- 30% of the world’s population will meet the criteria for an anxiety disorder in their lifetime
- 20% of the world’s population will meet the criteria for a depressive disorder in their lifetime
- 50% of those with an anxiety disorder and 80% of those with a depressive disorder also meet the criteria for another (comorbid) disorder.
The prevalence of anxiety and depressive disorders is very high. What makes the numbers worse is that rarely do these disorders occur in isolation; there is a staggering overlap between the two – a comorbidity that cries out for improved treatments.
TBT – A Promising New Treatment
Over the last couple of decades, considerable research has focused on the development of evidence-based treatments for anxiety and mood disorders. Cognitive-behavioral therapy (CBT) is one form of treatment that has been shown to be efficacious for these disorders (Hofmann, Sawyer, Korte, & Smits, 2009). Although effective at treating symptoms of a given disorder, these disorder specific protocols are limited in that they may not adequately address comorbid disorders (Kessler, Merikangas, & Wang, 2007). As such, the development of treatment protocols targeting multiple disorders concurrently are especially important to enhance the efficiency of treatment delivery in patients presenting with multiple symptom constellations.
Further, despite the efficacy of disorder specific CBT protocols, the dissemination of these treatments to the community has been limited (Andrews & Titov, 2009). One approach to enhance the dissemination of efficacious CBT treatments is through the development of transdiagnostic treatments protocols. Transdiagnostic treatments aim to provide a parsimonious approach to treatment by creating protocols designed to treat multiple disorders. These approaches have been designed to treat disorders that are deemed to be similar in nature by having the same underlying or maintaining factors and tend to be responsive to the same treatment mechanisms (Barlow et al., 2011; Gros, 2014; Norton, 2008; Schmidt et al., 2012). These treatments have been shown to be efficacious in the treatment of anxiety disorders (Norton, 2008; Schmidt et al., 2012) and comorbid depression (Barlow et al. 2011; Gros, 2012), thereby providing an attractive alternative to disorder specific treatment CBT protocols.
Gros (2014) developed a transdiagnostic treatment approach for veterans with symptoms of anxiety, depression and traumatic stress disorders called, Transdiagnostic Behavior Therapy (TBT). TBT is designed to treat multiple affective disorders (i.e., anxiety and depressive disorders) primarily through the use of transdiagnostic behavioral exposure practices that are used in disorder specific treatment protocols for anxiety and mood disorders. This focus provides a streamlined approach to treating these disorders by focusing on the common treatment techniques known to be efficacious in treating these disorders, thereby providing a treatment approach that may be easier for providers in community settings to learn, implement, and disseminate.
A typical course of treatment using TBT protocol involves 12 sessions of individual therapy. Each session ranges from 45-60 minutes in duration. The first six sessions focus on providing psychoeducation about affective disorders and designing and implementing exposure exercises. Once daily exposure exercises are implemented, optional treatment modules can be utilized (Sessions 7 – 15) to address potential obstacles in completing the exposure practices and therefore enhance exposures and overall treatment outcome. These optional treatment modules focus on response prevention, light cognitive therapy, sleep hygiene, mild substance use, anger management, progressive muscle relaxation, prolonged grief, and chronic pain. These eight optional modules allow for the TBT protocol to be individualized to various client specific problems that may be interfering with the implementation of exposure exercises.
Especially Effective For Veterans
TBT has been shown to be effective in treating veterans with a principal diagnosis of an affective disorder (see Gros, 2014). Specifically, veterans receiving TBT demonstrated significant reductions in depression, anxiety, stress, general impairment, and PTSD. The latter finding is especially important, as this is the first study to show the efficacy of treating symptoms of PTSD using a transdiagnostic treatment approach. Moreover, the reduction of PTSD symptoms is key when working with veteran populations as the rate of PTSD is high in this population and it is essential for a transdiagnostic treatment to be effective at reducing PTSD symptoms for it to be fully implemented in the VA healthcare system.
The development of transdiagnostic treatments is an exciting advancement in the treatment of anxiety and depressive disorders. Transdiagnostic treatments, such as TBT, may lead to improved dissemination of cognitive-behavioral approaches for the treatment of anxiety, traumatic stress and depressive disorders, while also allowing for the treatment of multiple disorders concurrently. It seems that parsimonious, transdiagnostic treatment approaches, are the future of CBT
Sources
Andrews, G & Titov, N. (2009). Hit and miss: innovation and dissemination of evidence-based psychological treatments. Behavior Research and Therapy, 47, 974-979.
Barlow, D.H., Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C.L., & Ehrenreich-May, J. (2011). The unified protocol for the transdiagnostic treatment of emotional disorders: Therapist guide. New York: Oxford University Press.
Brawman-Mintzer, Lydiard, Emmanuel, & Payeur, 1993; Brown et al., 2001
Gros, D. F. (2014). Development and initial evaluation of Transdiagnostic Behavior Therapy (TBT) for veterans with affective disorders. Psychiatry Research, 220, 275-282.
Hofmann, S.G., Sawyer, A. T., Korte, K.J., & Smits, J.A.J. (2009). Is it beneficial to add pharmacotherapy to cognitive-behavioral therapy when treating anxiety disorders? A meta-analytical review. International Journal of Cognitive Therapy, 2, 162-178.
Norton, P.J. (2008). An open trial of a transdiagnostic cognitive-behavioral group therapy for anxiety disorder. Behavior Therapy, 39, 242-250.
Riccardi, C.J., Korte, K.J., & Schmidt, N.B. (under review). False Safety Behavior Elimination Therapy: A randomized study of a brief individual transdiagnostic treatment for anxiety disorders.
Schmidt, N.B., Buckner, J.D., Pusser, A., Woolaway-Bickel, K., Preston, J.L., & Norr, A.M. (2012). Randomized controlled trial of False Safety Behavior Elimination
Therapy (F-SET): A unified cognitive behavioral treatment for anxiety
psychopathology. Behavior Therapy, 43, 518-532.
Daniel F. Gros, Ph.D., completed his Honors B.S. in psychology at Virginia Commonwealth University and his M.A. and Ph.D. in clinical psychology at the University at Buffalo. He completed his clinical psychology internship at the Charleston Consortium in 2008. Upon completion of his internship, Dr. Gros was hired as a staff psychologist at the Ralph H. Johnson (RHJ) VAMC and joined the Medical University of South Carolina Department of Psychiatry and Behavioral Sciences as an assistant professor. Dr. Gros has been central in advancing evidence-based psychotherapeutic practices at the RHJ VAMC, including creating/directing two very successful psychotherapy clinics within the hospital.
Dr. Gros also has been an active supervisor within the Charleston Consortium Internship Program and an active research collaborator with several faculty within the department. The main focus of Dr. Gros’s research is the development, investigation, implementation, and dissemination of transdiagnostic assessment and treatment practices. To compliment these interests, Dr. Gros has been successful in creating his own transdiagnostic assessment tools and psychotherapy protocols.
Of particular note, Transdiagnostic Behavior Therapy (TBT), a brief evidence-based protocol for patients with any of the depressive and/or anxiety disorders developed by Dr. Gros at the RHJ VAMC, has received a lot of attention in the research community with the initial findings published in Psychiatry Research.
Dr. Gros’s work on TBT also resulted in the award of a Clinical Science Research and Development VA Career Development Award (VA’s K-Award) that involves a randomized controlled trial comparing the efficacy of TBT to an established evidence-based psychotherapy in veterans with affective disorders. Dr. Gros has published over 90 manuscripts and 5 book chapters.
Kristina J. Korte, M.S., completed her Honors B.A. at the University of Iowa and her M.A. at Boston University. Kristina is a doctoral candidate in clinical psychology at Florida State University and is she currently completing her clinical psychology internship at the Charleston Consortium. Her work focuses on the nature, prevention, and treatment of anxiety psychopathology, with a particular focus on the implementation and dissemination of empirically supported treatments.
Ms. Korte has received the prestigious National Research Service Award from the National Institute of Mental Health to fund her dissertation research focusing on the development of a transdiagnostic preventative intervention for subclinical anxiety. Kristina has published 16 manuscripts in peer-reviewed journals and 2 book chapters.
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