Clinical Psychology and Personality

Clinical Psychology and Personality

The Efficacy of Integrated Transdiagnostic Therapy on Emotion Regulation, Irritability, Resilience, and Worry in Individuals with Generalized Anxiety Disorder: A Case Study

Document Type : Original Article

Authors
Zahra Askari 1
Marzie Hashemi 2
1 Master of Clinical Psychology, Khatam University, Tehran, Iran.
2 Assistant Professor, Department of Psychology and Educational Sciences, Khatam University, Tehran, Iran.
10.22070/cpap.2023.16973.1296
Abstract
 
Introduction: This study aimed to determine the effectiveness of integrated Transdiagnostic therapy on emotion regulation, irritability, resilience, and worry among individuals suffering from generalized anxiety disorder.
Method: The study utilized a single-case design with multiple baselines (ABAB) and a one-month follow-up. The statistical population comprised individuals diagnosed with generalized anxiety disorder who visited the Arvin Clinic in Tehran in 1401 [2022]. Out of these, three were selected via a convenience sampling method. Twelve sessions of integrated Transdiagnostic therapy (UP) were administered to the participants. Data collection tools included a 7-item scale for generalized anxiety, the Gross and John Emotion Regulation Questionnaire, an irritability questionnaire, a resilience scale, and the Pennsylvania State Worry Questionnaire. For data analysis, the improvement percentage formula, Cohen's effect size, PND effect size, intra-situational visual analysis, and visual plotting were utilized.
Results: The results indicated that integrated Transdiagnostic therapy led to improvements in the research variables. The overall improvement percentages for generalized anxiety in the three participants were 58%, 55%, and 57%, respectively, and these rates remained stable at the one-month follow-up.
Discussion and Conclusion: The data analysis suggests the effectiveness of integrated Transdiagnostic therapy in regulating emotions, reducing irritability, enhancing resilience, and decreasing worry among the participants. This treatment can serve as an educational tool for the rehabilitation and improvement of life quality for patients with generalized anxiety disorder.
Keywords
Integrated Transdiagnostic Therapy
Emotion Regulation
Irritability
Resilience
Worry
Generalized Anxiety Disorder

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    1. American Psychiatric Association. Dsm-5. Diagnostic and statistical manual of mental disorders. 2013. https://www.psychiatry.org/psychiatrists/practice/dsm
    2. Robichaud M, Dugas MJ. Cognitive-behavioral treatment for generalized anxiety disorder: From science to practice. Routledge; 2012 Oct 12. https://doi.org/10.4324/9781315709741
    3. Sharifi V, Esmaeili A, Motevalian A, Rahimimovaghar A, Hefazati M, Radgoodarzi R, Hajebi A. Translation and validation of the Iranian version of the Sheehan Disability Scale. Annual Conference of Scientific Association of Psychiatrists of Iran. 2011, 28. https://ijps.tums.ac.ir/index.php/ijps/article/view/59 [Persian]
    4. Stein MB, Sareen J. Generalized anxiety disorder. New England Journal of Medicine. 2015 Nov 19; 373(21): 2059-68. https://doi.org/10.1056/NEJMcp1502514
    5. Newman MG, Llera SJ, Erickson TM, Przeworski A, Castonguay LG. Worry and generalized anxiety disorder: a review and theoretical synthesis of evidence on nature, etiology, mechanisms, and treatment. Annual review of clinical psychology. 2013; 9: 275. https://doi.org/10.1146/annurev-clinpsy-050212-185544
    6. Esmaeili L, Aghaei A, Abedi MR, Esmaeili M. Effectiveness of emotion regulation in the mental health of epileptic girls. https://doi.org/10.1016/j.sbspro.2012.05.451 [Persian].
    7. Bargh JA, Williams LE. The nonconscious regulation of emotion. Handbook of emotion regulation. 2007; 1: 429-45. https://awspntest.apa.org/record/2007-01392-021
    8. Gross JJ, Thompson RA. Emotion regulation conceptual: Handbook of emotion regulation. New York: Guilfors Publication. 2007. https://psycnet.apa.org/record/2007-01392-001
    9. Aldao A, Nolen-Hoeksema S, Schweizer S. Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical psychology review. 2010 Mar 1; 30(2): 217-37. https://doi.org/10.1016/j.cpr.2009.11.004
    10. Kring AM, Sloan DM, editors. Emotion regulation and psychopathology: A transdiagnostic approach to etiology and treatment. Guilford Press; 2009 Nov 4. http://dx.doi.org/10.1146/annurev-clinpsy-032814-112739
    11. Mennin DS, McLaughlin KA, Flanagan TJ. Emotion regulation deficits in generalized anxiety disorder, social anxiety disorder, and their co-occurrence. Journal of anxiety disorders. 2009 Oct 1; 23(7): 866-71. https://doi.org/10.1016/j.janxdis.2009.04.006
    12. Salters-Pedneault K, Roemer L, Tull MT, Rucker L, Mennin DS. Evidence of broad deficits in emotion regulation associated with chronic worry and generalized anxiety disorder. Cognitive Therapy and Research. 2006 Aug; 30(4): 469-80. https://psycnet.apa.org/doi/10.1007/s10608-006-9055-4
    13. Sheybani H, Mikaeili N, Narimani M. The effectiveness of Cognitive-behavioral Therapy and Emotion Regulation Training on Irritability, Depression, anxiety, and emotion regulation in adolescents with Disruptive Mood Dysregulation Disorder. Journal of Clinical Psychology. 2020 Aug 22; 12(2): 41-50. https://doi.org/10.22075/jcp.2020.19250.1778 [Persian].
    14. St-Louis AC, Rapaport M, Chénard Poirier L, Vallerand RJ, Dandeneau S. On emotion regulation strategies and well-being: The role of passion. Journal of Happiness Studies. 2021 Apr; 22(4): 1791-818. https://doi.org/10.1007/s10902-020-00296-8
    15. O’Toole MS, Renna ME, Mennin DS, Fresco DM. Changes in decentering and reappraisal temporally precede symptom reduction during Emotion Regulation Therapy for generalized anxiety disorder with and without co-occurring depression. Behavior therapy. 2019 Nov 1; 50(6): 1042-52. https://doi.org/10.1016/j.beth.2018.12.005
    16. Fida R, Paciello M, Barbaranelli C, Tramontano C, Fontaine RG. The role of irritability in the relation between job stressors, emotional reactivity, and counterproductive work behaviour. European Journal of work and organizational psychology. 2014 Jan 2; 23(1): 31-47. https://doi.org/10.1080/1359432X.2012.713550
    17. Huang Z, Zhan S, Chen C, Li N, Ding Y, Hou Y, Wang L, Wang Y. The effect of insomnia on cortical excitability in patients with generalized anxiety disorder. Frontiers in Psychiatry. 2019‌: 755. https://doi.org/10.3389/fpsyt.2018.00755
    18. Feldman R. Social behavior as a transdiagnostic marker of resilience. Annual review of clinical psychology. 2021 May 7; 17: 153-80. https://doi.org/10.1146/annurev-clinpsy-081219-102046
    19. Meece JL, Glienke BB, Askew K. Gender and motivation. Handbook of motivation at school. 2009 Sep 10: 425-46. https://dx.doi.org/10.4324/9780203879498
    20. Mylant M, Ide B, Cuevas E, Meehan M. Adolescent children of alcoholics: Vulnerable or resilient? Journal of the American Psychiatric Nurses Association. 2002 Apr 1; 8(2): 57-64. https://doi.org/10.1067/mpn.2002.125037
    21. Newton-John TR, Mason C, Hunter M. The role of resilience in adjustment and coping with chronic pain. Rehabilitation psychology. 2014 Aug; 59(3): 360. https://psycnet.apa.org/doi/10.1037/a0037023
    22. Newman MG, Cho S, Kim H. Worry and generalized anxiety disorder: a review. Newman, MG, Cho, S., & Kim, H. (2017). Worry and Generalized Anxiety Disorder: A Review. Reference Module in Neuroscience and Biobehavioral Psychology. 2017; 10. https://doi.org/10.1016/B978-0-12-809324-5.05108-7
    23. Llera SJ, Newman MG. Rethinking the role of worry in generalized anxiety disorder: Evidence supporting a model of emotional contrast avoidance. Behavior Therapy. 2014 May 1; 45(3): 283-99. https://doi.org/10.1016/j.beth.2013.12.011
    24. Hallion LS, Steinman SA, Kusmierski SN. Difficulty concentrating in generalized anxiety disorder: An evaluation of incremental utility and relationship to worry. Journal of anxiety disorders. 2018 Jan 1; 53: 39. https://doi.org/10.1016/j.janxdis.2017.10.007
    25. Ito M, Horikoshi M, Kato N, Oe Y, Fujisato H, Yamaguchi K, Nakajima S, Miyamae M, Toyota A, Okumura Y, Takebayashi Y. Efficacy of the unified protocol for transdiagnostic cognitive-behavioral treatment for depressive and anxiety disorders: a randomized controlled trial. Psychological Medicine. 2022 Jan 10: 1-2. https://doi.org/10.1017/S0033291721005067
    26. Nasiri F, Mashhadi A, Bigdeli I, Chamanabad AG, Ellard KK. Augmenting the unified protocol for transdiagnostic treatment of emotional disorders with transcranial direct current stimulation in individuals with generalized anxiety disorder and comorbid depression: a randomized controlled trial. Journal of affective disorders. 2020 Feb 1; 262: 405-13. https://doi.org/10.1016/j.jad.2019.11.064 [Persian].
    27. Mohammadpour M, Sadeghi K, Foroughi A, Amiri S, Pouyanfard S, Parvizifard A, Khoramniya S. The unified protocol for transdiagnostic treatment of emotional disorders: treatment of comorbid psychopathology accompanying a generalized anxiety disorder. International Journal of Behavioral Sciences. 2018 Oct 24; 12(3): 125-31. https://www.behavsci.ir/article_86046.html [Persian].
    28. Abbasi A, Aghaei A, Moghadam HE. Effectiveness of metacognitive therapy on resiliency in the people with generalized anxiety. Journal of psychologicalscience. 2019 Sep 10; 18(78): 691-8. http://psychologicalscience.ir/article-1-356-en.html [Persian].
    29. Farchione TJ, Fairholme CP, Ellard KK, Boisseau CL, Thompson-Hollands J, Carl JR, Gallagher MW, Barlow DH. Unified protocol for transdiagnostic treatment of emotional disorders: a randomized controlled trial. Behavior therapy. 2012 Sep 1; 43(3): 666-78. https://doi.org/10.1016/j.beth.2012.01.001
    30. Cassiello-Robbins C, Southward MW, Tirpak JW, Sauer-Zavala S. A systematic review of Unified Protocol applications with adult populations: Facilitating widespread dissemination via adaptability. Clinical Psychology Review. 2020 Jun 1; 78: 101852. https://doi.org/10.1016/j.cpr.2020.101852
    31. Abbasi A, Aghaei A, Moghadam HE. Effectiveness of metacognitive therapy on resiliency in the people with generalized anxiety. Journal of psychologicalscience. 2019 Sep 10; 18(78): 691-8. http://psychologicalscience.ir/article-1-356-en.html [Persian].
    32. Dehshiri G, Golzari, M, Borjali A, Sohrabi F. Psychometrics Particularity of Farsi Version of Pennsylvania State Worry Questionnaire for College Students. Journal of Clinical Psychology, 2009; 1(4): 67-75. https://doi.org/10.22075/jcp.2017.1988 [Persian].
    33. Keshavarz afshar H, Rafei Z, Mirzaei A. Effectiveness of acceptance and acceptance therapy (ACT) on inclusive treatment. Payesh (Health Monitor). 2018; 17(3): 89-96. http://payeshjournal.ir/article-1-47-en.html [Persian].
    34. Nathan PE, Gorman JM, editors. A guide to treatments that work. Oxford University Press; 2015 Jun 26. https://doi.org/10.1093/med:psych/9780199342211.001.0001
    35. Dear BF, Staples LG, Terides MD, Karin E, Zou J, Johnston L, Gandy M, Fogliati VJ, Wootton BM, McEvoy PM, Titov N. Transdiagnostic versus disorder-specific and clinician-guided versus self-guided internet-delivered treatment for generalized anxiety disorder and comorbid disorders: a randomized controlled trial. Journal of anxiety disorders. 2015 Dec 1; 36: 63-77. https://doi.org/10.1016/j.janxdis.2015.09.003
    36. Ghaderi, F., Akrami, N., Namdari, K., Abedi, A. Comparing the effectiveness of integrated cognitive-behavioral therapy with transdiagnostic therapy on the symptoms of patients with generalized anxiety disorder coexisting with depression. 2021; 27(4): 440-457. http://dx.doi.org/10.32598/ijpcp.27.4.3067.3 [Persian].
    37. Sharafi MR, Jafari D, Bahrami. M. Comparing the effectiveness of cognitive-behavioral therapy and integrated transdiagnostic therapy on the social adjustment of adolescents with generalized anxiety disorder. Middle Eastern Journal of Disability Studies. 2020; 9(6): 83-95. http://jdisabilstud.org/article-1-2982-en.html [Persian].
    38. Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of internal medicine. 2006 May 22; 166(10): 1092-7. https://doi.org/10.1001/archinte.166.10.1092
    39. Naeinian MR, Shairi MR, Sharifi M, Hadian M. To study reliability and validity for a brief measure for assessing Generalized Anxiety Disorder (GAD-7). https://cpap.shahed.ac.ir/article_2647.html [Persian].
    40. Hosseini F, Kheir M. Investigation of the Role of Teacher in Mathematic Academic Emotions and Students Emotion Regulation. Journal of Modern Psychological Researches. 2011 Jan 21; 5(20): 41-63. https://psychologyj.tabrizu.ac.ir/article_4176_en.html?lang=en [Persian].
    41. Balzarotti S, John OP, Gross JJ. An Italian adaptation of the emotion regulation questionnaire. European journal of psychological assessment. 2010 Jan 25. https://doi.org/10.1027/1015-5759/a000009
    42. Taherifar Z, Ferdousi S, Moutabi F, Mazaheri MA, Fata L. The mediating role of failure of emotion regulation strategies in the relationship between negative emotion intensity and safety motivation with generalized anxiety symptoms. Contemporary psychology, the two-quarter journal of the Iranian Psychological Association. 2016 Mar 10; 10(2): 51-66. https://bjcp.ir/browse.php?a_id=898&sid=1&slc_lang=en
    43. Pourafrooz E, Setayeshi S, Alahbigdeli E, & Pedram M M. (2020). Making and Standardization the Psychometricof irritability questionnaire. PSYCHOMETRY, 8(32): 7-21. https://sanad.iau.ir/Journal/ps/Article/1111983 [Persian].
    44. Connor KM, Davidson JR. Development of a new resilience scale: The Connor‐Davidson resilience scale (CD‐RISC). Depression and anxiety. 2003 Sep; 18(2):76-82. https://doi.org/10.1002/da.10113
    45. Mohammadi M, Jazayeri AR, Rafiei AH. Jokar B, Pourshahbaz, A. Investigating resilience factors in people at risk of drug use. Scientific-Research Quarterly Journal of Psychology of Tabriz University. 2006; 1(3): 193-214. https://www.sid.ir/paper/120410/fa [Persian].
    46. MeyerM TJ, Miller ML, Metzger RL, Borkovec TD. Development and validation of the penn state worry questionnaire. Behaviour research and therapy. 1990 Jan 1; 28(6): 487-95. https://doi.org/10.1016/0005-7967 (90)90135-6
    47. Dehshiri G. The Effectiveness of Cognitive-Behavior Therapy on Anxiety and Worry of People with Generalized Anxiety Disorder. Journal of Clinical Psychology, 2012; 4(2): 19-28. https://doi.org/10.22075/jcp.2017.2085 [Persian].
    48. Barlow D. H, Farchione T J, Bullis J R, Gallagher M. W, Murray-Latin H, Sauer-Zavala S, ... & Cassiello-Robbins C. The unified protocol for transdiagnostic treatment of emotional disorders compared with diagnosis specific protocols for anxiety disorders: A randomized clinical trial. JAMA psychiatry. 2017; 74(9): 875-884. https://doi.org/10.1001/jamapsychiatry.2017.2164
    49. Bameshgi M, Kimiaei A, Mashhadi, A. Effectiveness of a unified protocol on emotion regulation and experiential avoidance in women with comorbid major depressive and generalized anxiety symptoms. Journal of Fundamentals of Mental Health, 2020; 22(6): 341-348. https://profdoc.um.ac.ir/paper-abstract-1083880.html [Persian].
    50. Ghezelseflo M, Nejatifar S, Aghaziarati A. students with internalized behavioral problems. Psychological Science. 2022 Jun; 21(111): 525-41. https://psychologicalscience.ir/article-1-1448-fa.html [Persian].
    51. Zemestani M, Imani M. Effectiveness of transdiagnostic treatment on depression/anxiety symptoms and emotion regulation. Contemporary psychology. 2016 Sep 10; 11(1): 21-32. https://bjcp.ir/browse.php?a_id=813&sid=1&slc_lang=en [Persian].
    52. Maia AC, Braga AA, Nunes CA, Nardi AE, Silva AC. Transdiagnostic treatment using a unified protocol: application for patients with a range of comorbid mood and anxiety disorders. Trends in psychiatry and psychotherapy. 2013; 35: 134-40. http://dx.doi.org/10.1590/S2237-60892013000200007
    53. Nasiri F, Mashhadi A, Bigdeli I, Chamanabad AG, Ellard KK. Augmenting the unified protocol for transdiagnostic treatment of emotional disorders with transcranial direct current stimulation in individuals with generalized anxiety disorder and comorbid depression: A randomized controlled trial. Journal of affective disorders. 2020 Feb 1; 262: 405-13. https://doi.org/10.1016/j.jad.2019.11.064 [Persian].
    54. Sheybani H, Mikaeili N, Narimani M. The effectiveness of Cognitive-behavioral Therapy and Emotion Regulation Training on Irritability, Depression, anxiety, and emotion regulation in adolescents with Disruptive Mood Dysregulation Disorder. Journal of Clinical Psychology. 2020 Aug 22; 12(2): 41-50. https://doi.org/10.22075/jcp.2020.19250.1778 [Persian].
    55. Grossman RA, Ehrenreich-May J. Using the unified protocol for Transdiagnostic treatment of emotional disorders with youth exhibiting anger and irritability. Cognitive and Behavioral Practice. 2020 May 1; 27(2): 184-201. https://doi.org/10.1016/j.cbpra.2019.05.004
    56. Hawks JL, Kennedy SM, Holzman JB, Ehrenreich–May J. Development and application of an innovative transdiagnostic treatment approach for pediatric irritability. Behavior therapy. 2020 Mar 1; 51(2): 334-49. https://doi.org/10.1016/j.beth.2019.07.004