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Clinical Implications of a General Psychopathology Factor: A Cognitive–Behavioral Transdiagnostic Group Treatment for Community Mental Health

American Psychological Association
Journal of Psychotherapy Integration
Authors:
Matthew A Meier at Arizona State University
Matthew A Meier
Madeline Meier at Arizona State University
Madeline Meier
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Implicaciones clínicas de un factor general de psicopatología: un grupo de diagnóstico cognitivo-conductual Tratamiento para la salud mental comunitaria La investigación sobre la estructura subyacente de la psicopatología ha encontrado que un solo factor psicopatológico general puede ser la base de todos los trastornos mentales. Este hallazgo es consistente con décadas de investigación que muestran que los mismos factores de riesgo están asociados con muchos trastornos diferentes. Revisamos estos hallazgos y discutimos una implicación primaria: que los médicos podrían utilizar potencialmente el mismo tratamiento para individuos con diferentes trastornos mentales y comórbidos. Este enfoque transdiagnóstico no es un concepto nuevo, pero estos tratamientos están recibiendo un renovado interés. Se ha demostrado que los tratamientos transdiagnósticos recientemente desarrollados son efectivos en entornos de investigación, pero estos tratamientos no satisfacen varias necesidades de salud mental de la comunidad. En consecuencia, proporcionamos un fundamento basado en la evidencia para un tratamiento grupal cognitivo-conductual de inscripción continua y totalmente transdiagnóstico que se basa en la investigación sobre la estructura de la psicopatología. Concluimos con sugerencias para investigaciones futuras que integran investigación científica básica, investigación sobre tratamientos y práctica clínica.
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... Practically, although the PVI involves eight aspects and differences across classes in various aspects exist, we recommend that future intervention strategies employ universal transdiagnostic treatment protocols. We made this recommendation because universal therapy makes theoretical and pragmatic sense 20,80 . From a theoretical standpoint, the general p-factor implies that numerous different disorders share common risk factors 81 . ...
... From a theoretical standpoint, the general p-factor implies that numerous different disorders share common risk factors 81 . Interventions targeting different disorders comprise the same evidence-based modules (e.g., psychoeducation, setting treatment goals, and cognitive restructuring), suggesting that they treat the constituents of the pfactor and possibly the p-factor itself 80 . From a practical perspective, transdiagnostic treatment protocols are being tested with several notable successes 80,82 . ...
... Interventions targeting different disorders comprise the same evidence-based modules (e.g., psychoeducation, setting treatment goals, and cognitive restructuring), suggesting that they treat the constituents of the pfactor and possibly the p-factor itself 80 . From a practical perspective, transdiagnostic treatment protocols are being tested with several notable successes 80,82 . Certain therapies originally developed for specific disorders have been applied in transdiagnostic interventions due to their demonstrated effectiveness across various conditions 83 . ...
Development of the psychopathological vulnerability index for screening at-risk youths: a Rasch model approach
Article
Full-text available
  • Dec 2024
Accumulating research on mental health emphasizes the general factor of psychopathology (p-factor) that unites various mental health issues. This study develops a psychopathological vulnerability assessment for youths, evaluating its psychometric properties and clinical utility. An umbrella review conceptualized multifactor psychopathological vulnerability, leading to a 57-item pool. A total of 11,224 individuals participated in this study. The resulting 22-item psychopathological vulnerability index (PVI) fitted the unidimensional Rasch model, demonstrating a person separation reliability of 0.78 and a Cronbach’s alpha of 0.84. Cut-off points of 11 and 5, derived from latent class analysis, were used to distinguish vulnerable and high-protection populations. The PVI’s concurrent and predictive hit rates ranged from 36.00% to 53.57% in clinical samples. The PVI concretized the vulnerability–stress model for identifying at-risk youths and may facilitate universal interventions by integrating the theoretical foundations of bifactor S-1 models with key symptoms from network models for theoretically grounded approaches.
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... That is, some mental disorders are more highly correlated with each other. Studies about the structure of psychopathology result in the incorporation of disorder clusters in research and the growth of transdiagnostic treatment (17,18). According to an existing psychopathology structure model (i.e., "three factor model"), mental disorders can be organized into three broad clusters (or higher-order factors): internalizing disorders (e.g., depression, generalized anxiety disorder, panic disorder, and post-traumatic stress disorder), externalizing disorders (e.g., conduct disorder, alcohol dependence, cannabis dependence, other drug dependence, and tobacco addiction), and thought disorders [e.g., obsessive-compulsive disorder (OCD), mania, and schizophrenia] (19)(20)(21). ...
How Different Pre-existing Mental Disorders and Their Co-occurrence Affects COVID-19 Clinical Outcomes? A Real-World Data Study in the Southern United States
Article
Full-text available
  • Jun 2022
Background Although a psychiatric history might be an independent risk factor for COVID-19 infection and mortality, no studies have systematically investigated how different clusters of pre-existing mental disorders may affect COVID-19 clinical outcomes or showed how the coexistence of mental disorder clusters is related to COVID-19 clinical outcomes. Methods Using a retrospective cohort study design, a total of 476,775 adult patients with lab-confirmed and probable COVID-19 between March 06, 2020 and April 14, 2021 in South Carolina, United States were included in the current study. The electronic health record data of COVID-19 patients were linked to all payer-based claims data through the SC Revenue and Fiscal Affairs Office. Pre-existing mental disorder diagnoses from Jan 2, 2019 to Jan 14, 2021 were extracted from the patients' healthcare utilization data via ICD-10 codes. Results There is an elevated risk of COVID-19-related hospitalization and death among participants with pre-existing mental disorders adjusting for key socio-demographic and comorbidity covariates. Co-occurrence of any two clusters was positively associated with COVID-19-related hospitalization and death. The odds ratio of being hospitalized was 1.26 (95% CI: 1.151, 1.383) for patients with internalizing and externalizing disorders, 1.65 (95% CI: 1.298, 2.092) for internalizing and thought disorders, 1.76 (95% CI: 1.217, 2.542) for externalizing and thought disorders, and 1.64 (95% CI: 1.274, 2.118) for three clusters of mental disorders. Conclusions Pre-existing internalizing disorders and thought disorders are positively related to COVID-19 hospitalization and death. Co-occurrence of any two clusters of mental disorders have elevated risk of COVID-19-related hospitalization and death compared to those with a single cluster.
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... The authors emphasize that one of the benefits of this modular proposal is its flexibility regarding the order in which the skills are practiced and the time spent on each component. Moreover, to promote access to these treatments and improve their efficiency, they can be applied in group format (Meier & Meier, 2018 To sum up, published results which show the usefulness of both contextual and cognitive-behavioral transdiagnostic therapies also coincide in calling for an analysis of the differential efficacy and specificity of each therapy in the clinical change. Furthermore, of the contextual therapies, although BA and ACT understand the nature of the psychological problem in the same way, the focus of attention and the weight given to the different therapeutic tasks/resources is different in each one (Kanter et al., 2006;Levin et al., 2020). ...
Is Activation the Active Ingredient of Transdiagnostic Therapies? A Randomized Clinical Trial of Behavioral Activation, Acceptance and Commitment Therapy, and Transdiagnostic Cognitive-Behavioral Therapy for Emotional Disorders
Article
Full-text available
  • Apr 2022
  • BEHAV MODIF
Studying the usefulness of contextual and cognitive transdiagnostic therapies calls for an analysis of both their differential efficacy and their specificity when acting on the transdiagnostic conditions on which they focus. This controlled trial compares the post-treatment and 3- and 6-month follow-up effects of Behavioral Activation (BA), Acceptance and Commitment Therapy (ACT) and Cognitive-Behavioral Transdiagnostic Therapy (TD-CBT) on emotional symptomatology, and analyses the role played by Experiential Avoidance, Cognitive Fusion, Activation and Emotion Regulation in the clinical change. One hundred twenty-eight patients who fulfilled diagnostic criteria for anxiety and/or depression (intention-to-treat sample) were randomly assigned to three experimental group-treatment conditions (BA, n = 34; ACT, n = 27; TD-CBT n = 33) and one control group (WL, n = 34). Ninety-nine (77.34%) completed the treatment (per-protocol sample). In the post-treatment, all therapies reduced anxiety and depression symptomatology. In the follow-ups, the reduction in emotional symptomatology was greater in the condition which produced greater and more prolonged effects on Activation. Activation appears to be the principal condition in modifying all the transdiagnostic patterns and BA was the most efficacious and specific treatment. The trial was registered at ClinicalTrials.gov NCT04117464. Raw data are available online http://dx.doi.org/10.17632/krj3w2hfsj.1 .
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... That is, some mental disorders are more highly correlated with each other. Studies about the structure of psychopathology result in the incorporation of disorder clusters in research and the growth of transdiagnostic treatment (23,24). For example, according to an existing psychopathology structure model, i.e., "three factor model" (25), mental disorders can be organized into three broad clusters (or higher-order factors): "internalizing disorders" (people with internalizing disorders keep maladaptive emotions and cognitions to themselves or internalize problems, e.g., depression and anxiety), "externalizing disorders" (mental disorders characterized by externalizing behaviors, maladaptive behaviors directed toward an individual's environment, which cause impairment or interference in life functioning, e.g., antisocial and substance use disorders), and "thought disorders" (disturbance in cognition that adversely affects language and thought content, and thereby communication, e.g., schizophrenia and schizotypal personality All rights reserved. ...
How different pre-existing mental disorders and their co-occurrence affects clinical outcomes of COVID-19? A study based on real-world data in the Southern United States
Preprint
  • Oct 2021
Importance: A growing body of research focuses on the impact of pre-existing mental disorders on clinical outcomes of COVID-19 illness. Although a psychiatric history might be an independent risk factor for COVID-19 infection and mortality, no studies have systematically investigated how different clusters of pre-existing mental disorders may affect COVID-19 clinical outcomes or showed how the coexistence of mental disorder clusters is related to COVID-19 clinical outcomes. Objective: To explore how different pre-existing mental disorders and their co-occurrence affects COVID-19-related clinical outcomes based on real-world data. Design, Setting, and Participants: Using a retrospective cohort study design, a total of 476,775 adult patients with lab-confirmed and probable COVID-19 between March 06, 2020 and April 14, 2021 in South Carolina, United States were included in the current study. The electronic health record data of COVID-19 patients were linked to all payer-based claims data through the SC Revenue and Fiscal Affairs Office. Main Outcomes and Measures: Key COVID-19 clinical outcomes included severity, hospitalization, and death. COVID-19 severity was defined as asymptomatic, mild, and moderate/severe. Pre-existing mental disorder diagnoses from Jan 2, 2019 to Jan 14, 2021 were extracted from the patients healthcare utilization data via ICD-10 codes. Mental disorders were categorized into internalizing disorders, externalizing disorders, and thought disorders. Results: Of the 476,775 COVID-19 patients, 55,300 had pre-existing mental disorders. There is an elevated risk of COVID-19-related hospitalization and death among participants with pre-existing mental disorders adjusting for key socio-demographic covariates (i.e., age, gender, race, ethnicity, residence, smoking). Co-occurrence of any two clusters was positively associated with COVID-19-related hospitalization and death. The odds ratio of being hospitalized was 2.50 (95%CI 2.284, 2.728) for patients with internalizing and externalizing disorders, 3.34 (95%CI 2.637, 4.228) for internalizing and thought disorders, 3.29 (95%CI 2.288, 4.733) for externalizing and thought disorders, and 3.35 (95%CI 2.604, 4.310) for three clusters of mental disorders. Conclusions and Relevance: Pre-existing internalizing disorders, externalizing disorders, and thought disorders are positively related to COVID-19 hospitalization and death. Co-occurrence of any two clusters of mental disorders have elevated risk of COVID-19-related hospitalization and death compared to those with a single cluster.
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... Other researchers are developing and testing new treatment methods that are designed to remediate the processes, e.g. negative emotionality, that all dimensions of psychopathology appear to share 82,83 . Tests of these new treatments may not only lead to better treatments with more widespread benefits, but will help us understand what underlies the general and specific factors of psychopathology. ...
Hierarchical models of psychopathology: empirical support, implications, and remaining issues
Article
  • Feb 2021
There is an ongoing revolution in psychology and psychiatry that will likely change how we conceptualize, study and treat psychological problems.­ Many theorists now support viewing psychopathology as consisting of continuous dimensions rather than discrete diagnostic categories. Indeed, recent papers have proposed comprehensive taxonomies of psychopathology dimensions to replace the DSM and ICD taxonomies of categories. The proposed dimensional taxonomies, which portray psychopathology as hierarchically organized correlated dimensions, are now well supported at phenotypic levels. Multiple studies show that both a general factor of psychopathology at the top of the hierarchy and specific factors at lower levels predict different functional outcomes. Our analyses of data on a large representative sample of child and adolescent twins suggested the causal hypothesis that phenotypic correlations among dimensions of psychopathology are the result of many familial influences being pleiotropic. That is, most genetic variants and shared environmental factors are hypothesized to non‐specifically influence risk for multiple rather than individual dimensions of psychopathology. In contrast, person‐specific experiences tend to be related to individual dimensions. This hierarchical causal hypothesis has been supported by both large‐scale family and molecular genetic studies. Current research focuses on three issues. First, the field has not settled on a preferred statistical model for studying the hierarchy of causes and phenotypes. Second, in spite of encouraging progress, the neurobiological correlates of the hierarchy of dimensions of psychopathology are only partially described. Third, although there are potentially important clinical implications of the hierarchical model, insufficient research has been conducted to date to rec­ommend evidence‐based clinical practices.
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... In the p-factor literature, theory and model are intertwined (for good reason) but are generally conflated, likely because the lion's share of research on the p-factor uses a single type of model to examine it (i.e., the bifactor model). Although much research has extolled the virtues of the p-factor in terms of its ability to enhance research on the sources, correlates, and even treatment implications of psychopathology (Caspi & Moffitt, 2018;Conway, Forbes, et al., 2019;Lahey et al., 2017;Meier & Meier, 2018), we caution against the adoption of a theoretical model that is built on a methodological house of cards. For the field to move toward a more precise understanding of the p-factor, should it exist, it needs to grapple with the issues we raise in this commentary. ...
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... In the p-factor literature, theory and model are intertwined (for good reason) but are generally conflated, likely because the lion's share of research on the p-factor uses a single type of model to examine it (i.e., the bifactor model). Although much research has extolled the virtues of the p-factor in terms of its ability to enhance research on the sources, correlates, and even treatment implications of psychopathology (Caspi & Moffit, 2018;Conway et al., 2019;Lahey et al., 2017;Meier & Meier, 2018), we caution against the adoption of a theoretical model that is built on a methodological house of cards. For the field to move towards a more precise understanding of the p-factor, should it exist, it needs to grapple with the issues we raise in this commentary. ...
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National Quality Framework for Mental Health Services Evidence Review
Book
Full-text available
  • Nov 2022
This evidence review presents the mental health peer reviewed research articles accessed to meet the Mental Health Commission (MHC) requirements for the development of a new quality framework. The extensive search includes research pertaining to mental health care and services. This includes frameworks, audits, toolkits, quality, recovery and wellness, legislation, acute adult and continuing long stay care, carers/family and peers, CAMHS, digital e-technology, forensics, medication management, intellectual disability, LGBTQ+, mother and infant, rehabilitation, professionals, psychiatry of later life and therapies including CBT.
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Longitudinal Assessment of Mental Health Disorders and Comorbidities Across 4 Decades Among Participants in the Dunedin Birth Cohort Study
Article
Full-text available
  • Apr 2020
Importance Mental health professionals typically encounter patients at 1 point in patients’ lives. This cross-sectional window understandably fosters focus on the current presenting diagnosis. Research programs, treatment protocols, specialist clinics, and specialist journals are oriented to presenting diagnoses, on the assumption that diagnosis informs about causes and prognosis. This study tests an alternative hypothesis: people with mental disorders experience many different kinds of disorders across diagnostic families, when followed for 4 decades. Objective To describe mental disorder life histories across the first half of the life course. Design, Setting, and Participants This cohort study involved participants born in New Zealand from 1972 to 1973 who were enrolled in the population-representative Dunedin Study. Participants were observed from birth to age 45 years (until April 2019). Data were analyzed from May 2019 to January 2020. Main Outcomes and Measures Diagnosed impairing disorders were assessed 9 times from ages 11 to 45 years. Brain function was assessed through neurocognitive examinations conducted at age 3 years, neuropsychological testing during childhood and adulthood, and midlife neuroimaging-based brain age. Results Of 1037 original participants (535 male [51.6%]), 1013 had mental health data available. The proportions of participants meeting the criteria for a mental disorder were as follows: 35% (346 of 975) at ages 11 to 15 years, 50% (473 of 941) at age 18 years, 51% (489 of 961) at age 21 years, 48% (472 of 977) at age 26 years, 46% (444 of 969) at age 32 years, 45% (429 of 955) at age 38 years, and 44% (407 of 927) at age 45 years. The onset of the disorder occurred by adolescence for 59% of participants (600 of 1013), eventually affecting 86% of the cohort (869 of 1013) by midlife. By age 45 years, 85% of participants (737 of 869) with a disorder had accumulated comorbid diagnoses. Participants with adolescent-onset disorders subsequently presented with disorders at more past-year assessments (r = 0.71; 95% CI, 0.68 to 0.74; P < .001) and met the criteria for more diverse disorders (r = 0.64; 95% CI, 0.60 to 0.67; P < .001). Confirmatory factor analysis summarizing mental disorder life histories across 4 decades identified a general factor of psychopathology, the p-factor. Longitudinal analyses showed that high p-factor scores (indicating extensive mental disorder life histories) were antedated by poor neurocognitive functioning at age 3 years (r = −0.18; 95% CI, −0.24 to −0.12; P < .001), were accompanied by childhood-to-adulthood cognitive decline (r = −0.11; 95% CI, −0.17 to −0.04; P < .001), and were associated with older brain age at midlife (r = 0.14; 95% CI, 0.07 to 0.20; P < .001). Conclusions and Relevance These findings suggest that mental disorder life histories shift among different successive disorders. Data from the present study, alongside nationwide data from Danish health registers, inform a life-course perspective on mental disorders. This perspective cautions against overreliance on diagnosis-specific research and clinical protocols.
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Clinician's Guide to Evidence-Based Practices: Behavioral Health and Addictions
Book
Full-text available
  • Dec 2016
Everyone, it seems, is talking and arguing about Evidence-Based Practice (EBP). Those therapies and assessments designated as EBP increasingly determine what is taught, researched, and reimbursed in health care. But exactly what is it, and how do you do it? The second edition of Clinician's Guide to Evidence-Based Practices is the concise, practitioner-friendly guide to applying EBPs in mental health. Step-by-step it explains how to conduct the entire EBP process-asking the right questions, accessing the best available research, appraising the research, translating that research into practice, integrating that research with clinician expertise and patient characteristics, evaluating the entire enterprise, attending to the ethical considerations, and when done, moving the EBP process forward by teaching and disseminating it. This book will help you: · Formulate useful questions that research can address · Search the research literature efficiently for best practices · Make sense out of the research morass, sifting wheat from chaff · Incorporate patient values and diversity into the selection of EBP · Blend clinician expertise with the research evidence · Translate empirical research into practice · Ensure that your clients receive effective, research-supported services · Infuse the EBP process into your organizational setting and training methods · Identify and integrate ethics in the context of EBP Coauthored by a distinguished quartet of clinicians, researchers, and a health care librarian, the Clinician's Guide has become the classic for graduate students and busy professionals mastering EBP.
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Chapter
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  • Nov 2015
Recent efforts to improve group psychotherapy have focused on codifying both evidencebased treatments and therapeutic relationships. This chapter reviews the numerous advances in empirical research on group psychotherapy and highlights therapeutic practices ensuing from the evidence. The authors synthesize some of the most crucial development in group psychotherapy research, such as the effectiveness of group treatments, the mechanisms of change of group therapies, the components of group relationship, and issues regarding methodological problems associated with the analysis of group data.
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Which adolescents develop persistent substance dependence in adulthood? Using population-representative longitudinal data to inform universal risk assessment
Article
Full-text available
  • Dec 2015
  • PSYCHOL MED
Background: To our knowledge, there are no universal screening tools for substance dependence that (1) were developed using a population-based sample, (2) estimate total risk briefly and inexpensively by incorporating a relatively small number of well-established risk factors, and (3) aggregate risk factors using a simple algorithm. We created a universal screening tool that incorporates these features to identify adolescents at risk for persistent substance dependence in adulthood. Method: Participants were members of a representative cohort of 1037 individuals born in Dunedin, New Zealand in 1972-1973 and followed prospectively to age 38 years, with 95% retention. We assessed a small set of childhood and adolescent risk factors: family history of substance dependence, childhood psychopathology (conduct disorder, depression), early exposure to substances, frequent substance use in adolescence, sex, and childhood socioeconomic status. We defined the outcome (persistent substance dependence in adulthood) as dependence on one or more of alcohol, tobacco, cannabis, or hard drugs at ⩾3 assessment ages: 21, 26, 32, and 38 years. Results: A cumulative risk index, a simple sum of nine childhood and adolescent risk factors, predicted persistent substance dependence in adulthood with considerable accuracy (AUC = 0.80). Conclusions: A cumulative risk score can accurately predict which adolescents in the general population will develop persistent substance dependence in adulthood.
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The Hierarchical Structure of Common Mental Disorders: Connecting Multiple Levels of Comorbidity, Bifactor Models, and Predictive Validity
Article
Full-text available
  • Nov 2015
Studies of mental disorder comorbidity have produced an unsynthesized literature with multiple competing transdiagnostic models. The current study attempted to (a) integrate these models into an overarching comorbidity hierarchy, (b) link the resulting transdiagnostic factors to the bifactor model of psychopathology, and (c) investigate predictive validity of transdiagnostic factors for important future outcomes. A series of exploratory structural equation models (ESEMs) was conducted on 12 common mental disorders from a large, 2-wave nationally representative sample, using the bass-ackwards method to explore the hierarchical structure of transdiagnostic comorbidity factors. These Wave 1 factors were then linked with the bifactor model and with mental disorders at Wave 2. Results indicated that common mental disorder comorbidity was structured into an interpretable hierarchy. Connections between the hierarchy's general factor of psychopathology (denoted p), internalizing, and distress were very strong; these factors also linked strongly with the bifactor model's p factor. Predictive validity analyses prospectively predicting subsequent diagnoses indicated that, overall: (a) transdiagnostic factors outperformed disorder-specific variance; (b) within hierarchy levels, transdiagnostic factors where disorders optimally loaded outperformed other transdiagnostic factors, but this differed by disorder type; and (c) between hierarchy levels, transdiagnostic factors where disorders optimally loaded showed similar predictive validity. We discuss implications for hierarchical structure modeling, the integration of multiple competing comorbidity models, and benefits of transdiagnostic factors for understanding the continuity of mental disorders over time.
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Cognitive Behavioural Processes across Psychological Disorders (DRAFT): A transdiagnostic approach to research and treatment
Book
  • Apr 2004
This title proposes an insightful and original approach to understanding these disorders, one that focuses on what they have in common. Instead of examining in isolation, for example, obsessive compulsive disorders, insomnia, schizophrenia, it asks - what do patients with these disorders have in common? It takes each cognitive and behavioural process - attention, memory, reasoning, thought, behaviour, and examines whether it is a transdiagnostic process - i.e., serves to maintain a broad range of psychological disorders. Having shown how these disorders share several important processes, it then describes the practical implications of such an approach to diagnosis and treatment. Importantly it explores why the different psychological disorders can present so differently, despite being maintained by the same cognitive and behavioural processes. It also provides an account of the high rates of comorbidity observed among the different disorders.
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Toward a Unified Treatment for Emotional Disorders – Republished Article
Article
  • Nov 2016
Over 40 years of development of cognitive behavioral approaches to treating anxiety and related emotional disorders have left us with highly efficacious treatments that are increasingly widely accepted. Nevertheless, these manualized protocols have become numerous and somewhat complex, restricting effective training and dissemination. Deepening understanding of the nature of emotional disorders reveals that commonalities in etiology and latent structure among these disorders supercedes differences. This suggests the possibility of distilling a set of psychological procedures that would comprise a unified intervention for emotional disorders. Based on theory and data emerging from the fields of learning, emotional development and regulation, and cognitive science, we identify three fundamental therapeutic components relevant to the treatment of emotional disorders generally. These three components include (a) altering antecedent cognitive reappraisals; (b) preventing emotional avoidance; and (c) facilitating action tendencies not associated with the emotion that is dysregulated. This treatment takes place in the context of provoking emotional expression (emotional exposure) through situational, internal, and somatic (interoceptive cues), as well as through standard mood-induction exercises, and differs from patient to patient only in the situational cues and exercises utilized. Theory and rationale supporting this new approach are described along with some preliminary experience with the protocol. This unified treatment may represent a more efficient and possibly a more effective strategy in treating emotional disorders, pending further evaluation.
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Intolerance of uncertainty and transdiagnostic group cognitive behavioral therapy for anxiety
Article
  • May 2016
Background: Recent evidence suggests intolerance of uncertainty (IU) is a transdiagnostic variable elevated across anxiety disorders. No studies have investigated IU's response to transdiagnostic group CBT for anxiety (TGCBT). This study evaluated IU outcomes following TGCBT across anxiety disorders. Methods: 151 treatment-seekers with primary diagnoses of social anxiety disorder, panic disorder, or GAD were evaluated before and after 12 weeks of TGCBT and completed self-report questionnaires at pre-, mid-, and post-treatment. Results: IU decreased significantly following treatment. Decreases in IU predicted improvements in clinical presentation across diagnoses. IU interacted with time to predict improvement in clinical presentation irrespective of primary diagnosis. IU also interacted with time to predict improvement in clinical presentation although interactions of time with diagnosis-specific measures did not. IUS interacted with time to predict reduction in anxiety and fear symptoms, and inhibitory IU interacted with time to predicted reductions in anxiety symptoms but prospective IU did not. Conclusion: IU appears to be an important transdiagnostic variable in CBT implicated in both initial presentation and treatment change. Further implications are discussed.
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Resistance and Clinical Behavior Therapy
Chapter
  • Jan 1982
The concept of resistance rarely if ever arose in the early literature on behavior therapy. Most of the original descriptions of behavior therapy conveyed an underlying assumption that, apart from their presenting problems, clients were totally “rational” beings who readily complied with the intervention procedures set forth. As behavior therapists began applying their procedures to unselected cases and were confronted with a wide variety of complex clinical problems, it became strikingly evident that the simple application of the appropriate technique was not always successful. Although the therapist might have been clear about the determinants associated with any problem behaviors, and may also have felt confident that certain therapeutic techniques had a good chance of bringing about the needed change, the clarity of the clinician’s thinking was not always matched by the client’s desire or ability to comply with the intervention procedures. It has been in the face of such instances of therapeutic noncompliance that the topic of resistance has come to the fore in behavior therapy.
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