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George MG, Roberge P, Provencher MD, Norton PJ. The effectiveness of transdiagnostic cognitive behavioural therapy for anxiety disorders: the role of and impact of comorbid depression. Cogn Behav Ther 2024; 53:105-118. [PMID: 37934006 DOI: 10.1080/16506073.2023.2274290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 10/18/2023] [Indexed: 11/08/2023]
Abstract
Transdiagnostic Cognitive Behaviour Therapy (tCBT), an intervention designed to be applicable across multiple diagnoses, was introduced to improve limitations in traditional therapy such as cost and access to trained therapists. It has been established as an effective and efficacious treatment for anxiety disorders, though there has been little research focussed on the role of depression. The current study investigated the role of comorbid depression during tCBT for anxiety disorders in primary care settings as an outcome and a moderator of anxiety outcomes. Results of multi-level ANOVAs indicated no significant difference in anxiety outcomes regardless of whether there was a comorbid depression diagnosis in the tCBT condition, and that individuals with a comorbid depression diagnosis experienced significantly greater reduction in anxiety severity than those without. Depression symptom severity decreased to a significantly greater extent in the tCBT condition than in TAU when the outcome measure of Patient Health Questionnaire was utilised as the outcome measure, but this was not mirrored when the Clinician Severity Rating was utilised as the outcome measure. This study provides preliminary support for the effectiveness of Transdiagnostic Cognitive Behaviour therapy for those with both a principal anxiety disorder and comorbid depression in symptom reduction.
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Affiliation(s)
- Megan G George
- Faculty of Psychology, Counselling, and Psychotherapy, The Cairnmillar Institute, Hawthorn East, Australia
| | - Pasquale Roberge
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | | | - Peter J Norton
- Faculty of Psychology, Counselling, and Psychotherapy, The Cairnmillar Institute, Hawthorn East, Australia
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Vasiliadis HM, Lamoureux-Lamarche C, Chapdelaine A, Provencher MD, Norton PJ, Berbiche D, Roberge P. Cost-Effectiveness of Group Transdiagnostic Cognitive Behavioural Therapy for Anxiety Disorders in Primary Care Settings: Economic Evaluation From the Healthcare System Perspective Over a 1-Year Time Horizon. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:43-53. [PMID: 37461378 PMCID: PMC10867409 DOI: 10.1177/07067437231187459] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
AIM To assess the incremental cost-effectiveness ratio (ICER) of group transdiagnostic cognitive-behavioural therapy (tCBT) added to treatment as usual (TAU) for anxiety disorders compared to TAU only from the healthcare system perspective over a 1-year time horizon. METHODS Data from a pragmatic multisite randomized controlled trial where adults (18-65 years) with an anxiety disorder were randomized to tCBT + TAU (n = 117) or TAU (n = 114). Group tCBT is a 12-week (2h weekly sessions) community-based intervention. Health service utilization and related costs were captured from medico-administrative data and included those for the intervention, ambulatory visits, hospitalizations and medications. Effectiveness was based on quality-adjusted life years (QALYs). The study included measures at baseline, 4, 8, and 12 months. Intention-to-treat and complete case analyses were carried out. Missing data were imputed using multiple imputation analyses. Seemingly unrelated regression analyses were used to assess the effect of the intervention on total costs and QALYs while also adjusting for baseline confounders. The probability of cost-effectiveness of the intervention was assessed according to different willingness-to-pay (WTP) thresholds using the net benefit regression method. RESULTS The ICER of tCBT + TAU as compared to TAU in the intention-to-treat analysis was $6,581/QALY. Complete case analyses showed a similar ICER of $6,642/QALY. The probability at a WTP threshold of $20,000 and $40,000 that tCBT + TAU as compared to TAU is cost-effective is 93.0% and 99.9%. CONCLUSION tCBT added to TAU appears to be cost-effective from the healthcare system perspective for treating adult patients with anxiety disorders. Larger trials including young and older adults as well as a range of anxiety disorders are needed to further investigate the cost-effectiveness of tCBT in different patient populations.
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Affiliation(s)
- Helen-Maria Vasiliadis
- Département des Sciences de la Santé Communautaire, Université de Sherbrooke, Longueuil, Québec, Canada
- Centre de recherche Charles-Le Moyne, Longueuil, Québec, Canada
| | - Catherine Lamoureux-Lamarche
- Département des Sciences de la Santé Communautaire, Université de Sherbrooke, Longueuil, Québec, Canada
- Centre de recherche Charles-Le Moyne, Longueuil, Québec, Canada
| | - Alexandra Chapdelaine
- PRIMUS Research Group, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Canada
| | | | | | - Djamal Berbiche
- Département des Sciences de la Santé Communautaire, Université de Sherbrooke, Longueuil, Québec, Canada
- Centre de recherche Charles-Le Moyne, Longueuil, Québec, Canada
| | - Pasquale Roberge
- Département de médecine familiale et d’urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada
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Chapdelaine A, Vasiliadis HM, Provencher MD, Norton PJ, Roberge P. Moderators of the cost-effectiveness of transdiagnostic CBT for anxiety disorders over an 8-month time horizon using a net-benefit regression framework. BMC Health Serv Res 2023; 23:596. [PMID: 37291599 DOI: 10.1186/s12913-023-09468-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/28/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Access to evidence-based psychological treatment is a concern in many parts of the globe due to government-level financial constraints and patient-level barriers. Transdiagnostic cognitive behavioural therapy (tCBT) is an effective treatment approach that uses a single protocol for anxiety disorders which could enhance the dissemination of evidence-based psychotherapy. In a context of limited resources, the study of treatment moderators can allow to identify subgroups for which the cost-effectiveness of an intervention differs, information that could impact decision-making. So far, there has been no economic evaluation of tCBT for different subpopulations. The objectives of this study, using the net-benefit regression framework, were to explore clinical and sociodemographic factors as potential moderators of the cost-effectiveness of tCBT compared to treatment-as-usual (TAU). METHODS This is a secondary data analysis of a pragmatic randomized controlled trial opposing tCBT added to TAU (n = 117) to TAU only (n = 114). Data on costs from the health system and the limited societal perspectives, as well as anxiety-free days, an effectiveness measure based on the Beck Anxiety Inventory, were collected over an 8-month time horizon and used to derive individual net-benefits. The net-benefit regression framework was used to assess moderators of the cost-effectiveness of tCBT + TAU as opposed to TAU alone. Variables of sociodemographic and clinical nature were assessed. RESULTS Results showed that the number of comorbid anxiety disorders significantly moderated the cost-effectiveness of tCBT + TAU compared to TAU from the limited societal perspective. CONCLUSIONS The number of comorbid anxiety disorders was identified as a moderator affecting the cost-effectiveness of tCBT + TAU compared to TAU from the limited societal perspective. More research is needed to strengthen the case of tCBT from an economic standpoint for large-scale dissemination. TRIAL REGISTRATION ClinicalTrials.gov: NCT02811458, 23/06/2016.
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Affiliation(s)
- Alexandra Chapdelaine
- PRIMUS Research Group, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12e Avenue N, Sherbrooke, Québec, J1H 5N4, Canada
| | - Helen-Maria Vasiliadis
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke - Campus de Longueuil, 150 Place Charles-Le Moyne, Longueuil, Québec, J4K 0A8, Canada.
- Centre de Recherche Charles-Le Moyne, 150 Place Charles-Le Moyne, Longueuil, Québec, J4K 0A8, Canada.
| | - Martin D Provencher
- École de psychologie, Université Laval, Pavillon Félix-Antoine-Savard, 2325 All. des Bibliothèques, Québec, Québec, G1V 0A6, Canada
| | - Peter J Norton
- The Cairnmillar Institute, 391-393 Tooronga Road, Hawthorn East, Victoria, VIC, 3123, Australia
| | - Pasquale Roberge
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12e Avenue N, Sherbrooke, Québec, J1H 5N4, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), 3001 12e Avenue N, Sherbrooke, Québec, J1H 5N4, Canada
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Rostami M, Provencher MD, Roberge P, Norton PJ. An analysis of differential improvement by diagnosis in group transdiagnostic cognitive behaviour therapy for anxiety disorders. J Ment Health 2023; 32:619-624. [PMID: 36840371 DOI: 10.1080/09638237.2023.2182419] [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: 02/26/2023]
Abstract
INTRODUCTION Anxiety disorders are the most prevalent among the mental health disorders and have a negative impact on an individual's life. Cognitive behaviour therapy (CBT) is documented as the most effective treatment for anxiety disorders. However, challenges associated with implementing diagnosis-specific CBT have led to transdiagnostic approaches of CBT (tCBT). tCBT uses a single protocol with core elements of CBT for treatment of anxiety disorders broadly. The aim of the current study is to examine whether participants with different principal anxiety diagnoses demonstrate similar anxiety reduction. METHODS The current study involved a secondary analysis of 117 participants randomly allocated to receive tCBT for anxiety disorders in a pragmatic randomised effectiveness trial. Beck Anxiety Inventory (BAI) and Clinician Severity Ratings (CSR) scales were administered at pre- and post-treatment and one-year follow-up, while the Anxiety Disorder Diagnostic Questionnaire - Weekly (ADDQ-W) was administered each session. RESULTS Mixed-factorial analyses of variance (ANOVAs) indicated that participants with GAD, SAD and PD/A improved to post-treatment and maintained to follow-up, with no differential improvement across principal diagnoses. Mixed effect regression modelling of session by session measures indicated non-differential negative slopes across principal diagnoses of GAD, SAD and PD/A. CONCLUSION Overall, results indicate that group tCBT for anxiety disorders shows equal effectiveness for GAD, PD/A, and SAD in real-world conditions.
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Chapdelaine A, Vasiliadis HM, Provencher MD, Norton PJ, Roberge P. Cost-effectiveness of transdiagnostic group cognitive behavioural therapy for anxiety disorders v. treatment as usual: economic evaluation of a pragmatic randomized controlled trial over an 8-month time horizon using self-reported data. Psychol Med 2023; 53:1-13. [PMID: 36695038 DOI: 10.1017/s0033291722003920] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND This economic evaluation supplements a pragmatic randomized controlled trial conducted in community care settings, which showed superior improvement in the symptoms of adults with anxiety disorders who received 12 sessions of transdiagnostic cognitive-behavioural group therapy in addition to treatment as usual (tCBT + TAU) compared to TAU alone. METHODS This study evaluates the cost-utility and cost-effectiveness of tCBT + TAU over an 8-month time horizon. For the reference case, quality-adjusted life years (QALYs) obtained using the EQ-5D-5L, and the health system perspective were chosen. Alternatively, anxiety-free days (AFDs), derived from the Beck Anxiety Inventory, and the limited societal perspective were considered. Unadjusted incremental cost-effectiveness/utility ratios were calculated. Net-benefit regressions were done for a willingness-to-pay (WTP) thresholds range to build cost-effectiveness acceptability curves (CEAC). Sensitivity analyses were included. RESULTS Compared to TAU (n = 114), tCBT + TAU (n = 117) generated additional QALYs, AFDs, and higher mental health care costs from the health system perspective. From the health system and the limited societal perspectives, at a WTP of Can$ 50 000/QALY, the CEACs showed that the probability of tCBT + TAU v. TAU being cost-effective was 97 and 89%. Promising cost-effectiveness results using AFDs are also presented. The participation of therapists from the public health sector could increase cost-effectiveness. CONCLUSIONS From the limited societal and health system perspectives, this first economic evaluation of tCBT shows favourable cost-effectiveness results at a WTP threshold of Can$ 50 000/QALY. Future research is needed to replicate findings in longer follow-up studies and different health system contexts to better inform decision-makers for a full-scale implementation.
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Affiliation(s)
- Alexandra Chapdelaine
- PRIMUS Research Group, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e avenue Nord, local Z7-3004, Sherbrooke, Québec, J1H 5N4, Canada
| | - Helen-Maria Vasiliadis
- Université de Sherbrooke - Campus de Longueuil, Charles-Le Moyne Research Center, 150 Place Charles Lemoyne, Longueuil, Québec, J4K 0A8, Canada
| | - Martin D Provencher
- École de psychologie, Pavillon Félix-Antoine-Savard, 2325, rue des Bibliothèques, Université Laval, Québec, Québec, G1V 0A6, Canada
| | - Peter J Norton
- The Cairnmillar Institute, 391-393 Tooronga Rd, Hawthorn East, Victoria 3123, Australia
| | - Pasquale Roberge
- Department of family medicine and emergency medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e avenue Nord, local Z7-3004, Sherbrooke, Québec, J1H 5N4, Canada
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Huynh AT, Gaboury I, Provencher MD, Norton PJ, Roberge P. Patient acceptability of group transdiagnostic cognitive behavior therapy for the treatment of anxiety disorders in community-based care: a qualitative study. CLIN PSYCHOL-UK 2022. [DOI: 10.1080/13284207.2022.2041363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Ai-Thuy Huynh
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Canada
| | - Isabelle Gaboury
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Canada
| | | | | | - Pasquale Roberge
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Canada
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Luong HK, Roberge P, Provencher MD, Kilby CJ, Drummond SPA, Norton PJ. Which, who and when? Therapeutic processes in group cognitive behaviour therapy for anxiety disorders. Clin Psychol Psychother 2022; 29:1742-1754. [PMID: 35383418 DOI: 10.1002/cpp.2740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 03/06/2022] [Accepted: 03/31/2022] [Indexed: 11/09/2022]
Abstract
The evidence for the effect of therapeutic alliance in group cognitive behaviour therapy (CBT) for anxiety disorders is unclear. Identifying whether the alliance-outcome relationship depends on (1) which components are assessed, (2) who is measuring the alliance and (3) when the alliance is measured will help to clarify the role of the client-therapist relationship in therapy. The present study explored the effects of alliance component (agreement vs. bond), rater perspective (client vs. therapist) and timing (early vs. late therapy) on the alliance-outcome relationship. Individuals with an anxiety disorder enrolled into transdiagnostic group CBT were studied, with n = 78 at early therapy and n = 57 at late therapy. Results showed that greater client-rated agreement significantly predicted improved post-treatment outcomes throughout the course of therapy, while stronger client-rated bond in late therapy predicted reduced treatment gains. In contrast, therapist perceptions of agreement and bond were not associated with post-treatment outcomes at any point in therapy. Client-reported group cohesion also was not associated with additional variance in outcome after accounting for client-rated alliance. Overall, the findings highlight the importance of prioritizing the client's perception of the client-therapist relationship in CBT for anxiety disorders, as well as distinguishing the effects of component, rater and timing in future process-outcome studies.
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Affiliation(s)
- Hoang K Luong
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Pasquale Roberge
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - Christopher J Kilby
- School of Psychology, Counselling, and Psychotherapy, The Cairnmillar Institute, Hawthorn East, Victoria, Australia
| | - Sean P A Drummond
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Peter J Norton
- School of Psychology, Counselling, and Psychotherapy, The Cairnmillar Institute, Hawthorn East, Victoria, Australia
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Mo Y, Lai X, Li L, Lu YZ. Sleep, depression, and anxiety in family caregivers of nasopharyngeal carcinoma patients before therapy. Acta Psychol (Amst) 2022; 223:103504. [PMID: 35051844 DOI: 10.1016/j.actpsy.2022.103504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 01/08/2022] [Accepted: 01/14/2022] [Indexed: 11/30/2022] Open
Abstract
Sleep disturbance, anxiety, and depression are frequently observed in cancer patients. There have fewer studies about the sleep and emotional status of nasopharyngeal carcinoma (NPC) patient family caregivers (FCs) before treatment. We explored the sleep, depression, and anxiety in NPC patient FCs before therapy, compared sleep quality between caregivers with and without depression and anxiety, and examined and related factors of sleep disturbance in FCs of NPC patients before therapy. FC-patient dyads included from two centers were 92 in total. The proportions of poor sleep, anxiety, and depression in NPC patient FCs were 45.7%, 43.5%, and 54.3%, respectively. FCs with anxiety or depression were more inclined to report decreased sleep quality. Depressed caregivers were 11.11 times more to be poor quality sleep before patients treatment (OR = 11.11, 95%; CI = 2.94-42.05). NPC patient FCs before treatment are at high risk of sleep disturbances, depression, and anxiety, especially those already experiencing anxiety and depression symptoms.
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Affiliation(s)
- Yanlin Mo
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Cancer Institute of Guangxi Zhuang Autonomous Region, Nanning 530021, China
| | - Xiaoying Lai
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Cancer Institute of Guangxi Zhuang Autonomous Region, Nanning 530021, China
| | - Ling Li
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Cancer Institute of Guangxi Zhuang Autonomous Region, Nanning 530021, China
| | - Yao-Zhen Lu
- Department of Radiation Oncology, Minzu Hospital of Guangxi Zhuang Autonomous Region, Affiliated Minzu Hospital of Guangxi Medical University, Nanning 530001, China.
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Wang Y, Zhang Y, Fan C, Wei Y, Meng J, Li Z, Zhong C. Genome-wide analysis of MYB transcription factors and their responses to salt stress in Casuarina equisetifolia. BMC PLANT BIOLOGY 2021; 21:328. [PMID: 34238224 PMCID: PMC8265015 DOI: 10.1186/s12870-021-03083-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/01/2021] [Indexed: 05/25/2023]
Abstract
BACKGROUND MYB transcription factors are a kind of DNA binding protein that can specifically interact with the promoter region. Members of MYB TFs are widely involved in plant growth and development, secondary metabolism, stress response, and hormone signal transduction. However, there is no report of comprehensive bioinformatics analysis on the MYB family of Casuarina equisetifolia. RESULTS In this study, bioinformatics methods were used to screen out 182 MYB transcription factors from the Casuarina equisetifolia genome database, including 69 1R-MYB, 107 R2R3-MYB, 4 R1R2R3-MYB, and 2 4R-MYB. The C. equisetifolia R2R3-MYB genes were divided into 29 groups based on the phylogenetic topology and the classification of the MYB superfamily in Arabidopsis thaliana, while the remaining MYB genes (1R-MYB, R1R2R3-MYB, and 4R-MYB) was divided into 19 groups. Moreover, the conserved motif and gene structure analysis shown that the members of the CeqMYBs were divided into the same subgroups with mostly similar gene structures. In addition, many conserved amino acids in the R2 and R3 domains of CeqMYBs by WebLogo analysis, especially tryptophan residues (W), with 3 conserved W in R2 repeat and 2 conserved W in R3 repeat. Combining promoter and GO annotation analysis, speculated on the various biological functions of CeqMYBs, thus 32 MYB genes were selected to further explore its response to salt stress by using qPCR analysis technique. Most CeqMYB genes were differentially regulated following multiple salt treatments. CONCLUSIONS Seven genes (CeqMYB164, CeqMYB4, CeqMYB53, CeqMYB32, CeqMYB114, CeqMYB71 and CeqMYB177) were assigned to the "response to salt stress" by GO annotation. Among them, the expression level of CeqMYB4 was up-regulated under various salt treatments, indicating CeqMYB4 might participated in the response to salt stress. Our results provide important information for the biological function of C. equisetifolia, as well as offer candidate genes for further study of salt stress mechanism.
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Affiliation(s)
- Yujiao Wang
- Research Institute of Tropical Forestry, Chinese Academy of Forestry, Guangzhou, 510520, China
| | - Yong Zhang
- Research Institute of Tropical Forestry, Chinese Academy of Forestry, Guangzhou, 510520, China.
| | - Chunjie Fan
- Research Institute of Tropical Forestry, Chinese Academy of Forestry, Guangzhou, 510520, China
| | - Yongcheng Wei
- Research Institute of Tropical Forestry, Chinese Academy of Forestry, Guangzhou, 510520, China
| | - Jingxiang Meng
- Research Institute of Tropical Forestry, Chinese Academy of Forestry, Guangzhou, 510520, China
| | - Zhen Li
- Research Institute of Tropical Forestry, Chinese Academy of Forestry, Guangzhou, 510520, China
| | - Chonglu Zhong
- Research Institute of Tropical Forestry, Chinese Academy of Forestry, Guangzhou, 510520, China
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Norton PJ, Provencher MD, Kilby CJ, Roberge P. Impact of group transdiagnostic cognitive-behavior therapy for anxiety disorders on comorbid diagnoses: Results from a pragmatic randomized clinical trial in primary care. Depress Anxiety 2021; 38:749-756. [PMID: 34142748 DOI: 10.1002/da.23184] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/27/2021] [Accepted: 06/08/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Anxiety and depressive disorders are the most common mental illnesses worldwide, with most individuals meeting criteria for more than one diagnosis. Most cognitive-behavioral therapy (CBT) approaches target only one disorder at a time, resulting in the need to treat comorbid diagnoses sequentially. Transdiagnostic CBT protocols have been developed that simultaneously treat principal and comorbid disorders. METHOD The current study reports on a secondary analysis of data from a pragmatic effectiveness randomized trial of group tCBT in comparison to treatment-as-usual (TAU) in primary care. Of the trial sample of 231 patients, 191 had at least one comorbid diagnosis of clinical severity at T0. RESULTS Overall rates of comorbidity decreased over time (82.0% at T0, 45.0% at T1, 45.7% at T3) and those receiving tCBT showed a significantly lower rate of comorbidity at T1 (33.7%) than TAU (55.7%) and at T3 (tCBT: 27.9%, TAU: 60.2%). Comorbid diagnosis severity ratings reduced to a significantly greater extent in tCBT than in TAU. CONCLUSIONS tCBT is effective in promoting remission of and reducing the severity of comorbid diagnoses. Implications for the treatment of whole persons as opposed to specific diagnoses is discussed.
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Behenck ADS, Wesner AC, Guimaraes LSP, Manfro GG, Dreher CB, Heldt E. Anxiety Sensitivity and Panic Disorder: Evaluation of the Impact of Cognitive-Behavioral Group Therapy. Issues Ment Health Nurs 2021; 42:112-118. [PMID: 32643490 DOI: 10.1080/01612840.2020.1780527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Anxiety sensitivity (AS) is a multidimensional construct associated with the etiology and maintenance of panic disorder (PD) symptoms. However, only a few studies have evaluated whether cognitive-behavioral group therapy (CBGT) can modify the condition. The objective of this study was to evaluate the impact of CBGT on AS in patients with PD and to analyze AS and its dimensions as predictors of response to CBGT. In the present clinical trial, an intervention group (n = 37) attended 12 CBGT sessions, while a control group (n = 52) did not receive any intervention. The severity of symptoms and of AS were evaluated before and after CBGT in the intervention group and once in the control group. Significant improvement occurred in all specific PD symptoms and in general anxiety and depressive symptoms. Furthermore, AS scores reduced significantly after intervention. This study confirmed that AS is higher in patients with more severe PD. The effectiveness of CBGT for reducing the physical, cognitive, and social dimensions of AS was also observed, supporting the hypothesis of a positive impact of therapy.
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Affiliation(s)
- Andressa da Silva Behenck
- School of Nursing, Federal University of Rio Grande do Sul (UFRGS) and Anxiety Disorders Program of Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Ana Cristina Wesner
- Federal University of Health Sciences of Porto Alegre (UFCSPA) and Anxiety Disorders Program of Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Gisele Gus Manfro
- Federal University of Rio Grande do Sul (UFRGS) and Anxiety Disorders Program of Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Carolina Blaya Dreher
- Federal University of Rio Grande do Sul (UFRGS), Anxiety Disorders Program of Hospital de Clínicas de Porto Alegre and Graduation in Medicine of Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Elizeth Heldt
- School of Nursing, Federal University of Rio Grande do Sul (UFRGS) and Anxiety Disorders Program of Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Roberge P, Provencher MD, Gaboury I, Gosselin P, Vasiliadis HM, Benoît A, Carrier N, Antony MM, Chaillet N, Houle J, Hudon C, Norton PJ. Group transdiagnostic cognitive-behavior therapy for anxiety disorders: a pragmatic randomized clinical trial. Psychol Med 2020; 52:1-11. [PMID: 33261700 PMCID: PMC9647541 DOI: 10.1017/s0033291720004316] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/03/2020] [Accepted: 10/26/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Transdiagnostic group cognitive-behavioral therapy (tCBT) is a delivery model that could help overcome barriers to large-scale implementation of evidence-based psychotherapy for anxiety disorders. The aim of this study was to assess the effectiveness of combining group tCBT with treatment-as-usual (TAU), compared to TAU, for the treatment of anxiety disorders in community-based mental health care. METHODS In a multicenter single-blind, two-arm pragmatic superiority randomized trial, we recruited participants aged 18-65 who met DSM-5 criteria for principal diagnoses of generalized anxiety disorder, social anxiety disorder, panic disorder, or agoraphobia. Group tCBT consisted of 12 weekly 2 h sessions. There were no restrictions for TAU. The primary outcome measures were the Beck Anxiety Inventory (BAI) and clinician severity rating from the Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5) for the principal anxiety disorder at post-treatment, with intention-to-treat analysis. RESULTS A total of 231 participants were randomized to either tCBT + TAU (117) or TAU (114), with outcome data available for, respectively, 95 and 106. Results of the mixed-effects regression models showed superior improvement at post-treatment for participants in tCBT + TAU, compared to TAU, for BAI [p < 0.001; unadjusted post-treatment mean (s.d.): 13.20 (9.13) v. 20.85 (10.96), Cohen's d = 0.76] and ADIS-5 [p < 0.001; 3.27 (2.19) v. 4.93 (2.00), Cohen's d = 0.79]. CONCLUSIONS Our findings suggest that the addition of group tCBT into usual care can reduce symptom severity in patients with anxiety disorders, and support tCBT dissemination in routine community-based care.
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Affiliation(s)
- Pasquale Roberge
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke (Québec), Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke (Québec), Canada
| | | | - Isabelle Gaboury
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke (Québec), Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke (Québec), Canada
| | - Patrick Gosselin
- Department of Psychology, Université de Sherbrooke, Sherbrooke (Québec), Canada
| | - Helen-Maria Vasiliadis
- Department of Community Health Sciences, Université de Sherbrooke, Québec (Québec), Canada
| | - Annie Benoît
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke (Québec), Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke (Québec), Canada
| | - Nathalie Carrier
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke (Québec), Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke (Québec), Canada
| | - Martin M. Antony
- Department of Psychology, Ryerson University, Toronto (Ontario), Canada
| | - Nils Chaillet
- Department of Obstetrics, Gynecology, and Reproduction, Université Laval, Québec (Québec), Canada
| | - Janie Houle
- Department of Psychology, Université du Québec à Montréal, Montréal (Québec), Canada
| | - Catherine Hudon
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke (Québec), Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke (Québec), Canada
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