Transdiagnostic versus Diagnosis-Specific Group Cognitive Behavioral Therapy for Anxiety Disorders and Depression: A Randomized Controlled Trial

Reinholt, Nina; Hvenegaard, Morten; Christensen, Anne Bryde; Eskildsen, Anita; Hjorthøj, Carsten; Poulsen, Stig; Arendt, Mikkel Berg; Rosenberg, Nicole Kristjansen; Gryesten, Jasmin Rejaye; Aharoni, Ruth Nielsen; Alrø, Anja Johnsen; Christensen, Clas Winding; Arnfred, Sidse Marie

doi:10.1159/000516380

Cited by 55Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and ApplicationsPsychological Treatments and Assessments

Transdiagnostic versus Diagnosis-Specific Group Cognitive Behavioral Therapy for Anxiety Disorders and Depression: A Randomized Controlled Trial

Reinholt, Nina, Hvenegaard, Morten, Christensen, Anne Bryde, Eskildsen, Anita, Hjorthøj, Carsten, Poulsen, Stig, Arendt, Mikkel Berg, Rosenberg, Nicole Kristjansen +5 more·2022·Psychotherapy and Psychosomatics

DOI 10.1159/000516380

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Abstract

Introduction: The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) delivered in a group format could facilitate the implementation of evidence-based psychological treatments. Objective: This study compared the efficacy of group UP and diagnosis-specific cognitive behavioral therapy (dCBT) for anxiety and depression in outpatient mental health services. Methods: In this pragmatic, multi-center, single-blinded, non-inferiority, randomized controlled trial (RCT), we assigned 291 patients with major depressive disorder, social anxiety disorder, panic disorder, or agoraphobia to 14 weekly sessions in mixed-diagnosis UP or single-diagnosis dCBT groups. The primary test was non-inferiority, using a priori criteria, on the World Health Organisation 5 Well-Being Index (WHO-5) at the end of the treatment. Secondary outcomes were functioning and symptoms. We assessed outcomes at baseline, end-of-treatment, and at a 6-month follow-up. A modified per-protocol analysis was performed. Results: At end-of-treatment, WHO-5 mean scores for patients in UP (n = 148) were non-inferior to those of patients in dCBT (n = 143; mean difference –2.94; 95% CI –8.10 to 2.21). Results were inconclusive for the WHO-5 at the 6-month follow-up. Results for secondary outcomes were non-inferior at end-of-treatment and the 6-month follow-up. Client satisfaction and rates of attrition, response, remission, and deterioration were similar across conditions. Conclusions: This RCT demonstrated non-inferior acute-phase outcomes of group-delivered UP compared with dCBT for major depressive disorder, social anxiety disorder, panic disorder, and agoraphobia in outpatient mental health services. The long-term effects of UP on well-being need further investigation. If study findings are replicated, UP should be considered a viable alternative to dCBT for common anxiety disorders and depression in outpatient mental health services.

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In a Danish multicenter randomized controlled trial (n = 291), only approximately half of the included subjects no longer fulfilled the diagnostic criteria for their illness at the end of the intervention.
“The results of this trial indicated that only approximately half of the included subjects no longer fulfilled the diagnostic criteria for their illness at the end of the intervention [21].”
From Results of a randomized controlled superiority trial of the effect of modified collaborative assessment vs. standard assessment on patients’ readiness for psychotherapy (CO-ASSM-RCT) (2024) · cites this paper as [21]
Considerable dropout is observed from current psychotherapy interventions, exemplified by the mentioned trial, where only 65% of patients completed treatment across conditions.
“Moreover, considerable dropout is observed from current psychotherapy interventions, exemplified by the mentioned trial, where only 65% of patients completed treatment across conditions [21].”
From Results of a randomized controlled superiority trial of the effect of modified collaborative assessment vs. standard assessment on patients’ readiness for psychotherapy (CO-ASSM-RCT) (2024) · cites this paper as [21]
In a recently finalized multicenter randomized controlled trial of 291 patients with anxiety disorders or depression, only half of the patients no longer met diagnostic criteria for their principal diagnosis by the end of treatment.
“In this trial, 291 patients with anxiety disorders or depression received standardized treatment programs from three Danish mental health services, and the results suggested that only half of the patients no longer met diagnostic criteria for their principal diagnosis by the end of treatment [22].”
From Social phobia and evasiveness: trial protocol for a randomized controlled feasibility and superiority trial of the effect of Modified Collaborative Assessment vs. standard assessment on patients’ readiness for psychotherapy (CO-ASSM-RCT) (2023) · cites this paper as [22]

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Authors: Reinholt, N., Hvenegaard, M., Christensen, A. B., Eskildsen, A., Hjorthøj, C., Poulsen, S., Arendt, M. B., Rosenberg, N. K., Gryesten, J. R., Aharoni, R. N., Alrø, A. J., Christensen, C. W., & Arnfred, S. M.
Affiliations: Copenhagen University Hospital (DK)
Aarhus University Hospital (DK)
University of Copenhagen (DK)
ORCID: Reinholt, Nina
Hvenegaard, Morten
Christensen, Anne Bryde
Eskildsen, Anita
Hjorthøj, Carsten
Poulsen, Stig
Rosenberg, Nicole Kristjansen
Gryesten, Jasmin Rejaye
Arnfred, Sidse Marie
Venue: Psychotherapy and Psychosomatics
Publisher: S. Karger AG
Published: 2021-06-10
Volume: 91
Issue: 1
Pages: 36-49
ISSN: 0033-3190 (ISSN-L)
1423-0348
DOI: 10.1159/000516380
OpenAlex: W3168264487
Cited by: 55
References: 51
Citations by year: 2026: 3 · 2025: 10 · 2024: 14 · 2023: 18 · 2022: 8 · 2021: 2
FWCI: 10.15
Type: journal article
Language: en
Open access: closed
Licence: www.karger.com/Services/SiteLicenses (vor)
www.karger.com/Services/SiteLicenses (tdm)
Locations: Psychotherapy and Psychosomatics (publishedVersion)
PubMed (publishedVersion)
Research at the University of Copenhagen (University of Copenhagen) (publishedVersion)
Scopus (Elsevier) (submittedVersion)
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
Keywords: transdiagnostic treatment, Unified Protocol for Transdiagnostic Treatment of Emotional Disorders, group cognitive behavioral therapy, anxiety disorders, depression, major depressive disorder, social anxiety disorder, panic disorder, agoraphobia, non-inferiority, outpatient mental health services
MeSH terms: Anxiety Disorders, Depression, Depressive Disorder, Major, Major Depressive Disorder, Humans, Cognitive Behavioral Therapy, Treatment Outcome

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Transdiagnostic versus Diagnosis-Specific Group Cognitive Behavioral Therapy for Anxiety Disorders and Depression: A Randomized Controlled Trial

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