Group therapy using the Unified Protocol or other transdiagnostic CBT approach for the treatment of adults with depression or anxiety

Depression and anxiety are two of the most common mental health conditions among adults and can have a significant impact on the quality of life. Transdiagnostic CBT (tCBT) focuses on what is common across different conditions, rather than being diagnosis-specific. The Unified Protocol is a form of tCBT that can simplify the work for clinicians, as it allows for the treatment of multiple conditions using the same method. This approach also allows for individuals with different diagnoses to be treated together in group therapy.

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SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

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Published: Report no: ut202502 Registration no: SBU 2024/696

Question

What systematic reviews have been published regarding group therapy with Unified Protocol or other transdiagnostic CBT approach for the treatment of adults with depression or anxiety?

Method

A systematic literature search was performed using the following databases: Medline and Scopus.

Two authors independently assessed the abstracts of all identified studies.
Risk of bias in relevant systematic reviews was assessed using an assessment tool based on AMSTAR.

Identified literature

One relevant systematic review with moderate risk of bias were identified [1]. The results and conclusions are presented in Table 1. In five relevant systematic reviews, the risk of bias was considered to be high, therefore the results and conclusions are not reported [2-6].

Table 1 Systematic reviews with moderate risk of bias.
CBT = cognitive behaviour therapy; tCBT = transdiagnostic cognitive behaviour therapy; RCT = randomised controlled trial
Included studies Population, Intervention, Control Outcome and Results
Andersen et al, 2016 [1]
Effectiveness of Transdiagnostic Cognitive Behaviour Therapy for Anxiety and Depression in Adults: A Systematic Review and Meta-analysis
8 RCT (n=345)

Relevant studies:
4 RCT (n=153)

Setting:
USA: 4 studies
Australia: 3 studies
Canada: 1 study		 Population:
Adults (aged 16 years or over). Participants at baseline met diagnostic criteria for an anxiety or depressive disorder.

Intervention:
Group tCBT (n:16–53)

Comparison:
Waitlist: 2 studiesActive treatment: 2 studies (relaxation, disorder-specific CBT)		 Depression and/or anxiety severity measures
No statistical synthesis due to heterogeneity.
Authors' conclusion:
”Quality assessment of the primary studies indicated a number of methodological concerns that may serve to inflate the observed effects of transdiagnostic approaches. Although there are positive signs of the value of transdiagnostic CBT, there is as yet insufficient evidence to recommend its use in place of disorder-specific CBT.”

References

  1. Andersen P, Toner P, Bland M, McMillan D. Effectiveness of Transdiagnostic Cognitive Behaviour Therapy for Anxiety and Depression in Adults: A Systematic Review and Meta-analysis. Behav Cogn Psychother. 2016;44(6):673-90. Available from: https://doi.org/10.1017/S1352465816000229.
  2. Ayuso-Bartol A, Gómez-Martínez MÁ, Riesco-Matías P, Yela-Bernabé JR, Crego A, Buz J. Systematic Review and Meta-analysis of the Efficacy and Effectiveness of the Unified Protocol for Emotional Disorders in Group Format for Adults. Int J Ment Health Addict. 2024. Available from: https://doi.org/10.1007/s11469-024-01330-z.
  3. Cuijpers P, Miguel C, Ciharova M, Ebert D, Harrer M, Karyotaki E. Transdiagnostic treatment of depression and anxiety: a meta-analysis. Psychol Med. 2023;53(14):6535-46. Available from: https://doi.org/10.1017/S0033291722003841.
  4. Joaquim SB, Simões de Almeida R, Marques AJ. Transdiagnostic Cognitive Behavioral Group Interventions: A Systematic Review. Cogn Ther Res. 2023;47(3):303-26. Available from: https://doi.org/10.1007/s10608-023-10372-x.
  5. Reinholt N, Krogh J. Efficacy of transdiagnostic cognitive behaviour therapy for anxiety disorders: a systematic review and meta-analysis of published outcome studies. Cogn Behav Ther. 2014;43(3):171-84. Available from: https://doi.org/10.1080/16506073.2014.897367.
  6. Schaeuffele C, Meine LE, Schulz A, Weber MC, Moser A, Paersch C, et al. A systematic review and meta-analysis of transdiagnostic cognitive behavioural therapies for emotional disorders. Nat Hum Behav. 2024;8(3):493-509. Available from: https://doi.org/10.1038/s41562-023-01787-3.

Search strategies

Medline via OvidSP 25 September 2024

Title: Unified protocol
/ = Term from the MeSH controlled vocabulary; .sh = Term from the MeSH controlled vocabulary; exp = Term from MeSH including terms found below this term in the MeSH hierarchy; .ti,ab = Title or abstract; .tw = Title or abstract; .kf = Keywords; .kw = Keywords, exact; .bt = Book title. NLM Bookshelf; .pt = Publication type; .ja = Journal abbreviation; .af = All fields; adjn = Adjacent. Proximity operator retrieving adjacent words, adj3 retrieves records with search terms within two terms from each other; * or $ = Truncation; “ “ = Citation Marks; searches for an exact phrase

a) Cochrane Highly Sensitive Search Strategy for identifying randomized trials in MEDLINE: sensitivity- and precision-maximizing version (2008 revision); Ovid format. The Cochrane Collaboration; 2008. Available from: https://training.cochrane.org/handbook/current/chapter-04-technical-supplement-searching-and-selecting-studies#section-3-6-1. with modifications: the following terms are added: clinical trial, phase iii.pt. ; randomised.ab. ; ("Phase 3" or "phase3" or "phase III" or P3 or "PIII").ti,ab,kw.
Search terms Items found
Intervention:
1. (transdiagnostic* or Unified protocol or tCBT or emotion* detective*).tw,kf,bt 5688
Study types: systematic reviews and meta-analysis / randomized controlled trials a)
2. ((Systematic Review/ or Meta-Analysis/ or Cochrane Database Syst Rev.ja. or ((systematic adj4 review) or "meta analys*" or metaanalys*).ti,bt,ab.) not (editorial/ or letter/ or case reports/)) 505 683
Combined sets:
3. 1 AND 2 430
Final result
4. 3 430

Scopus via scopus.com 25 September 2024

Title: Unified protocol
TITLE-ABS-KEY = Title, abstract or keywords (including indexed keywords and author keywords); ALL = All fields; W/n = Within. Proximity operator retrieving terms within n words from each other; PRE/n = Precedes by. Proximity operator, the first term in the search must precede the second by n words; LIMIT-TO (X) = Includes only results of specified type, e.g., publication type or time range; DOCTYPE = Publication type; “re” = review; “le” = letter; “ed” = editorial; “ch” = book chapter; “cp” = conference proceedings; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Intervention:
1. TITLE-ABS-KEY ( transdiagnostic* OR "Unified protocol" OR tCBT ) 7372
2. TITLE-ABS-KEY ( emotion* AND detective* ) 142
Study types: systematic reviews and meta-analysis / randomized controlled trials
3.; TITLE-ABS-KEY ( ( systematic W/2 review ) OR "meta analy*" OR metaanaly* ) AND (EXCLUDE (DOCTYPE, “le”) OR EXCLUDE (DOCTYPE, “ed”) OR EXCLUDE (DOCTYPE, “ch”) OR EXCLUDE (DOCTYPE, “cp”)) 745 157
Combined sets:
4. 1 OR 2 7745
5. 2 AND 4 558
Final result
6. 5 558

Citation Search

Scopus via Elsevier (citation search) 11 December 2024

Title: Unified protocol
LIMIT-TO (SRCTYPE, "j" = Limit to source type journal; LIMIT-TO (DOCTYPE, "ar" = Limit to document type article; LIMIT-TO (DOCTYPE, "re" = Limit to document  type review; LIMIT-TO (PUBYEAR, X = Limit to publication year
Search terms Items cited
Cited articles
1. DOI 10.1007/s11469-024-01330-z 1
2. DOI 10.1017/s1352465816000229 81
3. DOI 10.1017/S0033291722003841 19
4. DOI 10.1007/s10608-023-10372-x 3
5. DOI 10.1080/16506073.2014.897367 116
6. DOI 10.1038/s41562-023-01787-3 10
Citing articles
7. 1 OR 2 OR 3 OR 4 OR 5 OR 6 200
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