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Emergence of Transdiagnostic Treatments for PTSD and Posttraumatic Distress

  • Disaster Psychiatry: Trauma, PTSD, and Related Disorders (E Foa and A Asnaani, Section Editors)
  • Published:
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Abstract

Both theoretical and empirical findings have demonstrated similarities across diagnoses, leading to a growing interest in transdiagnostic interventions. Most of the evidence supporting transdiagnostic treatment has accumulated for depression, anxiety, and eating disorders, with minimal attention given to posttraumatic stress disorder and other reactions to traumatic stressors. Although single-diagnosis protocols are effective for posttraumatic stress disorder (PTSD) and other trauma-related disorders, in principle, transdiagnostic approaches may have beneficial applications within a traumatized population. This paper defines different types of transdiagnostic treatments, reviews transdiagnostic approaches used in related disorders, and discusses their applicability to PTSD. Examples are drawn from existing transdiagnostic treatments in order to provide a framework for the application of such interventions to the field of traumatic stress. Implications for implementation and dissemination are also discussed.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Barlow DH, Sauer-Zavala S, Carl JR, Bullis JR, Ellard KK. The nature, diagnosis, and treatment of neuroticism: back to the future. Clin Psychol Sci. 2014;2(3):344–65. doi:10.1177/2167702613505532. A review of the role of neuroticism in emotional disorders with an emphasis on research supporting its role from genetics and neurobiological factors, to psychological factors. The paper suggests considering treating disorders from the level of higher-order dimensions of personality rather than a diagnosis level.

    Article  Google Scholar 

  2. Barlow DH, Allen LB, Choate ML. Toward a unified treatment for emotional disorders. Behav Ther. 2004;35(2):205–30. doi:10.1016/S0005-7894(04)80036-4.

    Article  Google Scholar 

  3. Moses EB, Barlow DH. A New unified treatment approach for emotional disorders based on emotion science. Curr Dir Psychol Sci. 2006;15(3):146–50. doi:10.2307/20183098.

    Article  Google Scholar 

  4. McEvoy PM, Nathan P, Norton PJ. Efficacy of transdiagnostic treatments: a review of published outcome studies and future research directions. J Cogn Psychot. 2009;23(1):20–33. doi:10.1891/0889-8391.23.1.20.

    Article  Google Scholar 

  5. Borkovec TD, Abel JL, Newman H. Effects of psychotherapy on comorbid conditions in generalized anxiety disorder. J Consult Clin Psych. 1995;63:479–83.

    Article  CAS  Google Scholar 

  6. Brown TA, Antony MM, Barlow DH. Diagnostic comorbidity in panic disorder: effect on treatment outcome and course of comorbid diagnoses following treatment. J Consult Clin Psych. 1995;63:408–18.

    Article  CAS  Google Scholar 

  7. Tsao JC, Lewin MR, Craske MG. The effects of cognitive-behavioral therapy for panic disorder on comorbid conditions. J Anxiety Disord. 1998;12:357–71.

    Article  CAS  PubMed  Google Scholar 

  8. Tsao JC, Mystkowski JL, Zucker BG, Craske MG. Effects of cognitive-behavioral therapy for panic disorder on comorbid conditions: replication and extension. Behav Ther. 2002;33:493–509.

    Article  Google Scholar 

  9. Tsao JC, Mystkowski JL, Zucker BG, Craske MG. Impact of cognitive-behavioral therapy for panic disorder on comorbidity: a controlled investigation. Behav Res Ther. 2005;43:959–70.

    Article  PubMed  Google Scholar 

  10. Fairburn C, Cooper Z, Shafran R. Cognitive behaviour therapy for eating disorders: a ‘transdiagnostic’ theory and treatment. Behav Res Ther. 2003;41(5):509–28. doi:10.1016/S0005-7967(02)00088-8.

    Article  PubMed  Google Scholar 

  11. Norton P. An open trial of a transdiagnostic cognitive-behavioral group therapy for anxiety disorder. Behav Ther. 2008;39(3):242–50. doi:10.1016/j.beth.2007.08.002.

    Article  PubMed  Google Scholar 

  12. Norton PJ, Hope DA. Preliminary evaluation of a broad-spectrum cognitive-behavioral group therapy for anxiety. J Behav Ther Exp Psy. 2005;36:79–97.

    Article  Google Scholar 

  13. Ellard KK, Fairholme CP, Boisseau CL, Farchione TJ, Barlow DH. Unified protocol for the transdiagnostic treatment of emotional disorders: protocol development and initial outcome data. Cog Behav Pract. 2010;17(1):88–101. doi:10.1016/j.cbpra.2009.06.002.

    Article  Google Scholar 

  14. Farchione TJ, Fairholme CP, Ellard KK, Boisseau CL, Thompson-Hollands J, Carl JR, et al. Unified protocol for transdiagnostic treatment of emotional disorders: a randomized controlled trial. Behav Ther. 2012;43(3):666–78. doi:10.1016/j.beth.2012.01.001.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Bullis J, Sauer-Zavala S, Bentley K, Thompson-Hollands J, Carl J, Barlow DH. The unified protocol for transdiagnostic treatment of emotional disorders: preliminary exploration of effectiveness for group delivery. Behav Modif. 2015;39(2):295–321. doi:10.1177/0145445514553094. A pilot study examinig the unified protocol in group treatment across diverse symptoms presentations found moderate to strong effects.

    Article  PubMed  Google Scholar 

  16. McEvoy PM, Nathan PJ. Effectiveness of cognitive behaviour therapy for diagnostically heterogenous groups: a benchmarking study. J Consult Clin Psych. 2007;75:344–50.

    Article  Google Scholar 

  17. Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiat. 1995;52:1048–60. doi:10.1001/archpsyc.1995.03950240066012.

    Article  CAS  PubMed  Google Scholar 

  18. 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(4):585–99.

    Article  CAS  PubMed  Google Scholar 

  19. Sauer-Zavala S, Gutner C, Farchione T, Boettcher H, Bullis JR, Barlow DH. Current definitions of “transdiagnostic” in treatment development: a search for consensus. Under review. A review that outlines three key ways in which the word "transdiagnostic" is used, and advantages and disadvantages to each approach.

  20. Harvey A, Murray G, Chandler R, Soehner A. Sleep disturbance as transdiagnostic: consideration of neurobiological mechanisms. Clin Psychol Rev. 2011;31(2):225–35. doi:10.1016/j.cpr.2010.04.003.

    Article  PubMed  Google Scholar 

  21. Insel T, Cuthbert B, Garvey M, Heinssen R, Pine DS, Quinn K, et al. Research domain criteria (RDoC): toward a new classification framework for research on mental disorders. Am J Psychiat. 2010;167(7):748–51.

    Article  PubMed  Google Scholar 

  22. Chorpita BF, Weisz JR. Modular approach to therapy for children with anxiety, depression, or conduct problems. Honolulu and Boston: University of Hawaii at Manoa and Judge Baker Children’s Center, Harvard Medical School; 2005.

    Google Scholar 

  23. Chorpita BF, Taylor AA, Francis SE, Moffitt C, Austin AA. Efficacy of modular cognitive behavior therapy for childhood anxiety disorders. Behav Ther. 2004;35(2):263–87.

    Article  Google Scholar 

  24. Murray LK, Dorsey S, Haroz E, Lee C, Alsiary MM, Haydary A, et al. A common elements treatment approach for adult mental health problems in low- and middle-income countries. Cog Behav Pract. 2014;21(2):111–23. doi:10.1016/j.cbpra.2013.06.005. A description of the transdiagnostic Common Elements Treatment Approach and initialpilot data from low- and middle-income countries.

    Article  Google Scholar 

  25. Bolton P, Lee C, Haroz EE, Murray L, Dorsey S, Robinson C, et al. A transdiagnostic community-based mental health treatment for comorbid disorders: development and outcomes of a randomized controlled trial among Burmese refugees in Thailand. PLoS Med. 2014;11(11):e1001757. doi:10.1371/journal.pmed.1001757. A randomized trial treating Burmese Refugees trauma survivors in Thailand found the common elements treatment approach was highly effective in decreasing symptoms compared to waitlist controls when delivered by lay counselors.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Weiss WM, Murray LK, Zangana GAS, Mahmooth Z, Kaysen D, Dorsey S, et al. Community-based mental health treatments for survivors of torture and militant attacks in Southern Iraq: a randomized control trial. BMC Psychiatry. 2015;15(1):1–16. doi:10.1186/s12888-015-0622-7. A randomized trial finding cognitive processing therapy and common elements treatment approach reduced primary and comorbid symptoms in survivors of systematic violence in Southern Iraq when delivered by non-specialized health workers.

    Article  Google Scholar 

  27. Chorpita BF, Weisz JR, Daleiden EL, Schoenwald SK, Palinkas LA, Miranda J, et al. Long-term outcomes for the Child STEPs randomized effectiveness trial: a comparison of modular and standard treatment designs with usual care. J Consult Clin Psych. 2013;81(6):999. A randomized effectiveness trial demonstrating the incremental benefits of MATCH over usual care.

    Article  Google Scholar 

  28. Leichsenring F, Salzer S. A unified protocol for the transdiagnostic psychodynamic treatment of anxiety disorders: an evidence-based approach. Psychother. 2014;51(2):224–45. doi:10.1037/a0033815. A discussion of the need for, and development of, a unified protocol for the transdiagnostic psychodynamic treatment of anxiety disorders.

    Article  Google Scholar 

  29. Beck AT. Cognitive therapy and the emotional disorders. Madison: International Universities; 1976.

    Google Scholar 

  30. Butler AC, Chapman JE, Forman EM, Beck AT. The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clin Psychol Rev. 2006;100:316–36.

    Google Scholar 

  31. Dobson KS. A meta-analysis of the efficacy of cognitive therapy for depression. J Consult Clin Psych. 1989;57(3):414–9. doi:10.1037/0022-006X.57.3.414.

    Article  CAS  Google Scholar 

  32. Gaffan EA, Tsaousis J, Kemp-Wheeler SM. Researcher allegiance and meta-analysis: the case of cognitive therapy for depression. J Consult Clin Psych. 1995;63(6):966–80. doi:10.1037/0022-006X.63.6.966.

    Article  CAS  Google Scholar 

  33. Beck AT. Thinking and depression: I. Idiosyncratic content and cognitive distortions. Arch Gen Psych. 1963;9(4):324–33.

    Article  CAS  Google Scholar 

  34. Hollon SD, DeRubeis RJ, Shelton RC, Amsterdam JD, Salomon RM, O’Reardon JP, et al. Prevention of relapse following cognitive therapy vs medications in moderate to severe depression. Arch Gen Psych. 2005;62(4):417–22.

    Article  Google Scholar 

  35. Ehlers A, Clark DM. A cognitive model of posttraumatic stress disorder. Behav Res Ther. 2000;38(4):319–45.

    Article  CAS  PubMed  Google Scholar 

  36. Rogers C. Client-centered therapy. Cambridge: Riverside Press; 1951.

    Google Scholar 

  37. Abbass AA, Hancock JT, Henderson J, Kisely SR. Short-term psychodynamic psychotherapies for common mental disorders. Cochrane Db Syst Rev. 2006;4. doi: 10.1002/14651858.CD004687.pub3

  38. Baer RA. Mindfulness-based treatment approaches: clinician’s guide to evidence base and applications. Burlington: Elsevier; 2006.

    Google Scholar 

  39. Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. J Consult Clin Psych. 2010;78(2):169–83. doi: 2010-05835-004.

    Article  Google Scholar 

  40. Walser RD, Westrup D. Acceptance and commitment therapy for the treatment of post-traumatic stress disorder and trauma-related problems: a practitioner’s guide to using mindfulness and acceptance strategies. Oakland, CA: New Harbinger Publications; 2007

  41. Barlow DH. Disorders of emotion. Psychol Inq. 1991;2(58-71). doi:10.1207/s15327965pli0201_15

  42. Barlow DH, Farchione TJ, Fairholme CP, Ellard KK, Boisseau CL, Allen LB, et al. The unified protocol for transdiagnostic treatment of emotional disorders: therapist guide. New York: Oxford University Press; 2011.

    Google Scholar 

  43. Resick PA, Monson CM, Chard KM. Cognitive processing therapy: veteran/military version: therapist and patient materials manual. Washington: Department of Veterans Affairs; 2014.

    Google Scholar 

  44. Lang AJ, Schnurr PP, Jain S, Feng H, Walser RD, Bolton E et al. Randomized controlled trial of Acceptance and Commitment Therapy for distress and impairment in OEF/OIF/OND veterans. Psychological trauma: theory, research, practice, and policy. in press. A randomized trial found modest effects for both Acceptance and Commitment Therapy (ACT) and Present Centered Therapy (PCT) across a variety of outcomes related to posttraumatic distress. However, ACT did not outperform PCT.

  45. Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther. 2006;44:1–25.

    Article  PubMed  Google Scholar 

  46. Schnurr PP, Friedman MJ, Engel CC, Foa EB, Shea MT, Resick PM, et al. Issues in the design of multisite clinical trials of psychotherapy: VA Cooperative Study No. 494 as an example. Contemp Clin Trials. 2005;26(6):626–36. doi:10.1016/j.cct.2005.09.001.

    Article  PubMed  Google Scholar 

  47. Shin LM, Liberzon I. The neurocircuitry of fear, stress, and anxiety disorders. Neuropsychopharmacol. 2010;35(1):169–91. doi:10.1038/npp.2009.83.

    Article  Google Scholar 

  48. Breslau N, Schultz L. Neuroticism and post-traumatic stress disorder: a prospective investigation. Psychol Med. 2013;43(08):1697–702. A study confirming the role of neuroticism as diathesis in PTSD through prospective data.

    Article  CAS  PubMed  Google Scholar 

  49. Foa EB, Hembree EA, Rothbaum BO. Prolonged exposure therapy for PTSD: emotional processing of traumatic experiences therapist guide. Treatments that work. USA: Oxford University Press; 2007.

    Book  Google Scholar 

  50. Karlin BE, Ruzek JI, Chard KM, Eftekhari A, Monson CM, Hembree EA, et al. Dissemination of evidence‐based psychological treatments for posttraumatic stress disorder in the Veterans Health Administration. J Trauma Stress. 2010;23(6):663–73. doi:10.1002/jts.20588.

    Article  PubMed  Google Scholar 

  51. Health Do. Improving access to psychological therapies implementation plan. 2008.

    Google Scholar 

  52. Hayes SC, Strosahl KD, Wilson KG. Acceptance and commitment therapy: an experiential approach to behavior change. New York: Guilford Press; 1999.

    Google Scholar 

  53. Gallo KP, Barlow DH. Factors involved in clinician adoption and nonadoption of evidence-based interventions in mental health. Clin Psychol-Sci Pr. 2012;19(1):93–106. doi:10.1111/j.1468-2850.2012.01276.x.

    Article  Google Scholar 

  54. von Ranson KM, Robinson KE. Who is providing what type of psychotherapy to eating disorder clients? A survey. Int J Eat Disorder. 2006;39(1):27–34. doi:10.1002/eat.20201.

    Article  Google Scholar 

  55. Segal ZV, Williams JMG, Teasdale JD. Mindfulness-based cognitive therapy for depression. New York, NY: Guilford Press; 2012.

  56. Wang PS, Lane M, Olfson M, Pincus HA, Wells KB, Kessler RC. Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Arch Gen Psych. 2005;62(6):629–40. doi:10.1001/archpsyc.62.6.629.

    Article  Google Scholar 

  57. Norton PJ, Whittal ML. Thematic similarity and clinical outcome in obsessive–compulsive disorder group treatment. Depress Anxiety. 2004;20(4):195–7.

    Article  PubMed  Google Scholar 

  58. Watson D, Clark LA. The mood and anxiety symptom questionnaire. Unpublished manuscript, University of Iowa, Department of Psychology, Iowa City. 1991

  59. Lovibond SH, Lovibond PF. Manual for the depression anxiety stress scales (2nd Ed). Sydney: Psychology Foundation; 1995.

    Google Scholar 

  60. Rosellini AJ. Initial development and validation of a dimensional classification system for the emotional disorders. Unpublished Doctoral Dissertation Boston, MA: Boston University. 2013

  61. Rosellini AJ, Boettcher H, Brown TA, Barlow DH. A transdiagnostic temperament-phenotype profile approach to emotional disorder classification: an update. Psychopathol Rev. 2015;2:110–28. A summary of limitations of a using a categorical approach to the diagnosis of emotional disorders. This paper also provides and overview of the Multidimensional Emotional Disorder Index.

    Article  Google Scholar 

  62. Bass JK, Annan J, McIvor Murray S, Kaysen D, Griffiths S, Cetinoglu T, et al. Controlled trial of psychotherapy for Congolese survivors of sexual violence. New Engl J Med. 2013;368(23):2182–91. doi:10.1056/NEJMoa1211853. A trial of group Cognitive Processing Therapy in the Democratic Republic of Congo demonstrated significant improvements in PTSD and trauma-related symptoms.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. National Center for PTSD, Women’s Health Sciences Division, Boston University School of Medicine, 150 South Huntington Avenue, (116B-3), Boston, MA, 02130, USA

    Cassidy A. Gutner & Tara Galovski

  2. National Center for PTSD, Behavioral Science Division, Boston University School of Medicine, 150 South Huntington Avenue, (116B-3), Boston, MA, 02130, USA

    Michelle J. Bovin

  3. National Center for PTSD, Executive Division, VA Medical Center (116D), 215 North Main St, White River Junction, VT, 05009, USA

    Paula P. Schnurr

  4. Geisel School of Medicine at Dartmouth, Hanover, NH, 03755, USA

    Paula P. Schnurr

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  1. Cassidy A. Gutner
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  2. Tara Galovski
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  3. Michelle J. Bovin
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  4. Paula P. Schnurr
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Correspondence to Cassidy A. Gutner.

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Conflict of Interest

Cassidy A. Gutner, Michelle J. Bovin, and Paula P. Schnurr declare that they have no conflict of interest.

Tara Galovski has received funding from NIH and SAMHSA over the course of the last several years for a number of grants.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Disaster Psychiatry: Trauma, PTSD, and Related Disorders

Dr. Gutner was supported by a National Institute of Mental Health grant (1K23MH103396-01A1).

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Gutner, C.A., Galovski, T., Bovin, M.J. et al. Emergence of Transdiagnostic Treatments for PTSD and Posttraumatic Distress. Curr Psychiatry Rep 18, 95 (2016). https://doi.org/10.1007/s11920-016-0734-x

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  • DOI: https://doi.org/10.1007/s11920-016-0734-x

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