Disorder-specific versus transdiagnostic and clinician-guided versus self-guided internet-delivered treatment for panic disorder and comorbid disorders: A randomized controlled trial

Abstract

Transdiagnostic cognitive behaviour therapy (TD-CBT) aims to target the symptoms of multiple disorders whereas disorder-specific CBT (DS-CBT) targets the symptoms of principal disorders. This study compared the relative benefits of internet-delivered TD-CBT and DS-CBT when provided in clinician-guided (CG-CBT) and self-guided (SG-CBT) formats for people with a principal diagnosis of Panic Disorder (PD). Participants (n=145) were randomly allocated to receive TD-CBT or DS-CBT and CG-CBT or SG-CBT. Large reductions in symptoms of PD (Cohen's d ≥ 0.71; avg. reduction ≥ 36%) and moderate-to-large reductions in symptoms of comorbid depression (Cohen's d ≥ 0.71; avg. reduction ≥ 33%), generalised anxiety disorder (Cohen's d ≥ 0.91; avg. reduction ≥ 34%) and social anxiety disorder (Cohen's d ≥ 0.50; avg. reduction ≥ 15%) were found over the 24-month follow-up period. Highlighting their efficacy and acceptability, no marked and consistent differences were observed between TD-CBT and DS-CBT or CG-CBT and DS-CBT.

Internet- and mobile-based interventions for anxiety disorders: A meta-analytic review of intervention components

“…After removing duplicates and screening titles and abstracts, 159 full‐text articles were assessed for eligibility. Finally, we included 34 studies (Andersson, Carlbring, & Furmark, ; Andersson, Paxling, et al., ; Berger et al., ; Boettcher, Aström, et al., ; Boettcher, Berger, & Renneberg, ; Boettcher, Hasselrot, et al., ; Butler, Mobini, Rapee, Mackintosh, & Reynolds, ; Carlbring, Ekselius, & Andersson, ; Carlbring et al., ; Christensen et al., ; Dagöö et al., ; Dear et al., , ; Fogliati et al., ; Furmark et al., ; Gershkovich, ; Ivanova et al., ; Johansson et al., ; Johnston, Titov, Andrews, Spence, & Dear, ; Klein et al., ; Klein, Richards, & Austin, ; LaFreniere & Newman, ; Nordgren et al., ; Nordmo et al., ; Oromendia, Orrego, Bonillo, & Molinuevo, ; Richards, Klein, & Austin, ; Robinson et al., ; Schulz et al., ; Tillfors et al., ; Titov, Andrews, Choi, Schwencke, & Johnston, ; Titov, Andrews, Choi, Schwencke, & Mahoney, ; Titov, Andrews, Schwencke, et al., ; Titov et al., ) with 3,724 participants in this systematic review. The study selection process is outlined in the PRISMA flow chart (Figure ).…”

“…Guided IMIs and mostly unguided interventions revealed no significant differences on symptom severity at postintervention (four studies; SMD of –0.02 [95% CI: –0.20, 0.16]) and follow‐up (three studies; SMD of –0.02 [95% CI: –0.18, 0.13]) with marginal heterogeneity in both comparisons ( I ² = 21% and 0%; Supporting Information Figures and ) (Dear et al., , ; Fogliati et al., ; Gershkovich, ). However, guided IMIs resulted in higher number of completed modules ( SMD of 0.19 [95% CI: 0.01, 0.38]) and closely missed statistical significance for completer rate ( OR of 1.35 [95% CI: 0.98, 1.86]).…”

“…Three studies (Dear et al., , ; Fogliati et al., ) compared a transdiagnostic intervention (i.e., targeting symptoms of common mental disorders) with a disorder‐specific intervention (targeting GAD, SAD, or PD). Pooled group differences regarding symptom severity at postintervention assessment ( SMD = −0.01 [95% CI: −0.16, 0.15]; Supporting Information Figure ), symptom severity at 6–12 months follow‐up ( SMD = −0.13 [95% CI: −0.29, 0.03]; Supporting Information Figure ), mean number of completed modules ( SMD = −0.03 [95% CI: −0.18, 0.12]; Supporting Information Figure ), and completer rate ( OR = 0.84 [95% CI: 0.61, 1.15]; Supporting Information Figure ) were all nonsignificant.…”

“…Three studies (Dear et al, 2015Fogliati et al, 2016) Statistical heterogeneity of the reported meta-analyses was absent (I 2 = 0%).…”

Aplicación grupal del Protocolo Unificado para el tratamiento transdiagnóstico de los trastornos emocionales en población argentina

“…La terapia cognitivo conductual transdiagnóstica (TCC-T) sostiene que existen procesos cognitivos y conductuales diferentes responsables de ciertos síntomas compartidos por diversos trastornos psicológicos que comparten aspectos comunes en las áreas cognitivas, conductuales y/o emocionales (García-Escalera et al, 2016;Sandín et al, 2012) y que podrían explicar su mantenimiento (Egan, Wade, y Shafran, 2012;Mansell, Harvey, Watkins y Shafran, 2008). Se trata de una aplicación de amplio alcance que se focaliza en las dimensiones comunes y genéricas que comparten diferentes trastornos, es decir, un tratamiento transdiagnóstico aplicaría los mismos principios de tratamiento subyacentes a diferentes trastornos sin necesidad de adaptarlo a diagnósticos específi cos (Espejo et al, 2016;Fogliati, et al 2016;García-Escalera et al, 2016;Grill y Castañeiras, 2013;Ito et al, 2016;McEvoy, Nathan y Norton, 2009;Titov, et al, 2016).…”