Transdiagnostic Approaches to Anxiety and Avoidance

In psychotherapy, particularly in mindfulness and acceptance camps, psychological flexibility is the primary goal of intervention. As we’ve seen in acceptance and commitment therapy (ACT) interventions, the core processes such as mindfulness, self-as-context, and defusion are used as tools to achieve the overall goal of increasing one’s “ability to contact the present moment more fully as a conscious human being, and to change or persist on behavior when doing so serves valued ends” (Hayes & Strosahl, 1999).

“Flexibility is the hallmark of mental and emotional health,” says Michael Tompkins, PhD in his new transdiagnostic workbook, Anxiety and Avoidance: A Universal Treatment or Anxiety, Panic, and Fear, which integrates techniques from cognitive behavioral therapy (CBT), ACT, and dialectical behavior therapy (DBT). In this context, psychological flexibility entails flexibility of thinking, attending, and acting in order to shift more easily out of anxiety and avoidance, and into more reasonable and less anxiety-evoking thoughts and attitudes, so as to be able to see things as they really are. 

As an approach to anxiety and avoidance—widely regarded as two of the core issues that underlie anxiety-spectrum disorders—psychological flexibility will help clients become more flexible with their emotional systems as well. As one develops psychological flexibility, he may find it easier to calm himself and to shift an anxious response down when it makes sense to do so, as well as to shift the emotional system into high gear when that makes sense. The emotional flexibility piece is the key to recovery from anxiety disorders, says Tompkins.

Transdiagnostic therapies continue to gain momentum in the world of behavioral psychology, and notably in the field of treating anxiety and phobia. A paper published in a 2009 issue of the Journal of Cognitive Psychotherapy provided an overview of studies in the area of transdiagnostic therapies and their implications for the future of research in transdiagnostic interventions. One is including a promising study by University of Houston researcher Peter J. Norton, who found that people with anxiety disorders showed the most improvement when treated with CBT in combination with a transdiagnostic approach. Additional studies published in prestigious journals like Current Directions in Psychological Science and Journal of Nervous and Mental Disease also provide support for the transdiagnostic approach.

According to Tompkins, and other advocates for a unified, transdiagnostic method, all anxiety disorders share common factors that maintain anxiety and avoidance. In order for a treatment to be effective, it must target those common “root” factors by teaching common skills.

Next week we’ll take a closer look at Tompkins’s Anxiety and Avoidance, and go further into the specifics about why the transdiagnostic approach is particularly well-suited for anxiety disorders.  


Hayes, S. C., K. D. Strosahl, and K. G. Wilson. 1999. Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change. New York: The Guilford Press.

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