Abstract
BackgroundOnly about half of all patients with anxiety disorders or major depression respond to cognitive behaviour therapy (CBT), even though this is an evidence-based treatment. Personalized treatment offers an approach to increase the number of patients who respond to therapy. The aim of this study was to examine predictors and moderators of (differential) treatment outcomes in transdiagnostic versus diagnosis-specific group CBT.MethodsA sample of 291 patients from three different mental health clinics in Denmark was randomized to either transdiagnostic or diagnosis-specific group CBT. The study outcome was the regression slope of the individual patient's repeated scores on the WHO-5 Well-being Index. Pre-treatment variables were identified as moderators or predictors through a two-step variable selection approach.ResultsWhile the two-step approach failed to identify any moderators, four predictors were found: level of positive affect, duration of disorder, the detachment personality trait, and the coping strategy of cognitive reappraisal. A prognostic index was constructed, but did not seem to be robust across treatment sites.ConclusionsOur findings give insufficient evidence to support a recommendation of either transdiagnostic or diagnosis-specific CBT for a given patient or to predict the response to the applied group therapies.
Highlights
Major depressive disorder (MDD) and anxiety disorders are the most prevalent, often co-occurring, emotional disorders found in the western world
Cognitive behaviour therapy (CBT) and other evidence-based treatments exist for these disorders and generally show good effects, they do not work for every individual (Dunlop et al 2017; Hofmann et al 2012; Loerinc et al 2015; Springer et al 2018)
Within the cognitive behaviour therapy (CBT) framework, the frequent occurrence of co-morbidity among emotional disorders has spurred the development of transdiagnostic CBT, i.e., treatments that apply a unified set of interventions to address several anxiety disorders, depression, and other emotional disorders (Barlow et al 2016; McEvoy et al 2009; Reinholt and Krogh 2014; Reinholt et al 2017)
Summary
Major depressive disorder (MDD) and anxiety disorders are the most prevalent, often co-occurring, emotional disorders found in the western world. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP, Barlow et al 2011a, b; Barlow et al 2018) targets negative affectivity by stimulating emotion regulation strategies away from avoidance towards more adaptive strategies (Barlow et al 2014; Sauer-Zavala et al 2012). About half of all patients with anxiety disorders or major depression respond to cognitive behaviour therapy (CBT), even though this is an evidence-based treatment. The aim of this study was to examine predictors and moderators of (differential) treatment outcomes in transdiagnostic versus diagnosis-specific group CBT. Conclusions Our findings give insufficient evidence to support a recommendation of either transdiagnostic or diagnosisspecific CBT for a given patient or to predict the response to the applied group therapies
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