Changes in threat-related cognitions and experiential avoidance in group-based transdiagnostic CBT for anxiety disorders

Espejo, Emmanuel P.; Gorlick, Amanda; Castriotta, Natalie

doi:10.1016/j.janxdis.2016.06.006

Cited by 26 publications

(14 citation statements)

References 35 publications

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“…Most studies (45%) were investigating interventions (of which 50% were controlled, 48% uncontrolled, and 2% unclear). Less than half (46%) of the interventional studies were randomized.…”

Section: Resultsmentioning

confidence: 99%

Transdiagnostic psychiatry: a systematic review

et al. 2019

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The usefulness of current psychiatric classification, which is based on ICD/DSM categorical diagnoses, remains questionable. A promising alternative has been put forward as the "transdiagnostic" approach. This is expected to cut across existing categorical diagnoses and go beyond them, to improve the way we classify and treat mental disorders. This systematic review explores whether self-defining transdiagnostic research meets such high expectations. A multi-step Web of Science literature search was performed according to an a priori protocol, to identify all studies that used the word "transdiagnostic" in their title, up to May 5, 2018. Empirical variables which indexed core characteristics were extracted, complemented by a bibliometric and conceptual analysis. A total of 111 studies were included. Most studies were investigating interventions, followed by cognition and psychological processes, and neuroscientific topics. Their samples ranged from 15 to 91,199 (median 148) participants, with a mean age from 10 to more than 60 (median 33) years. There were several methodological inconsistencies relating to the definition of the gold standard (DSM/ICD diagnoses), of the outcome measures and of the transdiagnostic approach. The quality of the studies was generally low and only a few findings were externally replicated. The majority of studies tested transdiagnostic features cutting across different diagnoses, and only a few tested new classification systems beyond the existing diagnoses. About one fifth of the studies were not transdiagnostic at all, because they investigated symptoms and not disorders, a single disorder, or because there was no diagnostic information. The bibliometric analysis revealed that transdiagnostic research largely restricted its focus to anxiety and depressive disorders. The conceptual analysis showed that transdiagnostic research is grounded more on rediscoveries than on true innovations, and that it is affected by some conceptual biases. To date, transdiagnostic approaches have not delivered a credible paradigm shift that can impact classification and clinical care. Practical "TRANSD"iagnostic recommendations are proposed here to guide future research in this field.

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“…Most studies (45%) were investigating interventions (of which 50% were controlled, 48% uncontrolled, and 2% unclear). Less than half (46%) of the interventional studies were randomized.…”

Section: Resultsmentioning

confidence: 99%

Transdiagnostic psychiatry: a systematic review

et al. 2019

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show abstract

“…Experiential avoidance is characterized by the avoidance of unpleasant internal experiences and consists of two parts: unwillingness to remain in contact with unwanted inner experiences and attempts to avoid events that elicit these experiences (Hayes, Wilson, Gifford, Follette, & Strosahl, 1996 ). At first, this construct was the primary goal of Acceptance and Commitment Therapy (ACT); but, further research showed that various treatments could also affect change through alterations in experiential avoidance (Espejo, Gorlick, & Castriotta, 2016 ; Gloster et al, 2014 ). In addition, studies demonstrated that experiential avoidance is more a psychological vulnerability (Feldner, Zvolensky, Eifert, & Spira, 2003 ; Karekla, Forsyth, & Kelly, 2004 ) rather than the consequence of psychological problems, and it can be considered as an important transdiagnostic factor among various emotional disorders.…”

Section: Introductionmentioning

confidence: 99%

“…They stated that the experiential avoidance is, in fact, a collection of the behaviors that the person displays in order to avoid unwanted inner experiences, and thus can be considered as an underlying and transdiagnostic factor in the psychopathology and treatment of mental disorders (Malicki & Ostaszewski, 2014 ). Espejo, Gorlick, and Castriotta discussed that transdiagnostic group CBT could significantly reduce experiential avoidance in veterans (Espejo et al, 2016 ). Given that awareness and exposure techniques directly target avoidance, UP can be considered as an appropriate treatment option in reducing experiential avoidance among patients with emotional disorders.…”

Section: Introductionmentioning

confidence: 99%

Reductions in transdiagnostic factors as the potential mechanisms of change in treatment outcomes in the Unified Protocol: a randomized clinical trial

Khakpoor

Bytamar

Saed

2019

ResPsy

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Transdiagnostic approaches emphasize on the share underlying features of emotional disorders. In their view, these transdiagnostic factors play an important role in the etiology, maintenance, and treatment of emotional disorders. This study aimed to investigate the transdiagnostic factors as the potential mechanisms of change in the Unified Protocol (UP) for the transdiagnostic treatment of emotional disorders outcomes. The present study is a randomized clinical trial. Twenty-six individuals were selected based on the Beck anxiety inventory and Beck depression inventory and randomly assigned into two groups of control and treatment (n=13). The treatment group received 20 one-hour individual UP sessions. Beck Depression Inventory, Beck Anxiety Inventory, Difficulty in emotion regulation scale, Intolerance of Uncertainty scale and Acceptance and Action questionnaire were carried out in all three phases. UP enhances the difficulty in emotion regulation (large effect size, SEsg=1.81), intolerance of uncertainty (SEsg=1.91), and experiential avoidance (SEsg=1.78). In addition, the results of linear regression show the association between changes in anxiety and depression with changes in transdiagnostic factors. The difficulty in emotion regulation, intolerance of uncertainty and experiential avoidance can be considered as the potential mechanism of change in improving UP outcomes.

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“…Aversive reactions may take many forms, including experiential avoidance, emotional suppression, worry, rumination, or distraction -any behavior used to escape or distract from one's emotions. Recent evidence suggests that reductions in certain forms of aversive reactions (e.g., experiential avoidance, anxiety sensitivity) precede and predict reductions in anxiety symptoms in CBT [ (20)(21)(22)(23)(24)(25); cf. (26)].…”

Section: Evaluating Mechanisms Of Action Using Smartsmentioning

confidence: 99%

Experimental Manipulations to Test Theory-Driven Mechanisms of Cognitive Behavior Therapy

Southward

Sauer‐Zavala

2020

Front. Psychiatry

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Despite decades of randomized-controlled trials demonstrating the efficacy of cognitive-behavior therapy (CBT), the mechanisms by which CBT achieves its effects remain unclear. Here, we describe how one adaptive intervention, the sequential multiple assignment randomized trial (SMART), can be used to randomize patients at multiple decision points in treatment to draw stronger causal claims about mechanisms unfolding in the course of CBT. We illustrate this design using preliminary data and case examples from an ongoing SMART in which we are testing the role of aversive reactions to negative emotions as a hypothesized mechanism of change in the Unified Protocol. Finally, we address common concerns with SMARTs and highlight how mechanistic research serves to personalize and optimize the delivery of CBT.

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Changes in threat-related cognitions and experiential avoidance in group-based transdiagnostic CBT for anxiety disorders

Cited by 26 publications

References 35 publications

Transdiagnostic psychiatry: a systematic review

Transdiagnostic psychiatry: a systematic review

Reductions in transdiagnostic factors as the potential mechanisms of change in treatment outcomes in the Unified Protocol: a randomized clinical trial

Experimental Manipulations to Test Theory-Driven Mechanisms of Cognitive Behavior Therapy

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