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21 - Future Directions in Developing and Evaluating Psychological Interventions

from Part V - Intervention Approaches

Published online by Cambridge University Press:  23 March 2020

By
Shannon Sauer-Zavala
Edited by
Aidan G. C. Wright  and
Michael N. Hallquist
Aidan G. C. Wright
Affiliation:
University of Pittsburgh
Michael N. Hallquist
Affiliation:
Pennsylvania State University
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Summary

The goal of this chapter is to highlight several imperatives for continued progress with regard to treatment development for mental health conditions. Specifically, the importance of identifying core, transdiagnostic processes that can become the focus of treatment is emphasized, along with developing dimensional classification systems that reliably assess these targets. Additionally, techniques to confirm that components included in the treatment packages indeed engage these core processes are highlighted with the goal of ensuring that interventions are comprised of only active ingredients. Next, considerations for conducting treatment outcome studies specifically with transdiagnostic interventions are addressed. Finally, the rationale for moving away from the development of nomothetic, one-size-fits-all treatment protocols, in favor of personalized approaches are highlighted.

Keywords

transdiagnosticmechanismspsychological treatmentcomponent analysistreatment personalization
Type
Chapter
Information
The Cambridge Handbook of Research Methods in Clinical Psychology , pp. 279 - 286
Publisher: Cambridge University Press
Print publication year: 2020

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References

American Psychiatric Association (APA). (1980). Diagnostic and Statistical Manual of Mental Disorders (3rd edn.). Washington, DC: APA.Google Scholar
American Psychiatric Association (APA). (2000). Diagnostic and Statistical Manual of Mental Disorders (4th edn., text rev.). Washington, DC: APA.Google Scholar
American Psychiatric Association (APA). (2013). Diagnostic and Statistical Manual of Mental Disorders (5th edn.). Washington, DC: APA.Google Scholar
Barlow, D. H. (1991). Disorders of Emotion. Psychological Inquiry, 2, 58–71.Google Scholar
Barlow, D. H. (1996). The Effectiveness of Psychotherapy: Science and Policy. Clinical Psychology: Science and Practice, 3, 236–240.Google Scholar
Barlow, D. H. (2004). Psychological Treatments. American Psychologist, 59, 869–878.Google Scholar
Barlow, D. H. (2008). Clinical Handbook of Psychological Disorders: A Step-by-Step Treatment Manual (4th edn.). London: Oxford University Press.Google Scholar
Barlow, D. H., & Craske, M. G. (2007). Mastery of Your Anxiety and Panic (4th edn.) New York: Oxford University Press.Google Scholar
Barlow, D. H., Cohen, A. S., Waddell, M. T., Vermilyea, B. B., Klosko, J. S., Blanchard, E. B., & DiNardo, P. A. (1984). Panic and Generalized Anxiety Disorders: Nature and Treatment. Behavior Therapy, 15, 431–449.Google Scholar
Barlow, D. H., Craske, M. G., Cerny, J. A., & Klosko, J. S. (1989). Behavioral Treatment of Panic Disorder. Behavior Therapy, 20(2), 261–282.Google Scholar
Barlow, D. H., Gorman, J. M., Shear, M. K., & Woods, S. W. (2000). Cognitive-Behavioral Therapy, Imipramine, or Their Combination for Panic Disorder: A Randomized Controlled Trial. Journal of the American Medical Association, 283, 2529–2536.Google Scholar
Barlow, D. H., Nock, M., & Hersen, M. (2008). Single Case Research Designs: Strategies for Studying Behavior Change. New York: Allyn & Bacon.Google Scholar
Barlow, D. H., Sauer-Zavala, S., Carl, J. R., Bullis, J. R., & Ellard, K. E. (2014). The Nature, Diagnosis, and Treatment of Neuroticism: Back to the Future. Clinical Psychological Science, 2(3), 344–365.Google Scholar
Barlow, D. H., Farchione, T. J., Bullis, J. R., Gallagher, M. W., Murray-Latin, H., Sauer-Zavala, S., … Cassiello-Robbins, C. (2017). The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders Compared with Diagnosis-Specific Protocols for Anxiety Disorders: A Randomized Clinical Trial. JAMA Psychiatry, 74(9), 875–884.Google Scholar
Barlow, D. H., Sauer-Zavala, S., Farchione, T. J., Latin, H., Ellard, K. K., Bullis, J. R., … Cassiello-Robbins, C. (2018). Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Patient Workbook. New York: Oxford University Press.Google Scholar
Boswell, J. F., Farchione, T. J., Sauer-Zavala, S., Murray, H. W., Fortune, M. R., & Barlow, D. H. (2013). Anxiety Sensitivity and Interoceptive Exposure: A Transdiagnostic Construct and Change Strategy. Behavior Therapy, 44(3), 417–431.Google Scholar
Boswell, J. F., Anderson, L. M., & Barlow, D. H. (2014). An Idiographic Analysis of Change Processes in the Unified Transdiagnostic Treatment of Depression. Journal of Consulting and Clinical Psychology, 82(6), 1060–1071.Google Scholar
Brake, C. A., Sauer-Zavala, S., Boswell, J. F., Gallagher, M. W., Farchione, T. J., & Barlow, D. H. (2016). Mindfulness-Based Exposure Strategies as a Transdiagnostic Mechanism of Change: An Exploratory Alternating Treatment Design. Behavior Therapy, 47(2), 225–238.Google Scholar
Brown, T. A. & Barlow, D. H. (2009). A Proposal for a Dimensional Classification System Based on the Shared Features of the DSM-IV Anxiety and Mood Disorders: Implications for Assessment and Treatment. Psychological Assessment, 21(3), 256–271.Google Scholar
Brown, T. A., Chorpita, B. F. & Barlow, D. H. (1998). Structural Relationships among Dimensions of the DSM-IV Anxiety and Mood Disorders and Dimensions of Negative Affect, Positive Affect, and Autonomic Arousal. Journal of Abnormal Psychology, 107, 179–192.Google Scholar
Brown, T. A., Campbell, L. A., Lehman, C. L., Grisham, J. R., & Mancill, R. B. (2001). Current and Lifetime Comorbidity of the DSM-IV Anxiety and Mood Disorders in a Large Clinical Sample. Journal of Abnormal Psychology, 110, 49–58.Google Scholar
Charles, C., Gafni, A., & Whelan, T. (1997). Shared Decision-Making in the Medical Encounter: What Does It Mean? (Or It Takes at Least Two to Tango). Social Science & Medicine (1982), 44(5), 681–692.Google Scholar
Cheavens, J. S., Strunk, D. R., Lazarus, S. A., & Goldstein, L. A. (2012). The Compensation and Capitalization Models: A Test of Two Approaches to Individualizing the Treatment of Depression. Behaviour Research and Therapy, 50(11), 699–706.Google Scholar
Chorpita, B. F., & Weisz, J. R. (2005). Modular Approach to Therapy for Children with Anxiety, Depression, or Conduct Problems. Honolulu: University of Hawaii at Manoa; Boston, MA: Harvard Medical School.Google Scholar
Chorpita, B. F., Taylor, A. A., Francis, S. E., Moffitt, C. E., & Austin, A. A. (2004). Efficacy of Modular Cognitive Behavior Therapy for Childhood Anxiety Disorders. Behavior Therapy, 35, 263–287.Google Scholar
Chorpita, B. F., Daleiden, E., & Weisz, J. (2005). Identifying and Selecting Common Elements of Evidence-Based Treatment: A Distillation and Matching Model. Mental Health Services Research, 7, 5–20.Google Scholar
Craske, M., & Barlow, D. H. (2006). Mastery of Your Anxiety and Worry (2nd edn.). New York: Oxford University Press.Google Scholar
Craske, M. G., Farchione, T. J., Allen, L. B., Barrios, V., Stoyanova, M., & Rose, R. (2007). Cognitive Behavioral Therapy for Panic Disorder and Comorbidity: More of the Same or Less of More? Behaviour Research and Therapy, 45(6), 1095–1109.Google Scholar
Ellard, K. K., Fairholme, C. P., Boisseau, C. L., Farchione, T. J., & Barlow, D. H. (2010). Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders: Protocol Development and Initial Outcome Data. Cognitive and Behavioral Practice, 17(1), 88–101.Google Scholar
Elwyn, G., Edwards, A., & Thompson, R. (Eds.). (2016). Shared Decision-Making in Health Care: Achieving Evidence-Based Patient Choice (3rd edn.). Oxford: Oxford University Press.Google Scholar
Fagerlin, A., Pignone, M., Abhyankar, P., Col, N., Feldman-Stewart, D., Gavaruzzi, T., … Witteman, H. O. (2013). Clarifying Values: An Updated Review. BMC Medical Informatics and Decision Making, 13(2), 2–8.Google Scholar
Fairburn, C. (2008). Cognitive Behavioral Therapy and Eating Disorders. New York: Guilford Press.Google Scholar
Fairburn, C. G., Peveler, R. C., Jones, R., Hope, R. A., & Doll, H. A. (1993). Predictors of 12 Month Outcome in Bulimia Nervosa and the Influence of Attitudes to Shape and Weight. Journal of Consulting and Clinical Psychology, 61(4), 696–698.Google Scholar
Fairburn, C., Cooper, Z., & Shafran, R. (2003). Cognitive Behaviour Therapy for Eating Disorders: A “Transdiagnostic” Theory and Treatment. Behaviour Research and Therapy, 41(5), 509–528.Google Scholar
Fairburn, C.G., Cooper, Z. Doll, H. A., O’Connor, M. E., Bohn, K., Hawker, D. M., … Palmer, R. L. (2009). Transdiagnostic Cognitive-Behavioral Therapy for Patients with Eating Disorders: A Two-Site Trial with 60-Week Follow-Up. American Journal of Psychiatry, 166, 311–319.Google Scholar
Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L., Thompson-Hollands, J., Carl, J. R., … Barlow, D. H. (2012). Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: A Randomized Controlled Trial. Behavior Therapy, 43(3), 666–678.Google Scholar
Foa, E. B., Yadin, E., & Lichner, T. K. (2008). Obsessive-Compulsive Disorder: A Cognitive Behavioral Therapy Approach. New York: Oxford University Press.Google Scholar
Gibbons, C. J., & DeRubeis, R. J. (2008). Anxiety Symptom Focus in Sessions of Cognitive Therapy for Depression. Behavior Therapy, 39, 117–125.Google Scholar
Greene, C. J., Morland, L. A., Durkalski, V. L., & Frueh, B. C. (2008). Noninferiority and Equivalence Designs: Issues and Implications for Mental Health Research. Journal of Traumatic Stress, 21(5), 433–439.Google Scholar
Harvey, A., Murray, G., Chandler, R., & Soehner, A. (2011). Sleep Disturbance as Transdiagnostic: Consideration of Neurobiological Mechanisms. Clinical Psychology Review, 31, 225–235.Google Scholar
Heimberg, R. G., Liebowitz, M. R., & Hope, D. A. (1998). Cognitive Behavioral Group Therapy versus Phenelzine Therapy for Social Phobia: 12-Week Outcome. Archives of General Psychiatry, 55, 1133–1141.Google Scholar
Hollon, S. D., Thase, M. E., & Markowitz, J. C. (2002). Treatment and Prevention of Depression. Psychological Science in the Public Interest, 3, 39–77.Google Scholar
Hope, D. A., Heimberg, R. G., & Turk, C. L. (2006). Managing Social Anxiety: A Cognitive-Behavioral Therapy Approach: Therapist Guide. San Antonio, TX: Oxford University Press.Google Scholar
Hopwood, C. J., Thomas, K. M., Markon, K. E., Wright, A. G., & Krueger, R. F. (2012). DSM-5 Personality Traits and DSM-IV Personality Disorders. Journal of Abnormal Psychology, 121(2), 424–432.Google Scholar
Insel, T. R., & Gogtay, N. (2014). National Institute of Mental Health Clinical Trials: New Opportunities, New Expectations. JAMA Psychiatry, 71(7), 745–746.Google Scholar
Insel, T., Cuthbert, B., Garvey, M., Heinssen, R., Pine, D. S., Quinn, K., … & Wang, P. (2010). Research Domain Criteria (RDoC): Toward a New Classification Framework for Research on Mental Disorders. American Journal of Psychiatry, 167(7), 748–751.Google Scholar
Kazdin, A. E. (2007). Mediators and Mechanisms of Change in Psychotherapy Research. Annual Review of Clinical Psychology, 3(1), 1–27.Google Scholar
Kelly, J., Gooding, P., Pratt, D., Ainsworth, J., Welford, M., & Tarrier, N. (2012). Intelligent Real-Time Therapy: Harnessing the Power of Machine Learning to Optimise the Delivery of Momentary Cognitive-Behavioural Interventions. Journal of Mental Health, 21(4), 404–414.Google Scholar
Kessler, R. C., Nelson, C. B., McGonagle, K. A., Liu, J., Swartz, M., & Blazer, D. G. (1996). Comorbidity of DSM-III-R Major Depressive Disorder in the General Population: Results from the US National Comorbidity Survey. British Journal of Psychiatry. Supplement, (30), 17–30.Google Scholar
Kessler, R. C., Stang, P. E., Wittchen, H. U., Ustun, T. B., Roy-Burne, P. P., & Walters, E. E. (1998). Lifetime Panic-Depression Comorbidity in the National Comorbidity Survey. Archives of General Psychiatry, 55(9), 801–808.Google Scholar
Kessler, R. C., van Loo, H. M., Wardenaar, K. J., Bossarte, R. M., Brenner, L. A., Cai, T., … & Nierenberg, A. A. (2016). Testing a Machine-Learning Algorithm to Predict the Persistence and Severity of Major Depressive Disorder from Baseline Self-Reports. Molecular Psychiatry, 21, 1366–1371.Google Scholar
Linehan, M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press.Google Scholar
Mansell, W., Harvey, A., Watkins, E., & Shafran, R. (2009). Conceptual Foundations of the Transdiagnostic Approach to CBT. Journal of Cognitive Psychotherapy, 23(1), 6–19.Google Scholar
McHugh, R. K., Murray, H. W., & Barlow, D. H. (2009). Balancing Fidelity and Adaptation in the Dissemination of Empirically-Supported Treatments: The Promise of Transdiagnostic Interventions. Behaviour Research and Therapy, 47(11), 946–953.Google Scholar
Murray, L. K., Dorsey, S., Haroz, E., Lee, C., Alsiary, M. M., Haydary, A., … & Bolton, P. (2013). A Common Elements Treatment Approach for Adult Mental Health Problems in Low-and Middle-Income Countries. Cognitive and Behavioral Practice, 21(2), 111–123.Google Scholar
Nathan, P. E., & Gorman, J. M. (Eds.). (2007). A Guide to Treatments That Work (3rd edn.). London: Oxford University Press.Google Scholar
Purdon, C. (1999). Thought Suppression and Psychopathology. Behaviour Research and Therapy, 37(11), 1029–1054.Google Scholar
Rapee, R. M., Kennedy, S., Ingram, M., Edwards, S., & Sweeney, L. (2005). Prevention and Early Intervention of Anxiety Disorders in Inhibited Preschool Children. Journal of Consulting and Clinical Psychology, 73(3), 488–497.Google Scholar
Rosellini, A. J., Boettcher, H., Brown, T. A., & Barlow, D. H. (2015) A Transdiagnostic Temperament-Phenotype Profile Approach to Emotional Disorder Classification: An Update. Psychopathological Review, 2, 110–128.Google Scholar
Rosellini, A. J., Lawrence, A., Meyer, J., & Brown, T. A. (2010). The Effects of Extraverted Temperament on Agoraphobia in Panic Disorder. Journal of Abnormal Psychology, 119, 420–426.Google Scholar
Sauer-Zavala, S., Boswell, J. F., Gallagher, M. W., Bentley, K. H., Ametaj, A., & Barlow, D. H. (2012). The Role of Negative Affectivity and Negative Reactivity to Emotions in Predicting Outcomes in the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders. Behaviour Research and Therapy, 50(9), 551–557.Google Scholar
Sauer-Zavala, S., Bentley, K. H., & Wilner, J. G. (2016). Transdiagnostic Treatment of Borderline Personality Disorder and Comorbid Disorders: A Clinical Replication Series. Journal of Personality Disorders, 30(1), 35–51.Google Scholar
Sauer-Zavala, S., Cassiello-Robbins, C., Conklin, L., Bullis, J. R., Thompson-Hollands, J., & Kennedy, K. (2017a). Isolating the Unique Effects of the Unified Protocol Treatment Modules Using Single-Case Experimental Design. Behavior Modification, 40, 286–307.Google Scholar
Sauer-Zavala, S., Gutner, C., Farchione, T. J., Boettcher, H. T., Bullis, J. R., & Barlow, D. H. (2017b). Current Definitions of “Transdiagnostic” in Treatment Development: A Search for Consensus. Behavior Therapy, 48(1), 128–138.Google Scholar
Sauer-Zavala, S., Wilner, J. G., Cassiello-Robbins, C., Saraff, P., & Pagan, D. S. (2019). Opposite Action in Borderline Personality Disorder: A Laboratory-based Alternating Treatment Design. Behaviour Research and Therapy, 117, 79–86.Google Scholar
Simon, G. E., & Perlis, R. H. (2010). Personalized Medicine for Depression: Can We Match Patients with Treatments? American Journal of Psychiatry, 167(12), 1445–1455.Google Scholar
Thornicroft, G. (2007). Most People with Mental Illness Are not Treated. The Lancet, 370(9590), 807–808.Google Scholar
Wang, P. S., Aguilar-Gaxiola, S., Alonso, J., Angermeyer, M. C., Borges, G., Bromet, E. J., … & Haro, J. M. (2007). Use of Mental Health Services for Anxiety, Mood, and Substance Disorders in 17 Countries in the WHO World Mental Health Surveys. The Lancet, 370(9590), 841–850.Google Scholar
Wenzlaff, R. M., & Wegner, D. M. (2000). Thought Suppression. Annual Review of Psychology, 51(1), 59–91.Google Scholar
Widiger, T. A., & Crego, C. (2013). Diagnosis and Classification. In Weiner, I. B., Stricker, G., & Widiger, T. A. (Eds.), Handbook of Psychology: Clinical Psychology (2nd edn., pp. 3–18). Hoboken, NJ: Wiley.Google Scholar
Widiger, T. A., & Krueger, R. F. (2013). Personality Disorders in the DSM-5: Current Status, Lessons Learned, and Future Challenges. Personality Disorders: Theory, Research, & Treatment, 4, 341.Google Scholar
Widiger, T. A., & Trull, T. J. (2007). Plate Tectonics in the Classification of Personality Disorder: Shifting to a Dimensional Model. American Psychologist, 62(2), 71–83.Google Scholar
Wilson, G. T., Fairburn, C. C., Agras, W. S., Walsh, B. T., & Kraemer, H. (2002). Cognitive-Behavioral Therapy for Bulimia Nervosa: Time Course and Mechanisms of Change. Journal of Consulting and Clinical Psychology, 70(2), 267–274.Google Scholar
Weisz, J. R. (2012). Testing Standard and Modular Designs for Psychotherapy Treating Depression, Anxiety, and Conduct Problems in Youth: A Randomized Effectiveness Trial. Archives of General Psychiatry, 69(3), 274–282.Google Scholar
Weber, E. U., & Johnson, E. J. (2009). Mindful Judgment and Decision Making. Annual Review of Psychology, 60(1), 53–85.Google Scholar
Yadin, E., Foa, E., & Lichner, T. (2012). Treating Your OCD with Exposure and Response (Ritual) Prevention (2nd edn.). New York: Oxford University Press.Google Scholar
Zinbarg, R., Craske, M., & Barlow, D. H. (2006). Therapist’s Guide for the Mastery of Your Anxiety and Worry Program. New York: Oxford University Press.Google Scholar

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