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Clin Psychol Rev. 2015 Aug;40:91-110. doi: 10.1016/j.cpr.2015.06.002. Epub 2015 Jun 6.

Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood.

Author information

1
Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, 390 Victoria Street, Darlinghurst, NSW 2010, Australia. Electronic address: j.newby@unsw.edu.au.
2
Medical Research Council Cognition and Brain Sciences Unit, 15 Chaucer Road, Cambridge CB2 7EF, United Kingdom.
3
Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford OX37JX, United Kingdom.
4
Department of Health Sciences, The University of York, Seebohm Rowntree Building, Heslington, York YO105DD, United Kingdom.
5
Medical Research Council Cognition and Brain Sciences Unit, 15 Chaucer Road, Cambridge CB2 7EF, United Kingdom; Cambridgeshire and Peterborough Mental Health Foundation Trust, Cambridge, United Kingdom.

Abstract

A broad array of transdiagnostic psychological treatments for depressive and anxiety disorders have been evaluated, but existing reviews of this literature are restricted to face-to-face cognitive behavioural therapy (CBT) protocols. The current meta-analysis focused on studies evaluating clinician-guided internet/computerised or face-to-face manualised transdiagnostic treatments, to examine their effects on anxiety, depression and quality of life (QOL). Results from 50 studies showed that transdiagnostic treatments are efficacious, with large overall mean uncontrolled effects (pre- to post-treatment) for anxiety and depression (gs=.85 and .91 respectively), and medium for QOL (g=.69). Uncontrolled effect sizes were stable at follow-up. Results from 24 RCTs that met inclusion criteria showed that transdiagnostic treatments outperformed control conditions on all outcome measures (controlled ESs: gs=.65, .80, and .46 for anxiety, depression and QOL respectively), with the smallest differences found compared to treatment-as-usual (TAU) control conditions. RCT quality was generally poor, and heterogeneity was high. Examination of the high heterogeneity revealed that CBT protocols were more effective than mindfulness/acceptance protocols for anxiety (uncontrolled ESs: gs=.88 and .61 respectively), but not depression. Treatment delivery format influenced outcomes for anxiety (uncontrolled ESs: group: g=.70, individual: g=.97, computer/internet: g=.96) and depression (uncontrolled ESs: group: g=.89, individual: g=.86, computer/internet: g=.96). Preliminary evidence from 4 comparisons with disorder-specific treatments suggests that transdiagnostic treatments are as effective for reducing anxiety, and may be superior for reducing depression. These findings show that transdiagnostic psychological treatments are efficacious, but higher quality research studies are needed to explore the sources of heterogeneity amongst treatment effects.

KEYWORDS:

Anxiety; Depression; Meta-analysis; Systematic review; Transdiagnostic; Treatment outcome

PMID:
26094079
DOI:
10.1016/j.cpr.2015.06.002
[Indexed for MEDLINE]
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