1
|
Morris L, Lovell K, McEvoy P, Emsley R, Carter LA, Edge D, Bates R, Wallwork T, Mansell W. A brief transdiagnostic group (the take control course) compared to individual low-intensity CBT for depression and anxiety: a randomized non-inferiority trial. Cogn Behav Ther 2023; 52:176-197. [PMID: 36625458 DOI: 10.1080/16506073.2022.2143418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Few studies have examined brief transdiagnostic groups. The Take Control Course (TCC) was developed for patients with mild to moderate common mental health problems. We examined whether TCC is non-inferior to individual low-intensity cognitive behaviour therapy (CBT) in a single-blind individually randomised parallel non-inferiority trial. The primary outcomes were depression (PHQ9) and anxiety (GAD7) at 6-month follow-up (primary outcome point) and 12-month follow-up. The non-inferiority margin that we set, based on previous trials, corresponds to approximately 3 points on the PHQ9 and approximately 2.5 points on the GAD7. Intention-to-treat (ITT) and per-protocol (PP) analyses of 6-month data of 156 randomised patients indicated that TCC was non-inferior to individual low-intensity CBT on anxiety (ITT Coefficient = 0.24; 95% CI: -1.45 to 1.92; d = 0.04; p = .79), and depression (ITT Coefficient = 0.82; 95% CI: -1.06 to 2.69; d = 0.14; p = .39) outcomes, and functioning (ITT Coefficient = 0.69; 95% CI: -2.56 to 3.94; d = 0.08; p = .68). The findings at 12 months were inconclusive and require further testing. This randomised trial provides preliminary support that TCC is not less effective than short-term individual CBT within Improving Access to Psychological Therapies (IAPT) services.
Collapse
Affiliation(s)
- Lydia Morris
- Division of Psychology & Mental Health, University of Manchester, Coupland 1 Building, Oxford Rd, Manchester M13 9PL, UK
| | - Karina Lovell
- Division of Nursing, Midwifery & Social Work, University of Manchester, Greater Manchester Mental Health NHS Foundation Trust, Oxford Rd, Manchester M13 9PL, UK
| | - Phil McEvoy
- Six Degrees Social Enterprise, Greenwood Business Centre, Southwood House, Regent Road, Salford M5 4QH, UK
| | - Richard Emsley
- Institute of Psychiatry, Psychology & Neuroscience, King's College, University of London, 16 De Crespigny Park, London SE5 8AB, UK
| | - Lesley-Anne Carter
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Jean McFarlane Building, Oxford Rd, Manchester M13 9PL, UK
| | - Dawn Edge
- Division of Psychology & Mental Health, University of Manchester, Coupland 1 Building, Oxford Rd, Manchester M13 9PL, UK
| | - Rachel Bates
- Six Degrees Social Enterprise, Greenwood Business Centre, Southwood House, Regent Road, Salford M5 4QH, UK
| | - Tanya Wallwork
- Six Degrees Social Enterprise, Greenwood Business Centre, Southwood House, Regent Road, Salford M5 4QH, UK
| | - Warren Mansell
- School of Population Health, Curtin University, Kent Street, Bentley 6102, Western Australia
| |
Collapse
|
2
|
Salvaris CA, Galea S, Yap MBH, Lawrence KA. Enhanced Cognitive-Behavioral Treatment for Anxiety Disorders in Children of Clinically Anxious Parents: Two Case Studies. Clin Case Stud 2022. [DOI: 10.1177/15346501221078979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Children with anxiety disorders are significantly less likely to recover following cognitive-behavioral therapy (CBT) if they have a parent with clinical anxiety. Despite this, prior research which has adapted CBT treatments to cater for this vulnerable clinical cohort of children is limited. In response to the identified need to optimize treatment outcomes for this particular group of children with anxiety disorders, an enhanced CBT intervention was recently developed, specifically to target anxiety maintenance factors in clinically anxious child–parent dyads. This dual case study presents the implementation of the enhanced intervention with two children with complex clinical presentations. Prior to treatment, both children met criteria for multiple anxiety disorders, as did their mothers. The presented case studies describe session-by-session treatment accounts, with a particular focus on the children’s experiences of individual and joint-observational exposure treatment components. Outcome data is provided for both children and their mothers, based on assessment measures collected at pre- and post-treatment, and during the intervention. At post-treatment, both children demonstrated symptom reduction and improved functioning across all diagnoses, including remission on a secondary diagnosis, although both still met criteria for their primary diagnoses. Additionally, self-reported outcomes on intervention acceptability measures were favorable. Results implied that the enhanced intervention provided a viable alternative treatment approach for children and their parents with co-occurring anxiety disorders. Recommendations are provided for clinicians delivering CBT to clinically anxious child–parent dyads.
Collapse
Affiliation(s)
- Chloe A. Salvaris
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Samantha Galea
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Marie B. H. Yap
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Katherine A. Lawrence
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| |
Collapse
|
3
|
Morris L, Mansell W, Amos R, Edge D. Experiences of a transdiagnostic group, the Take Control Course, for clients with common mental health problems: A qualitative study. Clin Psychol Psychother 2018; 25:730-744. [PMID: 29947160 PMCID: PMC6220761 DOI: 10.1002/cpp.2303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 05/24/2018] [Accepted: 05/24/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Despite the promising effectiveness findings for transdiagnostic groups, studies have not explored clients' experiences. There is a risk that clients could perceive that the content of transdiagnostic groups is not sufficiently tailored to their specific problems. Our aims were to examine whether a brief transdiagnostic group, the Take Control Course (TCC), was acceptable to participants and to explore participants' perceptions of psychological change. METHODS Qualitative data were collected via 12 semistructured, in-depth interviews. Data collection and thematic analysis were concurrent and iterative. RESULTS Three superordinate themes were identified: "Style and format," "Control and flexibility," and "Change." The flexible group format was appreciated, as participants felt able to engage at their own pace and adapt relevant aspects. Greater clarity regarding what was within participants' control reduced distress and enabled effective pursuit of valued goals. Participants described significant (predominantly gradual) changes, including substantial improvements within relationships. CONCLUSIONS The transdiagnostic format did not prevent participants experiencing the TCC as individually relevant. The flexibility and consistent theoretical framework seemed to contribute to this. The results indicated that greater consideration of control and mindfulness allowed greater cognitive flexibility, an ability to reprioritize and let go of unhelpful habits, which better enabled participants to meet their goals. Implications for group therapy include (a) clearly explaining the format of such groups to clients and (b) providing flexibility in the way the group is delivered where possible. Additional qualitative studies of transdiagnostic groups are required to establish if themes generalize to other transdiagnostic groups.
Collapse
Affiliation(s)
- Lydia Morris
- University of ManchesterSchool of Psychological SciencesManchesterUK
| | - Warren Mansell
- University of ManchesterSchool of Psychological SciencesManchesterUK
| | - Rebekah Amos
- University of ManchesterSchool of Psychological SciencesManchesterUK
| | - Dawn Edge
- University of ManchesterSchool of Psychological SciencesManchesterUK
| |
Collapse
|
4
|
Harris KR, Norton PJ. Transdiagnostic Cognitive Behavioral Therapy for the Treatment of Emotional Disorders: A Group Case Study. Clin Case Stud 2018. [DOI: 10.1177/1534650118793938] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A recent shift in the conceptualization of both depressive and anxiety disorders supports the notion that these disorders may best fall under a single classification of “emotional disorders.” This understanding has resulted in the development of various transdiagnostic cognitive behavioral therapy (tCBT) protocols to address underlying core pathology shared by emotional disorders. While there is evidence to suggest tCBT is effective in reducing co-occurring depression, research into the efficacy of face-to-face tCBT has generally focused on the delivery of tCBT to individuals with predominantly anxiety diagnoses. The current case study aims to expand the research by examining the impact of group tCBT for individuals with a principal depressive diagnosis. A session-by-session explanation of a 12-week group tCBT protocol designed to treat a heterogeneous group of individuals diagnosed with an emotional disorder is provided in detail and accompanied by a quantitative case study of a recently delivered treatment group. The case study demonstrates the feasibility and pragmatic application of the group tCBT treatment approach. Data presented support the continued research of transdiagnostic interventions for the treatment of emotional disorders and justify future randomized controlled trials to further evaluate the presented intervention.
Collapse
|
5
|
Neudeck P, Brahm CI, Hamm AO. Transdiagnostische expositionsbasierte Behandlung von Angststörungen. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2017. [DOI: 10.1026/1616-3443/a000446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Hintergrund: Neben störungsspezifischen Behandlungskonzepten werden in den letzten Jahren vermehrt transdiagnostische Behandlungsmanuale in der expositionsbasierten Behandlung von Ängsten und komorbiden Störungen eingesetzt. Die vorliegende narrative systematische Übersichtsarbeit beschreibt den Stand der Forschung zu transdiagnostischen Behandlungskonzepten in Hinsicht auf Angst- und komorbide Störungen. Methode: Die Literaturrecherche und die Datenanalyse wurden angelehnt an die PRISMA Guidelines vorgenommen. Die Ergebnisse von 17 Untersuchungen zu expositionsbasierten transdiagnostischen Behandlungskonzepten der letzten fünfzehn Jahre werden beschrieben. Ergebnisse: Die Resultate der referierten Studien zeigen, dass expositionsbasierte transdiagnostische Behandlungen die Symptome, sowohl der primären als auch der komorbiden Störungen, signifikant reduzieren. Expositionsbasierte transdiagnostische Konzepte sind effektiv zur Behandlungen von Angststörungen und komorbider Störungen. Sie stellen eine geeignete Alternative zu störungsspezifischen Behandlungen dar. Diskussion: Die Implikationen transdiagnostischer Konzepte für das praktische Vorgehen bei der individualisierten Diagnostik, der Vorbereitung und Durchführung von Expositionen werden erörtert. Schließlich werden Vorschläge für die Konzeptualisierung einer störungsübergreifenden Behandlung von Angststörungen, insbesondere solcher mit komorbider Symptomatik, vorgestellt.
Collapse
Affiliation(s)
| | | | - Alfons O. Hamm
- Institut für Psychologie, Ernst-Moritz-Arndt-Universität Greifswald
| |
Collapse
|
6
|
Abstract
Anxiety disorders occur frequently, and can have a negative impact on the quality of people's lives. They often begin at an early age and can have some serious consequences. This article is an overview of the recent studies concerning group cognitive-behavioral interventions for anxiety disorders. In the last few years, anxiety disorder prevention for children and adolescents has become an important focus of research work. Group prevention programs are based on standard cognitive behavioral therapy (CBT) strategies and are aimed at preventing anxiety disorders as early as possible. Numerous cognitive behavioral group therapies for children as well as adults have been well studied. There are many CBT protocols that have been developed for treating specific anxiety disorders. Now, specialized CBT programs are available for individuals who suffer from different anxiety disorders, enabling them to be treated together in groups.
Collapse
Affiliation(s)
- Laure Wolgensinger
- Pôle de Psychiatrie de I'Enfant et de I'Adolescent, Centre Hospitalier de Rouffach, France
| |
Collapse
|
7
|
Diagnosis-specific CBT as a stepping stone to transdiagnostic CBT in a complex case. COGNITIVE BEHAVIOUR THERAPIST 2015. [DOI: 10.1017/s1754470x15000550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractComorbid anxiety and mood disorders are common but the majority of treatments tend to focus on a particular diagnosis. Previous research has found that cognitive behavioural therapy (CBT) targeted at a specific diagnosis can lead to improvements in comorbidities, especially in the case of CBT for panic. However, there is an emerging evidence base that transdiagnostic CBT, which addresses common underlying processes across presenting problems, may be effective at treating comorbidities simultaneously. Given the simple nature of the cognitive formulation of panic it is arguable that a panic-specific CBT intervention could help socialize patients to CBT before progressing to a transdiagnostic approach. This paper uses a single-case experimental design to illustrate an example of using diagnosis-specific CBT as a springboard to transdiagnostic CBT with a patient presenting with panic and agoraphobia, social anxiety, depression, uncontrollable worry, suicidality, self-harming behaviours and a history of bulimia. Results suggest that this was a well-received and effective intervention. Clinical implications are discussed as well as limitations and directions for future research
Collapse
|
8
|
Norton PJ, Barrera TL, Mathew AR, Chamberlain LD, Szafranski DD, Reddy R, Smith AH. Effect of transdiagnostic cbt for anxiety disorders on comorbid diagnoses. Depress Anxiety 2013; 30:168-73. [PMID: 23212696 DOI: 10.1002/da.22018] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 09/24/2012] [Accepted: 10/06/2012] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE The present study examines the effectiveness of a 12-week transdiagnostic cognitive-behavioral group in reducing comorbid diagnoses. METHOD Data from 79 treatment completers (60.8% women; M age = 32.57 years) during three previous trials of transdiagnostic cognitive behavior therapy (CBT) were examined to compare treatment effects between those with and without comorbid diagnoses. Additionally, rates of remission of comorbid diagnoses were compared to published diagnosis-specific CBT trials. RESULTS Results indicate that a majority of clients (64.6%) had at least one comorbid disorder and that those with comorbid diagnoses had higher primary diagnosis severity scores than did those without comorbid diagnoses. The presence of a comorbid diagnosis at pretreatment was not associated with differential improvement in primary diagnosis severity following treatment. Two-thirds of completers with comorbid diagnoses at pretreatment (66.7%) no longer met criteria for a clinically severe comorbid diagnosis at posttreatment, a rate higher than that associated with most trials of diagnosis-specific CBT for anxiety disorders used as benchmarks. CONCLUSIONS These results suggest that transdiagnostic cognitive-behavioral group treatment for anxiety may be associated with greater decreases in comorbidity than traditional diagnosis-specific CBT.
Collapse
Affiliation(s)
- Peter J Norton
- Department of Psychology, University of Houston, Houston, Texas 77204-5022, USA.
| | | | | | | | | | | | | |
Collapse
|
9
|
Smith AH, Norton PJ, McLean CP. Client Perceptions of Therapy Component Helpfulness in Group Cognitive-Behavioral Therapy for Anxiety Disorders. J Clin Psychol 2012; 69:229-39. [DOI: 10.1002/jclp.21926] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
10
|
Norton PJ, Barrera TL. Transdiagnostic versus diagnosis-specific cbt for anxiety disorders: a preliminary randomized controlled noninferiority trial. Depress Anxiety 2012; 29:874-82. [PMID: 22767410 PMCID: PMC3463777 DOI: 10.1002/da.21974] [Citation(s) in RCA: 128] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 04/16/2012] [Accepted: 06/03/2012] [Indexed: 11/11/2022] Open
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 Cognitive-Behavioral Therapy (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.
Collapse
Affiliation(s)
- Peter J Norton
- Department of Psychology, University of Houston, Houston, Texas 77204-5022, USA.
| | | |
Collapse
|
11
|
Norton PJ. A randomized clinical trial of transdiagnostic cognitve-behavioral treatments for anxiety disorder by comparison to relaxation training. Behav Ther 2012; 43:506-17. [PMID: 22697440 PMCID: PMC3484173 DOI: 10.1016/j.beth.2010.08.011] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 08/19/2010] [Accepted: 08/24/2010] [Indexed: 01/23/2023]
Abstract
Transdiagnostic cognitive-behavioral treatments (CBT) for anxiety disorders have been gaining increased attention and empirical study in recent years. Despite this, all of the research on transdiagnostic anxiety treatments to date have either not used a control condition, or have relied on no-treatment or delayed-treatment controls, thus limiting inferences about comparative efficacy. The current study was a randomized clinical trial examining the efficacy of a 12-week transdiagnostic cognitive-behavioral group treatment in comparison to a 12-week comprehensive relaxation training program. Results from 87 treatment initiators suggested significant and statistically equivalent/noninferior outcomes across conditions, although relaxation was associated with a greater rate of dropout despite no differences in treatment credibility. No evidence was found for any differential effects of transdiagnostic CBT for any primary or comorbid diagnoses.
Collapse
Affiliation(s)
- Peter J Norton
- Department of Psychology, University of Houston,Houston, TX 77204–5022, USA.
| |
Collapse
|