Transdiagnostic versus Diagnosis-Specific Group Cognitive Behavioral Therapy for Anxiety Disorders and Depression: A Randomized Controlled Trial

Abstract

<b><i>Introduction:</i></b> The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) delivered in a group format could facilitate the implementation of evidence-based psychological treatments. <b><i>Objective:</i></b> This study compared the efficacy of group UP and diagnosis-specific cognitive behavioral therapy (dCBT) for anxiety and depression in outpatient mental health services. <b><i>Methods:</i></b> In this pragmatic, multi-center, single-blinded, non-inferiority, randomized controlled trial (RCT), we assigned 291 patients with major depressive disorder, social anxiety disorder, panic disorder, or agoraphobia to 14 weekly sessions in mixed-diagnosis UP or single-diagnosis dCBT groups. The primary test was non-inferiority, using a priori criteria, on the World Health Organisation 5 Well-Being Index (WHO-5) at the end of the treatment. Secondary outcomes were functioning and symptoms. We assessed outcomes at baseline, end-of-treatment, and at a 6-month follow-up. A modified per-protocol analysis was performed. <b><i>Results:</i></b> At end-of-treatment, WHO-5 mean scores for patients in UP (<i>n</i> = 148) were non-inferior to those of patients in dCBT (<i>n</i> = 143; mean difference –2.94; 95% CI –8.10 to 2.21). Results were inconclusive for the WHO-5 at the 6-month follow-up. Results for secondary outcomes were non-inferior at end-of-treatment and the 6-month follow-up. Client satisfaction and rates of attrition, response, remission, and deterioration were similar across conditions. <b><i>Conclusions:</i></b> This RCT demonstrated non-inferior acute-phase outcomes of group-delivered UP compared with dCBT for major depressive disorder, social anxiety disorder, panic disorder, and agoraphobia in outpatient mental health services. The long-term effects of UP on well-being need further investigation. If study findings are replicated, UP should be considered a viable alternative to dCBT for common anxiety disorders and depression in outpatient mental health services.

Application of the Unified Protocol for a Japanese Patient with Post-Traumatic Stress Disorder and Multiple Comorbidities: A Single-Case Study

“…It also teaches adaptive emotion regulation skills. The efficacy of the UP for anxiety and depressive disorders has been confirmed through several open-label studies [ 9 , 10 , 11 , 12 , 13 ], randomized controlled trials [ 14 , 15 , 16 , 17 , 18 , 19 ], and meta-analyses [ 20 , 21 , 22 ].…”

Development of Individual Add-On Interventions for Patients With Depression Who are Persistently Not on Track in Group Cognitive Behavioural Therapy: A Protocol for a Treatment Development and Feasibility Study

“…Despite the existence of numerous well-established psychotherapeutic treatments, research shows that only about 50% of patients suffering from depression recover after psychotherapeutic treatment (Cuijpers et al, 2014) and up to 10% of cases actually deteriorate (Cuijpers et al, 2018). This is also seen following evidence-based cognitive behaviour therapy (CBT) delivered in groups as currently done in Danish Mental Health Service (Reinholt et al, 2021). Since treatment failure might result in patients' continuing suffering and societal costs of prolonged psychiatric service and lost productivity, it is critical to (a) identify patients at risk of treatment failure and (b) tailor appropriate interventions for these patients.…”

“Despite the Differences, We Were All the Same”. Group Cohesion in Diagnosis-Specific and Transdiagnostic CBT Groups for Anxiety and Depression: A Qualitative Study

“…The current study was carried out within the TRACT-RCT [19], a multicenter, naturalistic, non-inferiority, randomized clinical trial. The therapy delivered in the TRACT-RCT was weekly group CBT over 14 sessions.…”

“…The current study included 23 patients from four psychiatric outpatient clinics in Denmark. All of the patients had participated in the TRACT-RCT [19]. Participants in the TRACT-RCT were contacted by telephone upon completion of the treatment and asked if they wished to participate in an interview regarding their experiences with therapy.…”

“…One such protocol is the Unified Protocol for treatment of emotional disorders (UP), which is designed to treat a range of emotional disorders such as anxiety disorders, MDD, Post Traumatic Stress Disorder (PTSD) and Obsessive Compulsive Disorder (OCD) by focusing on underlying neuroticism and emotion regulation rather than diagnosis-specific symptomatology. The UP has been found to be non-inferior to diagnosis-specific CBT for a range of anxiety disorders in individual therapy [18] and for social anxiety disorder, panic disorder/agoraphobia and MDD in group therapy [19]. One of the main arguments for delivering standard diagnosis-specific CBT in groups is that patients may experience normalization through similarities in symptoms and disorder-related experiences [20].…”