A University of Houston researcher has found that patients suffering from anxiety disorders showed the most improvement when treated with cognitive-behavioral therapy (CBT) — in conjunction with a “transdiagnostic” approach, which allows therapists to use one kind of treatment no matter what the anxiety.
The problem up to now, according to Peter Norton, Ph.D., an associate professor in clinical psychology and director of the Anxiety Disorder Clinic at the University of Houston, has been that each anxiety disorder — such as panic disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), social anxiety disorder, and phobias — has had a targeted treatment.
The transdiagnostic approach recognizes that many overlapping dimensions exist among these anxiety disorders. It suggests that thinking about anxiety disorders as a whole from a behavioral dimension and/or psychological dimension perspective may yield important insights into these disorders.
Norton, who says the specific treatments aren’t all that different from each other, has shown that a combination of CBT with the transdiagnostic approach has proven more effective than CBT combined with other types of anxiety disorder treatments, such as relaxation training.
“The Diagnostic and Statistical Manual of Mental Disorders (DSM) has been an important breakthrough in understanding mental health, but people are dissatisfied with its fine level of differentiation,” he said. The DSM uses a categorical approach to classifying mental disorders, including anxiety concerns.
“Panic disorders are considered something different from social phobia, which is considered something different from PTSD. The hope was that by getting refined in the diagnosis we could target interventions for each of these diagnoses, but in reality that just hasn’t played out.”
Norton’s research began 10 years ago when he was a graduate student in Nebraska and found he couldn’t get enough people together on the same night to run a group session for social phobia.
“What I realized is that I could open a group to people with anxiety disorders in general and develop a treatment program regardless of the artificial distinctions between social phobia and panic disorder, or obsessive-compulsive disorder, and focus on the core underlying things that are going wrong,” said Norton.
He says cognitive-behavioral therapy, which has a specific time frame and goals, is the most effective treatment as it helps patients understand the thoughts and feelings that influence their behaviors. The twist for him was using CBT in conjunction with the transdiagnostic approach.
The patients receiving the transdiagnostic treatment showed considerable improvement, especially with treating comorbid diagnoses, a disease or condition that co-exists with a primary disease and can stand on its own as a specific disease, like depression. Anxiety disorders often occur with a secondary illness, such as depression or substance and alcohol abuse, he noted.
“What I have learned from my past research is that if you treat your principal diagnosis, such as social phobia, you are going to show improvement on some of your secondary diagnosis,” he said. “Your mood is going to get a little better, your fear of heights might dissipate. So there is some effect there, but when we approach things with a transdiagnostic approach, we see a much bigger impact on comorbid diagnoses.”
“In my research study, over two-thirds of [co-existing] diagnoses went away, versus what we typically find when I’m treating a specific diagnosis such as a panic disorder, where only about 40 percent of people will show that sort of remission in their secondary diagnosis,” he continued.
“The transdiagnostic treatment approach [appears to be] more efficient in treating the whole person rather than just treating the diagnosis… then treating the next diagnoses.”
Norton notes the larger contributions of the studies are to guide further development and interventions for how clinical psychologists, therapists and social workers treat people with anxiety disorders. The data collected will be useful for people out on the front lines to effectively treat people to reduce anxiety disorders, he said.
Source: University of Houston