A Web-Based Transdiagnostic Intervention for Affective and Mood Disorders: Randomized Controlled Trial

Bogdan Tudor Tulbure, Andrei Rusu, Florin Alin Sava, Nastasia Sălăgean, Todd J Farchione, Bogdan Tudor Tulbure, Andrei Rusu, Florin Alin Sava, Nastasia Sălăgean, Todd J Farchione

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://ichgcp.net/clinical-trials-registry/NCT02739607 (Archived by WebCite at http://www.webcitation.org/6yY1VeYIZ).

Keywords: anxiety disorders; cognitive therapy; depressive disorder; transdiagnostic.

Conflict of interest statement

Conflicts of Interest: The Romanian team developed the e-cbt.ro web-platform that is exclusively used for research purposes.

©Bogdan Tudor Tulbure, Andrei Rusu, Florin Alin Sava, Nastasia Sălăgean, Todd J Farchione. Originally published in JMIR Mental Health (http://mental.jmir.org), 24.05.2018.

Figures

Figure 1
Figure 1
The flowchart depicting participants’ recruitment and progress throughout the program. SCID-I: Structural Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition Axis I Disorders.
Figure 2
Figure 2
Attrition diagram.
Figure 3
Figure 3
The evolution of the two groups during the treatment on the Overall Anxiety Severity and Impairment Scale (OASIS).
Figure 4
Figure 4
The evolution of the two groups during the treatment on the Overall Depression Severity and Impairment Scale (ODSIS).

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