<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.

Social anxiety disorder (SAD) is a highly prevalent and impairing disorder. Current best practice is cognitive behavioral therapy (CBT), but there are several challenges associated with performing exposure therapy. Virtual reality exposure (VRE) may improve treatment efficacy of SAD in a group therapy context, because it allows for greater control, flexibility, and individualization of the exposure stimuli. However, to date no study has investigated the use of VRE for SAD in a group context. In the present study, nine patients who had undergone group CBT with VRE for SAD and three therapists responsible for the treatment were interviewed about their experiences. The objective of the study was to investigate the practical and therapeutic challenges of using VRE in a group therapy context. Thematic analysis was used to analyze the data. The results showed that it was difficult for the patients to engage with the VRE in a group therapy context and that there were several practical challenges. However, all participants found the VRE exercises to be meaningful, because it gave them a medium to practice and understand typically avoided social situations. The latter has not previously been described as a treatment mechanism for anxiety through virtual reality. However, the appropriateness of VRE in group therapy remains unclear. Implications are discussed.What is the significance of this article for the general public? Anxiety disorders are increasingly common and represent a growing economic burden in most developed countries. Group therapy that focuses on building skills, facing fears, and changing unhelpful habits is an often used and efficacious treatment. Virtual reality has been used to help people with anxiety face their fears in a safe and flexible environment. However, it has never been investigated if virtual reality can be used in group therapy. The present study is the first to examine the use of virtual reality in group therapy, by interviewing patients and therapists. Several challenges to the treatment format were discovered and recommendations to meet them are proposed. It remains uncertain if virtual reality is a meaningful addition to group therapy.

Background Only 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. Methods A 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. Results While 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. Conclusions Our 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.