Transdiagnostic Versus Diagnosis-Specific CBT for Anxiety Disorders: A Preliminary Randomized Controlled Noninferiority Trial

Abstract

BACKGROUND Transdiagnostic cognitive-behavioral treatments for anxiety disorders have been gaining increased attention and empirical study in recent years. Despite this, research on transdiagnostic anxiety treatments has, to date, relied on open trials, or comparisons to waitlist conditions, published benchmarks, or relaxation-based interventions. METHODS The current study was a randomized clinical trial examining the efficacy of a 12-week transdiagnostic cognitive-behavioral group treatment in comparison to 12-week diagnosis-specific group CBT protocols for panic disorder, social anxiety disorder and generalized anxiety disorder. RESULTS Results from 46 treatment initiators suggested significant improvement during treatment, strong evidence for treatment equivalence across transdiagnostic and diagnosis-specific CBT conditions, and no differences in treatment credibility. CONCLUSIONS This study provides evidence supporting the efficacy of transdiagnostic CBT by comparison to current gold-standard diagnosis-specific CBT for social anxiety disorder, generalized anxiety disorder, and panic disorder. Transdiagnostic group CBT has the benefit of potentially easing dissemination and increasing access to evidence based treatments for anxiety without sacrificing efficacy.

Eficacia de la terapia cognitivo conductual transdiagnóstica en el tratamiento de la ansiedad y la depresión en adultos, niños y adolescentes: Un meta-análisis

“…Except for 6 studies that only reported the changes in anxiety Norton & Barrera, 2012;Titov et al, 2010 [1&2]), effect sizes for both anxiety and depression outcomes were calculated in all studies. The measures chosen to calculate the effect sizes were the ones present to a greater extent in the majority of included studies (Table 1), and most of the times were the ones defi ned by the studies' authors as principal outcome measures.…”

“…Concerning the 21 included RCTs, 20 studied adults whereas only 1 , which used WLC, included participants younger than 18 years of age. Out of the 20 RCTs with adults, 13 studies involved WLC (Bolton et al, 2014;Chu et al, 2016;Newby et al, 2013 (1); Norton, Hayes, & Hope, 2004;Norton & Hope, 2005;Schmidt et al, 2012; (1); Wuthrich & Rapee, 2013), one study used a discussion group for comparison (Wuthrich, Rapee, Kangas, & Perini, 2016), one used TAU for comparison , one used relaxation training , and fi ve studies compared T-CBT with disorder-specifi c CBT (Dear et al, 2015;Lotfi , Bakhtiyari, Asgharnezhad-Farid, & Amini, 2014;Norton & Barrera, 2012;Titov et al, 2015b). The study characteristics can be found in Table 1.…”

“…= The Wellbeing Program or The Wellbeing Course. *p < 0.05 **p < 0.01 a For this variable we also included the pre-post treatment data (T-CBT group) of the following studies: Norton and Barrera (2012) and Norton (2012). and for depression (g = 1.19).…”

“Lumping” and “splitting” medically unexplained symptoms: is there a role for a transdiagnostic approach?

“…In their systematic review and meta-analysis, (Newby et al, 2015) concluded that transdiagnostic approaches are as effective as disorder specific treatments for treating anxiety and may be superior for reducing depression. Similarly, Norton & Barrera (2012) observed treatment equivalence between disorder specific and transdiagnostic treatments for anxiety in a non-inferiority randomised controlled trial (RCT).…”

“…In their systematic review and meta-analysis, (Newby et al, 2015) concluded that transdiagnostic approaches are as effective as disorder specific treatments for treating anxiety and may be superior for reducing depression. Similarly, Norton & Barrera (2012) observed treatment equivalence between disorder specific and transdiagnostic treatments for anxiety in a non-inferiority randomised controlled trial (RCT).We have developed a transdiagnostic cognitive behavioural approach for PPS which can also be used for long-term conditions. We anticipate that the adapted transdiagnostic approach may address the need for efficiency while maintaining the efficacy of larger effects seen in specific condition treatment programmes.…”