(PS8-C67) Functional Differences in Diagnostic Characteristics Predicting Therapeutic Skill Use

 Background: Given high rates of comorbidity amongst common mental health diagnoses, there has been a recent emergence of transdiagnostic interventions. Transdiagnostic treatments, such as the Unified Protocol (UP; Barlow et al., 2018), typically consists of multiple therapeutic skills (e.g., mindfulness, cognitive flexibility, behavior change) that, when tested in their entirety, have demonstrated efficacy in addressing a range of conditions (e.g., Barlow et al., 2017; Cassiello-Robbins et al., 2020). However, it is possible that patients with different diagnoses may exhibit different patterns of skill use and may benefit from the prioritization of different skill modules within the transdiagnostic treatment package. Specifically, our aim was to determine whether patients with a depressive disorder, with or without comorbid anxiety or related (obsessive-compulsive or trauma-related) disorders, differ from patients without a depressive disorder on several dimensions of skill use (Southward et al., 2020): frequency, quality, quantity of different skill used). Given that individuals with depression often struggle with a lack of interest or hopelessness (5th ed.; DSM–5; American Psychiatric Association, 2013), we hypothesized that patients with a depressive disorder would exhibit lower levels across all skill use dimensions. A second study aim was to determine whether patients with depression exhibited specific patterns of strengths and deficits in pre-treatment levels of discrete cognitive behavioral skills.

Method: Utilizing data from a sequential multiple assignment randomized trial (SMART) (Sauer-Zavala, 2022) we examined the diagnostic characteristics from a baseline intake (DIAMOND; Tolin et al., 2016), as well as self-reported skill use (Southward & Sauer-Zavala, in press) weekly during treatment. Patients with a range of emotional disorders (n = 71) were first assigned to one of three module sequences for the UP (prioritization of patient strengths or weaknesses, or the standard published order).

Results: We ran two separate regressions predicting dimensions of skills use, with severity of depressive symptoms as the predictor variable. There were no significant associations with severity of depression and pretreatment skill efficacy (p=.967), frequency (p=.206), and effectiveness (p=.402), suggesting that depressive symptoms do not affect the extent to which patients use emotion regulation skills before treatment is applied. A similar pattern of results was observed after 6 sessions of treatment for efficacy (p=.376), frequency (p=.527) and effectiveness (p=.422), suggesting that there is no difference in how patients apply skills during treatment as a function of depression severity. Additionally, no data was associated with individuals with depressive disorder having a particular pattern of weakness of therapeutic skill.

Conclusion: Although we did not find significant differences in skill use as a function of depressive severity, these null results may indicate that diagnostic status is not a useful consideration of tailoring treatment. In other words, transdiagnostic treatments may exert their emotion regulation effects similarly across disorders.