Transdiagnostic Treatment for Anxiety Disorders, depression and other disorders

What is transdiagnostic treatment of emotional disorders? They are treatment methods that focus on the theoretical and practical commonalities in theory of different disorders to treat emotional disorders and other disorders.

Some of the disorders treated by the use of transdiagnostic treatment include anxiety disorders, depression, eating disorders and other related disorders.

According to recent studies, different psychiatric disorders have similar fundamental underlying susceptibilities. Because of this, currently there has been developed of transdiagnostic treatment to focus on the underlying susceptibilities of different disorders.

Some of the core features and susceptibilities of anxiety disorders are targeted by transdiagnostic treatment include:

  • Anxiety signals and triggers (e.g. situational, perceptive, and interoceptive signals or cues)
  • Perceptive or mental processes and biases (e.g., intolerance of uncertainty)
  • Avoidance behaviors (e.g., situational, interoceptive, cognitive, and emotional avoidance)
  • Physical signs and symptoms, and amplified arousal
  • Compulsions/ impulses and safety behaviors
  • Skills and competencies deficits

This approach is different to single-diagnosis protocol where the focus is on one disorder only. Transdiagnostic approach has improved the treatment prognosis of different emotional disorders.

The making of transdiagnostic treatment can happen through three (3) separate approaches giving
rise to three clear categories:

  • Modular/common elements approach
  • Universally applied therapeutic approach
  • Mechanistically transdiagnostic approach

Modular/ common elements approach

This seems to be the most practical and realistic method for transdiagnostic treatment development. The modular/ common element approach is made of several therapeutic approaches and elements that have proven to be effective across therapies like cognitive restructuring or exposure.

Each patient receives selected empirically proven approaches/ strategies according to the patient’s problem in addition to demographic and contextual aspects that are individually exclusive. Thus, doctors can formulate a treatment that is unique to each patient.

The modular/ common element approach has extensively been used in children and in low to middle income countries.

In children MATCH (modular approach to therapy for children with anxiety), is an example of this approach in use. Match uses a decision tool to formulate a therapy specific to each child.

In adults CETA (common elements treatment approach), has been very effective in low to middle income countries in the treatment of trauma related disorders. CETA gives the therapist a guide on how to systematically use the different elements to ensure healing. Some of these elements include behavioral activation and cognitive restructuring.

Universally applied therapeutic approach

Since transdiagnostic treatment was also developed using the universally applied therapeutic principles, theoretically derived approaches are believed to be the fundamental course of change. These theoretically
derived approaches such as therapeutic relationship and cognitive change were used in other psychotherapies before.

These approaches have recently been classified as transdiagnostic because historically they have been used in the study of several mental disorders.

Cognitive therapy (CT), developed by Aaron T. Beck, is an example of a transdiagnostic therapy that has used this approach. CT takes a top-down approach to treat mental disorders. This is different from the mechanistically transdiagnostic approach which employs a bottom-up approach.

CT was formulated to contest any patient’s inaccurate thoughts in several disorders to give rise to precise balanced deductions. These distorted thoughts may be about the yourself, the world and others.

In cognitive therapy, the thoughts that are contributing the most to mental disorders symptoms are the ones that are focused on.

CT has been successful in a number of anxiety disorders and other mental disorders.

Other universally applies therapeutic approaches therapies in use include mindfulness-based therapy, client-centered therapy, psychodynamic psychotherapy, acceptance and commitment therapy (ACT) among
others.

Mechanistically transdiagnostic approach

This approach singles out psychological processes that underlie a certain disorder class. Examples of such processes include overvaluation of shape and weight for eating disorders, meaning you misperceive your own body shape as larger or smaller than the normal body of a healthy person. In addition, you may perceive
some body shapes as more pleasant.

A group of psychiatric disorders including anxiety disorders, eating disorders and others manifest themselves by recurrent, severe adverse assumptions, powerful aversive responses to the adverse effect, and substantial attempts to elude or evade the negative affect. In other words, emotional disorders have three major features
namely:

  • Recurrent strong emotions
  • Negative reaction to the emotions
  • Avoidance and attempts to escape the emotions

This approach targets the fundamental process such as the high negative affect in treating the emotional disorders.

One of the commonly used mechanistically transdiagnostic approach is the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP). UP targets the underlying vulnerability of different disorders rather than the diagnostic category.

The UP targets the high negative affect and the low positive affect that affects the patient. This is different from targeting the strong emotions caused by one disorder.

The UP has a minimum of 8 modules which are covered in sessions. Each module can be addressed in one or more sessions depending on the patient.

UP has been demonstrated to be efficacious in several anxiety disorders such as generalized anxiety disorder (GAD), Social anxiety disorder
(SAD), Obsessive compulsive disorder (OCD), panic disorder, agoraphobia and PTSD. It is also effective in depression and hypochondria among other disorders.

Types of anxiety disorders

What are the 6 common types of anxiety disorders? There are several types of anxiety disorders. Anxiety disorders according to ADAA affects over 40 million adults in the USA every year. Some of the types of anxiety
disorders include:

  • Generalized Anxiety Disorder (GAD)
  • Obsessive-Compulsive Disorder (OCD)
  • Panic Disorder
  • Post-Traumatic Stress Disorder (PTSD)
  • Social Phobia (or Social Anxiety Disorder)
  • Specific phobias
  • Separation Anxiety Disorder
  • Agoraphobia
  • Situational anxiety
  • Selective mutism

The common 6 anxiety disorders are generalized Anxiety disorder (GAD), social anxiety disorder (SAD), Panic disorder, specific phobia, separation anxiety disorders and post-traumatic stress disorder (PTSD).

Generalized Anxiety Disorder (GAD)

This anxiety disorder is characterized by extreme fear and nervousness on various general events. The symptoms associated with GAD must be present for a period of more than 6 months to have a more conclusive diagnosis.

People with GAD are referred on the street as neurotics or worrywarts. These people are always worry about something.

The common anxiety symptoms that are experienced in GAD include:

  • Persistent edginess
  • Constant difficulty in paying attention or poor concentration.
  • Being always tired or fatigued.
  • Being fatigued easily
  • Having tense muscles
  • Restlessness
  • Sleep problems like insomnia

Generalized anxiety disorders affect around 6.8% of Americans. This translates to around 6.8 million Americans.

Social anxiety disorder (SAD) or Social phobia

This anxiety disorder is the feeling of overwhelming fear or worry concerning social events where scrutiny is expected. The anxiety about these social situations is about the fear of being scrutinized, ridiculed, embarrassed, ignored or judged.

The fixating fear and the constant need to avoid such situations define the social phobia. In people suffering from SAD, these situations are faced only if there is extreme pressure.

People with SAD always overjudge a situation. The fear may be caused by a very small threat which the patient registers it as extreme.

Social anxiety disorder is therefore deduced if there is repeated extreme fear of social situations and subsequent employment of abnormal behaviors to cope or avoid the situation.

Specific phobias

Specific phobias are extreme and excessive fear about a specific situation or object which are substantially beyond what is expected for the actual threat involved. The fears include fear of heights, flying, darkness, insects, flying, seas among others.

Other fears may be about threatening situations or objects like snakes, spiders, enclosed spaces, sharks etc.

The object or situation that the individual fears is avoided or coped with in an abnormal and dysfunctional manner. If this fear and the behavior of coping the situation lasts for more than 6 months, the person is
said to have that specific phobia.

Panic disorder

Panic disorder: Treatment by transdiagnostic treatment

This is an anxiety disorder where there are repeated, random and extreme feeling of fear and panic. The panic attack present with the following symptoms: Sweating, shaking, chest pain, a feeling of getting choked and palpitations (irregular heartbeat). Other symptoms include nausea, dizziness and chills.

Patients describe the attack to be similar to a heart attack or you are going crazy. Some also describe the feeling like a feeling of losing control or having someone else’s body. The panic attack can happen at any time even when you are sleeping.

In panic disorder, the panic attacks are followed by a period of extreme fear about getting another attack that lasts for more than a month. Panic disorders may be hereditary since studies show that they increase in case a relative had panic disorder or other anxiety disorders.

Women are twice as much likely to get a panic disorder as compared to men. In the USA, about 6 million (2.7%) are affected by panic disorders.

Panic disorder is related to disorders of other body systems like endocrine and cardiovascular systems. Patients with panic disorder often are prone to depression and substance abuse.

Agoraphobia

According to DSM-5, the agoraphobia was defined as its own anxiety disorder. Agoraphobia is strongly related to panic disorder.

Agoraphobia is the fear and worry about being in situations or places where it is difficult to escape, is uncomfortable or in situations when support is unavailable when it is required.

Agoraphobia is caused by the concern about getting a panic attack thus the relations with panic disorder. People with agoraphobia are seen to be concentrating in escape routes or positioning themselves in an area where
the door is visible if they are in a room.

In addition to the fear, people with agoraphobia have avoidance behaviors. These behaviors sometimes add to the fear or cause serious consequences.

Some of the situations that are avoided by people with agoraphobia include:

  • Using public transport
  • Using a taxi alone
  • Being in enclosed spaces
  • Being in open spaces or in a crowd
  • Standing in line with others
  • Going out of home alone.

When the fears and avoidance behaviors manifest for over 6 months with interference in daily activities, agoraphobia is suspected.  The fear felt in agoraphobia is normally disproportionate as compared to the danger posed by the fear causing event or situation.

Separation anxiety disorder (SepAD)

People with this fear have repeated, extreme and inappropriate anxiety about being separated from a person or place where you are attached to. It is quite different from separation anxiety which is normal in babies.

Separation anxiety disorder affects 4% and 7% of children and adults respectively. It is more severe in adults than in children.

The individuals suffering separation anxiety disorder may refuse to leave a place or person he is accustomed to. When they are in a different place or the accustomed person is not around, they may suffer from lack of sleep or may get nightmares.

SepAD may develop in childhood and persist to adulthood if not treated. Therefore, it is recommended that the diagnosis in children should be done early enough and the condition treated to prevent complications.

Obsessive-Compulsive Disorder (OCD)

This disorder is characterized by repetitive obsessive thoughts (obsession) or performing certain rituals or behaviors (compulsions). These obsessions and compulsions make life unbearable.

People with OCD have compulsions like counting, cleaning, handwashing or checking if the door is closed. These compulsions are done to avoid or cope with the unwanted thoughts.

Not making the compulsions increases anxiety and making them offers temporary relief.

OCD is associated with an increase in the risk of suicide and tics. The risk factors for obsessive-compulsive disorder are genetics, and certain infects even though the cause is unknown. OCD may also develop if there
was a history of abuse and exposure to stress in your childhood.

Post-Traumatic Stress Disorder (PTSD)

PTSD is a mental health disorder that develops in some individuals after exposure to a terrifying event. The terrifying event may have caused or threatened to cause bodily injury.

PTSD may develop if you or someone close to you experienced the terrifying event in your presence. Events that have been seen to cause PTSD in Americans include violent personal assaults, disasters, military battle or accidents.

The symptoms of PTSD include flashbacks, nightmares and severe fear. These happen in addition to overwhelming thoughts about the event.

The symptoms can be aggregated into avoidance, intrusive memories, foul moods and thoughts and having disparities in physical and emotional reactions.

The PTSD symptoms may start within a month after being exposed to the terrifying event or may even take years to start. These symptoms cause problems in performing the daily activities thus affecting your work or family.

Some people heal after exposure to the traumatic event, but some develop PTSD. Healing may require time and self-care. There are several successful treatment methods for PTSD including Unified Protocol.

Selective mutism

Selective mutism is a childhood anxiety disorder where an individual with speaking abilities is incapable of speaking in particular situations or to some people. For most people suffering from selective mutism,
the disorder co-exists with social anxiety and being shy.

For children or adults with selective mutism, silence is sustained even when they are sure of being mocked, humiliated, punished or socially ostracized. Selective mutism affects 0.8% of all people.

It is quite overwhelming and painful. Selective mutism affects the child’s social skills. The severity of the disorder varies from individual to individual.

The selective mutism cause is unknown like in other anxiety disorders, but genetics play a huge role in it. The children with selective mutism have extreme anxiety tendencies, are shy, moody and throw tantrums often in addition to having sleeping problems.

What causes anxiety disorders to develop?

In almost all anxiety disorders, the following are the most mentioned causes:

  • Genetics
  • History of trauma or suffering
  • Abuse of drugs and other substances
  • Diseases
  • Side effects of some medications

The bottom line

Transdiagnostic treatment for anxiety disorders are ground-breaking treatment options for emotional disorders. These treatment methods are great in targeting almost all emotional disorders.

The different transdiagnostic approaches work well for all anxiety disorders. They utilize the fundamental vulnerabilities of all emotional disorders to formulate a treatment.

The main strength of transdiagnostic treatment is the ease in its dissemination. This way it can be deployed in the treatment of all emotional disorders with reduced costs.