Emotion regulation as a transdiagnostic treatment construct across anxiety, depression, substance, eating and borderline personality disorders: A systematic review

OBJECTIVE\nUnderstanding the factors that predict a favourable outcome following specialist treatment for an eating disorder may assist in improving treatment efficacy, and in developing novel interventions. This review and meta-analysis examined predictors of treatment outcome and drop-out.\n\n\nMETHOD\nA literature search was conducted to identify research investigating predictors of outcome in individuals treated for an eating disorder. We organized predictors first by statistical type (simple, meditational, and moderational), and then by category. Average weighted mean effect sizes (r) were calculated for each category of predictor.\n\n\nRESULTS\nThe most robust predictor of outcome at both end of treatment (EoT) and follow-up was the meditational mechanism of greater symptom change early during treatment. Simple baseline predictors associated with better outcomes at both EoT and follow-up included higher BMI, fewer binge/purge behaviors, greater motivation to recover, lower depression, lower shape/weight concern, fewer comorbidities, better interpersonal functioning and fewer familial problems. Drop-out was predicted by more binge/purge behaviors and lower motivation to recover. For most predictors, there was large interstudy variability in effect sizes, and outcomes were operationalized in different ways. There were generally insufficient studies to allow analysis of predictors by eating disorder subtype or treatment type.\n\n\nDISCUSSION\nTo ensure that this area continues to develop with robust and clinically relevant findings, future studies should adopt a consistent definition of outcome and continue to examine complex multivariate predictor models. Growth in this area will allow for stronger conclusions to be drawn about the prediction of outcome for specific diagnoses and treatment types.

Predictors of treatment outcome in individuals with eating disorders: A systematic review and meta-analysis: PREDICTORS OF TREATMENT OUTCOME IN INDIVIDUALS WITH EATING DISORDERS

The clinical significance of 2 main dimensions of perfectionism (perfectionistic strivings and perfectionistic concerns) was examined via a meta-analysis of studies investigating perfectionism in the psychopathology literature.We investigated relationships between psychopathology outcomes (clinical diagnoses of depression, anxiety disorders, obsessive-compulsive disorder, and eating disorders; symptoms of these disorders; and outcomes related to psychopathology, such as deliberate self-harm, suicidal ideation, and general distress) and each perfectionism dimension. The relationships were examined by evaluating (a) differences in the magnitude of association of the 2 perfectionism dimensions with psychopathology outcomes and (b) subscales of 2 common measures of perfectionism.A systematic literature search retrieved 284 relevant studies, resulting in 2,047 effect sizes that were analysed with meta-analysis and meta-regression while accounting for data dependencies.Findings support the notion of perfectionism as a transdiagnostic factor by demonstrating that both dimensions are associated with various forms of psychopathology.

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The relationship between perfectionism and psychopathology: a meta-analysis

In response to rapidly growing rates of comorbidity among psychiatric disorders, clinical scientists have become interested in identifying transdiagnostic processes that can help explain dysfunction across diagnostic categories (e.g., Kring & Sloan, 2009). One factor that has received a great deal of attention is that of emotion regulation, namely, the ability to modulate the intensity and/or duration of emotional states (e.g., Cicchetti, Ackerman, & Izard, 1995; Gross, 1998). Recent theoretical and empirical work has begun to emphasize the role that emotion regulation plays in the temporal comorbidity between internalizing and externalizing conditions (e.g., Aldao & De Los Reyes, 2015; De Los Reyes & Aldao, 2015; Drabick & Kendall, 2010; Jarrett & Ollendick, 2008; Patrick & Hajcak, 2016). However, close inspection of this work reveals two very pertinent areas of growth: (a) this literature is characterized by mixed findings that are likely explained, in part, by methodological heterogeneity; and (b) emotion regulation tends to be studied in relatively narrow terms. To address these issues, we provide a series of recommendations for facilitating cross-study comparisons and leveraging multifaceted approaches to studying emotion regulation processes within a developmental psychopathology framework. We hope that our perspective can enhance the organization and growth of this very important area of inquiry, and ultimately result in more effective prevention and treatment programs.

Emotion regulation as a transdiagnostic factor in the development of internalizing and externalizing psychopathology: Current and future directions.

Death anxiety and its role in psychopathology: Reviewing the status of a transdiagnostic construct

Perfectionism as a transdiagnostic process: A clinical review

Purpose. The purpose of this paper is to review the rationale for 'transdiagnostic' approaches to the understanding and treatment of anxiety disorders. Methods. Databases, searches and examination of the reference lists of relevant studies were used to identify papers of relevance. Results. There is increasing recognition that diagnosis-specific interventions for single anxiety-disorders are of less value than might appear since a large proportion of patients have more than one coexisting anxiety disorder and the treatment of one anxiety disorder does not necessarily lead to the resolution of others. As transdiagnostic approaches have the potential to address multiple coexisting anxiety disorders they are potentially more clinically relevant than single anxiety disorder interventions. They may also have advantages in ease of dissemination and in treating anxiety disorder not otherwise specified. Conclusions. The merits of the various transdiagnostic cognitive-behavioural approaches that have been proposed are reviewed. Such approaches have potential benefits, particularly in striking the balance between completely idiosyncratic formulations and diagnosis-driven treatments of anxiety disorders. However, caution is needed to ensure that transdiagnostic theories and treatments benefit from progress made by research on diagnosis-specific treatments, and further empirical work is needed to identify the shared maintaining processes that need to be targeted in the treatment of anxiety disorders. Copyright © The British Psychological Society.

Rosamund Lucy Shafran

Papers

Perfectionism as a transdiagnostic process: A clinical review

What does a transdiagnostic approach have to offer the treatment of anxiety disorders