Transdiagnostic approaches: Why a single treatment for anxiety disorders?

As of 2013, there are twelve anxiety-disorder diagnoses and over twenty-five subtypes and categories of these disorders, with specific treatments for about half of them. Research has demonstrated that these treatments, particularly cognitive behavioral ones (Hofmann and Smits 2008; Norton and Price 2007), help most people recover from anxiety disorders. Over the last few years, however, researchers have studied the effectiveness of general, rather than specific ones for anxiety disorders. These new treatments target core factors thought to maintain anxiety disorders in general (Erickson 2003).

There are several advantages to using a single treatment for anxiety disorders. First, many people have anxiety symptoms that don’t quite meet the full criteria for a particular anxiety disorder. For example, someone might have features of social phobia and obsessive-compulsive disorder, but too few of the symptoms to meet the criteria for one over the other. Often, psychotherapists diagnose these individuals with anxiety disorder not otherwise specified (NOS). At this time, we don’t have a specific treatment for anxiety disorder NOS, nor do we know how many people have this diagnosis. A treatment that targets common factors in all anxiety disorders might help anxiety disorder NOS too. Furthermore, a single treatment that targets the central factors thought responsible for excessive anxiety and fearfulness might improve the lives of people who do not have an anxiety disorder but would like strategies to manage the excessive anxiety they experience from time to time.

See also: Transdiagnostic Approaches to Anxiety and Avoidance

Second, more than half of people with one anxiety disorder have another anxiety disorder too (Brown et al. 2001). This means that in treating specific anxiety disorders, you must seek multiple treatments for each disorder, one at a time. For example, if you have both social phobia and panic disorder, you might first receive treatment for panic disorder, followed by treatment for social phobia, or vice versa. Either way, you must delay treatment of one of your anxiety disorders until you have recovered from the other. A single treatment that targets common factors and teaches common skills might help people recover more quickly without the need to complete multiple treatments in sequence. This can save people time, money, and suffering.

Third, research suggests that the factors that are common to anxiety disorders might be common to other emotional disorders, such as depressive disorders, as well (Fairholme et al. 2010). For example, nearly half of the people who have a major depressive episode in their lifetimes also have an anxiety disorder (Regier et al. 1998). Therefore, people who have both an anxiety disorder and a depressive disorder might benefit from a single treatment that targets the common factors that contribute to both of these conditions. Furthermore, even if the person with an anxiety disorder is not depressed, he might learn common skills that will help him recover from or manage his depression if he becomes depressed later in life.

The final and perhaps most compelling reason that a single treatment for anxiety disorders makes sense—apart from simplifying your life and the lives of psychotherapists—is that there appears to be considerable overlap among the active components of treatments for different anxiety disorders (Norton 2006). Most treatments include strategies to increase your awareness of your anxious experience as well as the parts of your anxious response that contribute to it. And most treatments include ways to change your anxious thoughts, as well as to decrease your avoidance of your anxious response and the situations and objects linked to it.

Finally, most treatments include strategies to decrease the frequency of your anxiety-driven behaviors, such as checking or reassurance seeking, and to increase your willingness to practice the skills in this book, including stepping toward discomfort, rather than away from it. Because all of these treatments help, researchers suggest that these common skills or strategies might tap into factors found in all anxiety disorders. A single treatment that more directly targets the essential factors that maintain problematic anxiety and avoidance might benefit more people, and appears to work as well as the specific treatments for these disorders—at least the cognitive behavioral ones (McEvoy, Nathan, and Norton 2009), which are the psychological treatments of choice for anxiety disorders.

We’ll continue looking at some of the skills and strategies you can teach clients to change the way they experience and follow up on their anxious responses, from the new groundbreaking workbook by renowned psychologist Michael Tompkins, PhD, Anxiety and Avoidance.

References

Hofmann, S. G., and J. A. J. Smits. 2008. “Cognitive-Behavioral Therapy for Adult Anxiety Disorders: A Meta-Analysis of Randomized Placebo-Controlled Trials.” Journal of Clinical Psychiatry 69 (4): 621–32.

Norton, P. J., and E. C. Price. 2007. “A Meta-Analytic Review of Adult Cognitive-Behavioral Treatment Outcome across the Anxiety Disorders.” Journal of Nervous and Mental Disease 195(6): 521–31.

Erickson, D. H. 2003.“Group Cognitive Behavioural Therapy for Heterogeneous Anxiety Disorders.”Cognitive Behaviour Therapy 32 (4): 179–86.

Brown, T. A., L. A. Campbell, C. L. Lehman, J. R. Grisham, and R. B. Mancill. 2001. “Current and Lifetime Comorbidity of the DSM-IV Anxiety and Mood Disorders in a Large Clinical Sample.” Journal of Abnormal Psychology 110 (4): 585–99.

Regier, D. A., D. S. Rae, W. E. Narrow, C. T. Kaelber, and A. F. Schatzberg. 1998. “Prevalence of Anxiety Disorders and Their Comorbidity with Mood and Addictive Disorders.” British Journal of Psychiatry, Suppl. 34: 24–28.

Fairholme, C. P., C. L. Boisseau, K. K. Ellard, J. T. Ehrenreich, and D. H. Barlow. 2010. “Emotions,Emotion Regulation, and Psychological Treatment: A Unified Perspective.” In EmotionRegulation and Psychopathology: A Transdiagnostic Approach to Etiology and Treatment, edited by A. M. Kring and D. M. Sloan, 283–309. New York: The Guilford Press.

Norton, P. J. 2006. “Toward a Clinically-Oriented Model of Anxiety Disorders.” Cognitive Behaviour Therapy 35 (2): 88–105.

McEvoy, P. M., P. Nathan, and P. J. Norton. 2009. “Efficacy of Transdiagnostic Treatments: A Review of Published Outcome Studies and Future Research Directions.” Journal of Cognitive Psychotherapy 23 (1): 27–40.