Short- and Long-term Efficacy of Transdiagnostic Cognitive Behavioral Therapies for Emotional Disorders: Systematic Review and Meta-Analysis

Transdiagnostic cognitive-behavioral psychotherapy (TD-CBT) may facilitate treatment of emotional disorders. We investigate short- and long-term efficacy of TD-CBT for emotional disorders in individual, group, and Internet-based settings in randomized controlled trials (PROSPERO CRD42019141512). Two independent reviewers screened results from PubMed, MEDLINE, PsycINFO, Google Scholar, medRxiv, and OSF Preprints published between January 2000 and January 2023, selected studies for inclusion, extracted data and evaluated risk of bias (Cochrane risk-of-bias tool 2.0). Absolute efficacy from pre- to post-treatment and relative efficacy between TD-CBT and control treatments were investigated with random-effects models. Of 56 identified studies, 53 (6610 participants) were included in the meta-analysis. TD-CBT had large effects on depression (d = 1.15, 95%CI = 1.03 - 1.28) and anxiety (d = 1.08, 95%CI = 0.95 - 1.21), from pre- to post treatment. Across treatment formats, TD-CBT was superior to waitlist (depression: g = 1.31, 95%CI = 0.88 - 1.74; anxiety: g = 1.22, 95%CI = 0.82 - 1.63) and treatment-as-usual (depression: g = 0.87, 95%CI = 0.63 - 1.11; anxiety: g = 0.94, 95%CI = 0.57 - 1.30). TD-CBT showed comparable effects to disorder-specific treatments, with indications of TD-CBT’s superiority (depression: g = 0.16, 95%CI = 0.01 - 0.32; anxiety: g = 0.15, 95%CI = 0.04 - 0.26). Large effects were reported for Internet-based TD-CBT for up to 2 years. Studies were heterogeneous in design and methodological quality. This review and meta-analysis strengthens the evidence for TD-CBT as an efficacious treatment for emotional disorders in different settings.