Origin of the term transdiagnostic and its influence in developing personalized, adaptable, process-based therapeutic interventions

Riccardo Dalle Grave, MD – Department of Eating and Weight Disorders, Villa Garda Hospital

Christopher Fairburn, Zafra Cooper, and Roz Shafran were the first to introduce the term “transdiagnostic” in the field of mental disorders. They used this term to describe the innovative transdiagnostic cognitive-behavioral therapy (CBT) model for eating disorders in their influential 2003 paper, “Cognitive Behavior Therapy for Eating Disorders: A ‘Transdiagnostic’ Theory and Treatment” [1].

The transdiagnostic view on the processes that maintain eating disorder psychopathology was based on the observation that the main maintaining processes are likely to be largely the same across different eating disorder diagnoses. Therefore, if these maintaining processes can be disrupted in one eating disorder, it should be possible to disrupt them in other eating disorders. Hence, the Centre for Research on Eating Disorders at Oxford (CREDO) team reconceptualized the existing evidence-based form of CBT for bulimia nervosa and adapted it to make it suitable for all forms of eating disorders. The result was the development of a new transdiagnostic cognitive behavioral treatment called Enhanced CBT (CBT-E) [1].

Fairburn’s work significantly advanced the idea of transdiagnostic treatments, not just within the context of eating disorders but also across other mental health conditions.

For example, David Barlow, a world-renowned researcher and psychologist best known for his work on anxiety and emotional disorders, describes that around the year 2000, he was triggered to develop the Unified Protocol for The Transdiagnostic Treatment of Emotional Disorders (UP) reading a grant application from the Wellcome Trust by Chris Fairburn that explained the need for a transdiagnostic eating disorder treatment [2]. The UP can be used to treat many common mental health concerns like anxiety, depression, and other emotional disorders [3]. As the CBT-E for eating disorders, the UP is a transdiagnostic treatment, which means it is meant to help anyone struggling to manage emotions, regardless of their diagnosis.

In recent decades, the transdiagnostic approach has become fundamental in developing more adaptable, process-based therapeutic interventions aimed at targeting specific processes that extend across various disorders. The ultimate goal is to tailor psychotherapy to each individual client. Notable examples include memory specificity training [4], attentional bias modification [5], interpretive bias modification for particular processes such as repetitive negative thinking (RNT) [6], and attentional control training for treating cognitive anxiety sensitivity [7]. Additionally, this approach is reflected in interventions that address a wider range of processes within established therapeutic frameworks, such as rumination-focused CBT (RfCBT) [8], augmented depression therapy (ADepT) [9], and the broader application of Process-Based Therapy (PBT) [10].

References

  1. Fairburn CG, Cooper Z, Shafran R. Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment. Behav Res Ther. 2003;41(5):509-28. doi: 10.1016/s0005-7967(02)00088-8.
  2. Allman R: Dr David H. Barlow and the Unified Protocol. https://www.psychologytools.com/articles/dr-david-h-barlow-and-the-unified-protocol/ (2023). Accessed 17 August 2024.
  3. Barlow DH, Allen LB, Choate ML. Toward a unified treatment for emotional disorders. Behav Ther. 2004;35(2):205-30. doi: https://doi.org/10.1016/S0005-7894(04)80036-4.
  4. Werner-Seidler A, Hitchcock C, Bevan A, McKinnon A, Gillard J, Dahm T, et al. A cluster randomized controlled platform trial comparing group MEmory specificity training (MEST) to group psychoeducation and supportive counselling (PSC) in the treatment of recurrent depression. Behav Res Ther. 2018;105:1-9.
  5. MacLeod C, Rutherford E, Campbell L, Ebsworthy G, Holker L. Selective attention and emotional vulnerability: assessing the causal basis of their association through the experimental manipulation of attentional bias. J Abnorm Psychol. 2002;111(1):107-23.
  6. Hirsch CR, Krahé C, Whyte J, Bridge L, Loizou S, Norton S, et al. Effects of modifying interpretation bias on transdiagnostic repetitive negative thinking. J Consult Clin Psychol. 2020;88(3):226-39. doi: 10.1037/ccp0000455.
  7. Allan NP, Albanese BJ, Judah MR, Gooch CV, Schmidt NB. A multimethod investigation of the impact of attentional control on a brief intervention for anxiety and depression. J Consult Clin Psychol. 2020;88(3):212-25. doi: 10.1037/ccp0000484.
  8. Watkins ER. Rumination-focused cognitive-behavioral therapy for depression. Guilford Publications; 2018.
  9. Dunn BD, Widnall E, Reed N, Owens C, Campbell J, Kuyken W. Bringing light into darkness: A multiple baseline mixed methods case series evaluation of Augmented Depression Therapy (ADepT). Behav Res Ther. 2019;120:103418. doi: 10.1016/j.brat.2019.103418.
  10. Hayes SC, Hofmann SG. Process-based CBT: The science and core clinical competencies of cognitive behavioral therapy. New Harbinger Publications; 2018.