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Transdiagnostic psychological treatments for anxiety and depression

The high prevalence and cost of anxiety and depressive disorders have resulted in unprecedented efforts to support dissemination of evidencebased treatments for these conditions. Although there is extensive evidence for psychological treatments for each anxiety disorder and depression (i.e. disorder-specific cognitive behaviour therapy [DSCBT]), this model of treatment does have some limitations. In the community, the most common presentations are a mix of anxiety and depressive symptoms rather than pure disorders. Anxiety and depressive disorders are also highly comorbid, both with each other and other anxiety disorders. Somewhat surprisingly in view of this, remarkably few studies address the question of how the treatment of mixed anxiety and depression, or comorbid anxiety and depressive disorders is best addressed. For example, should DSCBT be offered for just one disorder or to both sequentially, which disorder is treated first and what are the costs of this? A further concern with DSCBT relates to training and dissemination. In research and specialist settings, there is no problem training clinicians in each of the treatment models and their delivery. This is, however, more challenging in real-world settings where clinicians have funding restrictions on the number of sessions they can provide, are often not from a psychology background and have limited access to training and supervision. It has been suggested that these factors have resulted in the poor dissemination of evidence-based treatment into clinical practice. Transdiagnostic treatment may go some way to addressing these issues. From a service delivery perspective, focussing treatment on presentations which are often a mix of anxiety and depressive symptoms, or anxiety and depression with comorbidity rather than specific disorders, is likely to be beneficial. From a training perspective, clinicians only need to be trained in a single model of treatment which they can not become confident in delivering. In addition, there is often a drive for treatments to be delivered in a group format for pragmatic reasons (e.g. efficiency, cost-effectiveness). A transdiagnostic approach facilitates this because people with different disorders can all be started in a group, whereas in a disorder-specific approach, there is often delay in collecting together sufficient numbers with the same diagnosis presenting at a similar time.