A web-based transdiagnostic intervention for affective and mood disorders: randomized controlled trial.
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Abstract
BACKGROUND: Research increasingly supports a transdiagnostic conceptualization of emotional disorders (ie applying the same underlying treatment principles across mental disorders, without tailoring the protocol to specific diagnoses), and many international researchers are currently investigating this issue. OBJECTIVE: The aim of this study was to evaluate the efficacy and acceptability of a Web-based transdiagnostic program using a sample of Romanian adults diagnosed with anxiety and/or depression. METHODS: Volunteer participants registered for the study and completed a series of online self-report measures. Participants who fulfilled basic inclusion criteria on these measures were contacted for a telephone diagnostic interview using the Structural Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition Axis I Disorders (SCID-I). Enrolled participants were randomized to either the active treatment group (N=69) or the wait-list control group (N=36) using a 2:1 ratio. The transdiagnostic treatment was based on the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP; Barlow et al, 2011) that addresses common underlying mechanisms of anxiety and depression. Participants randomized to the active treatment condition received 10 weeks of Web-based treatment based on the UP. Throughout treatment, graduate students in clinical psychology provided guidance that consisted of asynchronous written communication on a secure Web platform. After the intervention, participants in both study conditions were invited to complete a set of self-report measures and a postintervention SCID-I interview conducted by a different team of graduate students blinded to participants' group and diagnostic status. Six months later, participants in the active treatment group were invited to complete an online follow-up assessment. RESULTS: During the intervention, active treatment participants completed on average 19 homework assignments (SD 12.10), and we collected data from 79.0% (83/105) at postintervention and 51% (35/69) at follow-up for self-report measures. Postintervention SCID-I interviews were collected from 77.1% (81/105) participants. Relative to the wait-list control group, the transdiagnostic intervention yielded overall medium to large effect sizes for the primary outcome measures (within-group Hedges g=0.52-1.34 and between-group g=0.39-0.86), and also for anxiety sensitivity (g=0.80), symptom interference (g=0.48), and quality of life (g=0.38). Significant within-groups effects only were reported for the active treatment group on Panic Disorder Severity Scale-Self Report (PDSS-SR, g=0.58-0.65) and Yale-Brown Obsessive Compulsive Scale (Y-BOCS, g=0.52-0.58). CONCLUSIONS: Insignificant between-group differences for the Y-BOCS and PDSS-SR could be explained by the small number of participants with the associated primary diagnostic (eg, only 3 participants with obsessive compulsive disorder) by the choice of outcome measure (PDSS-SR was not rated among the evidence-based measures) and by the fact that these disorders may be more difficult to treat. However, the overall results suggest that the transdiagnostic intervention tested in this study represents an effective treatment option that may prove easier to disseminate through the use of Web-based delivery systems. TRIAL REGISTRATION: ClinicalTrials.gov CT02739607; https://clinicaltrials.gov/ct2/show/study/NCT02739607 (Archived by WebCite at http://www.webcitation.org/6yY1VeYIZ).
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Tulbure et al. (2018) found that the 9UP, relative to a wait-list control, yielded medium to large effect sizes for primary and secondary outcomes immediately after treatment and 6 months later.
“Recently, Tulbure et al. (2018) delivered a shorter version of the UP that consisted of 9 web-based sessions (9UP) and found that relative to the wait-list control group, the intervention yielded medium to large effect sizes for the primary (e.g., anxiety, depression) and secondary (e.g., anxiety sensitivity) outcome measures.”
From Can We Boost Treatment Adherence to an Online Transdiagnostic Intervention by Adding Self-Enhancement Strategies? Results From a Randomized Controlled Non-inferiority Trial (2021) · cites this paper as Tulbure et al., 2018
The Results sections on primary and secondary outcomes report improvements relative to the wait-list group immediately after treatment, including anxiety, depression, and anxiety sensitivity. But some between-group effects were small (primary outcomes as low as g=0.39), and the Methods (Statistical Methods; page unavailable) state that six-month follow-up measures were collected only for the treatment group. The paper therefore does not support a six-month effect relative to the wait-list group. (LLM, conf=0.90)
Experimental — accuracy not yet measuredAge, gender, and baseline treatment credibility were included as covariates in all linear mixed models.
“As in the previous trial on 9UP (Tulbure et al., 2018), we included age, gender, and treatment credibility (which was assessed at baseline) as covariates in all LMM models.”
From Can We Boost Treatment Adherence to an Online Transdiagnostic Intervention by Adding Self-Enhancement Strategies? Results From a Randomized Controlled Non-inferiority Trial (2021) · cites this paper as Tulbure et al., 2018
The Methods, Statistical Methods section (page unavailable) says the trial added gender and treatment credibility to its between-group linear mixed models, but lists previous psychotherapy—not age—as the other covariate. It describes treatment adherence as a covariate in the follow-up models, so the cited paper does not support the claim that age, gender, and credibility were included in all models. (LLM, conf=0.91)
Experimental — accuracy not yet measuredIn the previous trial of the online 9UP, the sum of homework assignments completed correlated with treatment effectiveness.
“We used this operationalization since it correlated with the treatment effectiveness in the previous trial of the online 9UP (Tulbure et al., 2018).”
From Can We Boost Treatment Adherence to an Online Transdiagnostic Intervention by Adding Self-Enhancement Strategies? Results From a Randomized Controlled Non-inferiority Trial (2021) · cites this paper as Tulbure et al., 2018
In Tulbure et al. (2018), each participant's number of finished assignments correlated negatively with the number of clinical disorders diagnosed at post-treatment (r = -0.23).
“Importantly, each participant’s number of finished assignments correlated negatively with the number of clinical disorders diagnosed at post-treatment (r = –0.23).”
From Can We Boost Treatment Adherence to an Online Transdiagnostic Intervention by Adding Self-Enhancement Strategies? Results From a Randomized Controlled Non-inferiority Trial (2021) · cites this paper as Tulbure et al., 2018
In Tulbure et al. (2018), participants completed on average a bit less than 50% of the homework assignments.
“from the maximum of homework assignments, on average, participants completed a bit less than 50% of them.”
From Can We Boost Treatment Adherence to an Online Transdiagnostic Intervention by Adding Self-Enhancement Strategies? Results From a Randomized Controlled Non-inferiority Trial (2021) · cites this paper as Tulbure et al., 2018
The 9UP intervention was perceived as credible, and participants declared themselves satisfied with the program.
“Moreover, the intervention was perceived as credible, and participants declared themselves to be satisfied with the program.”
From Can We Boost Treatment Adherence to an Online Transdiagnostic Intervention by Adding Self-Enhancement Strategies? Results From a Randomized Controlled Non-inferiority Trial (2021) · cites this paper as Tulbure et al., 2018
On average, participants in both groups completed only approximately half of the assignments.
“Hence, on average, participants of both groups managed to work only on approximately half the assignments (as also in the previous validation of the web-based 9UP; Tulbure et al., 2018).”
From Can We Boost Treatment Adherence to an Online Transdiagnostic Intervention by Adding Self-Enhancement Strategies? Results From a Randomized Controlled Non-inferiority Trial (2021) · cites this paper as Tulbure et al., 2018
The dropout rate recorded in this study was higher than previously recorded on 9UP (Tulbure et al., 2018) and similar for both groups, with almost half the sample lost at post-intervention and another 20% at follow-up.
“the dropout rate recorded in our study was higher than previously recorded on 9UP (Tulbure et al., 2018) and similar for both groups (i.e., almost half the sample was lost at post-intervention and another 20% at follow-up).”
From Can We Boost Treatment Adherence to an Online Transdiagnostic Intervention by Adding Self-Enhancement Strategies? Results From a Randomized Controlled Non-inferiority Trial (2021) · cites this paper as Tulbure et al., 2018
The short version of Barlow's UP (9UP) retained the essential ingredients of Barlow's protocol and was previously proven effective.
“This short version of Barlow’s UP (9 web-based modules or the 9UP) that retained the essential ingredients of Barlow’s protocol was previously proven effective (see Tulbure et al., 2018; for details regarding this web-based intervention).”
From Can We Boost Treatment Adherence to an Online Transdiagnostic Intervention by Adding Self-Enhancement Strategies? Results From a Randomized Controlled Non-inferiority Trial (2021) · cites this paper as Tulbure et al., 2018
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- Authors
- Tulbure, B. T., Rusu, A., Sava, F. A., Sălăgean, N., & Farchione, T. J.
- Affiliations
- West University of Timişoara (RO)
- Boston University (US)
- Corresponding author
- Tulbure, Bogdan Tudor
- Venue
- JMIR Mental Health
- Publisher
- JMIR Publications Inc.
- Published
- 2018-05-24
- Volume
- 5
- Issue
- 2
- Pages
- e36
- ISSN
- 2368-7959 (ISSN-L)
- PMC
- PMC5992454
- OpenAlex
- W2803586052
- Cited by
- 43
- References
- 66
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 7 · 2023: 10 · 2022: 4 · 2021: 5 · 2020: 5 · 2019: 3 · 2018: 1
- FWCI
- 4.41
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR Mental Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Keywords
- transdiagnostic treatment, online intervention, Unified Protocol for Transdiagnostic Treatment of Emotional Disorders, anxiety disorders, depression, mood disorders, anxiety sensitivity, symptom interference, quality of life, treatment acceptability, homework adherence, Romanian adults, waitlist control, treatment efficacy, panic disorder, generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder
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