Long-term effectiveness and trajectories of change after treatment with SMART, a transdiagnostic CBT for adolescents with emotional problems

Veronica Lorentzen, Kenneth Fagermo, Bjørn Helge Handegård, Simon-Peter Neumer, Ingunn Skre, Veronica Lorentzen, Kenneth Fagermo, Bjørn Helge Handegård, Simon-Peter Neumer, Ingunn Skre

Abstract

Background: There is a need for long-term effectiveness trials of transdiagnostic treatments. This study investigates the effectiveness and diagnosis-specific trajectories of change in adolescent patients attending SMART, a 6-week transdiagnostic CBT for anxiety and depression, with 6-month follow-up.

Methods: A randomized controlled trial with waiting list control (WLC) was performed at three child and adolescent mental health outpatient services (CAMHS) in Norway. Referred adolescents (N = 163, age = 15.72, 90.3% females) scoring 6 or more on the emotional disorders subscale of the Strengths and Difficulties Questionnaire (SDQ) were randomly assigned to treatment or to WLC. Long-term follow-up (N = 83, baseline age = 15.57, 94% females) was performed 6 months after treatment completion (Mean = 7.1 months, SD = 2.5). Linear mixed model analysis was used to assess time by group effects in patients with no diagnosis, probable anxiety, depressive disorder, and combined anxiety and depressive disorder.

Results: Almost one third (31%) obtained full recovery according to the inclusion criterium (SDQ emotional). There was highly significant change in all outcome variables. Effect sizes (ES) were largest for general functioning, measured with CGAS (ES: d = 2.19), and on emotional problems measured with SDQ (ES: d = 2.10), while CORE-17, BDI-II and CGAS all obtained ES's close to 1. There were no significant time by diagnostic group interactions for any outcomes, indicating similar trajectories of change, regardless of diagnostic group. Waiting 6 weeks for treatment had no significant impact on long-term treatment effects.

Limitations: Possible regression to the mean. Attrition from baseline to follow-up.

Conclusions: Six weeks of transdiagnostic treatment for adolescents with emotional problems showed highly significant change in emotional symptoms and functioning at 6-month follow-up. Patients with anxiety, depression, combined anxiety and depression, and emotional problems with no specific diagnoses, all had similar trajectories of change. Hence this transdiagnostic SMART treatment can be recommended for adolescent patients with symptoms within the broad spectrum of emotional problems.

Trial registration: ClinicalTrials.gov Identifier: NCT02150265. First registered May 29, 2014.

Keywords: Adolescence; Anxiety; Child and adolescent mental health services; Cognitive behavioral therapy; Depression; Emotional disorders; Long-term effectiveness; Psychological treatment; Trajectories of change; Transdiagnostic.

Conflict of interest statement

The second last author SPN received royalties from the publisher of the manual. All other authors do not have any competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Flowchart showing points of, and time between measurements in weeks
Fig. 2
Fig. 2
Consort flow diagram
Fig. 3
Fig. 3
Overall change from baseline to follow-up (SDQ Emotional)
Fig. 4
Fig. 4
Overall change from baseline to follow-up (CGAS)
Fig. 5
Fig. 5
Overall change from baseline to follow-up (BDI-II)
Fig. 6
Fig. 6
Overall change from baseline to follow-up (CORE 17)
Fig. 7
Fig. 7
Overall change from baseline to follow-up (MASC)

References

    1. Chavira DA, Stein MB, Bailey K, Stein MT. Child anxiety in primary care: prevalent but untreated. Depress Anxiety. 2004;20(4):155–164. doi: 10.1002/da.20039.
    1. Costello EJ, Mustillo S, Erkanli A, Keeler G, Angold A. Prevalence and development of psychiatric disorders in childhood and adolescence. Arch Gen Psychiatry. 2003;60(8):837–844. doi: 10.1001/archpsyc.60.8.837.
    1. Gore FM, Bloem PJ, Patton GC, Ferguson J, Joseph V, Coffey C, et al. Global burden of disease in young people aged 10–24 years: a systematic analysis. Lancet. 2011;377(9783):2093–2102. doi: 10.1016/S0140-6736(11)60512-6.
    1. Sørensen MJ, Nissen JB, Mors O, Thomsen PH. Age and gender differences in depressive symptomatology and comorbidity: an incident sample of psychiatrically admitted children. J Affect Disord. 2005;84(1):85–91. doi: 10.1016/j.jad.2004.09.003.
    1. Weersing VR, Gonzalez A, Campo JV, Lucas AN. Brief behavioral therapy for pediatric anxiety and depression: piloting an integrated treatment approach. Cogn Behav Pract. 2008;15(2):126–139. doi: 10.1016/j.cbpra.2007.10.001.
    1. Nigatu YT, Liu Y, Uppal M, Mckinney S, Rao S, Gillis K, et al. Interventions for enhancing return to work in individuals with a common mental illness: systematic review and meta-analysis of randomized controlled trials. Psychol Med. 2016;46(16):3263–3274. doi: 10.1017/S0033291716002269.
    1. Asselmann E, Wittchen H-U, Lieb R, Beesdo-Baum K. Sociodemographic, clinical, and functional long-term outcomes in adolescents and young adults with mental disorders. Acta Psychiatr Scand. 2018;137(1):6–17. doi: 10.1111/acps.12792.
    1. de Lijster JM, Dieleman GC, Utens EMWJ, Dierckx B, Wierenga M, Verhulst FC, et al. Social and academic functioning in adolescents with anxiety disorders: a systematic review. J Affect Disord. 2018;230:108–117. doi: 10.1016/j.jad.2018.01.008.
    1. Higa-McMillan CK, Francis SE, Rith-Najarian L, Chorpita BF. Evidence base update: 50 years of research on treatment for child and adolescent anxiety. J Clin Child Adolesc Psychol. 2016;45(2):91–113. doi: 10.1080/15374416.2015.1046177.
    1. Weersing VR, Jeffreys M, Do M-CT, Schwartz KTG, Bolano C. Evidence base update of psychosocial treatments for child and adolescent depression. J Clin Child Adolesc Psychol. 2017;46(1):11–43. doi: 10.1080/15374416.2016.1220310.
    1. Gutermann J, Schwartzkopff L, Steil R. Meta-analysis of the long-term treatment effects of psychological interventions in youth with PTSD symptoms. Clin Child Fam Psychol Rev. 2017;20(4):422–434. doi: 10.1007/s10567-017-0242-5.
    1. Kendall PC, Peterman JS. CBT for adolescents with anxiety: mature yet still developing. Am J Psychiatry. 2015;172(6):519–530. doi: 10.1176/appi.ajp.2015.14081061.
    1. James AC, James G, Cowdrey FA, Soler A, Choke A. Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev. 2013 doi: 10.1002/14651858.cd013162.
    1. Weisz JR, Donenberg GR, Han SS, Weiss B. Bridging the gap between laboratory and clinic in child and adolescent psychotherapy. J Consult Clin Psychol. 1995;63(5):688–701. doi: 10.1037/0022-006X.63.5.688.
    1. Weisz JR, Ugueto AM, Cheron DM, Herren J. Evidence-based youth psychotherapy in the mental health ecosystem. J Clin Child Adolesc Psychol. 2013;42(2):274–286. doi: 10.1080/15374416.2013.764824.
    1. Hunsley J, Lee CM. Research-informed benchmarks for psychological treatments: efficacy studies, effectiveness studies, and beyond. Prof Psychol Res Pract. 2007;38:21–33. doi: 10.1037/0735-7028.38.1.21.
    1. Santucci LC, Thomassin K, Petrovic L, Weisz JR. Building evidence-based interventions for the youth, providers, and contexts of real-world mental-health care. Child Dev Perspect. 2015;9(2):67–73. doi: 10.1111/cdep.12118.
    1. Wergeland GJH, Riise EN, Öst L-G. Cognitive behavior therapy for internalizing disorders in children and adolescents in routine clinical care: a systematic review and meta-analysis. Clin Psychol Rev. 2021;83:101918. doi: 10.1016/j.cpr.2020.101918.
    1. Queen AH, Barlow DH, Ehrenreich-May J. The trajectories of adolescent anxiety and depressive symptoms over the course of a transdiagnostic treatment. J Anxiety Disord. 2014;28(6):511–521. doi: 10.1016/j.janxdis.2014.05.007.
    1. Garber J, Weersing VR. Comorbidity of anxiety and depression in youth: implications for treatment and prevention. Clin Psychol Sci Pract. 2010;17(4):293–306. doi: 10.1111/j.1468-2850.2010.01221.x.
    1. Olatunji BO, Naragon-Gainey K, Wolitzky-Taylor KB. Specificity of rumination in anxiety and depression: a multimodal meta-analysis. Clin Psychol Sci Pract. 2013;20(3):225–257.
    1. Aldao A, Nolen-Hoeksema S, Schweizer S. Emotion-regulation strategies across psychopathology: a meta-analytic review. Clin Psychol Rev. 2010;30(2):217–237. doi: 10.1016/j.cpr.2009.11.004.
    1. Brown TA, Chorpita BF, Barlow DH. Structural relationships among dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and autonomic arousal. J Abnorm Psychol. 1998;107(2):179–192. doi: 10.1037/0021-843X.107.2.179.
    1. Trosper SE, Whitton SW, Brown TA, Pincus DB. Understanding the latent structure of the emotional disorders in children and adolescents. J Abnorm Child Psychol. 2012;40(4):621–632. doi: 10.1007/s10802-011-9582-7.
    1. Kendall PC, Safford S, Flannery-Schroeder E, Webb A. Child anxiety treatment: outcomes in adolescence and impact on substance use and depression at 7.4-year follow-up. J Consult Clin Psychol. 2004;72(2):276–287. doi: 10.1037/0022-006X.72.2.276.
    1. Weisz JR, McCarty CA, Valeri SM. Effects of psychotherapy for depression in children and adolescents: a meta-analysis. Psychol Bull. 2006;132(1):132–149. doi: 10.1037/0033-2909.132.1.132.
    1. McHugh RK, Barlow DH. The dissemination and implementation of evidence-based psychological treatments: a review of current efforts. Am Psychol. 2010;65(2):73–84. doi: 10.1037/a0018121.
    1. Emmelkamp PMG, David D, Beckers T, Muris P, Cuijpers P, Lutz W, et al. Advancing psychotherapy and evidence-based psychological interventions: advancing psychotherapy. Int J Methods Psychiatr Res. 2014;23(S1):58–91. doi: 10.1002/mpr.1411.
    1. Barlow DH, Allen LB, Choate ML. Toward a unified treatment for emotional disorders. Behav Therapy. 2004;35(2):205–230. doi: 10.1016/S0005-7894(04)80036-4.
    1. Cook SC, Schwartz AC, Kaslow NJ. Evidence-based psychotherapy: advantages and challenges. Neurotherapeutics. 2017;14(3):537–545. doi: 10.1007/s13311-017-0549-4.
    1. Mansell W, Harvey A, Watkins ER, Shafran R. Cognitive behavioral processes across psychological disorders: a review of the utility and validity of the transdiagnostic approach. Int J Cogn Ther. 2008;1(3):181–191. doi: 10.1521/ijct.2008.1.3.181.
    1. 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. Cogn Behav Pract. 2010;17(1):88–101. doi: 10.1016/j.cbpra.2009.06.002.
    1. Bilek EL, Ehrenreich-May J. An open trial investigation of a transdiagnostic group treatment for children with anxiety and depressive symptoms. Behav Ther. 2012;43(4):887–897. doi: 10.1016/j.beth.2012.04.007.
    1. Ehrenreich-May J, Rosenfield D, Queen AH, Kennedy SM, Remmes CS, Barlow DH. An initial waitlist-controlled trial of the unified protocol for the treatment of emotional disorders in adolescents. J Anxiety Disord. 2017;46:46–55. doi: 10.1016/j.janxdis.2016.10.006.
    1. Kennedy SM, Bilek EL, Ehrenreich-May J. A randomized controlled pilot trial of the unified protocol for transdiagnostic treatment of emotional disorders in children. Behav Modif. 2019;43(3):330–360. doi: 10.1177/0145445517753940.
    1. Jensen-Doss A, Ehrenreich-May J, Nanda MM, Maxwell CA, LoCurto J, Shaw AM, et al. Community study of outcome monitoring for emotional disorders in teens (COMET): a comparative effectiveness trial of a transdiagnostic treatment and a measurement feedback system. Contemp Clin Trials. 2018;74:18–24. doi: 10.1016/j.cct.2018.09.011.
    1. Weersing VR, Brent DA, Rozenman MS, Gonzalez A, Jeffreys M, Dickerson JF, Lynch FL, Porta G, Iyengar S. Brief behavioral therapy for pediatric anxiety and depression in primary care: a randomized clinical trial. JAMA Psychiat. 2017;74(6):571–578. doi: 10.1001/jamapsychiatry.2017.0429.
    1. Brent DA, Porta G, Rozenman MS, Gonzalez A, Schwartz KTG, Lynch FL, Dickerson JF, Iyengar S, Weersing VR. Brief behavioral therapy for pediatric anxiety and depression in primary care: a follow-up. J Am Acad Child Adolesc Psychiatry. 2020;59(7):856–867. doi: 10.1016/j.jaac.2019.06.009.
    1. Chu BC, Crocco ST, Esseling P, Areizaga MJ, Lindner AM, Skriner LC. Transdiagnostic group behavioral activation and exposure therapy for youth anxiety and depression: initial randomized controlled trial. Behav Res Ther. 2016;76:65–75. doi: 10.1016/j.brat.2015.11.005.
    1. Martinsen KD, Rasmussen L, Wentzel-Larsen T, Holen S, Sund AM, Løvaas M, Patras J, Kendall PC, Waaktaar T, Neumer SP. Prevention of anxiety and depression in school children: effectiveness of the transdiagnostic EMOTION program. J Consult Clin Psychol. 2019;87(2):212–219. doi: 10.1037/ccp0000360.
    1. Guzick AG, Leong AW, Dickinson EM, Schneider SC, Zopatti K, Manis J, Meinert AC, Barth AM, Perez M, Campo DM, Weinzimmer SA, Cepeda SL, Mathai D, Shah A, Goodman WK, Salloum A, Kennedy S, Ehrenreich-May J, Storch EA. Brief, parent-led, transdiagnostic cognitive-behavioral teletherapy for youth with emotional problems related to the COVID-19 pandemic. J Affect Disord. 2022;301:130–137. doi: 10.1016/j.jad.2022.01.034.
    1. Neumer SP, Junge-Hoffmeister J. SMART: Forebygging av emosjonelle problemer hos ungdom: veileder (in Norwegian) Oslo: Kommuneforlaget; 2010.
    1. Lorentzen V, Fagermo K, Handegård BH, Skre I, Neumer SP. A randomized controlled trial of a six-session cognitive behavioral treatment of emotional disorders in adolescents 14–17 years old in child and adolescent mental health services (CAMHS) BMC Psychol. 2020;8(1):25. doi: 10.1186/s40359-020-0393-x.
    1. Ginsburg GS, Becker EM, Keeton CP, Sakolsky D, Piacentini J, Albano AM, et al. Naturalistic follow-up of youths treated for pediatric anxiety disorders. JAMA Psychiat. 2014;71(3):310–318. doi: 10.1001/jamapsychiatry.2013.4186.
    1. Kennard BD, Silva SG, Tonev S, Rohde P, Hughes JL, Vitiello B, et al. Remission and recovery in the treatment for adolescents with depression study (TADS): acute and long-term outcomes. J Am Acad Child Adolesc Psychiatry. 2009;48(2):186–195. doi: 10.1097/CHI.0b013e31819176f9.
    1. Rith-Najarian LR, Mesri B, Park AL, Sun M, Chavira DA, Chorpita BF. Durability of cognitive behavioral therapy effects for youth and adolescents with anxiety, depression, or traumatic stress: a meta-analysis on long-term follow-ups. Behav Ther. 2019;50(1):225–240. doi: 10.1016/j.beth.2018.05.006.
    1. Copeland WE, Angold A, Shanahan L, Costello EJ. Longitudinal patterns of anxiety from childhood to adulthood: the great smoky mountains study. J Am Acad Child Adolesc Psychiatry. 2014;53:21–33. doi: 10.1016/j.jaac.2013.09.017.
    1. Reynolds S, Wilson C, Austin J, Hooper L. Effects of psychotherapy for anxiety in children and adolescents: a meta-analytic review. Clin Psychol Rev. 2012;32:251–262. doi: 10.1016/j.cpr.2012.01.005.
    1. Sherman ML, Barnum DD, Buhman-Wiggs A, Nyberg E. Clinical intake of child and adolescent consumers in a rural community mental health center: Does wait-time predict attendance? Community Ment Health J. 2009;45(1):78–84. doi: 10.1007/s10597-008-9153-8.
    1. Goodman R, Ford T, Richards H, Gatward R, Meltzer H. The development and well-being assessment: description and initial validation of an integrated assessment of child and adolescent psychopathology. J Child Psychol Psychiatry. 2000;41(5):645–655. doi: 10.1111/j.1469-7610.2000.tb02345.x.
    1. Goodman A, Heiervang E, Collishaw S, Goodman R. The, “DAWBA bands” as an ordered-categorical measure of child mental health: description and validation in British and Norwegian samples. Soc Psychiatry Psychiatr Epidemiol. 2011;46(6):521–532. doi: 10.1007/s00127-010-0219-x.
    1. Goodman R. Psychometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adolesc Psychiatry. 2001;40(11):1337–1345. doi: 10.1097/00004583-200111000-00015.
    1. Rønning JA, Mørch W-T, Handegaard BH, Sourander A. The Strengths and difficulties self-report questionnaire as a screening instrument in Norwegian community samples. Eur Child Adolesc Psychiatry. 2004;13(2):73–82. doi: 10.1007/s00787-004-0356-4.
    1. Bøe T, Hysing M, Skogen JC, Breivik K. The strengths and difficulties questionnaire (SDQ): factor structure and gender equivalence in Norwegian adolescents. PLoS ONE. 2016;11(5):e0152202–e0152202. doi: 10.1371/journal.pone.0152202.
    1. Muris P, Meesters C, Van den Berg F. The strengths and difficulties questionnaire (SDQ) further evidence for its reliability and validity in a community sample of Dutch children and adolescents. Eur Child Adolesc Psychiatry. 2003;12(1):1–8. doi: 10.1007/s00787-003-0298-2.
    1. Shaffer D, Gould MS, Brasic J, Fisher P, Aluwahlia S, Bird H. A children’s global assessment scale (CGAS) Arch Gen Psychiatry. 1983;40(11):1228–1231. doi: 10.1001/archpsyc.1983.01790100074010.
    1. Schorre BEH, Vandvik IH. Global assessment of psychosocial functioning in child and adolescent psychiatry: a review of three unidimensional scales (CGAS, GAF, GAPD) Eur Child Adolesc Psychiatry. 2004;13(5):273–286. doi: 10.1007/s00787-004-0390-2.
    1. Evans C, Mellor-Clark J, Frank M. CORE: clinical outcomes in routine evaluation. J Mental Health. 2000;9(3):247–255. doi: 10.1080/713680250.
    1. Barkham M, Evans C, Margison F. The rationale for developing and outcome batteriesfor routine use in service settings and psychotherapy outcome research implementing core. J Ment Health. 1998;7(1):35–47. doi: 10.1080/09638239818328.
    1. Barkham M, Margison F, Leach C, Lucock M, Mellor-Clark J, Evans C, et al. Service profiling and outcomes benchmarking using the CORE-OM: toward practice-based evidence in the psychological therapies. J Consult Clin Psychol. 2001;69(2):184–196. doi: 10.1037/0022-006X.69.2.184.
    1. Evans C, Connell J, Barkham M, Margison F, McGrath G, Mellor-Clark J, et al. Towards a standardised brief outcome measure: psychometric properties and utility of the CORE–OM. Br J Psychiatry. 2002;180(1):51–60. doi: 10.1192/bjp.180.1.51.
    1. Skre I, Friborg O, Elgarøy S, Evans C, Myklebust LH, Lillevoll K, et al. The factor structure and psychometric properties of the clinical outcomes in routine evaluation-outcome measure (CORE-OM) in Norwegian clinical and non-clinical samples. BMC Psychiatry. 2013;13(1):99. doi: 10.1186/1471-244X-13-99.
    1. Elfström ML, Evans C, Lundgren J, Johansson B, Hakeberg M, Carlsson SG. Validation of the Swedish version of the clinical outcomes in routine evaluation outcome measure (CORE-OM): validation of the Swedish version of CORE-OM. Clin Psychol Psychother. 2012;20:447–455.
    1. Kristjánsdóttir H, Sigurðsson BH, Salkovskis P, Ólason D, Sigurdsson E, Evans C, et al. Evaluation of the psychometric properties of the Icelandic Version of the clinical outcomes in routine evaluation-outcome measure, its transdiagnostic utility and cross-cultural validation: psychometric properties and transdiagnostic utility of the Icelandic CORE-OM. Clin Psychol Psychother. 2015;22(1):64–74. doi: 10.1002/cpp.1874.
    1. Palmieri G, Evans C, Hansen V, Brancaleoni G, Ferrari S, Porcelli P, et al. Validation of the Italian version of the clinical outcomes in routine evaluation outcome measure (CORE-OM) Clin Psychol Psychother. 2009;16(5):444–449. doi: 10.1002/cpp.646.
    1. Lorentzen V, Handegård BH, Moen CM, Solem K, Lillevoll K, Skre I. CORE-OM as a routine outcome measure for adolescents with emotional disorders: Factor structure and psychometric properties. BMC Psychol. 2020;8(1):86. doi: 10.1186/s40359-020-00459-5.
    1. Beck AT, Steer RA, Brown GK. Beck depression inventory–II. San Antonio. 1996;78(2):490–498.
    1. Osman A, Downs WR, Barrios FX, Kopper BA, Gutierrez PM, Chiros CE. Factor structure and psychometric characteristics of the Beck depression inventory-II. J Psychopathol Behav Assess. 1997;19(4):359–376. doi: 10.1007/BF02229026.
    1. Steer RA, Kumar G, Ranieri WF, Beck AT. Use of the Beck depression inventory-II with adolescent psychiatric outpatients. J Psychopathol Behav Assess. 1998;20(2):127–137. doi: 10.1023/A:1023091529735.
    1. Aasen H. An empirical investigation of depression symptoms: norms, psychometric characteristics and factor structure of the Beck depression inventory-II. Bergen: The University of Bergen; 2001.
    1. March JS, Parker JDA, Sullivan K, Stallings P, Conners CK. The multidimensional anxiety scale for children (MASC): factor structure, reliability, and validity. J Am Acad Child Adolesc Psychiatry. 1997;36(4):554–565. doi: 10.1097/00004583-199704000-00019.
    1. Rynn MA, Barber JP, Khalid-Khan S, Siqueland L, Dembiski M, McCarthy KS, et al. The psychometric properties of the MASC in a pediatric psychiatric sample. J Anxiety Disord. 2006;20(2):139–157. doi: 10.1016/j.janxdis.2005.01.004.
    1. Jacobson NS, Truax P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol. 1991;59(1):12–19. doi: 10.1037/0022-006X.59.1.12.
    1. Singer JD, Willett JB. Applied longitudinal data analysis: modeling change and event occurrence. Oxford: Oxford University Press; 2009. pp. 1–644.
    1. Feingold A. A regression framework for effect size assessments in longitudinal modeling of group differences. Rev Gen Psychol J Div Am Psychol Assoc. 2013;17(1):111–121. doi: 10.1037/a0030048.
    1. Cohen J. Statistical power analysis for the behavioral sciences. New York: Routledge; 1988.
    1. Gibby BA, Casline EP, Ginsburg GS. Long-term outcomes of youth treated for an anxiety disorder: a critical review. Clin Child Fam Psychol Rev. 2017;20:201–225. doi: 10.1007/s10567-017-0222-9.
    1. Villabø MA, Narayanan M, Compton SN, Kendall PC, Neumer SP. Cognitive-behavioral therapy for youth anxiety: an effectiveness evaluation in community practice. J Consult Clin Psychol. 2018;86(9):751–764. doi: 10.1037/ccp0000326.
    1. Stice E, Rohde P, Gau JM, Wade E. Efficacy trial of a brief cognitive-behavioral depression prevention program for high-risk adolescents: effects at 1- and 2-year follow-up. J Consult Clin Psychol. 2010;78(6):856–867. doi: 10.1037/a0020544.
    1. Cayirli T, Veral E. Outpatient scheduling in health care: a review of literature. Prod Oper Manag. 2003;12:519–549. doi: 10.1111/j.1937-5956.2003.tb00218.x.
    1. Oudhoff JP, Timmermans DRM, Bijnen AB, Van Der Wal G. Waiting for elective general surgery: physical, psychological and social consequences. ANZ J Surg. 2004;74(5):361–367. doi: 10.1111/j.1445-1433.2004.02998.x.
    1. Oudhoff JP, Timmermans DRM, Knol DL, Bijnen AB, Van der Wal G. Waiting for elective surgery: effect on physical problems and postoperative recovery. ANZ J Surg. 2007;77(10):892–898. doi: 10.1111/j.1445-2197.2007.04268.x.
    1. Sampalis J, Boukas S, Liberman M, Reid T, Dupuis G. Impact of waiting time on the quality of life of patients awaiting coronary artery bypass grafting. CMAJ. 2001;165(4):429–433.
    1. Newby JM, McKinnon A, Kuyken W, Gilbody S, Dalgleish T. Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood. Clin Psychol Rev. 2015;40:91–110. doi: 10.1016/j.cpr.2015.06.002.

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