This research-based and peer-reviewed article is testing the accuracy of transdiagnostic cognitive-behavioral therapy (tCBT), used for the treatment of emotional disorders for individuals that have been clinically diagnosed with depression. This form of cognitive-behavioral therapy had been well tested on those clinically diagnosed with anxiety but not those clinically diagnosed with depression. Kelly R. Harris and Peter J. Norton sought out treatment-seeking adults back in 2016 meeting the criteria established by the clinical global impression–improvement standards (CGI-I), for depression. Harris and Norton then enrolled them into a 12-week tCBT course that had the goal to find the underlying reason as to why depression and other major emotional disorders occur as emotional disorders are related. The findings of this study showed an overall improvement among the patients enrolled in it. 

Background

Depression is the number one mental disability in the world, followed by anxiety, including both developing and developed countries as proclaimed by World Health Organization in 2017. This has cost the global economy billions of dollars due to the range of aspects through which mental disorders can affect someone's life. There have been studies that show investing money towards treatments for anxiety and depression can yield a fourfold return, thus improving health and employment rates (WHO, 2017). Cognitive behavior therapy has been referred to as the superior method for the treatment of various mental disorders, yet psychotherapy research tells us it is not as effective due to the time and effort required to train clinicians at being competent in the delivery of this therapy. In the study done by Kelly R. Harris and Peter J. Norton, testing has been performed on the transdiagnostic interventions of depression and anxiety face-to-face as there is a lack of research to support it and yielded large effects on main depression but anxiety as well when compared to disorder-specific treatments. 

Emotional disorders such as anxiety and depression are difficult to diagnose based purely on the symptoms, hence why cognitive-behavioral theory exists. Transdiagnostic cognitive behavior therapy came about as a more efficient way to diagnose those with mood disorders. There were various studies before this one by Harris and Norton that inspired them to perform this. One study that was done by Gros in 2014 developed 12 to 16 sessions for individuals who met weekly for a transdiagnostic program that focused on exposure techniques for negatively associated emotions of depression and anxiety. There was also another study done in 2007 by McEvoy and Nathan, who used a benchmarking strategy that investigated the effectiveness of cognitive-behavioral therapy for anxiety and depression of diverse groups with a 10-week, 2-hour program. The protocol employed in that study combined Beck's (1979) depression treatment manual, Barlow and Craske’s (1994) anxiety treatment manual, and psychoeducation regarding anxiety and depression, calming techniques, behavioral activation tasks, exposure, and cognitive restructuring. With these studies being so early yet promising, there was little evaluation done for them. This study aims to evaluate transdiagnostic cognitive-behavioral therapy more extensively than previous studies have done. 

Methods

The recruiting of participants for this study consisted of 12 people who met the DSM-5 diagnostic criteria for a depressive disorder through various platforms. The DSM–5 is a manual for the assessment and diagnosis of mental disorders and does not include information or guidelines for the treatment of any disorder. The study itself was conducted at the FEAR (Fear, Emotions, Anxiety, Research) Clinic. All methods and procedures for the study were reviewed and approved. Participants had a comprehensive face-to-face structured diagnostic assessment utilizing the ADIS-5 to evaluate them for study eligibility. When the eligible participants received a diagnosis of a depressive disorder, they were instructed to rate a Trigger and Response Hierarchy of distressing situations or stimuli in preparation for the treatment. Participants also completed the BDI-II and ADDQ before the commencement of each of the treatment sessions. Post-treatment assessments commenced after the 12^th session of treatment and included a final face-to-face clinical interview with an assessor to re-administer the ADIS-5, CSR, and CGI ratings. This post-treatment process was also completed at 4-month mark follow-up. Participants were assigned to treatment groups based on the order that they showed up to the clinic. Once the first four to eight participants had completed pre-treatment assessments, they were able to begin the post-treatment. The treatments themselves consisted of 12 weekly sessions, 2 hours each, with two FEAR Clinic clinicians. Sessions followed a manualized treatment protocol titled “Transdiagnostic Cognitive Behavioral Therapy (tCBT) for Emotional Disorders”. Strategies to deal with stressors, lapses, and general bad experiences were explored and an action plan was constructed to address relapse prevention. 

Results

The results of the study showed significant comorbidity was observed within the sample of 12 participants meeting DSM5 criteria for a secondary diagnosis, 5 for a 3rd, 1 for a 4th, and 1 for a 5th comorbid diagnosis. 10 of the 12 participants completed post-treatment, 7 of those in a group format and the other 3 in an individual format. For principal diagnosis CSR, large effects were observed across participants post-treatment, similarly, a reduction in participant overall CSR was observed from pre-to post-treatment. 7 of 11 participants who returned for 4-month follow-up assessments had a principal diagnosis below the cut-off for clinical severity. In terms of comorbid diagnoses, 18 comorbid diagnoses of clinical severity were initially assigned to the 11 participants who returned for post-treatment assessment. Of those 18 diagnoses, 14 were assigned a CSR of a subclinical level by assessors at post-treatment. Overall this is stating how while some did make improvements thanks to the use of transdiagnostic cognitive behavioral therapy, there were others to note that stayed the same or even worsened after treatment. 

Discussion

While this study had its strengths and weaknesses, it was an important one to conduct. There is no miracle cure for those diagnosed with a mood disorder and so finding what works for each individual is crucial. There are pre-existing options for therapy such as behavioral or cognitive behavioral therapy. Figure 1 is provided to compare and contrast these two forms of therapy such as their involvement with the patient or the form of rehabilitation. Transdiagnostic cognitive-behavioral therapy aimed to find the ideal blend between these two preexisting forms of therapy. It is still relatively new and has kinks to work out, based upon the results that were performed well overall. Not everyone will react positively to this form of therapy as we are all different, hence why the study had people who dropped out, remained the same, or even worsened after the study, and these should not dampen the positive outcomes of the results. To truly make this form of therapy the new gold standard, more studies will need to be performed to analyze its applications. 

[+] References

[+] Other Work By Cori Dougher