Academic journal article Iranian Journal of Psychiatry

Transdiagnostic Treatment of Co-Occurrence of Anxiety and Depressive Disorders Based on Repetitive Negative Thinking: A Case Series

Academic journal article Iranian Journal of Psychiatry

Transdiagnostic Treatment of Co-Occurrence of Anxiety and Depressive Disorders Based on Repetitive Negative Thinking: A Case Series

Article excerpt

psychological treatments. One of the main problems faced by specific cognitive-behavioral therapies is the comorbidity of anxiety and mood disorders (13).

Due to complications caused by comorbidity, using this specific therapeutic protocol is not efficient for several reasons. First, high level of comorbidity of anxiety and mood disorders provokes patients' withdrawal during specific cognitive behavioral therapies and reduces patient compliance to finish their treatment. Second, comorbidity of anxiety and mood disorders lowers the efficacy of specific cognitive behavioral therapies since using several therapeutic protocols for patients with co-occurrence of anxiety and mood disorders is not economically efficient, and these patients cannot afford to finish their treatment. Third, coexistence of anxiety and mood disorders raises severe dangers including risk of suicide in patients and requires serious interventions (14-16).

Approaching comorbidity of anxiety and mood disorders and resolving previously mentioned challenges is only possible by developing methods that consider comorbidity at both theoretical and practical levels. Transdiagnostic therapies are leading in this new approach toward development of therapeutic protocols. Transdiagnostic approaches are trying to resolve therapeutic problems and challenges arising from comorbidity by studying theoretical nature of comorbidity and recognizing common aspects of emotional disorders particularly anxiety and depression disorders (17-21; 15, 16).

Based on the review article on transdiagnostic therapies, early published transdiagnostic therapies were pragmatic. These therapies were the first attempts to treat comorbidity anxiety and mood disorders. These protocols are mainly based on clinical experiences and common and similar techniques of specific cognitive behavioral therapies and concentrate on common symptoms of anxiety and depression disorders. Several studies have shown the effect of pragmatic transdiagnostic therapies in treating emotional disorders. However, results of most of transdiagnostic therapies implicate the moderate effectiveness of these therapeutic protocols. Based on this meta-analysis, the most important justification for the moderate effectiveness of pragmatic transdiagnostic protocols is its disregard for common cognitive-behavioral mechanisms of emotional disorders (16, 18, 19, 22, 23).

Moderate effectiveness of pragmatic transdiagnostic therapies led to designing protocols that had other foundations. Therefore, Barlow et al. (24) made a considerable improvement in designing theoretical-practical transdiagnostic protocols through several studies with emphasis on the role of 'emotion regulation' as the main cognitive-behavioral mechanism in emotional disorders. This protocol is more effective than other pragmatic transdiagnostic therapeutic protocols since it has a greater theoretical basis. Although in Barlow's model, theory and therapy come together and 'emotion regulation' is considered and emphasized in the context of treatment, yet it does not sufficiently match with the theoretical knowledge of common psychopathology of emotional disorders (24-26).

Recent studies have shown that repetitive negative thinking is the most important common cognitive behavioral process in formation and continuation of emotional disorders. Repetitive negative thinking includes worry, rumination, treatment monitoring, obsessions and any other kind of repetitive negative thoughts which is the core of depression and anxiety disorders. Surveying more than 50 studies in cognitive pathology of emotional disorders shows that repetitive negative thinking is the main transdiagnostic factor in more than 13 diagnostic classes, including depression disorders, anxiety disorders, sleep disorder, eating disorder, substance abuse disorder and schizophrenic disorder (17-32).

Considering these studies, One potential way to improve the efficacy of pragmatic transdiagnostic therapies and Barlow's transdiagnostic therapy (24) for co-occurrence of anxiety and depressive disorders is to adapt transdiagnostic therapies to specifically address repetitive negative thinking as core transdiagnostic processes underlying emotional disorders. …

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