Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-27T05:15:16.945Z Has data issue: false hasContentIssue false

Transdiagnostic Versus Construct-Specific Cognitive Behavioural Therapy for Emotional Disorders in Patients with High Anxiety Sensitivity: A Double-Blind Randomised Clinical Trial

Published online by Cambridge University Press:  22 April 2021

Reza Ahmadi
Affiliation:
Department of Clinical Psychology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
Roya Ahmadizadeh
Affiliation:
Department of Clinical Psychology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
Mohsen Hasani
Affiliation:
Department of Clinical Psychology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
Omid Saed*
Affiliation:
Department of Clinical Psychology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
*
*Corresponding author: Omid Saed, Department of Clinical Psychology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, 4513615788, Iran. Email: o.saed@zums.ac.ir
Get access

Abstract

Anxiety sensitivity (AS) is a common vulnerability in emotional disorders. Due to the pathological role of AS, individuals with high AS are faced with emotional problems. Thus, cognitive behavioural interventions try to reduce these problems by targeting AS. The present study aimed to compare the efficacy of transdiagnostic cognitive behavioural therapy (T-CBT) and construct-specific CBT (CS-CBT) on AS, anxiety, depression, and positive and negative affect in these patients. To this end, 40 patients with high AS were randomly assigned to one of the three groups of T-CBT, CS-CBT, and wait list. Participants were assessed using the Anxiety and Related Disorders Interview Schedule for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Anxiety Sensitivity Index-3, Beck Anxiety Inventory, Beck Depression Inventory-II, and Positive and Negative Affect Schedule at baseline, post-treatment, 3-month follow-up, and 6-month follow-up. The findings showed that T-CBT and CS-CBT have a significant effect on AS, anxiety, and negative affect; however, contrary to T-CBT, CS-CBT is not effective for reducing depression and positive affect. T-CBT had a more promising efficacy than CS-CBT in all treatment outcomes. The results show better and more stable efficacy of T-CBT among patients with high AS. It is essential to consider AS as a target for cognitive behavioural intervention for the spectrum of emotional disorders.

Type
Standard Paper
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of the Australian Association for Cognitive and Behaviour Therapy

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Asmundson, GJ, Weeks, JW, Carleton, RN, Thibodeau, MA and Fetzner, MG (2011). Revisiting the latent structure of the anxiety sensitivity construct: More evidence of dimensionality. Journal of Anxiety Disorders, 25, 138147.CrossRefGoogle Scholar
Bardhoshi, G, Duncan, K and Erford, BT (2016). Psychometric meta-analysis of the English version of the Beck Anxiety Inventory. Journal of Counseling & Development, 94, 356373.CrossRefGoogle Scholar
Barlow, DH, Farchione, TJ, Bullis, JR, Gallagher, MW, Murray-Latin, H, Sauer-Zavala, S, et al. (2017). The Unified Protocol for transdiagnostic treatment of emotional disorders compared with diagnosis-specific protocols for anxiety disorders: A randomized clinical trial. JAMA Psychiatry, 74, 875884.CrossRefGoogle ScholarPubMed
Beck, AT and Steer, RA (1984). Internal consistencies of the original and revised Beck Depression Inventory. Journal of Clinical Psychology, 40, 13651367.3.0.CO;2-D>CrossRefGoogle ScholarPubMed
Beck, AT, Ward, CH, Mendelson, M, Mock, J and Erbaugh, J (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561571.CrossRefGoogle ScholarPubMed
Beck, AT, Epstein, N, Brown, G and Steer, RA (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893897.CrossRefGoogle ScholarPubMed
Blakey, SM, Abramowitz, JS, Reuman, L, Leonard, RC and Riemann, BC (2017). Anxiety sensitivity as a predictor of outcome in the treatment of obsessive-compulsive disorder. Journal of Behavior Therapy and Experimental Psychiatry, 57, 113117.CrossRefGoogle ScholarPubMed
Boswell, JF, Sauer-Zavala, SE, Gallagher, MW, Delgado, NK and Barlow, DHJPR (2012). Readiness to change as a moderator of outcome in transdiagnostic treatment. Psychotherapy Research, 22, 570578.CrossRefGoogle ScholarPubMed
Boswell, JF, Farchione, TJ, Sauer-Zavala, S, Murray, HW, Fortune, MR and Barlow, DH (2013). Anxiety sensitivity and interoceptive exposure: A transdiagnostic construct and change strategy. Behavior Therapy, 44, 417431.CrossRefGoogle ScholarPubMed
Boswell, JF, Anderson, LM and Barlow, DH (2014). An idiographic analysis of change processes in the unified transdiagnostic treatment of depression. Journal of Consulting and Clinical Psychology, 82, 10601071.CrossRefGoogle ScholarPubMed
Brown, TA and Barlow, DH (2014). Anxiety and related disorders interview schedule for DSM-5, adult and lifetime version: clinician manual. New York: Oxford University Press.Google Scholar
Dixon, LJ, Sy, JT, Kemp, JJ and Deacon, B (2013). Does anxiety sensitivity cause panic symptoms? An experimental investigation. Journal of Experimental Psychopathology, 4, 208223.CrossRefGoogle Scholar
Ellard, KK, Fairholme, CP, Boisseau, CL, Farchione, TJ and Barlow, DH (2010). Unified Protocol for the transdiagnostic treatment of emotional disorders: Protocol development and initial outcome data. Cognitive and Behavioral Practice, 17, 88101.CrossRefGoogle ScholarPubMed
Eustis, EH, Cardona, N, Nauphal, M, Sauer-Zavala, S, Rosellini, AJ, Farchione, TJ, et al. (2020). Experiential avoidance as a mechanism of change across cognitive-behavioral therapy in a sample of participants with heterogeneous anxiety disorders. Cognitive Therapy and Research, 44, 275286.CrossRefGoogle Scholar
Farchione, TJ, Fairholme, CP, Ellard, KK, Boisseau, CL, Thompson-Hollands, J, Carl, JR, et al. (2012). Unified Protocol for transdiagnostic treatment of emotional disorders: A randomized controlled trial. Behavior Therapy, 43, 666678.CrossRefGoogle ScholarPubMed
Gallagher, MW, Payne, LA, White, KS, Shear, KM, Woods, SW, Gorman, JM, et al. (2013). Mechanisms of change in cognitive behavioral therapy for panic disorder: The unique effects of self-efficacy and anxiety sensitivity. Behaviour Research and Therapy, 51, 767777.CrossRefGoogle ScholarPubMed
Ghisi, M, Bottesi, G, Altoè, G, Razzetti, E, Melli, G and Sica, C (2016). Factor structure and psychometric properties of the Anxiety Sensitivity Index-3 in an Italian community sample. Frontiers in Psychology, 7, 160.CrossRefGoogle Scholar
Keough, ME and Schmidt, NB (2012). Refinement of a brief anxiety sensitivity reduction intervention. Journal of Consulting and Clinical Psychology, 80, 766772.CrossRefGoogle ScholarPubMed
Khakpoor, S, Mohammadi Bytamar, J and Saed, O (2019a). Reductions in transdiagnostic factors as the potential mechanisms of change in treatment outcomes in the Unified Protocol: A randomized clinical trial. Research in Psychotherapy: Psychopathology, Process and Outcome, 22(3), 402412.Google Scholar
Khakpoor, S, Saed, O and Armani Kian, A (2019b). Emotion regulation as the mediator of reductions in anxiety and depression in the Unified Protocol (UP) for transdiagnostic treatment of emotional disorders: Double-blind randomized clinical trial. Trends in Psychiatry and Psychotherapy, 41 , 227 236.CrossRefGoogle Scholar
Lakens, D (2013). Calculating and reporting effect sizes to facilitate cumulative science: A practical primer for t-tests and ANOVAs. Frontiers in Psychology, 4, 863. doi: 10.3389/fpsyg.2013.00863CrossRefGoogle ScholarPubMed
Leue, A and Lange, S (2011). Reliability generalization: An examination of the positive affect and negative affect schedule. Assessment, 18, 487501.CrossRefGoogle ScholarPubMed
Naragon-Gainey, K (2010). Meta-analysis of the relations of anxiety sensitivity to the depressive and anxiety disorders. Psychological Bulletin, 136, 128150.CrossRefGoogle ScholarPubMed
Norr, AM, Allan, NP, Macatee, RJ, Keough, ME and Schmidt, NB (2014). The effects of an anxiety sensitivity intervention on anxiety, depression, and worry: Mediation through affect tolerances. Behaviour Research and Therapy, 59, 1219.CrossRefGoogle ScholarPubMed
Oh, H, Park, K, Yoon, S, Kim, Y, Lee, S-H, Choi, YY, et al. (2018). Clinical utility of Beck Anxiety Inventory in clinical and nonclinical Korean samples. Frontiers in Psychiatry, 9, 666. doi: 10.3389/fpsyt.2018.00666CrossRefGoogle ScholarPubMed
Olthuis, JV, Watt, MC, Mackinnon, SP and Stewart, SH (2014a). Telephone-delivered cognitive behavioral therapy for high anxiety sensitivity: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 82, 10051022.CrossRefGoogle Scholar
Olthuis, JV, Watt, MC and Stewart, SH (2014b). Anxiety Sensitivity Index (ASI-3) subscales predict unique variance in anxiety and depressive symptoms. Journal of Anxiety Disorders, 28, 115124.CrossRefGoogle Scholar
Otto, MW, Smits, JA, Fitzgerald, HE, Powers, MB and Baird, SO (2019) The clinician's guide to anxiety sensitivity treatment and assessment. Elsevier, pp. 179193.CrossRefGoogle Scholar
Pompoli, A, Furukawa, TA, Efthimiou, O, Imai, H, Tajika, A and Salanti, G (2018). Dismantling cognitive-behaviour therapy for panic disorder: A systematic review and component network meta-analysis. Psychological Medicine, 48, 19451953.CrossRefGoogle ScholarPubMed
Reiss, S, Peterson, RA, Gursky, DM and McNally, RJ (1986). Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behaviour Research and Therapy, 24, 18.CrossRefGoogle ScholarPubMed
Riskind, JH, Black, D and Shahar, G (2010). Cognitive vulnerability to anxiety in the stress generation process: Interaction between the Looming Cognitive Style and Anxiety Sensitivity. Journal of Anxiety Disorders, 24, 124128.CrossRefGoogle ScholarPubMed
Sakiris, N and Berle, D (2019). A systematic review and meta-analysis of the Unified Protocol as a transdiagnostic emotion regulation based intervention. Clinical Psychology Review, 72, 101751.CrossRefGoogle ScholarPubMed
Sauer-Zavala, S, Boswell, JF, Gallagher, MW, Bentley, KH, Ametaj, A and Barlow, DH (2012). The role of negative affectivity and negative reactivity to emotions in predicting outcomes in the Unified Protocol for the transdiagnostic treatment of emotional disorders. Behaviour Research and Therapy, 50, 551557.CrossRefGoogle ScholarPubMed
Sauer-Zavala, S, Bentley, KH, Steele, SJ, Tirpak, JW, Ametaj, AA, Nauphal, M, et al. (2019). Treating depressive disorders with the Unified Protocol: A preliminary randomized evaluation. Journal of Affective Disorders 264, 438445.CrossRefGoogle ScholarPubMed
Schmidt, NB, Zvolensky, MJ and Maner, JK (2006). Anxiety sensitivity: Prospective prediction of panic attacks and Axis I pathology. Journal of Psychiatric Research, 40, 691699.CrossRefGoogle ScholarPubMed
Schmidt, NB, Eggleston, AM, Woolaway-Bickel, K, Fitzpatrick, KK, Vasey, MW and Richey, JA (2007). Anxiety Sensitivity Amelioration Training (ASAT): A longitudinal primary prevention program targeting cognitive vulnerability. Journal of Anxiety Disorders, 21, 302319.CrossRefGoogle ScholarPubMed
Schmidt, NB, Mitchell, MA and Richey, JA (2008). Anxiety sensitivity as an incremental predictor of later anxiety symptoms and syndromes. Comprehensive Psychiatry, 49, 407412.CrossRefGoogle ScholarPubMed
Stewart, S and Watt, M (2007). Overcoming the fear of fear: How to reduce anxiety sensitivity. Oakland: New Harbinger Publications.Google Scholar
Taylor, S, Koch, WJ, Woody, S and McLean, P (1996). Anxiety sensitivity and depression: How are they related? Journal of Abnormal Psychology, 105, 474479.CrossRefGoogle ScholarPubMed
Taylor, S, Zvolensky, MJ, Cox, BJ, Deacon, B, Heimberg, RG, Ledley, DR, et al. (2007). Robust dimensions of anxiety sensitivity: Development and initial validation of the Anxiety Sensitivity Index-3. Psychological Assessment, 19, 176188.CrossRefGoogle ScholarPubMed
Troy, AS, Shallcross, AJ, Brunner, A, Friedman, R and Jones, MC (2018). Cognitive reappraisal and acceptance: Effects on emotion, physiology, and perceived cognitive costs. Emotion, 18, 5874.CrossRefGoogle ScholarPubMed
Tulbure, BT, Rusu, A, Sava, FA, Salagean, N and Farchione, TJ (2018). A web-based transdiagnostic intervention for affective and mood disorders: Randomized controlled trial. JMIR Mental Health, 5, e36e36.CrossRefGoogle ScholarPubMed
Wang, YP and Gorenstein, C (2013). Psychometric properties of the Beck Depression Inventory-II: A comprehensive review. Brazilian Journal of Psychiatry, 35, 416431.CrossRefGoogle ScholarPubMed
Watson, D, Clark, LA and Carey, G (1988). Positive and negative affectivity and their relation to anxiety and depressive disorders. Journal of Abnormal Psychology, 97, 346353.CrossRefGoogle ScholarPubMed
Wheaton, MG, Deacon, BJ, McGrath, PB, Berman, NC and Abramowitz, JS (2012). Dimensions of anxiety sensitivity in the anxiety disorders: Evaluation of the ASI-3. Journal of Anxiety Disorders, 26, 401408.CrossRefGoogle ScholarPubMed
Wilamowska, ZA, Thompson-Hollands, J, Fairholme, CP, Ellard, KK, Farchione, TJ and Barlow, DH (2010). Conceptual background, development, and preliminary data from the Unified Protocol for transdiagnostic treatment of emotional disorders. Depression and Anxiety, 27, 882890.CrossRefGoogle ScholarPubMed
Wilner Tirpak, J, Cassiello-Robbins, C, Ametaj, A, Olesnycky, OS, Sauer-Zavala, S, Farchione, TJ, et al. (2019). Changes in positive affect in cognitive-behavioral treatment of anxiety disorders. General Hospital Psychiatry, 61, 111115.CrossRefGoogle ScholarPubMed
Wilson, KA and Hayward, C (2006). Unique contributions of anxiety sensitivity to avoidance: A prospective study in adolescents. Behaviour Research and Therapy, 44, 601609.CrossRefGoogle ScholarPubMed
Zinbarg, RE, Barlow, DH and Brown, TA (1997). Hierarchical structure and general factor saturation of the Anxiety Sensitivity Index: Evidence and implications. Psychological Assessment, 9, 277284.CrossRefGoogle Scholar