Shared Transdiagnostic Factors in Depression and Anxiety

Automatic thoughts, dysfunctional thinking, rumination and thought suppression have been found to be transdiagnostic factors in depression and anxiety (Yapan et al., 2022).

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In one study, increases in anxiety were predicted by baseline depression and increases in depression were predicted by baseline anxiety. Rumination fully mediated both associations which underscores the importance of focusing on rumination from a transdiagnostic perspective (McLaughlin et al., 2011).

Rumination can lead to:

  • More negative thinking

  • Less effective solutions to the problem(s) at hand

  • Feeling uncertain and frozen when attempting to implement solutions

  • Lack of drive to engage in activities that might distract from rumination or lift the mood (McLaughlin et al., 2011)

Furthermore, observational studies suggest that those who ruminate may experience more social friction, may be perceived less favourably by their peers, and may receive less social support (McLaughlin et al., 2011).

Anxiety sensitivity, where an individual believes that their anxiety symptoms will have harmful or catastrophic consequences, is another transdiagnostic factor that is elevated in individuals with anxiety and depressive disorders. It is related to a large range of negative health behaviours. Anxiety sensitivity amplifies the aversiveness of different somatic experiences and motivates maladaptive avoidance and escape responses (Smits et al., 2019).

In addition to the aforementioned factors, there are some common mechanisms which fuel anxiety disorders and depression:

  • Maladaptive cognitive appraisals

  • Poor emotional regulation

  • Emotional avoidance

  • Behaviour congruent with the disorder emotion

  • Intolerance of uncertainty (McManus et al., 2010; Khakpoor et al., 2019)

In addition, there are others which tend to fuel only anxiety disorders:

  • Hypervigilance to threat and supportive physiology

  • Danger-laden judgments

  • Avoidant behaviour (McManus et al., 2010)

Transdiagnostic Factors for Anxiety Only

As previously discussed, many of the anxiety disorders and anxiety-related disorders share similar features. Furthermore, data suggests the likelihood of clients having more than one anxiety disorder. Therefore, a transdiagnostic approach must be taken in developing a treatment plan (McManus et al., 2010). Some common symptoms across multiple anxiety disorders are included below:

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Selective attention

Individuals who focus on a specific piece of information of sensory input while ignoring other simultaneously occuring sensory input or information (McManus et al., 2020; Bar-Hiam, Lamy, Pergamin, Bakermans-Kranenburg, & Van Ijzendoorn, 2007).

Attentional biases

Individuals who typically interpret ambiguous information as threatening (McManus et al., 2020; Bar-Hiam, Lamy, Pergamin, Bakermans-Kranenburg, & Van Ijzendoorn, 2007).

Interpretive and Expectancy Biases

Individuals who typically anticipate that negative events are likely to happen (McManus et al., 2020; Bar-Hiam, Lamy, Pergamin, Bakermans-Kranenburg, & Van Ijzendoorn, 2007).

References

Bar-Haim, Y., Lamy, D., Pergamin, L., Bakermans-Kranenburg, M. J., & van IJzendoorn, M. H. (2007). Threat-related attentional bias in anxious and nonanxious individuals: a meta-analytic study. Psychological bulletin, 133(1), 1–24.

Khakpoor, S., Mohammadi Bytamar, J., & Saed, O. (2019). Reductions in transdiagnostic factors as the potential mechanisms of change in treatment outcomes in the Unified Protocol: a randomized clinical trial. Research in psychotherapy (Milano), 22(3), 379.

McLaughlin, K. A. & Nolen-Hoeksema, S. (2011). Rumination as a transdiagnostic factor in depression and anxiety. Behaviour Research Therapy, 49(3), 186-193.

Smits, J. A. J., Otto, M. W., Powers, M. B., & Baird, S. 0. (2019). Anxiety sensitivity as a transdiagnostic treatment target. In J. A. J. Smits, M. W. Otto, M. B. Powers, & S. O. Baird (Eds.), The clinician's guide to anxiety sensitivity treatment and assessment (pp. 1–8). Elsevier Academic Press.

Yapan, S., Türkçapar, M.H. & Boysan, M. (2022). Rumination, automatic thoughts, dysfunctional attitudes, and thought suppression as transdiagnostic factors in depression and anxiety. Current Psychology, 41, 5896–5912.