Group treatments are a response to long waiting lists for individual therapy. They can also help to normalise a child’s difficulty and help parents to feel less isolated. In recent years there has been a trend away from diagnosis specific groups to transdiagnostic groups. But a just published paper in the Clinical Psychology Review of 80 studies suggests they are no more effective than active controls. Rather than answer whether ‘going transdiagnostic’ represents added value over traditional disorder specific interventions, (the appropriate counterfactual), these authors simply make a case for more rigorous research.! In this vacuum marketing is likely to win – 29 of the studies were by author’s of the developed protocols.
Caution is needed in translating these studies to routine practice:.
- Only 1 of the 80 studies was conducted in the Uk, a mentalisation based treatment for youth.
- Half the studies had parental involvement an average of 8 sessions. The children had on average 11 sessions.
- 59 of the studies were of CBT consisting of mindfulness, emotional regulation and cognitive restructuring. But the author’s of the studies, self-labelled their interventions. The meaning of ’emotional regulation’ was unclear.
- 14 of the studies involved children with ASD or ADHD.There is a bottleneck in the UK for ASD and ADHD assessments, as they are the passport to extra help at school. In this context Group Transdiagnostic approaches are likely to be heralded as, at least a ‘first-line approach’. Welcomed by schools to head-off the extra staffing investment this ‘passport’ would confer. Parents may be led to believe that their children are getting a new evidence-based treatment. Service providers are likely to seize upon transdiagnostic group interventions as a simple solution to the pressure of referrals. There is a need to look beyond convenience.
In ‘Simply Effective Group CBT’ London: Routledge (2011) I detailed how it was perfectly possible to address the commonplace additional disorders in this modality with Adults, without losing focus on the principal disorder. But over the last decade the conventional wisdom has been to label the additional disorders as constituting ‘complexity’, with a supposed need for a ‘complex’ intervention. However there is no empirical evidence that this shift in focus has resulted in better group CBT for adults. Unfortunately the ‘complexity’ myth has spread to interventions with the young.
Dr Mike Scott