Transdiagnostic Treatment of Co-occurrence of Anxiety and Depressive Disorders based on Repetitive Negative Thinking: A Case Series
Abstract
Objective: The transdiagnostic cognitive behavioral treatments for treating the coexistence of anxiety and mood disorders received useful empirical supports in the recent years. However, these treatments still have moderate efficacy. Following the improvements and developments in transdiagnostic protocols and considering the importance of repetitive negative thinking as a core transdiagnostic factor in emotional disorders, this study examined a new form of transdiagnostic treatment based on Repetitive Negative Thinking (TTRNT) of co-occurrence of anxiety and depressive disorders.
Methods: Treatment efficacy was assessed using single case series with multiple baselines. Three patients meeting the criteria for co-occurrence of anxiety and depressive disorders were selected using the Anxiety Disorders Interview Schedule for DSM-IV. The patients were treated individually for 12 weekly sessions. Participants completed the standardized outcome measures during the baseline, treatment and one-month follow-up.
Results: At post-treatment, all participants showed significant clinical changes on a range of standardized outcome measures, and these gains were largely maintained through the one-month follow-up both in the principle and co-principal diagnosis.
Conclusions: Although the results of this preliminary investigation indicated that TTRNT could be a time effective and efficient treatment for individuals with co-occurrence of anxiety and depressive disorders, further controlled clinical trials are necessary to examine this new treatment approach.
Kessler RC, Berglund P, Demler O, Jin R, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey replication. Arch Gen Psychiatry 2005; 62: 593-602.
Brown T A, Campbell LA, Lehman CL, Grisham JR, Mancill RB. Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. J Abnorm Psychol 2001; 110: 585–599.
Kessler RC, Nelson CB, McGonagle KA, Lui J, Swartz M, Blazer DG. Comorbidity of DSM-III-R major depressive disorder in the general population: Results from the National Comorbidity Survey. Br J Psychiatry 1996; 168: 17-30.
Kessler RC, Stang PE, Wittchen HU, Ustan TB, RoyByrne PP, Walters EE. Lifetime panic-depression comorbidity in the National Comorbidity Survey. Arch Gen Psychiatry. 1998; 55: 801–808.
Clark LA, Watson D. Tripartite model of anxiety and depression: Psychometric evidence and taxonomic implications. J Abnorm Psychol 1991; 103: 103-116.
Brown TA, Campbell LA, Lehman CL, Grisham JR, Mancill RB. Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. J Abnorm Psychol 2001; 110: 49-58.
Brown TA. Temporal course and structural relationships among dimensions of temperament and DSM-IV anxiety and mood disorders. J Abnorm Psychol 2007; 116: 313–328.
Brown TA, Barlow DH. A proposal for a dimensional classification system based on the shared features of the DSM-IV anxiety and mood disorders: Implications for assessment and treatment. Psychol Assess 2009; 21: 256-271.
Antony MM, Stein MB, Eds. Handbook of anxiety disorders. New York: Oxford University Press; 2009.
Barlow DH. Anxiety and its disorders: The nature and treatment of anxiety and panic. 2nd ed. New York: Guilford Press; 2002.
Norton PJ, Price EC. A meta-analytic review of adult cognitive-behavioral treatment outcome across anxiety disorders. J Nerv Ment Dis 2007; 195: 521-531.
Smits JA, Hoffman SG. A meta-analytic review of the effects of psychotherapy control conditions for anxiety disorders. Psychol Med. 2008; 39: 229-239.
Barlow DH, Allen LB, Choate ML. Toward a unified treatment for emotional disorders. Behav Ther 2004; 35: 205-230.
McHugh RK, Murray HW, Barlow DH. Balancing fidelity and adaptation in the dissemination of empirically-supported treatments: The promise of transdiagnostic interventions. Behav Res Ther 2009; 47: 946-953.
Norton PJ, Philipp LM. Transdiagnostic approaches to the treatment of anxiety disorders: A quantitative review. Psychotherapy 2008; 45: 214-226.
McEvoy PM, Nathan P, Norton P. Efficacy of Transdiagnostic Treatments: A Review of Published Outcome Studies and Future Research Directions. Int J Cogn Ther. 2009; 23: 20-33.
Mansell W, Harvey A, Watkins E, Shafran R. Conceptual foundations of the transdiagnostic approach to CBT. J Cogn Psychother 2009; 23: 6-19.
Mansell W, Harvey A, Watkins E, Shafran R. Cognitive Behavioral Processes across Psychological Disorders: A Review of the Utility and Validity of the Transdiagnostic Approach. Int J Cogn Ther 2009; 1: 181–191,
Clark DA, Taylor S. The Transdiagnostic Perspective on Cognitive-Behavioral Therapy for Anxiety and Depression: New Wine for Old Wineskins? J Cogn Psychother. 2009; 23: 60-66.
Mansell W. Keep it Simple-The Transdiagnostic Approach to CBT. Int J Cogn Ther 2008; 1: 179–180.
Brown GP, Roach A, Irving L, Joseph K. Personal Meaning: A Neglected Transdiagnostic Construct. Int J Cogn Ther 2008; 1: 223-236.
Dozois DJA, Collins KA. Transdiagnostic Approaches to the Prevention of Depression and Anxiety. Int J Cogn Ther 2009; 23: 44-59.
Norton PJ, Hayes SA, Springer JR. Transdiagnostic cognitive-behavioral group therapy for anxiety: Outcome and process. Int J Cogn Ther 2008; 1: 266-279.
Barlow DH, Farchione TJ, Fairholme CP, Ellard KK, Boisseau CL, Allen LB, Ehrenreich MJ. The unified protocol for transdiagnostic treatment of emotional disorders: Therapist guide. New York: Oxford University Press; 2011.
Ellard KK, Fairholme CP, Boisseau CL, Farchione T, Barlow DH. Unified protocol for the transdiagnostic treatment of emotional disorders: Protocol development and initial outcome data. Cogn Behav Pract 2010; 17: 88–101.
Farchione TJ, Fairholme CP, Ellard KK, Boisseau CL, Thompson-Hollands J, Carl JR, Gallagher M, Barlow DH. The unified protocol for the transdiagnostic treatment of emotional disorders: A randomized controlled trial. Behav Ther 2012; 43: 666-678.
Ehring T, Watkins ER. Repetitive negative thinking as a transdiagnostic process. Int J Cogn Ther 2008; 1: 192-205.
Spasojevic J, Alloy LB. Rumination as a common mechanism relating depressive risk factors to depression. Emotion 2001; 1: 25-37.
Harvey AG, Watkins ER, Mansell W, Shafran R. Cognitive behavioural processes across psychological disorders: A transdiagnostic approach to research and treatment. Oxford: Oxford University Press; 2004.
McEvoy PM, Moulds ML, Mahoney AE J. Mechanisms driving pre- and post-stressor repetitive negative thinking: metacognitions, cognitive avoidance, and thought control. J Behav Ther Exp Psychiatry 2013; 44: 84–93.
McEvoy PM, Mahoney A, Perini S, Kingsep P. Changes in metacognitions and post-event processing during a course of cognitive behaviour group therapy for social phobia. J Anxiety Disord 2009; 23: 617–623.
Raes F. Repetitive Negative Thinking Predicts Depressed Mood at 3-Year Follow-up in Students. J Psychopathol Behav Assess 2012; 34: 497–501.
Akbari M, Shaieri MR, Roshan R, Ladan F. The transdiagnostic protocol based on repetitive negative thinking of emotional disorders: Therapist guide. [Unpublished treatment manual]. 2013.
Barlow DH, Hersen M. Single case experimental designs: Strategies for studying behavior change. 2nd ed. Newton, MA: Allyn & Bacon; 1984.
Brown TA, DiNardo PA, Lehman CL, Campbell LA. Reliability of DSM-IV anxiety and mood disorders: Implications for the classification of emotional disorders. J Abnorm Psychol 2001; 110: 49-58.
Mohammadi A, Birashk B. Gharraee B. Comparison of the effect of group transdiagnostic therapy and group cognitive therapy on anxiety and depressive symptoms. [Dissertation]. [Tehran]: Tehran University of Medical Sciences; 2011.
Beck AT, Steer RA, Brown GK. Manual for the Beck Depression Inventory–II. San Antonio, TX: Psychological Corporation; 1996.
Dozois DJA, Dobson KS, Ahnberg JL. A psychometric evaluation of the Beck Depression Inventory-II. Psychol Assess 1998; 10: 83-89.
Ghassemzadeh H, Mojtabai R, Karamghadiri N, Ebrahimkhani N. Psychometric properties of a Persian-language version of the Beck Depression Inventory-Second edition: BDI-IIPERSIAN. Depress Anxiety 2005; 21: 185-192.
Steer RA, Ranieri WF, Beck AT, Clark DA. Further evidence for the validity of the Beck Anxiety Inventory with psychiatric disorders. J Anxiety Disord 1993; 7: 195–205.
Fata L, Birashk B, Atefvahid M, Dabson K. Meaning Assignment Structures/ Schema, Emotional States and Cognitive Processing of Emotional Information: Comparing Two Conceptual Frameworks. IJPCP 2005; 11: 312-326
Watson D, Clark LA, Tellegen A. Development and validation of brief measures of positive and negative affect: The PANAS scales. J Pers Soc Psychol 1988; 54: 1063-1070.
Bakhshipour Roodsari A, Dejkam M, Mehryar A, Birashk B. Structural Relationships between Dimensions of DSM-IV Anxiety and Depressive Disorders and Dimensions of Tripartite Model. IJPCP 2004; 9: 63-76
McEvoy PM, Mahoney AEJ, Moulds ML. Are worry, rumination, and post-event processing one and the same? Development of the repetitive thinking questionnaire. J Anxiety Disord 2010; 24: 509-519.
Meyer TJ, Miller ML, Metzger RL, Borkovec TD. Development and validation of the Penn State Worry Questionnaire. Behav Res Ther 1990; 28: 487-495.
Nolen-Hoeksema S, Morrow J, Fredrickson BL. Response styles and the duration of episodes of depressed mood. J Abnorm Psychol 1993; 102: 20-28.
McEvoy PM, Kingsep P. The post-event processing questionnaire in a clinical sample with social phobia. Behav Res Ther 2006; 44: 1689-1697.
Khaleghi S, Liaghat R, Ganjdanesh Y. The repetitive thinking questionnaire: psychometric properties in Iranian students and relationship with depression, anxiety and social anxiety. Paper presented at the 2nd international conference on psychiatry and psychotherapy-PSYCHO; 2011 Feb 23-25; Cambridge: UK.
Mundt JC, Marks IM, Shear MK, Greist JM. The work and social adjustment scale: A simple measure of impairment in functioning. Br J Psychiatry 2002; 180: 461-464.
Brown TA, Barlow DH. Long-term outcome in cognitive behavioral treatment of panic disorder: Clinical predictors and alternative strategies for assessment. J Consult Clin Psychol 1995; 63: 754–756.
Soleimani M, Mohamadkhani P, Dolatshahi B. A Comparative Study of Group Behavioral Activation Treatment and Group Cognitive Therapy in Reducing Subsyndromal Anxiety and Depressive Symptoms. [Dissertation]. [Tehran]: University of Social Welfare and Rehabilitation Sciences; 2011.
Goodman WK, Price LH, Ramussen SA, Mazure C, Fleischmann RL, Hill CL, et al. The Yale–Brown obsessive compulsive scale: I. Development, use and reliability. Arch Gen Psychiatry 1989; 46: 1006-1011.
Taylor S. Assessment of obsessions and compulsions: Reliability, validity, and sensitivity to treatment effects. Clin Psychol Rev 1995; 15: 261–296.
van Oppen P, Emmelkamp PMG, van Balkom ALM, van Dyck R. The sensitivity to change of measures for obsessive–compulsive disorder. J Anxiety Disord 1995; 9: 241–248.
Rabiei M, Khormdel K, Kalantari K, Molavi H. Validity of the Yale-Brown Obsessive Compulsive Scale modified for Body Dysmorphic Disorder (BDD) in students of the University of Isfahan. IJPCP 2010; 15: 343-350.
Molina S, Borkovec TD. The Penn State Worry Questionnaire: psychometric properties and associated characteristics. In: Davey GCL, Tallis F, editors. Worrying: perspectives on theory, assessment and treatment. New York: Wiley; 1994..
Brown TA, Antony MM, Barlow DH. Psychometric properties of the Penn State Worry Questionnaire in a clinical anxiety disorders sample. Behav Res Ther 1992; 30: 33–37.
van Rijsoort S, Emmelkamp P, Vervaeke G. The Penn State Worry Questionnaire and the Worry Domains Questionnaire: structure, reliability and validity. Clin Psychol Psychother 1999; 6: 297–307.
Borkovec TD, Costello E. Efficacy of applied relaxation and cognitive behavioral therapy in the treatment of generalized anxiety disorder. J Consult Clin Psychol 1993; 61: 611–619.
Startup HM, Erickson TM. The Penn State Worry Questionnaire (PSWQ). In Davey GCL, Wells A, editors. Worry and its psychological disorders: Theory, assessment and treatment. Chichester, UK: Wiley; 2006.
Shirinzadeh Dastgiri S, Gudarzi MA, Ghanizadeh A, Naghavi SMR. Comparison of metacognitive and responsibility beliefs in patients with obsessive-compulsive disorder, generalized anxiety disorder and normal individuals. IJPCP. 2008; 14: 46-55.
Wells A. Metacognitive therapy for anxiety and depression. New York: Guilford Press; 2009.
Todman JB, Dugard P. Single-case and small-n experimental designs: A practical guide to randomization tests. London: Lawrence Erlbaum; 2001.
Parsonson BS, Baer DM. The visual analysis of data, research into the stimuli controlling it. In Kratochwill TR, Levin JR, editors. Single-case research design and analysis: New directions for psychology and education. Hillsdale, NJ: Lawrence Erlbaum; 1992.
Jacobson NS, Truax P. Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol. 1991; 59: 12–19.
Jacobson NS, Follette WC, Revenstorf D. Psychotherapy outcome research: methods for reporting variability and evaluating clinical significance. Behav Ther 1984; 15: 336-352.
Pallanti S, Hollander E, Bienstock C, Koran L, Leckman JF, Marazziti D, et al. Treatment non-response in OCD: Methodological issues and operational definitions. Int J Neuropsychopharmacol 2002; 5: 181–191.
Fisher, P. L. The efficacy of psychological treatments for generalised anxiety disorder. In Davey GCL, Wells A, editors. Worry and its psychological disorders: Theory, assessment and treatment. Chichester, UK: Wiley; 2006.
Cohen J. Statistical power analysis for the behavioral sciences. revised ed. New York: Academic Press; 1977.
Watkins E, Scott J, Wingrove J, Rimes K, Bathurst N, Steiner H, et al. Rumination-focused cognitive behaviour therapy for residual depression: a case series. Behav Res Ther 2007; 45: 2144-2154.
Wells A, Sembi S. Metacognitive therapy for PTSD: a preliminary investigation of a new brief treatment. J Behav Ther Exp Psychiatry 2004; 35: 307-318.
Searson R, Mansell W, Lowens I, Tai S. Think Effectively About Mood Swings (TEAMS): A case series of cognitive behavioural therapy for bipolar disorders. J Behav Ther Exp Psychiat 2012; 43: 770-779.
Mundt JC, Clarke GN, Burroughs D, Brenneman DO, Griest JH. Effectiveness of antidepressant pharmacotherapy: the impact of medication compliance and patient education. Depress Anxiety 2001; 13: 1-10.
Erickson DH, Janeck AS, Tallman K. A cognitive-behavioral group for patients with various anxiety disorders. Psychiatr Serv. 2007; 58: 1205-1211.
McEvoy PM, Nathan P. Effectiveness of cognitive behavior therapy for diagnostically heterogenous groups: A benchmarking study. J Consult Clin Psychol 2007; 75: 344-350.
Norton PJ. An open trial of a transdiagnostic cognitive-behavioral group therapy for anxiety disorder. Behav Ther. 2008; 39: 242-250.
Norton PJ, Hope DA. Preliminary evaluation of a broad-spectrum cognitive-behavioral group therapy for anxiety. J Behav Ther Exp Psychiatry 2005; 36: 79-97.
Mohammadi A, Birashk B, Gharraee B. Comparison of the Effect of Group Transdiagnostic Treatment and Group Cognitive Therapy on Emotion Regulation . IJPCP. 2014; 19:187-94.
Fairburn CG, Cooper Z, Shafran R. Cognitive behaviour therapy for eating disorders: A "transdiagnotic" theory and treatment. Behav Res Ther 2003; 41: 509-528.
Addis ME, Wade WA, Hatgis C. Barriers to dissemination of evidence-based practices: Addressing practitioners’ concerns about manual-based psychotherapies. Clin Psychol 1999; 4: 430-441.
Barlow DH, Levitt JT, Bufka LF. The dissemination of empirically supported treatments: A view to the future. Behav Res Ther 1999; 37: 147-162.
McHugh RK, Barlow DH. Dissemination and implementation of evidence-based psychological interventions: A review of current efforts. Am Psychol 2010; 65: 73-84.
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Issue | Vol 10 No 3 (2015) | |
Section | Articles | |
Keywords | ||
Transdiagnostic Treatment Repetitive Negative Thinking Anxiety Depression |
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