Skip to main content Accesibility Help
×
×
Home

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

  • Philip Andersen (a1), Paul Toner (a1), Martin Bland (a1) and Dean McMillan (a2)
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.

Copyright
Corresponding author
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: dean.mcmillan@york.ac.uk
References
Hide All
Beck, A. T. and Steer, R. A. (1990). The Beck Anxiety Inventory Manual. San Antonio, TX: Psychological Corporation.
Beck, A. T., Steer, R. A. and Brown, G. K. (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.
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.
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, 1731.
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.
Cochrane Collaboration (2012). Review Manager (RevMan) [computer program]. Version 5.2. Copenhagen: The Nordic Cochrane Centre.
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, 10951109.
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.
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.
Erickson, D. H., Janeck, A. S. and Tallman, K. (2007). A cognitive-behavioral group for patients with various anxiety disorders. Psychiatric Services, 58, 12051211.
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, 666678.
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, 432439.
Guy, W. (1976). ECDEU Assessment Manual for Psychopharmacology. Rockville, MD: U.S. Department of Health, Education, and Welfare.
Hamilton, M. (1959). The assessment of anxiety states by rating. British Journal of Medical Psychology, 32, 5055.
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 5662.
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, 209215.
Health and Safety Executive (2012). Health and Safety Executive Annual Statistics Report 2011/12. London: Health and Safety Executive (HSE).
Hedges, L. V. (1981). Distribution theory for Glass's estimator of effect size and related estimators. Journal of Educational and Behavioral Statistics, 6, 107128.
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, 19.
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, 427440.
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, 285315.
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.
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, 617627.
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, 606613.
Leykin, Y. and DeRubeis, R. J. (2009). Allegiance in psychotherapy outcome research: separating association from bias. Clinical Psychology: Science and Practice, 16, 5465.
Lovibond, S. H. and Lovibond, P. F. (1995). Manual for the Depression Anxiety Stress Scales (2nd ed.). Sydney, Australia: Psychology Foundation.
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, 95106.
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, 2033.
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.
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, 264269.
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, 501511.
NICE (2011). Common Mental Health Disorders: identification and pathways to care. Leicester and London: The British Psychological Society and The Royal College of Psychiatrists.
Norton, P. J. (2012). A randomized clinical trial of transdiagnostic cognitve-behavioral treatments for anxiety disorder by comparison to relaxation training. Behavior Therapy, 43, 506517.
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, 874882.
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, 198202.
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, 7997.
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, 214226.
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, 557577.
Otte, C. (2011). Cognitive behavioral therapy in anxiety disorders: current state of the evidence. Dialogues in Clinical Neuroscience, 13, 413421.
Paul, K. I. and Moser, K. (2009). Unemployment impairs mental health: meta-analyses. Journal of Vocational Behavior, 74, 264282.
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, 25942604.
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, 171184.
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, 1130.
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), 19211928.
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.
Schulz, K. F., Altman, D. G. and Moher, D. (2010). CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ, 340, 698702.
Schulz, K. F. and Grimes, D. A. (2002). Allocation concealment in randomised trials: defending against deciphering. The Lancet, 359, 614618.
Sheehan, D. V. (1983). The Anxiety Disease. New York: Scribner.
Song, F., Eastwood, A. J., Gilbody, S., Duley, L. and Sutton, A. J. (2000). Publication and related biases. Health Technology Assessment, 4, 1115.
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.
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, 10921097.
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, 107118.
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, 890899.
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, 441452.
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, 601605.
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, 314325.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Behavioural and Cognitive Psychotherapy
  • ISSN: 1352-4658
  • EISSN: 1469-1833
  • URL: /core/journals/behavioural-and-cognitive-psychotherapy
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Type Description Title
WORD
Supplementary materials

Andersen supplementary material
Appendices

 Word (17 KB)
17 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed