HealthTransdiagnostic Behavior Therapy (TBT) - A Promising New Therapy

Transdiagnostic Behavior Therapy (TBT) – A Promising New Therapy


  • 30% of the world’s population will meet the criteria for an anxiety disorder in their lifetime
  • 20% of the world’s population will meet the criteria for a depressive disorder in their lifetime
  • 50% of those with an anxiety disorder and 80% of those with a depressive disorder also meet the criteria for another (comorbid) disorder.

The prevalence of anxiety and depressive disorders is very high. What makes the numbers worse is that rarely do these disorders occur in isolation; there is a staggering overlap between the two – a comorbidity that cries out for improved treatments.

TBT – A Promising New Treatment

Over the last couple of decades, considerable research has focused on the development of evidence-based treatments for anxiety and mood disorders. Cognitive-behavioral therapy (CBT) is one form of treatment that has been shown to be efficacious for these disorders (Hofmann, Sawyer, Korte, & Smits, 2009). Although effective at treating symptoms of a given disorder, these disorder specific protocols are limited in that they may not adequately address comorbid disorders (Kessler, Merikangas, & Wang, 2007). As such, the development of treatment protocols targeting multiple disorders concurrently are especially important to enhance the efficiency of treatment delivery in patients presenting with multiple symptom constellations.

Further, despite the efficacy of disorder specific CBT protocols, the dissemination of these treatments to the community has been limited (Andrews & Titov, 2009). One approach to enhance the dissemination of efficacious CBT treatments is through the development of transdiagnostic treatments protocols. Transdiagnostic treatments aim to provide a parsimonious approach to treatment by creating protocols designed to treat multiple disorders. These approaches have been designed to treat disorders that are deemed to be similar in nature by having the same underlying or maintaining factors and tend to be responsive to the same treatment mechanisms (Barlow et al., 2011; Gros, 2014; Norton, 2008; Schmidt et al., 2012). These treatments have been shown to be efficacious in the treatment of anxiety disorders (Norton, 2008; Schmidt et al., 2012) and comorbid depression (Barlow et al. 2011; Gros, 2012), thereby providing an attractive alternative to disorder specific treatment CBT protocols.

Gros (2014) developed a transdiagnostic treatment approach for veterans with symptoms of anxiety, depression and traumatic stress disorders called, Transdiagnostic Behavior Therapy (TBT). TBT is designed to treat multiple affective disorders (i.e., anxiety and depressive disorders) primarily through the use of transdiagnostic behavioral exposure practices that are used in disorder specific treatment protocols for anxiety and mood disorders. This focus provides a streamlined approach to treating these disorders by focusing on the common treatment techniques known to be efficacious in treating these disorders, thereby providing a treatment approach that may be easier for providers in community settings to learn, implement, and disseminate.

A typical course of treatment using TBT protocol involves 12 sessions of individual therapy. Each session ranges from 45-60 minutes in duration. The first six sessions focus on providing psychoeducation about affective disorders and designing and implementing exposure exercises. Once daily exposure exercises are implemented, optional treatment modules can be utilized (Sessions 7 – 15) to address potential obstacles in completing the exposure practices and therefore enhance exposures and overall treatment outcome. These optional treatment modules focus on response prevention, light cognitive therapy, sleep hygiene, mild substance use, anger management, progressive muscle relaxation, prolonged grief, and chronic pain. These eight optional modules allow for the TBT protocol to be individualized to various client specific problems that may be interfering with the implementation of exposure exercises.

Especially Effective For Veterans

TBT has been shown to be effective in treating veterans with a principal diagnosis of an affective disorder (see Gros, 2014). Specifically, veterans receiving TBT demonstrated significant reductions in depression, anxiety, stress, general impairment, and PTSD. The latter finding is especially important, as this is the first study to show the efficacy of treating symptoms of PTSD using a transdiagnostic treatment approach. Moreover, the reduction of PTSD symptoms is key when working with veteran populations as the rate of PTSD is high in this population and it is essential for a transdiagnostic treatment to be effective at reducing PTSD symptoms for it to be fully implemented in the VA healthcare system.

The development of transdiagnostic treatments is an exciting advancement in the treatment of anxiety and depressive disorders. Transdiagnostic treatments, such as TBT, may lead to improved dissemination of cognitive-behavioral approaches for the treatment of anxiety, traumatic stress and depressive disorders, while also allowing for the treatment of multiple disorders concurrently. It seems that parsimonious, transdiagnostic treatment approaches, are the future of CBT


Andrews, G & Titov, N. (2009). Hit and miss: innovation and dissemination of evidence-based psychological treatments. Behavior Research and Therapy, 47, 974-979.

Barlow, D.H., Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C.L., & Ehrenreich-May, J. (2011). The unified protocol for the transdiagnostic treatment of emotional disorders: Therapist guide. New York: Oxford University Press.

Brawman-Mintzer, Lydiard, Emmanuel, & Payeur, 1993; Brown et al., 2001

Gros, D. F. (2014). Development and initial evaluation of Transdiagnostic Behavior Therapy (TBT) for veterans with affective disorders. Psychiatry Research, 220, 275-282.

Hofmann, S.G., Sawyer, A. T., Korte, K.J., & Smits, J.A.J. (2009). Is it beneficial to add pharmacotherapy to cognitive-behavioral therapy when treating anxiety disorders? A meta-analytical review. International Journal of Cognitive Therapy, 2, 162-178.

Norton, P.J. (2008). An open trial of a transdiagnostic cognitive-behavioral group therapy for anxiety disorder. Behavior Therapy, 39, 242-250.

Riccardi, C.J., Korte, K.J., & Schmidt, N.B. (under review). False Safety Behavior Elimination Therapy: A randomized study of a brief individual transdiagnostic treatment for anxiety disorders.

Schmidt, N.B., Buckner, J.D., Pusser, A., Woolaway-Bickel, K., Preston, J.L., & Norr, A.M. (2012). Randomized controlled trial of False Safety Behavior Elimination

Therapy (F-SET): A unified cognitive behavioral treatment for anxiety

psychopathology. Behavior Therapy, 43, 518-532.

Associate Professor at Boston University

Daniel F. Gros, Ph.D., is a clinical psychologist known for advancing evidence-based psychotherapy at the Ralph H. Johnson VAMC and the Medical University of South Carolina. His research focuses on transdiagnostic assessment and treatment practices, leading to the development of Transdiagnostic Behavior Therapy (TBT), a protocol for depressive and anxiety disorders. Dr. Gros has supervised interns, collaborated on research, and received awards for his work, publishing over 90 manuscripts and 5 book chapters.

Doctoral Candidate in Clinical Psychology at Boston University

Kristina J. Korte, M.S., is a clinical psychology doctoral candidate at Florida State University. Her research concentrates on anxiety psychopathology, emphasizing empirically supported treatments' implementation and dissemination. She received the esteemed National Research Service Award from the National Institute of Mental Health to fund her dissertation research on a transdiagnostic preventative intervention for subclinical anxiety. With 16 journal manuscripts and 2 book chapters published, Kristina is an accomplished researcher.


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