but statistically significant differences, the conclusion is drawn that one treatment is superior to another (Leichsenring et al., in press). In a randomized controlled feasibility study of generalized anxiety disorder, PDT was equally effective as a supportive therapy with regard to continuous measures of anxiety, but significantly superior on symptomatic remission rates (Crits-Christoph, Connolly Gibbons, Narducci, Schamberger, & Gallop, 2005). However, the sample sizes of that study were relatively small (N ¼ 15 vs. N ¼ 16), and the study was not sufficiently powered to detect more possible differences between treatments. In another RCT of generalized anxiety disorder, PDT was compared to CBT (Leichsenring et al., 2009). PDT and CBT were equally effective with regard to the primary outcome measure. However, in some secondary outcome measures, CBT was found to be superior, both at the end of therapy and at the six- month follow-up. Other differences may exist that were not detected due to the limited sample size and power (CBT: N ¼ 29; PDT: N ¼ 28). In the one-year follow-up, results proved to be stable (Salzer, Winkelbach, Leweke, Leibing, & Leichsenring, 2011). Contrary to short-term PDT (STPP), a core element in the applied method of CBT consisted of a modification of worrying. This specific difference between the treatments may explain the superiority of CBT in the Penn State Worry Questionnaire (Meyer, Miller, Metzger, & Borkovec, 1990) and, in part, also in the State-Trait Anxiety Inventory (trait measure) (Spielberger, Gorsuch, & Lushene, 1970) – the latter also contains several items related to worrying. The results of that study may suggest that the outcome of STPP in generalized anxiety disorder may be further optimized by employing a stronger focus on the process of worrying. In PDT, worrying can be conceptualized as a mechanism of defense that protects the subject from fantasies or feelings that are even more threatening than the contents of his or her worries (Crits- Christoph, Wolf-Palacio, Ficher, & Rudick, 1995). According to the available RCTs, PDT is efficacious in anxiety disorders. If differences between PDT and CBT were found, they showed up in secondary outcome measures or corresponded to small differences in effect size. This is consistent with a recent meta-analysis by Baardseth et al. (2013) who did not find significant differences in favor of CBT compared to bona fide treatments. For CBT, a recent historical review showed that the efficacy of treatments for anxiety disorders has not increased but rather decreased from the 1980s to the present ( Öst, 2008). Furthermore, a substantial proportion of patients do not sufficiently benefit from the treatments and the proportion of nonresponders does not appear to have decreased over time (Öst, 2008). For these reasons, there is a need to further improve the treatment of anxiety disorders (Schmidt, 2012). This is true not just for CBT, but also for PDT as well (Leichsenring, Klein, Salzer, 2014). In one of the most promising approaches to address this problem, psychotherapy research is moving from single-disorder-focused manualized approaches toward ‘transdiagnostic’ and modular treatments (e.g., Barlow, Allen, & Choate, 2004; McHugh, Murray, & Barlow, 2009). The rationale for transdiagnostic treatments focuses on similarities among disorders, particularly in a similar class of diagnoses (e.g., anxiety disorders), including high rates of comorbidity and improvements in comorbid conditions when treating a principal disorder (Barlow et al., 2004; McHugh et al., 2009). For these reasons, researchers in the field of CBT have developed transdiagnostic treatment protocols (e.g., Barlow et al., 2004; McHugh et al., 2009; Norton & Phillip, 2008). It is an advantage that PDT is traditionally less tailored to single mental disorders, but focuses on core underlying processes of mental disorders. A recent review has shown that the empirically supported methods of PDT for specific anxiety disorders have core treatment components in common (Leichsenring & Salzer, in press). These components have been distilled and integrated into an evidence-based Unified Psychodynamic Protocol for ANXiety disorders (UPPAnx; Leichsenring & Salzer, in press). Integrating treatment elements of empirically supported methods of PDT for specific anxiety disorders, the manualized UPP-Anx has the potential to: (1) be more effective than single-disorder psychotherapy, (2) be more effective than routine PDT, (3) improve comorbid symptoms, (4) enhance patients’ quality of life, (5) facilitate translation of research into clinical practice of mental health professionals, (6) facilitate training for practitioners and dissemination of the approach relative to
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