A New Transdiagnostic Psychotherapy for Veterans With Affective Disorders: Transdiagnostic Behavior Therapy (TBT)

Comorbidity as a moderator of the differential efficacy of transdiagnostic behavior therapy and behavioral activation for affective disorders

OBJECTIVE

Transdiagnostic psychotherapies have been proposed as an effective means for addressing the needs of patients with multiple, comorbid disorders. Yet, it remains unknown whether transdiagnostic approaches empirically outperform disorder-specific psychotherapies for patients with comorbid disorders. Thus, this study tested whether comorbidity moderated the efficacy of transdiagnostic behavior therapy (TBT) and behavioral activation (BA) for patients with various affective disorders.

METHODS

Data derived from a randomized controlled trial in which 93 treatment-seeking veterans received 12 sessions of TBT (n = 46) or BA (n = 47). Baseline comorbidity was assessed with a diagnostic interview. Patients rated their symptoms and functioning throughout treatment, and therapists recorded premature treatment discontinuation.

RESULTS

Multilevel models revealed significant interactive effects on changes in symptoms and functioning, but not on the posttreatment levels of these outcomes; whereas patients with more comorbidity experienced greater reductions in distress and symptom interference in TBT compared to BA, those with one disorder had better outcomes in BA. Similarly, whereas patients with more comorbidity were less likely to prematurely discontinue TBT compared to BA, those with one disorder were less likely to prematurely discontinue BA.

CONCLUSIONS

The results lend empirical support to previously untested hypotheses for potential benefits of transdiagnostic psychotherapies.Trial registration: ClinicalTrials.gov identifier: NCT01947647.

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

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.

A randomized controlled trial comparing Transdiagnostic Behavior Therapy (TBT) and behavioral activation in veterans with affective disorders

This randomized controlled trial (RCT) compared the efficacy of Transdiagnostic Behavior Therapy (TBT) to Behavioral Activation Treatment for Depression (BATD) in veterans diagnosed with affective disorders. TBT is a transdiagnostic psychotherapy designed to address depressive, anxiety, and post-traumatic stress disorder (PTSD) symptoms. Preliminary findings have been promising; however, no RCT has been completed to date. 105 treatment-seeking veterans were recruited and completed diagnostic and self-report measures, and then randomized into TBT or BATD treatment conditions for 12 weekly psychotherapy sessions. Assessment measures were re-administered at immediate post-treatment and 6-month follow-up. Of the 93 participants initiating treatment, 50 participants completed the full treatment protocol (TBT n = 29; BATD n = 21). No differences were observed in treatment completion across groups. Participants demonstrated significant treatment improvements across all assessments, including measures of depression, anxiety (general, cognitive, and somatic), stress, PTSD symptoms, and transdiagnostic impairment. Group differences with small effect sizes were observed in most of the studied measures, favoring TBT compared to BATD. Together, the findings support the growing literature on the efficacy of transdiagnostic psychotherapies, compared to disorder-specific treatments (DSTs). Related to the outcome findings, the benefits for transdiagnostic protocols in terms of symptom coverage, dissemination, and access were discussed.