Over the last decade there has been an increased interest in transdiagnostic cognitive behavioural therapy– treatment for anxiety that focuses on underlying processes which are common to all anxiety disorders, as opposed to targeting specific anxiety disorders like phobias, PTSD and OCD. Such treatments are effective in curing a broad range of anxiety disorders as well as alleviating symptoms of depression, with research showing that a transdiagnostic approach has similar success rates to specific treatments for anxiety disorders. This review provides a summary of the current evidence and support for a transdiagnostic approach to overcoming anxiety.
The transdiagnostic view argues that anxiety disorders are all caused by fundamentally similar processes, and are simply different in the way they manifest. The main difference between such disorders is the stimulus which causes fear- spiders, public speaking, memories of past trauma- and the means of coping with this fear.
Regardless of what causes the fear, anxiety is driven by the belief that the feared stimulus is more harmful than it really is. This overestimation of danger causes the emotional experience of fear, which leads to attempts to avoid coming into contact with the feared stimulus or situation. This cycle of overestimation, fearful response and avoidance is central to all anxiety disorders, and all anxiety treatment aims to disrupt the cycle.
Comorbidity between anxiety disorders is often high (around 55%) and comorbidity with depressive disorders is even higher (76%). Research also shows that anxiety disorder diagnosis is not always stable, and many patients show a shift from one anxiety disorder to another. These findings strongly suggest that anxiety disorders all stem from the same core components.
Further evidence for a transdiagnostic view of anxiety treatment comes from studying patterns of diagnosis in families. Research shows little evidence that specific anxiety disorders can be inherited or shared among family members, but rather that an underlying vulnerability to anxiety may be passed down, which then manifests in different ways based on upbringing and learning.
The neurobiology and brain chemistry of anxiety is extremely complex, with a huge variety of brain systems involved in detecting threats, interpreting information and motivating a response. Despite this there are still some areas and processes which are common to all anxiety disorders. These include the neural circuits between the amygdale and the cortex, the hippocampus and the prefrontal cortex.
There are numerous cognitive processes which are universal to all anxiety disorders. Patients suffering from any anxiety disorder will show an exaggerated belief in the danger of their feared stimuli, and will also display an increased vigilance for such threats in their environment, such that they are constantly on the lookout for danger and more likely to interpret non-harmful stimuli as threatening.
Finally, evidence for a transdiagnostic approach can also be found by examining treatment effectiveness. Many treatments, such as cognitive behavioural therapy, are equally effective at treating all anxiety disorders and can be applied to different conditions with minimal changes. Research also shows that providing general CBT for anxiety can have a positive impact on comorbid disorders- if you receive CBT for one disorder it may end up helping get rid of another as well.
While there are some differences between the anxiety disorders, the above research highlights how they are similar on a number of levels including diagnosis, genetics, neurobiology, cognitive processes and treatment effectiveness. Further research into effective transdiagnostic treatment may help us develop powerful ways of overcoming anxiety in all its different forms.
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