Toward a unified treatment for emotional disorders

Barlow, David H.; Allen, Laura B.; Choate, Molly L.

doi:10.1016/s0005-7894(04)80036-4

Cited by 1,184 publications

(551 citation statements)

References 67 publications

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Section: Discussionmentioning

confidence: 92%

“…A useful question for future research is whether the effects of youth depression treatment on anxiety result from increased skill in addressing the negative affectivity that is apparently shared by the two syndromes. Whatever the answer to this question, the findings do offer some support for the possibility that youth depression and anxiety might be treated by a common intervention encompassing emotional disorders (see Barlow et al, 2004).Taken together, these findings on the magnitude and specificity of effects may help inform the debate over alternatives to antidepressant medication, as discussed in the introduction (see Glass, 2004;Safer, 1997; TADS Team, 2004;Vitiello & Swedo, 2004;Weisz & Jensen, 1999;Whittington et al, 2004). Our results suggest that for those who seek an alternative to antidepressants, psychotherapy offers a reasonable option, generating a small to medium ES that generalizes to comorbid anxiety symptoms and shows substantial holding power for some months after treatment ends.…”

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confidence: 95%

“…We expected that depression effects might not carry over to symptoms so different as those in the externalizing domain; however, high correlations between youth depression and anxiety (see, e.g., Achenbach, 1990) and theories that posit common risk factors for anxiety and depression (e.g., the tripartitate model of emotion; Clark, Watson, & Mineka, 1994) suggest that treatments that reduce depression may have benevolent effects on anxiety as well. This possibility is directly relevant to recent debates about whether depression and anxiety require separate treatments or can be treated by combined intervention for emotional disorders (i.e., depression plus anxiety; see Barlow, Allen, & Choate, 2004), but no previous meta-analysis has addressed the issue. Thus, we assessed the specificity of depression treatment effects by assessing outcomes separately for (a) depression measures, (b) measures of anxiety, and (c) measures of externalizing problems (e.g., disruptive conduct).…”

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confidence: 99%

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Effects of psychotherapy for depression in children and adolescents: A meta-analysis.

Weisz¹,

McCarty²,

Valeri³

2006

Psychological Bulletin

752

641

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Serious sequelae of youth depression, plus recent concerns over medication safety, prompt growing interest in the effects of youth psychotherapy. In previous meta-analyses, effect sizes (ESs) have averaged .99, well above conventional standards for a large effect and well above mean ES for other conditions. The authors applied rigorous analytic methods to the largest study sample to date and found a mean ES of .34, not superior but significantly inferior to mean ES for other conditions. Cognitive treatments (e.g., cognitive-behavioral therapy) fared no better than noncognitive approaches. Effects showed both generality (anxiety was reduced) and specificity (externalizing problems were not), plus short-but not long-term holding power. Youth depression treatments appear to produce effects that are significant but modest in their strength, breadth, and durability. Keywords depression; children; adolescents; psychotherapy; meta-analysis Depression in children and adolescents (herein referred to collectively as youths) is a significant, persistent, and recurrent public health problem that undermines social and school functioning, generates severe family stress, and prompts significant use of mental health services (Angold et al., 1998;Clarke, DeBar, & Lewinsohn, 2003). Youth depression is also linked to increased risk of other psychiatric disorders (Angold & Costello, 1993) as well as drug use and suicide (Gould et al., 1998;Rohde, Lewinsohn, & Seeley, 1991), which is the third most common cause of death among adolescents (Arias, MacDorman, Strobino, & Guyer, 2003). Relapse rates have been reported at 12% within 1 year and 33% within 4 years (Lewinsohn, Clarke, Seeley, & Rohde, 1994), and by the age of 18 years, some 20% of youths will have met criteria for a diagnosis of major depressive disorder at least once (Birmaher et al., 1996). Prospective longitudinal research has shown substantial continuity of youth depression into adulthood, with impaired functioning in work, social, and family life, and markedly elevated risk of adult suicide attempts and completed suicide (see, e.g., Costello et al., 2002;Weissman et al., 1999). The extent, impact, and long-term sequelae of youth depression underscore the need for effective treatment. A primary purpose of the current article was to assess the effects of the most extensively tested genre of youth depression treatment: psychotherapy. In this article, we seek to answer the six questions listed below. What Is the Overall Effect of Psychotherapy on Youth Depression?The need to examine psychotherapy effects is underscored not only by evidence on the extent, impact, and sequelae of youth depression but also by recent debate over medication risks. Selective serotonin reuptake inhibitors (SSRIs) have become a widely used treatment for depressed youths (Safer, 1997; Treatment for Adolescents with Depression Study [TADS] Team, 2004;Weisz & Jensen, 1999), but concerns over possible risks, including suicidal ideation and suicide attempts (Vitiello & Swedo, 2004;Whittington...

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Section: Discussionmentioning

confidence: 92%

mentioning

confidence: 95%

mentioning

confidence: 99%

See 1 more Smart Citation

Effects of psychotherapy for depression in children and adolescents: A meta-analysis.

Weisz¹,

McCarty²,

Valeri³

2006

Psychological Bulletin

752

641

View full text Add to dashboard Cite

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“…At a more general level anxiety about the experience of negative emotions may be common to many psychological disorders (Barlow, Allen, & Choate, 2004;Liverant, Brown, Barlow, & Roemer, 2008) and health problems. Consequently, interventions should also focus on reducing fear experiences in individuals suffering from chronic pain and PTSD in particular.…”

Section: Discussionmentioning

confidence: 99%

Basic emotion profiles in healthy, chronic pain, depressed and PTSD individuals

Finucane

Dima

Ferreira

et al. 2011

Clin Psychology and Psychoth

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ObjectivesTo compare self-reports of five basic emotions across four samples: healthy, chronic pain, depressed and PTSD, and to investigate the extent to which basic emotion reports discriminate between individuals in healthy or clinical groups. MethodsIn total, 439 participants took part in this study: healthy (N = 131), chronic pain (N = 220), depressed (N = 24) and PTSD (N = 64). Participants completed the trait version of the Basic Emotion Scale (Dalgleish & Power, 2004). Basic emotion profiles were compared both within each group and between the healthy group and each of the three other groups. Discriminant analysis was used to assess the extent to which basic emotions can be used to classify participants as belonging to the healthy group or one of the clinical groups.2 ResultsIn the healthy group, happiness was experienced more than any other basic emotion.This was not found in the clinical groups. In comparison to healthy participants, the chronic pain group experienced more fear, anger and sadness; the depressed group reported more sadness; and the PTSD group experienced all of the negative emotions more frequently. Discriminant analysis revealed that happiness was the most important variable in determining whether an individual belonged to the healthy group or one of the clinical groups. Anger was found to further discriminate between depressed and chronic pain individuals. ConclusionThe findings demonstrate that basic emotion profile analysis can provide a useful foundation for the exploration of emotional experience both within and between healthy and clinical groups. Key Practitioner Message• More frequent experiences of happiness relative to discrete negative emotions most clearly discriminate between individuals in healthy and clinical groups.More frequent anger experiences further discriminate between individuals with chronic pain and those with depression while disgust levels help discriminate between those with PTSD and depression.• More frequent experiences of high arousal negative emotions -fear, anger and disgust are characteristic of individuals with PTSD.• Fear is the most frequently experienced negative emotion in both healthy and clinical groups. Higher levels of fear compared to other discrete negative emotions are not necessarily an indicator of psychopathology. Consideration of emotional profiles more generally and the relative frequency with which happiness is experienced relative to negative emotions may be more useful in delineating between healthy individuals and those with chronic pain, depression or PTSD. 3Although emotions play an important role in psychopathology, few studies have applied models of everyday emotions to research in psychopathology. Nonetheless,

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“…Positive experiences were also described, such as feeling empowered (Khan et al, 2007; Knowles et al, 2014). A key example of low‐intensity groups is the cognitive–behavioural therapy (CBT)‐based Stress Control course for Generalized Anxiety Disorder (White, Keenan, & Brooks, 1992), as recently, it has been suggested that this course is transdiagnostic because it works on negative affect (Barlow, Allen, & Choate, 2004; White, 2010). Average satisfaction ratings are high for both Stress Control (Burns, Kellett, & Donohoe, 2016) and Take Control Course (TCC; Morris, Mansell, Emsley, et al, 2016), but detailed qualitative understandings of participants' positive (and negative) experiences are lacking.…”

Section: Introductionmentioning

confidence: 99%

Experiences of a transdiagnostic group, the Take Control Course, for clients with common mental health problems: A qualitative study

Morris

Mansell

Amos

et al. 2018

Clin Psychology and Psychoth

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ObjectivesDespite the promising effectiveness findings for transdiagnostic groups, studies have not explored clients' experiences. There is a risk that clients could perceive that the content of transdiagnostic groups is not sufficiently tailored to their specific problems. Our aims were to examine whether a brief transdiagnostic group, the Take Control Course (TCC), was acceptable to participants and to explore participants' perceptions of psychological change.MethodsQualitative data were collected via 12 semistructured, in‐depth interviews. Data collection and thematic analysis were concurrent and iterative.ResultsThree superordinate themes were identified: “Style and format,” “Control and flexibility,” and “Change.” The flexible group format was appreciated, as participants felt able to engage at their own pace and adapt relevant aspects. Greater clarity regarding what was within participants' control reduced distress and enabled effective pursuit of valued goals. Participants described significant (predominantly gradual) changes, including substantial improvements within relationships.ConclusionsThe transdiagnostic format did not prevent participants experiencing the TCC as individually relevant. The flexibility and consistent theoretical framework seemed to contribute to this. The results indicated that greater consideration of control and mindfulness allowed greater cognitive flexibility, an ability to reprioritize and let go of unhelpful habits, which better enabled participants to meet their goals. Implications for group therapy include (a) clearly explaining the format of such groups to clients and (b) providing flexibility in the way the group is delivered where possible. Additional qualitative studies of transdiagnostic groups are required to establish if themes generalize to other transdiagnostic groups.

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Toward a unified treatment for emotional disorders

Cited by 1,184 publications

References 67 publications

Effects of psychotherapy for depression in children and adolescents: A meta-analysis.

Effects of psychotherapy for depression in children and adolescents: A meta-analysis.

Basic emotion profiles in healthy, chronic pain, depressed and PTSD individuals

Experiences of a transdiagnostic group, the Take Control Course, for clients with common mental health problems: A qualitative study

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