A systematic review and meta-analysis of transdiagnostic cognitive behavioural therapies for emotional disorders

Abstract

Transdiagnostic cognitive behavioural psychotherapy (TD-CBT) may facilitate the treatment of emotional disorders. Here we investigate short- and long-term efficacy of TD-CBT for emotional disorders in individual, group and internet-based settings in randomized controlled trials (PROSPERO CRD42019141512). Two independent reviewers screened results from PubMed, MEDLINE, PsycINFO, Google Scholar, medRxiv and OSF Preprints published between January 2000 and June 2023, selected studies for inclusion, extracted data and evaluated risk of bias (Cochrane risk-of-bias tool 2.0). Absolute efficacy from pre- to posttreatment and relative efficacy between TD-CBT and control treatments were investigated with random-effects models. Of 56 identified studies, 53 (6,705 participants) were included in the meta-analysis. TD-CBT had larger effects on depression (g = 0.74, 95% CI = 0.57-0.92, P < 0.001) and anxiety (g = 0.77, 95% CI = 0.56-0.97, P < 0.001) than did controls. Across treatment formats, TD-CBT was superior to waitlist and treatment-as-usual. TD-CBT showed comparable effects to disorder-specific CBT and was superior to other active treatments for depression but not for anxiety. Different treatment formats showed comparable effects. TD-CBT was superior to controls at 3, 6 and 12 months but not at 24 months follow-up. Studies were heterogeneous in design and methodological quality. This review and meta-analysis strengthens the evidence for TD-CBT as an efficacious treatment for emotional disorders in different settings.

Fig. 1. PRISMA flowchart of the literature search and screening procedure.

Three studies could not be included in the meta-analysis because either no self-report of anxiety or depression was available or no data were available^,. For one study, treatment effects at 12 months follow-up were reported in a separate publication which was not included in the final number of studies as this reflects the number of RCTs identified. However, we included the follow-up values in our meta-analysis.

Fig. 2. Risk of bias assessment.

Traffic-light plot of the domain-level judgements. Risk of bias was assessed across five domains for each study included in the meta-analysis using the revised Cochrane risk-of-bias tool (RoB 2.0). The combination of assessments in the five domains results in an overall risk of bias rating.

Fig. 3. Forest plots of controlled effect sizes (posttreatment) for depression.

Studies are clustered according to the setting in which they investigated TD-CBT. One study compared TD-CBT to ACT and BA. We used a random-effects (RE) model to estimate pooled effects. n denotes the number of studies included. For each study, the black square represents the effect size (standardized mean difference, SMD) and the horizontal bars represent the 95% CI. The overall estimated effect size (Hedges‘ g) is depicted by the diamond with the dotted bars representing its 95% CI.

Fig. 4. Forest plots of controlled effect sizes (posttreatment) for anxiety.

Studies are clustered according to the setting in which they investigated TD-CBT. One study compared TD-CBT to ACT and BA. We used an RE model to estimate pooled effects. n denotes the number of studies included. For each study, the black square represents the effect size SMD and the horizontal bars represent the 95% CI. The overall estimated effect size (Hedges‘ g) is depicted by the diamond with the dotted bars representing its 95% CI.