroscience, 13, 413–421.Google Scholar
Paul, K. I. and Moser, K. (2009). Unemployment impairs mental health: meta-analyses. Journal of Vocational Behavior, 74, 264–282.Google Scholar
Piaggio, G., Elbourne, D. R., Pocock, S. J., Evans, S. J., Altman, D. G. and CONSORT Group (2012). Reporting of noninferiority and equivalence randomized trials: extension of the CONSORT 2010 statement. JAMA, 308, 2594–2604.Google Scholar
Reinholt, N. and Krogh, J. (2014). Efficacy of transdiagnostic cognitive behaviour therapy for anxiety disorders: a systematic review and meta-analysis of published outcome studies. Cognitive Behaviour Therapy, 43, 171–184.CrossRefGoogle ScholarPubMed
Rodgers, M., Asaria, M., Walker, S., McMillan, D., Lucock, M., Harden, M., et al. (2012). The clinical effectiveness and cost-effectiveness of low-intensity psychological interventions for the secondary prevention of relapse after depression: a systematic review. Health Technology Assessment, 16, 1–130.Google Scholar
Roy-Byrne, P., Craske, M. G., Sullivan, G., Rose, R. D., Edlund, M. J., Lang, A. J., et al. (2010). Delivery of evidence-based treatment for multiple anxiety disorders in primary care: a randomized controlled trial. JAMA, 303 (19), 1921–1928.Google Scholar
Schmidt, N. B., Buckner, J. D., Pusser, A., Woolaway-Bickel, K., Preston, J. L. and Norr, A. (2012). Randomized controlled trial of false safety behavior elimination therapy: a unified cognitive behavioral treatment for anxiety psychopathology. Behavior Therapy, 43, 518–32.CrossRefGoogle ScholarPubMed
Schulz, K. F., Altman, D. G. and Moher, D. (2010). CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ, 340, 698–702.Google Scholar
Schulz, K. F. and Grimes, D. A. (2002). Allocation concealment in randomised trials: defending against deciphering. The Lancet, 359, 614–618.Google Scholar
Sheehan, D. V. (1983). The Anxiety Disease. New York: Scribner.Google Scholar
Song, F., Eastwood, A. J., Gilbody, S., Duley, L. and Sutton, A. J. (2000). Publication and related biases. Health Technology Assessment, 4, 1–115.Google Scholar
Spielberger, C. D., Gorsuch, R. L., Lushene, R., Vagg, P. R. and Jacobs, G. A. (1983). Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press.Google Scholar
Spitzer, R. L., Kroenke, K., Williams, J. B. and Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166, 1092–1097.Google Scholar
Steinert, C., Hofmann, M., Kruse, J. and Leichsenring, F. (2014). Relapse rates after psychotherapy for depression - stable long-term effects? A meta-analysis. Journal of Affective Disorders, 168, 107–118.Google Scholar
Titov, N., Andrews, G., Johnston, L., Robinson, E. and Spence, J. (2010). Transdiagnostic internet treatment for anxiety disorders: a randomized controlled trial. Behaviour Research and Therapy, 48, 890–899.CrossRefGoogle ScholarPubMed
Titov, N., Dear, B. F., Schwencke, G., Andrews, G., Johnston, L., Craske, M. G., et al. (2011). Transdiagnostic internet treatment for anxiety and depression: a randomised controlled trial. Behaviour Research and Therapy, 49, 441–452.Google Scholar
Wood, L., Egger, M., Gluud, L. L., Schulz, K. F., Jüni, P., Altman, D. G., et al. (2008). Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes: meta-epidemiological study. BMJ, 336, 601–605.CrossRefGoogle ScholarPubMed
Yates, S. L., Morley, S., Eccleston, C. and Williams, A. C. de C. (2005). A scale for rating the quality of psychological trials for pain. Pain, 117, 314–325.Google Scholar
Supplementary material: File

Andersen supplementary material

Appendices

Download Andersen supplementary material(File)
File 17.5 KB
Submit a response

Comments

No Comments have been published for this article.