Tanılar Üstü Psikolojik Müdahale Programlarının Depresyon ve Anksiyete Bozuklukları Üzerindeki Etkisi: Sistematik Bir Derleme

Yıl 2021, Cilt: 13 Sayı: 2, 261 - 281, 30.06.2021

Özge Erarslan İngeç , Orçun Yorulmaz

https://doi.org/10.18863/pgy.768731

Öz

Yaşam boyu birlikte görülme oranları oldukça yüksek olan depresyon ve anksiyete bozukluklarının etiyolojisindeki ortaklıklar birlikte ele alındığında, en son araştırmalar bu ortak özelliklerden hareketle geliştirilen bir dizi duygularla ilişkili bozukluğa uygulanabilen tanılar üstü bir yaklaşımı gündeme getirmiştir. Bu çalışmada tanılar üstü müdahale programlarının depresyon ve anksiyete bozuklukları üzerindeki etkilerini inceleyen görgül araştırmalar gözden geçirilmiştir. Yapılan incelemeler sonucunda ulaşılan 18 seçkisiz kontrollü ve 13 seçkisiz olmayan çalışma örneklem özellikleri, yöntemsel arka planları ve sonuçları bakımından incelenmiştir. Bu çalışma kapsamında incelenen araştırmalar genel olarak değerlendirildiğinde ilk olarak, tanılar üstü psikolojik müdahale programlarının çeşitli anksiyete bozuklukları ve depresyonun tedavisinde etkili olduğu sonucu çıkarılabilir. Anksiyete ve depresif belirtilerin bir arada olduğu durumlarda tanılar üstü yaklaşımın tanıya özgü protokollere kıyasla önemli avantajlar sağlayabileceği önerilmektedir. Gelecek çalışmalarda bu yaklaşımın farklı tanı gruplarında tanıya özgü tedavilere kıyasla etkisinin incelenmesinin önemli olduğu sonucuna varılmıştır. Ülkemizde de tanılar üstü müdahalelerin etkinliğini ve tanıya özgü protokollere kıyasla olası klinik ve ekonomik avantajlarını araştırmanın önemli olduğu düşünülmektedir.

Anahtar Kelimeler

Tanılar üstü yaklaşım, Bütünleşik protokol, Duygularla ilişkili bozukluklar, Depresyon, anksiyete bozuklukları

Effect of Transdiagnostic Psychological Intervention Programs on Depression and Anxiety Disorders: A Systematic Review

Öz

By considering the etiological similarities of depression and anxiety disorders with high lifetime coexistence rates, recent research has introduced a transdiagnostic approach applicable to a range of emotional disorders with these common features. This paper reviews empirical studies examining the effects of transdiagnostic intervention programs on depression and anxiety disorders. The literature search identified 18 randomized controlled and 12 non-randomized studies. These were examined in terms of their sample characteristics, methodological approaches, and findings. Overall, the reviewed transdiagnostic psychological intervention programs treat various anxiety disorders and depression effectively. In cases where anxiety and depressive symptoms are comorbid, the transdiagnostic approach has significant advantages over diagnosis-specific protocols. Future studies should investigate the effect of the transdiagnostic approach in different diagnostic groups compared to diagnosis-specific treatments. In Turkey specifically, it is important to investigate the effectiveness of transdiagnostic interventions and potential clinical and economic advantages compared to diagnostic specific protocols.

Anahtar Kelimeler

Cognitive behavioral therapy, unified protocol, emotional disorders, depression, anxiety disorders, transdiagnostic

Kaynakça

• Barlow DH (2004) Anxiety and its disorders: The nature and treatment of anxiety and panic. Guilford press.
• Barlow DH, Ellard KK, Fairholme CP, Farchione CP, Boisseau CL, Allen LB et al. (2011) The unified protocol for transdiagnostic treatment of emotional disorders: Client workbook.
• Barlow DH, Farchione TJ, Bullis JR, Gallagher MW, Murray-Latin H, Sauer-Zavala S et al. (2017) The unified protocol for transdiagnostic treatment of emotional disorders compared with diagnosis-specific protocols for anxiety disorders: A randomized clinical trial. JAMA psychiatry, 74(9), 875-884.
• Bell C, Jordan J, Alexander A (2016) Transdiagnostic psychological treatments for anxiety and depression. Australian & New Zealand Journal of Psychiatry, 50(3), 201-202.
• Bentley KH, Sauer-Zavala S, Cassiello-Robbins CF, Conklin LR, Vento S, Homer D (2017) Treating suicidal thoughts and behaviors within an emotional disorders framework: Acceptability and feasibility of the unified protocol in an inpatient setting. Behavior modification, 41(4), 529-557.
• Brown TA, Barlow DH (2009) A proposal for a dimensional classification system based on the shared features of the DSM-IV anxiety and mood disorders: Implications for assessment and treatment. Psychological assessment, 21(3), 256.
• Bullis JR, Fortune MR, Farchione TJ, Barlow DH (2014) A preliminary investigation of the long-term outcome of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders. Comprehensive psychiatry, 55(8), 1920-1927.
• Bullis JR, Sauer-Zavala S, Bentley KH, Thompson-Hollands J, Carl JR, Barlow DH (2015) The unified protocol for transdiagnostic treatment of emotional disorders: preliminary exploration of effectiveness for group delivery. Behavior Modification, 39(2), 295-321.
• Ciraulo DA, Barlow DH, Gulliver SB, Farchione T, Morissette SB, Kamholz BW et al. (2013) The effects of venlafaxine and cognitive behavioral therapy alone and combined in the treatment of co-morbid alcohol use-anxiety disorders. Behaviour research and therapy, 51(11), 729-735.
• Cuijpers P, Marks IM, van Straten A, Cavanagh K, Gega L, Andersson G (2009) Computer‐aided psychotherapy for anxiety disorders: A meta‐analytic review. Cognitive behaviour therapy, 38(2), 66-82.
• de Ornelas Maia ACC, Nardi AE, Cardoso A (2015) The utilization of unified protocols in behavioral cognitive therapy in transdiagnostic group subjects: A clinical trial. Journal of affective disorders, 172, 179-183.
• de Ornelas Maia ACC, Sanford J, Boettcher H, Nardi AE, Barlow D (2017) Improvement in quality of life and sexual functioning in a comorbid sample after the unified protocol transdiagnostic group treatment. Journal of psychiatric research, 93, 30-36.
• Dear BF, Titov N, Schwencke G, Andrews G, Johnston L, Craske MG et al. (2011) An open trial of a brief transdiagnostic internet treatment for anxiety and depression. Behaviour research and therapy, 49(12), 830-837.
• Dear BF, Fogliati VJ, Fogliati R, Gandy M, McDonald S, Talley N et al. (2018) Transdiagnostic internet-delivered cognitive-behaviour therapy (CBT) for adults with functional gastrointestinal disorders (FGID): A feasibility open trial. Journal of psychosomatic research, 108, 61-69.
• Ellard KK, Bernstein EE, Hearing C, Baek JH, Sylvia LG, Nierenberg AA et al. (2017) Transdiagnostic treatment of bipolar disorder and comorbid anxiety using the Unified Protocol for Emotional Disorders: A pilot feasibility and acceptability trial. Journal of affective disorders, 219, 209-221.
• Farchione TJ, Fairholme CP, Ellard KK, Boisseau CL, Thompson-Hollands J, Carl JR et al. (2012) Unified protocol for transdiagnostic treatment of emotional disorders: a randomized controlled trial. Behavior therapy, 43(3), 666-678.
• Hadjistavropoulos HD, Nugent MM, Alberts NM, Staples L, Dear BF, Titov N (2016) Transdiagnostic Internet-delivered cognitive behaviour therapy in Canada: An open trial comparing results of a specialized online clinic and nonspecialized community clinics. Journal of Anxiety Disorders, 42, 19-29.
• Hadjistavropoulos HD, Schneider LH, Edmonds M, Karin E, Nugent MN, Dirkse D et al. (2017) Randomized controlled trial of internet-delivered cognitive behaviour therapy comparing standard weekly versus optional weekly therapist support. Journal of anxiety disorders, 52, 15-24.
• Ito M, Horikoshi M, Kato N, Oe Y, Fujisato H, Nakajima S et al. (2016) Transdiagnostic and transcultural: pilot study of unified protocol for depressive and anxiety disorders in Japan. Behavior therapy, 47(3), 416-430.
• Johnston L, Titov N, Andrews G, Dear BF, Spence J (2013) Comorbidity and internet-delivered transdiagnostic cognitive behavioural therapy for anxiety disorders. Cognitive Behaviour Therapy, 42(3), 180-192.
• Johnston L, Titov N, Andrews G, Spence J, Dear BF (2011) A RCT of a transdiagnostic internet-delivered treatment for three anxiety disorders: examination of support roles and disorder-specific outcomes. PloS one, 6(11).
• Kazdin AE (2007) Mediators and mechanisms of change in psychotherapy research. Annu. Rev. Clin. Psychol., 3, 1-27.
• Kessler RC, Chiu WT, Demler O, Walters EE (2005) Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of general psychiatry, 62(6), 617-627.
• Khakpoor S, Saed O, Armani Kian A (2019) Emotion regulation as the mediator of reductions in anxiety and depression in the Unified Protocol (UP) for transdiagnostic treatment of emotional disorders: double-blind randomized clinical trial. Trends in psychiatry and psychotherapy, 41(3), 227-236.
• Mennin DS, Heimberg RG, Turk CL, Fresco DM (2005) Preliminary evidence for an emotion dysregulation model of generalized anxiety disorder. Behaviour research and therapy, 43(10), 1281-1310.
• Mohajerin B, Bakhtiyar M, Olesnycky OS, Dolatshahi B, Motabi F (2019) Application of a transdiagnostic treatment for emotional disorders to body dysmorphic disorder: A randomized controlled trial. Journal of affective disorders, 245, 637-644.
• Mohammadi A, Birashk B, Gharaie B (2013) Comparison of the effect of group transdiagnostic therapy and group cognitive therapy on anxiety and depressive symptoms. Iranian journal of public health, 42(1), 48.
• Mohsenabadi H, Zanjani Z, Shabani MJ, Arj A (2018) A randomized clinical trial of the Unified Protocol for Transdiagnostic treatment of emotional and gastrointestinal symptoms in patients with irritable bowel syndrome: evaluating efficacy and mechanism of change. Journal of psychosomatic research, 113, 8-15.
• Mullin A, Dear BF, Karin E, Wootton BM, Staples LG, Johnston L et al. (2015) The UniWellbeing course: A randomised controlled trial of a transdiagnostic internet-delivered cognitive behavioural therapy (CBT) programme for university students with symptoms of anxiety and depression. Internet Interventions, 2(2), 128-136.
• Newby JM, Mewton L, Andrews G (2017) Transdiagnostic versus disorder-specific internet-delivered cognitive behaviour therapy for anxiety and depression in primary care. Journal of anxiety disorders, 46, 25-34.
• Newby JM, McKinnon A, Kuyken W, Gilbody S, Dalgleish T (2015) Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood. Clinical psychology review, 40, 91-110.
• Norton PJ (2008) An open trial of a transdiagnostic cognitive-behavioral group therapy for anxiety disorder. Behavior Therapy, 39(3), 242-250.
• Norton PJ (2012) A randomized clinical trial of transdiagnostic cognitve-behavioral treatments for anxiety disorder by comparison to relaxation training. Behavior Therapy, 43(3), 506-517.
• Norton PJ, Barrera TL (2012) Transdiagnostic versus diagnosis‐specific CBT for anxiety disorders: A preliminary randomized controlled noninferiority trial. Depression and Anxiety, 29(10), 874-882.
• Norton PJ, Hope DA (2005) Preliminary evaluation of a broad-spectrum cognitive-behavioral group therapy for anxiety. Journal of Behavior Therapy and Experimental Psychiatry, 36(2), 79-97.
• Norton PJ, Hayes SA, Hope DA (2004) Effects of a transdiagnostic group treatment for anxiety on secondary depression. Depression and anxiety, 20(4), 198-202.
• Norton PJ, Barrera TL, Mathew AR, Chamberlain LD, Szafranski DD, Reddy R et al. (2013) Effect of transdiagnostic CBT for anxiety disorders on comorbid diagnoses. Depression and Anxiety, 30(2), 168-173.
• Owens VA, Hadjistavropoulos HD, Schneider LH, Gullickson KM, Karin E, Titov N et al. (2019) Transdiagnostic, internet-delivered cognitive behavior therapy for depression and anxiety: Exploring impact on health anxiety. Internet interventions, 15, 60-66.
• Reinholt N, Krogh J (2014) Efficacy of transdiagnostic cognitive behaviour therapy for anxiety disorders: a systematic review and meta-analysis of published outcome studies. Cognitive Behaviour Therapy, 43(3), 171-184.
• Reinholt N, Aharoni R, Winding C, Rosenberg N, Rosenbaum B, Arnfred S (2017) Transdiagnostic group CBT for anxiety disorders: the unified protocol in mental health services. Cognitive behaviour therapy, 46(1), 29-43.
• Roemer L, Salters K, Raffa SD, Orsillo SM (2005) Fear and avoidance of internal experiences in GAD: Preliminary tests of a conceptual model. Cognitive Therapy and Research, 29(1), 71-88.
• Sakiris N, Berle D (2019) A systematic review and meta-analysis of the Unified Protocol as a transdiagnostic emotion regulation based intervention. Clinical psychology review, 72, 101751.
• Steele SJ, Farchione TJ, Cassiello-Robbins C, Ametaj A, Sbi S, Sauer-Zavala S et al. (2018) Efficacy of the Unified Protocol for transdiagnostic treatment of comorbid psychopathology accompanying emotional disorders compared to treatments targeting single disorders. Journal of psychiatric research, 104, 211-216.
• Twohig M, Field C, Armstrong A, Dahl A (2010) Acceptance and mindfulness as mechanisms of change in mindfulness-based interventions for children and adolescents. Assessing mindfulness and acceptance processes in clients: Illuminating the theory and practice of change, 225-249.
• Titov N, Andrews G, Johnston L, Robinson E, Spence J (2010) Transdiagnostic Internet treatment for anxiety disorders: A randomized controlled trial. Behaviour research and therapy, 48(9), 890-899.
• Titov N, Dear BF, Schwencke G, Andrews G, Johnston L, Craske MG et al. (2011) Transdiagnostic internet treatment for anxiety and depression: a randomised controlled trial. Behaviour research and therapy, 49(8), 441-452.
• Tulbure BT, Rusu A, Sava FA, Sălăgean N, Farchione TJ (2018) A web-based transdiagnostic intervention for affective and mood disorders: randomized controlled trial. JMIR mental health, 5(2), e36.
• Vand HDA, Gharraee B, Farid AAA, Bandi MFG, Habibi M (2018) Investigating the Effects of the Unified Protocol on Common and Specific Factors in a Comorbid Insomniac Sample: A Single-Case Experimental Design. Iranian Journal of Psychiatry and Behavioral Sciences, 12(3).
• Varkovitzky RL, Sherrill AM, Reger GM (2018) Effectiveness of the unified protocol for Transdiagnostic treatment of emotional disorders among veterans with posttraumatic stress disorder: a pilot study. Behavior modification, 42(2), 210-230.
• Weihs KL, McConnell MH, Wiley JF, Crespi CM, Sauer‐Zavala S, Stanton AL (2019) A preventive intervention to modify depression risk targets after breast cancer diagnosis: Design and single‐arm pilot study. Psycho‐oncology, 28(4), 880-887.
• Wittchen HU, Jacobi F, Rehm J, Gustavsson A, Svensson M, Jönsson B et al. (2011) The size and burden of mental disorders and other disorders of the brain in Europe 2010. European neuropsychopharmacology, 21(9), 655-679.