Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-24T02:24:29.390Z Has data issue: false hasContentIssue false
  • English
  • Français

Transdiagnostic Cognitive Behavioural Therapy for Individuals with Anxiety Disorders: An Open Trial

Published online by Cambridge University Press:  09 December 2020

Shaun Pearl  and
Peter J. Norton Open the ORCID record for Peter J. Norton [Opens in a new window]
Shaun Pearl
Affiliation:
Monash University, Clayton, Victoria, Australia
Peter J. Norton*
Affiliation:
Cairnmillar Institute, Hawthorn East, Victoria, Australia
*
*Corresponding author: Peter J. Norton, The Cairnmillar Institute, 391-393 Tooronga Road, Hawthorn East, VIC3123, Australia. Email: [email protected]
Get access

Abstract

Objective:

To evaluate the effect of a transdiagnostic cognitive behavioural therapy (tCBT) protocol in an individual delivery format, adapted from a protocol that has been extensively evaluated in a group delivery format.

Method:

tCBT was provided to a cohort (N = 18) of adults with a range of anxiety disorders (55.6% male; M age = 40.6, SD = 17.6), at a speciality anxiety disorder research clinic. A within-subjects repeated measures design was employed. Pre-to-post-treatment diagnostic assessments were analysed through repeated measures analysis of variance, and session-by-session self-reported measures of anxiety, depression, and quality of life were modelled through mixed-effect regression modelling (MRM) to maximise the sample of treatment initiators.

Results:

Significant and large reductions for clinician-rated primary diagnosis severity (Hedges g = 1.63), and overall clinical global impressions (g = 1.43) were observed, and self-reported anxiety and depression symptoms showed significant reductions over the course of treatment with medium-to-large effect sizes (g = 0.66 and 0.74, respectively). Significant improvement to quality of life was also observed with medium effect size (g = 0.53).

Conclusions:

There is now preliminary support for the use of an adaptation of an established group-based tCBT protocol for use with individuals. Implications and recommendations for future investigations are provided.

Keywords

anxiety disordercognitive behaviour therapytransdiagnosticindividual treatmentoutcomes
Type
Standard Paper
Information
Behaviour Change , Volume 38 , Issue 2 , June 2021 , pp. 73 - 83
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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

Anderson, RA and Rees, CS (2007). Group versus individual cognitive-behavioural treatment for obsessive-compulsive disorder: A controlled trial. Behaviour Research and Therapy, 45, 123–137. doi:10.1016/j.brat.2006.01.016.CrossRefGoogle ScholarPubMed
Back, SE and Brady, KT (2008). Anxiety disorders with comorbid substance use disorders: Diagnostic and treatment considerations. Psychiatric Annals, 38, 724–729. doi:10.3928/00485713-20081101-01.CrossRefGoogle ScholarPubMed
Barlow, DH, Ellard, KK and Fairholme, CP (2010). Unified protocol for transdiagnostic treatment of emotional disorders: Workbook. New York: Oxford University Press.Google Scholar
Barlow, DH, Farchione, TJ, Bullis, JR, Gallagher, MW, 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, 875–884. doi:10.1001/jamapsychiatry.2017.2164.CrossRefGoogle ScholarPubMed
Barlow, DH, Farchione, TJ, Sauer-Zavala, S, Latin, HM, Ellard, KK, Bullis, JR, … Cassiello-Robbins, C (2017). Unified protocol for transdiagnostic treatment of emotional disorders: Therapist guide. Oxford University Press.Google Scholar
Beck, AT, Steer, RA and Brown, GK (1996). Manual for the Beck Depression Inventory-II (vol. 1). Toronto: Harcourt Brace; The Psychological Corporation.Google Scholar
Borkovec, TD and Nau, SD (1972). Credibility of analogue therapy rationales. Journal of Behavior Therapy and Experimental Psychiatry, 3, 257–260. doi:10.1016/0005-7916(72)90045-6.CrossRefGoogle Scholar
Brown, JSL, Sellwood, K, Beecham, JK, Slade, M, Andiappan, M, Landau, S, … Smith, R (2011). Outcome, costs and patient engagement for group and individual CBT for depression: A naturalistic clinical study. Behavioural and Cognitive Psychotherapy, 39, 355–358. doi:10.1017/S135246581000072X.CrossRefGoogle Scholar
Brown, TA and Barlow, DH (2014). Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5L): Lifetime Version. Client Interview Schedule. New York, NY: Oxford University Press.Google Scholar
Brown, TA, Campbell, LA, Lehman, CL, Grisham, JR and Mancill, RB (2001). Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. Journal of Abnormal Psychology, 110, 585–599. doi:10.1037//0021-843x.110.4.585.CrossRefGoogle Scholar
Clark, DA and Taylor, S (2009). The transdiagnostic perspective on cognitive-behavioral therapy for anxiety and depression: New wine for old wineskins? Journal of Cognitive Psychotherapy (New York), 23, 60–66. doi:10.1891/0889-8391.23.1.60.CrossRefGoogle Scholar
Deacon, BJ and Abramowitz, JS (2004). Cognitive and behavioral treatments for anxiety disorders: A review of meta-analytic findings. Journal of Clinical Psychology, 60, 429–441. doi:10.1002/jclp.10255.CrossRefGoogle ScholarPubMed
Ellard, KK, Fairholme, CP, Boisseau, CL, Farchione, TJ and Barlow, DH (2010). Unified protocol for the transdiagnostic treatment of emotional disorders: Protocol development and initial outcome data. Cognitive and Behavioral Practice, 17, 88–101. doi:10.1016/j.cbpra.2009.06.002.CrossRefGoogle ScholarPubMed
Espejo, EP, Castriotta, N, Bessonov, D, Kawamura, M, Werdowatz, EA and Ayers, CR (2016). A pilot study of transdiagnostic group cognitive-behavioral therapy for anxiety in a veteran sample. Psychological Services, 13, 162–169. doi:10.1037/ser0000052.CrossRefGoogle Scholar
Hagell, P, Westergren, A and Årestedt, K (2017). Beware of the origin of numbers: Standard scoring of the SF-12 and SF-36 summary measures distorts measurement and score interpretations. Research in Nursing & Health, 40, 378–386. doi:10.1002/nur.21806.CrossRefGoogle ScholarPubMed
Heuzenroeder, L, Donnelly, M, Haby, MM, Mihalopoulos, C, Rossell, R, Carter, R, … Vos, T (2004). Cost-effectiveness of psychological and pharmacological interventions for generalized anxiety disorder and panic disorder. Australian and New Zealand Journal of Psychiatry, 38, 602–612. doi:10.1080/j.1440-1614.2004.01423.x.CrossRefGoogle ScholarPubMed
Hofmann, SG, Asnaani, A, Vonk, IJJ, Sawyer, AT and Fang, A (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36, 427–440. doi:10.1007/s10608-012-9476-1.CrossRefGoogle ScholarPubMed
Hope, DA, Heimberg, RG, Juster, HR and Turk, CL (2000). Managing social anxiety: A cognitive-behavioral therapy approach: Therapist guide. New York, NY: Oxford University Press.Google Scholar
Kaczkurkin, AN and Foa, EB (2015). Cognitive-behavioral therapy for anxiety disorders: An update on the empirical evidence. Dialogues in Clinical Neuroscience, 17, 337–346.Google ScholarPubMed
Lakens, D (2013). Calculating and reporting effect sizes to facilitate cumulative science: A practical primer for t-tests and ANOVAs. Frontiers in Psychology, 4. doi:10.3389/fpsyg.2013.00863.CrossRefGoogle ScholarPubMed
Lamers, F, van Oppen, P, Comijs, HC, Smit, JH, Spinhoven, P, van Balkom, AJLM, … Penninx, BWJH (2011). Comorbidity patterns of anxiety and depressive disorders in a large cohort study: The Netherlands Study of Depression and Anxiety (NESDA). The Journal of Clinical Psychiatry, 72, 341–348. doi:10.4088/JCP.10m06176blu.CrossRefGoogle Scholar
McEvoy, PM, Burgess, MM and Nathan, P (2014). The relationship between interpersonal problems, therapeutic alliance, and outcomes following group and individual cognitive behaviour therapy. Journal of Affective Disorders, 157, 25–32. doi:10.1016/j.jad.2013.12.038.CrossRefGoogle ScholarPubMed
McManus, F, Shafran, R and Cooper, Z (2010). What does a transdiagnostic approach have to offer the treatment of anxiety disorders? British Journal of Clinical Psychology, 49, 491–505. doi:10.1348/014466509X476567.CrossRefGoogle ScholarPubMed
Mojtabai, R, Stuart, EA, Hwang, I, Susukida, R, Eaton, WW, Sampson, N and Kessler, RC (2015). Long-term effects of mental disorders on employment in the national comorbidity survey ten-year follow-up. Social Psychiatry and Psychiatric Epidemiology, 50, 1657–1668. doi:10.1007/s00127-015-1097-z.CrossRefGoogle ScholarPubMed
Newby, JM, McKinnon, A, Kuyken, W, Gilbody, S and Dalgleish, T (2015). Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood. Clinical Psychology Review, 40, 91–110. doi:10.1016/j.cpr.2015.06.002.CrossRefGoogle ScholarPubMed
Nock, MK, Hwang, I, Sampson, NA and Kessler, RC (2010). Mental disorders, comorbidity and suicidal behavior: Results from the national comorbidity survey replication. Molecular Psychiatry, 15, 868–876. doi:10.1038/mp.2009.29.CrossRefGoogle ScholarPubMed
Norton, PJ (2008). An open trial of a transdiagnostic cognitive-behavioral group therapy for anxiety disorder. Behavior Therapy, 39, 242–250. doi:10.1016/j.beth.2007.08.002.CrossRefGoogle ScholarPubMed
Norton, PJ (2012a). A randomized clinical trial of transdiagnostic cognitive-behavioral treatments for anxiety disorder by comparison to relaxation training. Behavior Therapy, 43, 506–517. doi:10.1016/j.beth.2010.08.011.CrossRefGoogle Scholar
Norton, PJ (2012b). Group Cognitive-Behavioral Therapy of Anxiety: A Transdiagnostic Treatment Manual. New York, NY: Guilford Press.Google Scholar
Norton, PJ and Barrera, TL (2012). Transdiagnostic versus diagnosis-specific CBT for anxiety disorders: A preliminary randomized controlled noninferiority trial. Depression and Anxiety, 29, 874–882. doi:10.1002/da.21974.CrossRefGoogle ScholarPubMed
Norton, PJ, Barrera, TL, Mathew, AR, Chamberlain, LD, Szafranski, DD, Reddy, R and Smith, AH (2013). Effect of transdiagnostic CBT for anxiety on comorbid diagnoses. Depression and Anxiety, 30, 168–173. doi:10.1002/da.22018.CrossRefGoogle ScholarPubMed
Norton, PJ and Hope, DA (2005). Preliminary evaluation of a broad-spectrum cognitive-behavioral group therapy for anxiety. Journal of Behavior Therapy and Experimental Psychiatry, 36, 79–97. doi:10.1016/j.jbtep.2004.07.002.CrossRefGoogle ScholarPubMed
Norton, PJ and Paulus, DJ (2017). Transdiagnostic models of anxiety disorder: Theoretical and empirical underpinnings. Clinical Psychology Review, 56, 122–137. doi:10.1016/j.cpr.2017.03.004.CrossRefGoogle ScholarPubMed
Pearl, SB and Norton, PJ (2017). Transdiagnostic versus diagnosis specific cognitive behavioural therapies for anxiety: A meta-analysis. Journal of Anxiety Disorders, 46, 11–24. doi:10.1016/j.janxdis.2016.07.004.CrossRefGoogle ScholarPubMed
Pirkis, J, Ftanou, M, Williamson, M, Machlin, A, Spittal, MJ, Bassilios, B and Harris, M (2011). Australia's better access initiative: An evaluation. Australian and New Zealand Journal of Psychiatry, 45, 726–739. doi:10.3109/00048674.2011.594948.CrossRefGoogle ScholarPubMed
Remes, O, Brayne, C, van der Linde, R and Lafortune, L (2016). A systematic review of reviews on the prevalence of anxiety disorders in adult populations. Brain and Behavior, 6, e00497. doi:10.1002/brb3.497.CrossRefGoogle ScholarPubMed
Revicki, DA, Travers, K, Wyrwich, KW, Svedsäter, H, Locklear, J, Mattera, MS, … Montgomery, S (2012). Humanistic and economic burden of generalized anxiety disorder in North America and Europe. Journal of Affective Disorders, 140, 103–112. doi:10.1016/j.jad.2011.11.014.CrossRefGoogle ScholarPubMed
Smith, AH, Paulus, DJ and Norton, PJ (2017). Transdiagnostic assessment of anxiety symptoms using the anxiety disorder diagnostic questionnaire – weekly version. Anxiety, Stress, & Coping, 30, 96–106. doi:10.1080/10615806.2016.1186272.CrossRefGoogle ScholarPubMed
Springer, KS, Levy, HC and Tolin, DF (2018). Remission in CBT for adult anxiety disorders: A meta-analysis. Clinical Psychology Review, 61, 1–8. doi:10.1016/j.cpr.2018.03.002.CrossRefGoogle ScholarPubMed
Talkovsky, AM, Green, KL, Osegueda, A and Norton, PJ (2017). Secondary depression in transdiagnostic group cognitive behavioral therapy among individuals diagnosed with anxiety disorders. Journal of Anxiety Disorders, 46, 56–64. doi:10.1016/j.janxdis.2016.09.008.CrossRefGoogle ScholarPubMed
Talkovsky, AM and Norton, PJ (2014). Mediators of transdiagnostic group cognitive behavior therapy. Journal of Anxiety Disorders, 28, 919–924. doi:10.1016/j.janxdis.2014.09.017.CrossRefGoogle ScholarPubMed
Ware, JE, Kosinski, M and Keller, SD (1996). A 12-Item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34, 220–233. doi:10.1097/00005650-199603000-00003.CrossRefGoogle ScholarPubMed
Whiteford, HA, Ferrari, AJ, Degenhardt, L, Feigin, V and Vos, T (2015). The global burden of mental, neurological and substance use disorders: An analysis from the global burden of disease study 2010. PLoS ONE, 10, e0116820. doi:10.1371/journal.pone.0116820.CrossRefGoogle ScholarPubMed