Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood

Abstract

A broad array of transdiagnostic psychological treatments for depressive and anxiety disorders have been evaluated, but existing reviews of this literature are restricted to face-to-face cognitive behavioural therapy (CBT) protocols. The current meta-analysis focused on studies evaluating clinician-guided internet/computerised or face-to-face manualised transdiagnostic treatments, to examine their effects on anxiety, depression and quality of life (QOL). Results from 50 studies showed that transdiagnostic treatments are efficacious, with large overall mean uncontrolled effects (pre- to post-treatment) for anxiety and depression (gs=.85 and .91 respectively), and medium for QOL (g=.69). Uncontrolled effect sizes were stable at follow-up. Results from 24 RCTs that met inclusion criteria showed that transdiagnostic treatments outperformed control conditions on all outcome measures (controlled ESs: gs=.65, .80, and .46 for anxiety, depression and QOL respectively), with the smallest differences found compared to treatment-as-usual (TAU) control conditions. RCT quality was generally poor, and heterogeneity was high. Examination of the high heterogeneity revealed that CBT protocols were more effective than mindfulness/acceptance protocols for anxiety (uncontrolled ESs: gs=.88 and .61 respectively), but not depression. Treatment delivery format influenced outcomes for anxiety (uncontrolled ESs: group: g=.70, individual: g=.97, computer/internet: g=.96) and depression (uncontrolled ESs: group: g=.89, individual: g=.86, computer/internet: g=.96). Preliminary evidence from 4 comparisons with disorder-specific treatments suggests that transdiagnostic treatments are as effective for reducing anxiety, and may be superior for reducing depression. These findings show that transdiagnostic psychological treatments are efficacious, but higher quality research studies are needed to explore the sources of heterogeneity amongst treatment effects.

Eficacia de la terapia cognitivo conductual transdiagnóstica en el tratamiento de la ansiedad y la depresión en adultos, niños y adolescentes: Un meta-análisis

“…This result is consistent with the evidence reported by Newby et al (2015), which indicated that CBT outperformed mindfulness/acceptance-based treatments in reducing anxiety symptoms. Even though mindfulness has acquired a great diffusion and popularity in psychology and other disciplines as a powerful strategy to treat emotional and physical problems, its effi cacy has not yet been demonstrated (Goyal et al, 2014;Miró et al, 2011;Öst, 2008).…”

“…Apart from certain systematic reviews (McEvoy et al, 2009;McManus et al, 2010), a few recent meta-analyses have examined the effectiveness of T-CBT for emotional disorders. Three of these examined the effi cacy of T-CBT in adult samples focusing on anxiety (Norton & Philipp, 2008;Reinholt & Krogh, 2014) or on anxiety and depression (Newby, McKinnon, Kuyken, Gilbody, & Dalgleish, 2015). Only one meta-analysis on T-CBT for young people has been published (Ewing, Monsen, Thompson, Cartwright-Hatton, & Field, 2015), and it only dealt with anxiety.…”

Complaint-Directed Mini-Interventions for Depressive Symptoms: A Health-Economic Evaluation of Unguided Web-Based Self-Help Interventions (Preprint)

“…These brief and low-threshold interventions focus on psychological stress, sleep problems, and worry, because these complaints are highly prevalent, are demonstrably associated with depression, have a substantial economic impact, and are frequently presented to the GP [10][11][12]. The unique feature of the CDMIs as an approach for depression is that they were developed by taking into account that symptoms preceding or underlying depression may not be disorder-specific (e.g., worry) and may also vary by individual, which is in line with recent symptom-network and trans-diagnostic approaches to mental disorders [13][14][15]. Hence, they focus on complaints (symptoms) rather than disorders, which allows each individual to choose the complaint(s) they want to focus on.…”

“Lumping” and “splitting” medically unexplained symptoms: is there a role for a transdiagnostic approach?

“…In their systematic review and meta-analysis, (Newby et al, 2015) concluded that transdiagnostic approaches are as effective as disorder specific treatments for treating anxiety and may be superior for reducing depression. Similarly, Norton & Barrera (2012) observed treatment equivalence between disorder specific and transdiagnostic treatments for anxiety in a non-inferiority randomised controlled trial (RCT).…”

“…Transdiagnostic approaches and unified treatment protocols for mental disorders such as anxiety, depression and eating disorders have been developed to address this (Barlow et al, 2004;Fairburn et al, 2003;Kring & Sloan, 2010). They focus on identifying the core and common maladaptive temperamental, psychological, cognitive, emotional, interpersonal and behavioural processes that underlie a range of diagnostic presentations and target these in treatment (Newby et al, 2015). For example, there is evidence of mechanisms that link the process of rumination to both depression and anxiety.…”