Efficacy of transdiagnostic behavior therapy on transdiagnostic avoidance in veterans with emotional disorders

Abstract

Objective To date, transdiagnostic treatments have primarily investigated treatment outcomes of general psychiatric symptomatology, rather than the specific transdiagnostic symptoms implicated in their protocols. The present study sought to address this significant gap in the literature by investigating the effect of transdiagnostic behavior therapy (TBT) on transdiagnostic avoidance. Method Forty‐four veterans diagnosed with various emotional disorders initiated TBT, and completed diagnostic and self‐report measures at pre‐ and posttreatment. Results Participants demonstrated reliable treatment improvements in measures of situational, thought, and positive emotional avoidance, with moderate‐to‐large effect sizes, and in measures of physical/interoceptive avoidance with small‐to‐medium effect sizes. Conclusions The findings support the hypothesized effect of TBT in self‐report measures of four types of transdiagnostic avoidance in participants diagnosed with various emotional disorders. These findings contribute to the growing literature on the potential benefits of the transdiagnostic approaches to address symptomatology across diagnoses.

Exploring trajectories in transdiagnostic behavior therapy

“…TBT is heavily reliant on homework participation, with treatment procedures focused on between-session exposure practices and within-session processing and problem-solving of completed exposure practices (Gros, 2014). Of note, homework compliance has been shown to be improved in TBT compared to traditional, disorder-specific therapies that are similarly dependent on homework (e.g., behavioral activation; Shapiro & Gros, 2020). Unfortunately, although clinician-rated measures of in-session procedures and homework engagement did not elucidate the cause for poorer response (e.g., treatment-resistant vs. highly symptomatic), homework compliance consistently has been associated with therapy outcomes across studies and protocols (Mausbach et al, 2010;Rees et al, 2005) and likely contributed to nonresponse in these trajectories for PTSD and panic symptoms.…”

“…Each subscale has evidenced good internal consistency and temporal stability (Rapee et al., 1994/1995). The Agoraphobia subscale was used to assess behavioral avoidance in the current study (Gros et al., 2020). In the present sample, Cronbach's alpha was .85 at baseline.…”

“…Perseverative thinking was selected to represent cognitive appraisals; similar significance has been demonstrated for perseverative thinking across emotional disorders (Ehring et al., 2011; Sorg et al., 2012). Finally, behavioral avoidance was selected given its significance across emotional disorders (Gros, 2014) and because it serves as a primary target for the transdiagnostic psychotherapy investigated in the present study, transdiagnostic behavior therapy (TBT; Gros, 2014; Gros et al., 2020). Although there are numerous candidates to serve as additional predictors (Dewar et al., 2020), we sought to focus the scope of the present study on these predictors as an initial evaluation of transdiagnostic treatment trajectories and their associated predictors and to inform future study.…”

“…We further expected that participants would demonstrate consistent patterns of response across symptoms. Finally, based on the design of TBT (Gros, 2014) and initial findings related to the treatment (Coyne & Gros, 2022; Gros et al., 2020; Shapiro & Gros, 2022), behavioral avoidance, treatment participation, and diagnostic comorbidity were hypothesized as the strongest predictors of latent class membership.…”

Effectiveness of the massed delivery of unified protocol for emotional disorders within an intensive outpatient program for military service members and veterans.

“…However, since patients within this population often present with comorbid mental health concerns, disorder-specific treatments may not address the full scope of mental health needs (Funderburk et al, 2014). Outpatient transdiagnostic protocols that have been tailored to the experiences of military service members and veterans have shown high treatment satisfaction and symptom improvement across a wide variety of disorders (Gros, 2014; Gros & Allan, 2019; Gros & Oglesby, 2019; Gros et al, 2020; Varkovitzky et al, 2018). Targeting transdiagnostic vulnerabilities may be a parsimonious means of treating complex clinical presentations in this population.…”