Anksiyete Bozukluklarına Tanılar Üstü Yaklaşım: Ortak Faktörler ve Bütüncül Müdahaleler

Yıl 2026, Sayı: Advanced Online Publication, 1346 - 1366, 16.02.2026

Fulya Turk , Gökçen Dalkılınç , Sena Açıkgöz , Berkan Can Kara , Seda Nur Güven Kayacı , Aykut Kul , Zeynep Hamamcı

https://doi.org/10.18863/pgy.1841690

https://izlik.org/JA37WK69CB

Öz

Anksiyete bozuklukları, yaygınlıkları ve bireylerin işlevselliği ile yaşam kalitesini olumsuz yönde etkileyebilme potansiyelleri nedeniyle hem klinik hem de araştırma çalışmalarında önemli bir yer tutmaktadır. Geleneksel tanı temelli müdahale yaklaşımları, belirli bozukluklara özgü semptomları hedef alırken; eştanı yaygınlığı ve bireysel farklılıkların yeterince gözetilmemesi gibi önemli sınırlılıklar barındırmaktadır. Bu nedenle, farklı bozukluklarda ortak biçimde ortaya çıkan bilişsel ve duygusal süreçleri hedefleyen tanılar üstü yaklaşımlar, daha bütüncül ve esnek bir müdahale olanağı sunmaktadır. Bu derleme, anksiyete bozukluklarının ortaya çıkışı, gelişimi ve sürdürülmesinde rol oynayan başlıca tanılar üstü mekanizmaları ele almakta; ruminasyon, anksiyete duyarlılığı, duygu düzenleme güçlüğü, davranışsal kaçınma, belirsizliğe tahammülsüzlük, mükemmeliyetçilik, bilişsel esneklik, psikolojik esneklik, bilinçli farkındalık ve öz-şefkat süreçlerini kapsamlı bir biçimde incelemektedir. İlgili literatür bulguları doğrultusunda, incelenen tanılar üstü süreçlerin birden fazla psikopatolojiyle ilişkili olduğu, eş tanı örüntülerini açıklamada merkezi bir rol oynadığı ve müdahale hedefi haline geldiklerinde anksiyete ve eşlik eden belirtilerde anlamlı iyileşme sağlayabildikleri anlaşılmaktadır.

Anahtar Kelimeler

Tanılar üstü yaklaşımlar , anksiyete , anksiyete bozuklukları

Etik Beyan

Bu çalışma bir derleme makalesi olduğu için etik kurul izni gerektirmemektedir.

Destekleyen Kurum

Mevcut derleme çalışması için herhangi bir kurumdan fon alınmamıştır.

Transdiagnostic Approach to Anxiety Disorders: Common Factors and Integrative Interventions

https://izlik.org/JA37WK69CB

Öz

Anxiety disorders hold an important place in both clinical and research studies due to their prevalence and potential to negatively impact individuals' functioning and quality of life. Traditional diagnosis-based intervention approaches target symptoms specific to certain disorders; however, they have significant limitations, such as the prevalence of comorbidity and insufficient consideration of individual differences. Therefore, transdiagnostic approaches, which target cognitive and emotional processes that commonly occur across different disorders, offer a more comprehensive and flexible intervention opportunity. This review addresses the main transdiagnostic mechanisms involved in the onset, development, and maintenance of anxiety disorders, including comprehensively examining rumination, anxiety sensitivity, emotion regulation difficulties, behavioral avoidance, intolerance of uncertainty, perfectionism, cognitive flexibility, psychological flexibility, mindfulness, and self-compassion processes. In line with relevant literature findings, it is understood that the examined transdiagnostic processes are associated with multiple psychopathologies, play a central role in explaining comorbidity patterns, and can provide meaningful improvement in anxiety and accompanying symptoms when targeted for intervention.

Anahtar Kelimeler

Transdiagnostic approaches , anxiety , anxiety disorders

Etik Beyan

As this study is a review article, ethical approval was not required.

Destekleyen Kurum

No funding was received from any institution for this review study.

Kaynakça

• Abend R (2023) Understanding anxiety symptoms as aberrant defensive responding along the threat imminence continuum. Neurosci Biobehav Rev, 152:105305.
• Acartürk ZC, Abuhamdeh S, Jalal B, Unaldı N, Alyanak B, Cetinkaya M et al. (2019) Culturally adapted transdiagnostic CBT for SSRI resistant Turkish adolescents: A pilot study. Am J Orthopsychiatry, 89:222-227.
• Aktepe İ, Tolan Ö (2020) Bilinçli farkındalık: Güncel bir gözden geçirme. Psikiyatride Güncel Yaklaşımlar, 12:534-561.
• Aldao A (2012) Emotion regulation strategies as transdiagnostic processes: A closer look at the invariance of their form and function. Revista de Psicopatologia y Psicologia Clinica, 17:261-277.
• Aldao A, Nolen-Hoeksema S, Schweizer S (2010) Emotion-regulation strategies across psychopathology: A meta-analytic review. Clin Psychol Rev, 30:217-237.
• Alkan E, Kumar G, Ravichandran S, Kaushal S, Salazar-De-Pablo G, Alerci L et al. (2025) Effectiveness of mindfulness-based interventions in reducing depressive symptoms across mental disorders: A meta-analysis of randomized controlled trials. Psychiatry Res, 348:116472.
• Altan-Atalay A, Fatih Boluvat M (2024) Cognitive flexibility and depression: The moderator roles of humor styles. Curr Psychol, 43:20814-20823.
• Andersen P, Toner P, Bland M, McMillan D (2016) Effectiveness of transdiagnostic cognitive behaviour therapy for anxiety and depression in adults: A systematic review and meta-analysis. Behav Cogn Psychother, 44:673-690.
• APA (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Washington DC, American Psychiatric Association.
• Argus G, Thompson M (2008) Perceived social problem solving, perfectionism, and mindful awareness in clinical depression: An exploratory study. Cognit Ther Res, 32:745-757.
• Arı E (2023) The mediating role of cognitive flexibility between self-compassion and anxiety symptoms. Nesne-Psikoloji Dergisi, 11:520-531.
• Balideh D, Nejati F, Torkaman M (2025) Emotional regulation training for nursing students: Effects on emotional adjustment and psychological distress. BMC Nurs, 24:1379.
• Barlow DH, Farchione TJ, Bullis JR, Gallagher MW, Murray-Latin H, Sauer-Zavala S et al. (2017) The unified protocol for transdiagnostic treatment of emotional disorders compared with diagnosis-specific protocols for anxiety disorders: A randomized clinical trial. JAMA Psychiatry, 74:875-884.
• Barlow DH, Farchione TJ, Fairholme CP, Ellard KK, Boisseau CL, Allen LB et al. (2011) The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide. New York, Oxford University Press.
• Barrio-Martínez S, García-Campayo J, Pérez-Aranda A, Modrego-Alarcón M, López-del-Hoyo Y (2023) Worry, rumination and negative metacognitive beliefs as moderators of transdiagnostic cognitive behavioural therapy outcomes in emotional disorders. J Affect Disord, 338:349-357.
• Bates GW, Elphinstone B, Whitehead R (2021) Self‐compassion and emotional regulation as predictors of social anxiety. Psychol. Psychother: Theory Res. Pract. 94:426-442.
• Bazo Perez M, Hayes TB, Frazier LD (2023) Beyond generalized anxiety: The association of anxiety sensitivity with disordered eating. J Eat Disord, 11:173.
• Berg H, McDermott T, Kuplicki R, Yeh H, Thompson W, Smith R et al. (2025) Prediction of generalized anxiety disorder treatment outcomes with neurobehavioral responses to approach-avoidance conflict: A randomized clinical trial. Transl Psychiatry, 15:231.
• Bergmann N, Hahn E, Hahne I, Zierhut M, Ta T, Bajbouj M et al. (2021) The relationship between mindfulness, depression, anxiety, and quality of life in individuals with schizophrenia spectrum disorders. Eur Psychiatry, 64:708808.
• Berking M, Wirtz CM, Svaldi J, Hofmann SG (2014) Emotion regulation predicts symptoms of depression over five years. Behav Res Ther, 57:13-20.
• Bijulakshmi P, Kumar VVB (2025) The role of psychological flexibility in the treatment of anxiety disorders: A systematic review. Archives of Medicine and Health Sciences, 13:110-114.
• Boettcher J, Aström V, Påhlsson D, Schenström O, Andersson G, Carlbring P (2014) Internet-based mindfulness treatment for anxiety disorders: A randomized controlled trial. Behav Ther, 45:241-253.
• Bommarito S, Stevenson A, Warren R (2024) Self-compassion across anxiety and mood disorders: Implications for treatment. Curr Psychiatry Rep, 27:134-139.
• Borsboom D, Cramer AOJ (2013) Network analysis: An integrative approach to the structure of psychopathology. Annu Rev Clin Psychol, 9:91-121.
• Boswell JF, Thompson-Hollands J, Farchione TJ, Barlow DH (2013) Intolerance of uncertainty: a common factor in the treatment of emotional disorders. J Clin Psychol, 69:1-16.
• Bottesi G, Marchetti I, Sica C, Ghisi M (2020) Network analysis of intolerance of uncertainty: Associations with anxiety and depression symptoms. J Anxiety Disord, 76:102312.
• Bruce SE, Yonkers KA, Otto MW, Eisen JL, Weisberg RB, Pagano M et al. (2008) Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: A 12-year prospective study. Focus, 6:539-548.
• Buhr K, Dugas MJ (2002) The intolerance of uncertainty scale: Psychometric properties of the English version. Behav Res Ther, 40:931-945.
• Cai H, Bai W, Liu M, Wang Z, Li Q, Han L et al. (2024) A network model of depressive and anxiety symptoms: A systematic review and statistical evaluation of network analyses. Mol Psychiatry, 29:1173-1189.
• Carleton RN (2016) Into the unknown: A review and synthesis of contemporary models involving uncertainty. J Anxiety Disord, 39:30-43.
• Carlucci L, Saggino A, Balsamo M (2021) On the efficacy of the unified protocol for transdiagnostic treatment of emotional disorders: A systematic review and meta-analysis. Clin Psychol Rev, 87:101999.
• Corpas J, Moriana JA, Vencesla JF, Galvez-Lara M (2022) Effectiveness of brief group transdiagnostic therapy for emotional disorders in primary care: A randomized controlled trial identifying predictors of outcome. Psychother Res, 32:456-469.
• Craske MG, Kircanski K, Zelikowsky M, Mystkowski J, Chowdhury N, Baker A (2008) Optimizing inhibitory learning during exposure therapy. Behav Res Ther, 46:5-27.
• Cuijpers P, Miguel C, Ciharova M, Ebert D, Harrer M, Karyotaki E (2023) Transdiagnostic treatment of depression and anxiety: A meta-analysis. Psychol Med, 53:6535-6546.
• Curry J, Silva S, Rohde P, Ginsburg G, Kratochvil C, Simons A et al. (2011) Recovery and recurrence following treatment for adolescent major depression. Arch Gen Psychiatry, 68:263-270.
• Dağ İ, Gülüm V (2013) Yetişkin bağlanma örüntüleri ile psikopatoloji belirtileri arasındaki ilişkide bilişsel özelliklerin aracı rolü: Bilişsel esneklik. Turk Psikiyatri Derg, 24:240-247.
• Dalgleish T, Black M, Johnston D, Bevan A (2020) Transdiagnostic approaches to mental health problems: Current status and future directions. J Consult Clin Psychol, 88:179-195.
• Deniz ME, Erus SM, Büyükcebeci A (2017) Bilinçli farkındalık ile psikolojik iyi oluş ilişkisinde duygusal zekanın aracılık rolü. Türk Psikolojik Danışma ve Rehberlik Dergisi, 7:17-31.
• Deniz ME, Gündüz M (2021) Psychological inflexibility and cognitive flexbility as predictors of self-compassion. Kalem Eğitim ve İnsan Bilimleri Dergisi, 11:75-94.
• DeTore NR, Balogun O, Choi KW, Holt DJ (2025) Transdiagnostic prevention in youth mental health, Part II: Interventions. Neuropsychopharmacology, 51:310-322.
• Dillard AJ, Meier BP (2021) Trait mindfulness is negatively associated with distress related to COVID-19. Pers Individ Dif, 179:110955.
• Dindo L, Van Liew JR, Arch JJ (2017) Acceptance and commitment therapy: A transdiagnostic behavioral intervention for mental health and medical conditions. Neurotherapeutics, 14:546-553.
• Dozois DJ, Seeds PM, Collins KA (2009) Transdiagnostic approaches to the prevention of depression and anxiety. J Cogn Psychother, 23:44-59.
• Durlak JA (2011) The Importance of Implementation for Research, Practice, and Policy (Research Brief). Bethesda, Child Trends.
• Durlak JA, DuPre EP (2008) Implementation matters: A review of research on the influence of implementation on program outcomes and the factors affecting implementation. Am J Community Psychol, 41:327-350.
• Egan SJ, Wade TD, Shafran R (2011) Perfectionism as a transdiagnostic process: A clinical review. Clin Psychol Rev, 31:203-212.
• Ehring T, Watkins ER (2008) Repetitive negative thinking as a transdiagnostic process. Int J Cogn Behav Ther, 1:192-205.
• Einstein DA (2014) Extension of the transdiagnostic model to focus on intolerance of uncertainty: A review of the literature and implications for treatment. Clin Psychol (New York), 21:280-300.
• Eisenberg D, Hunt J, Speer N, Zivin K (2011) Mental health service utilization among college students in the United States. J Nerv Ment Dis, 199:301-308.
• Erarslan İngeç Ö (2021) Depresif ve kaygı belirtilerine yönelik bütünleşik tanılar üstü bir müdahalenin uyarlanması ve etkisinin değerlendirilmesi (Doktora tezi). İzmir, Dokuz Eylül Üniversitesi.
• Erarslan İngeç Ö, Yorulmaz O (2021) Tanılar üstü psikolojik müdahale programlarının depresyon ve anksiyete bozuklukları üzerindeki etkisi: Sistematik bir derleme. Psikiyatride Güncel Yaklaşımlar, 13:261-281.
• Farchione TJ, Fairholme CP, Ellard KK, Boisseau CL, Thompson-Hollands J, Carl JR, Gallagher MW, Barlow DH (2012) Unified protocol for transdiagnostic treatment of emotional disorders: a randomized controlled trial. Behav Ther, 43:666-678.
• Ferrari M, Hunt C, Harrysunker A, Abbott MJ, Beath AP, Einstein DA (2019) Self-compassion interventions and psychosocial outcomes: A meta-analysis of RCTs. Mindfulness, 10:1455-1473.
• Ferreira MG, Mariano LI, Rezende JV, Caramell P, Kishita N (2022) Effects of group acceptance and commitment therapy (act) on anxiety and depressive symptoms in adults: A meta-analysis. J Affect Disord, 309:297-308.
• Fitzgerald HE, Etkin A, Moshier SJ, Otto MW (2021) Anxiety sensitivity as a malleable mechanistic target for prevention interventions: A meta-analysis of the efficacy of brief treatment interventions. Clin Psychol, 28:323-337.
• Flores A, López FJ, Vervliet B, Cobos PL (2018) Intolerance of uncertainty as a vulnerability factor for excessive and inflexible avoidance behavior. Behav Res Ther, 104:34-43.
• Flores A, López FJ, Vervliet B, Cobos PL (2020) Prospective intolerance of uncertainty is associated with maladaptive temporal distribution of avoidance responses: An extension of Flores, López, Vervliet, and Cobos (2018) Behav Ther Exp Psychiatry, 68:101527.
• Frost R, Marten P, Lahart C, Rosenblate R (1990) The dimensions of perfectionism. Cogn Ther Res, 14:449-468.
• Gao J, Feng Y, Xu S, Wilson A, Li H, Wang X et al. (2023) Appearance anxiety and social anxiety: A mediated model of self-compassion. Front Public Health, 11:1105428.
• Gerdan G, Salcioglu E (2025) Experiential avoidance as a transdiagnostic mediator in the relationship between ıntolerance of uncertainty, maladaptive perfectionism, and psychiatric symptoms: structural and causal mediation analyses in a clinical sample. Clin Psychol Psychother, 32:e70102.
• Germer C (2004) What is mindfulness? Insight J, 22:24-29.
• Goldstein-Piekarski AN, Williams LM, Humphreys K (2016) A trans-diagnostic review of anxiety disorder comorbidity and the impact of multiple exclusion criteria on studying clinical outcomes in anxiety disorders. Transl Psychiatry, 6:e847.
• Grabovac AD, Lau MA, Willett BR (2011) Mechanisms of mindfulness: A Buddhist psychological model. Mindfulness, 2:154-166.
• Gratz KL, Roemer L (2004) Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. J Psychopathol Behav Assess, 26:41-54.
• Greifenberger A, Hill G, Toumeh E, Lokuge S, Fotinos K, Epstein I et al. (2025) Neurobiology of ıntolerance of uncertainty: A systematic review. J Psychiatry Psychiatr Disord, 9:140-154.
• Gros DF, Saulnier KG, Allan NP (2023) Exploring trajectories in transdiagnostic behavior therapy. J Trauma Stress, 36:668-681.
• Gross JJ (2014) Handbook of Emotion Regulation, 2nd ed. New York, Guilford Press.
• Haller H, Breilmann P, Schröter M, Dobos G, Cramer H (2021) A systematic review and meta-analysis of acceptance-and mindfulness-based interventions for DSM-5 anxiety disorders. Sci Rep, 11:20385.
• Han A, Kim TH (2023) Effects of self-compassion interventions on reducing depressive symptoms, anxiety, and stress: A meta-analysis. Mindfulness, 14:1553-1581.
• Harris E, Samuel V (2020) Acceptance and commitment therapy: A systematic literature review of prevention and intervention programs for mental health difficulties in children and young people. J Cogn Psychother, 34:280-305.
• Harris R (2022) ACT’i Kolay Öğrenmek: Kabul ve Kararlılık Terapisi için Hızlı Bir Başlangıç (Çeviri Ed. FB Esen, KF Yavuz). İstanbul, Litera Yayıncılık.
• Harvey AG, Watkins E, Mansell W, Shafran R (2004) Cognitive Behavioural Processes Across Psychological Disorders: A Transdiagnostic Approach to Research and Treatment. Oxford, Oxford University Press.
• Hayes SC, Strosahl KD, Wilson KG (2012) Acceptance and Commitment Therapy: The Process and Practice of Mindful Change, 2nd ed. New York, Guilford Press.
• Hayes SC, Wilson KG, Gifford EV, Follette VM, Strosahl K (1996) Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. J Consult Clin Psychol, 64:1152.
• Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A (2012) The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognit Ther Res, 36:427-440.
• Hofmann SG, Hinton DE (2014) Cross-cultural aspects of anxiety disorders. Curr Psychiatry Rep, 16:450.
• Hohl K, Dolcos S (2024) Measuring cognitive flexibility: A brief review of neuropsychological, self-report, and neuroscientific approaches. Front Hum Neurosci, 18:1331960.
• Huang V, Yu M, Carleton RN, Beshai S (2019) Intolerance of uncertainty fuels depressive symptoms through rumination: Cross-sectional and longitudinal studies. PLoS One, 14:e0224865.
• Hunt C, Exline JJ, Fletcher TL, Teng EJ (2022) Intolerance of uncertainty prospectively predicts the transdiagnostic severity of emotional psychopathology: Evidence from a Veteran sample. J Anxiety Disord, 86:102530.
• Hyman SE (2021) Psychiatric disorders: Grounded in human biology but not natural kinds. Perspect Biol Med, 64:6-28.
• Iannattone S, Spaggiari S, Di Riso D, Bottesi G (2024) Profiles of intolerance of uncertainty, separation anxiety, and negative affectivity in emerging adulthood: A person-centered approach. J Affect Disord, 345:51-58.
• Insel T, Cuthbert B, Garvey M, Heinssen R, Pine DS, Quinn K et al. (2010) Research domain criteria (RDoC): Toward a new classification framework for research on mental disorders. Am J Psychiatry, 167:748-751.
• Ipsos (2024) Ipsos Dünya Ruh Sağlığı Monitörü. https://www.ipsos.com/tr-tr/ipsos-dunya-ruh-sagligi-monitoru-arastirmasi (Accessed 27.08.2025).
• Jacoby RJ (2020) Intolerance of uncertainty. In Clinical Handbook of Fear and Anxiety (Eds Abramowitz JS, Blakey SM):45-63. Washington, American Psychological Association.
• Jazaieri H, Urry HL, Gross JJ (2013) Affective disturbance and psychopathology: An emotion regulation perspective. J Exp Psychopathol, 4:584-599.
• Justyna MK, Zorana I (2023) Emotion regulation strategies and mental health symptoms during COVID-19: the mediating role of insomnia. Int J Occup Med Environ Health, 36:151-159.
• Kağıtçıbaşı C (2005) Autonomy and relatedness in cultural context: Implications for self and family. J Cross Cult Psychol, 36:403-422.
• Kalon LS, Freund H, Rinn A, Watkins PC, Zarski AC, Lehr D (2025) Effectiveness of a gratitude app at reducing repetitive negative thinking as a transdiagnostic risk factor in the general population: Results from a pragmatic randomized controlled trial. J Affect Disord, 389:119664.
• Kara BC, Tolan ÖÇ (2025) Genç yetişkinlerde olumsuz değerlendirilme korkusu ve sosyal yeterlik ile sosyal kaygı arasındaki ilişkide bilişsel esnekliğin aracı rolü. Dokuz Eylül Üniversitesi Buca Eğitim Fakültesi Dergisi, 64:1286-1302.
• Karsten J, Hartman CA, Ormel J, Nolen WA, Penninx BWJH (2011) Psychiatric history and subthreshold symptoms as predictors of the occurrence of depressive or anxiety disorder within 2 years. Br J Psychiatry, 198:206.
• Karsten J, Penninx BW, Verboom CE, Nolen WA, Hartman CA (2013) Course and risk factors of functional impairment in subthreshold depression and anxiety. Depress Anxiety, 30:386-394.
• Kazdin AE (2007) Mediators and mechanisms of change in psychotherapy research. Annu Rev Clin Psychol, 3:1-27.
• Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE (2005) Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the national comorbidity survey replication. Arch Gen Psychiatry, 62:617-627.
• Kirby JN, Tellegen CL, Steindl SR (2017) A meta-analysis of compassion-based interventions: Current state of knowledge and future directions. Behav Ther, 48:778-792.
• Kladnitski N, Smith J, Uppal S, James MA, Allen AR, Andrews G et al. (2020) Transdiagnostic internet-delivered CBT and mindfulness-based treatment for depression and anxiety: A randomised controlled trial. Internet Interv, 20:100310.
• Korte KJ, Schmidt NB (2020) Transdiagnostic preventative intervention for subclinical anxiety: Development and initial validation. J Psychiatr Res, 126:34-42.
• Kotov R, Krueger RF, Watson D, Achenbach TM, Althoff RR, Bagby RM et al. (2017) The Hierarchical Taxonomy of Psychopathology (HiTOP): A dimensional alternative to traditional nosologies. J Abnorm Psychol, 126:454.
• Kul A, Türk F (2020) Kabul ve adanmışlık terapisi (ACT) üzerine bir derleme çalışması. OPUS Uluslararası Toplum Araştırmaları Dergisi, 16:3773-3805.
• Landy LN, Schneider RL, Arch JJ (2015) Acceptance and commitment therapy for the treatment of anxiety disorders: A concise review. Curr Opin Psychol, 2:70-74.
• Lee JK, Orsillo SM (2014) Investigating cognitive flexibility as a potential mechanism of mindfulness in generalized anxiety disorder. J Behav Ther Exp Psychiatry, 45:208-216.
• Lemmens LHJM, Galindo-Garre F, Arntz A, Peeters F, Hollon SD, Huibers MJH (2016) Mechanisms of change in psychotherapy for depression: An empirical update and evaluation of research aimed at identifying psychological mediators. Clin Psychol Rev, 50:65-79.
• Levin ME, Hildebrandt MJ, Lillis J, Hayes SC (2012) The impact of treatment components suggested by the psychological felxibility model: A meta-analysis of laboratory-based component studies, Behav Ther, 43:741-756.
• Levin ME, MacLane C, Daflos S, Seeley JR, Hayes SC, Biglan A et al. (2014) Examining psychological inflexibility as a transdiagnostic process across psychological disorders. J Contextual Behav Sci. 3:155-163.
• Lewis-Fernández R, Aggarwal NK, Hinton L, Hinton DE, Kirmayer LJ (2017) DSM-5 Handbook on the Cultural Formulation Interview. Br J Psychiatry, 211:321.
• Limburg K, Watson HJ, Hagger MS, Egan SJ (2017) The relationship between perfectionism and psychopathology: A meta-analysis. J Clin Psychol, 73:1301-1326.
• Liu X, Luo S, Wen X, Huang X, Wu J, Chen M et al. (2025) The effect of mindfulness-based stress reduction on presenteeism among ICU nurses: A cluster randomized controlled trial. PLoS One, 20:e0334825.
• Lønfeldt NN, Silverman WK, Esbjørn BH (2017) A systematic review and meta-analysis of the association between third-wave cognitive constructs and youth anxiety. Int J Cogn Ther, 10:115-137.
• Lunn J, Greene D, Callaghan T, Egan SJ (2023) Associations between perfectionism and symptoms of anxiety, obsessive-compulsive disorder and depression in young people: A meta-analysis. Cogn Behav Ther, 52:460-487.
• Luo X, Che X, Lei Y (2023) Characterizing the effects of self-compassion interventions on anxiety: Meta-analytic evidence from randomized controlled studies. J Contextual Behav Sci, 30:132-141.
• Lyubomirsky S, Layous K, Chancellor J, Nelson SK (2015) Thinking about rumination: The scholarly contributions and intellectual legacy of Susan Nolen-Hoeksema. Annu Rev Clin Psychol, 11:1-22.
• Mansell W, Harvey A, Watkins E, Shafran R (2009) Conceptual foundations of the transdiagnostic approach to CBT. J Cogn Psychother, 23:6-19.
• Månsson KNT, Sundquist K, de la Cruz L (2023) Transdiagnostic cognitive behavioural psychotherapy for emotional disorders: A systematic review and meta-analysis. Psychol Med, 53:1234-1248.
• Mantar A, Yemez B, Alkın T (2010) Anksiyete Duyarlılığı İndeksi‑3’ün Türkçe formunun geçerlik ve güvenilirlik çalışması. Turk Psikiyatri Derg, 21:225‑234.
• McEvoy PM, Hyett MP, Shihata S, Price JE, Strachan L (2019) The impact of methodological and measurement factors on transdiagnostic associations with intolerance of uncertainty: a meta-analysis. Clin Psychol Rev, 73:101778.
• McEvoy PM, Mahoney AE (2012) To be sure, to be sure: Intolerance of uncertainty mediates symptoms of various anxiety disorders and depression. Behav Ther, 43:533-545.
• McLeod BD, Wood JJ, Weisz JR (2007) Examining the association between parenting and childhood anxiety: A meta-analysis. Clin Psychol Rev, 27:155-172.
• McManus H, Milad MR (2025) Behavioral and brain mechanisms of active avoidance and their relevance to anxiety disorders. Curr Top Behav Neurosci, 73:57-72.
• McNally RJ (2016) Can network analysis transform psychopathology? Behav Res Ther, 86:95-104.
• Meier S, Petersen L, Mattheisen M, Mors O, Mortensen P, Laursen T (2015) Secondary depression in severe anxiety disorders: a population-based cohort study in Denmark. Lancet Psychiatry, 2:515-23.
• Melles H, Jansen A (2023) Transdiagnostic fears and avoidance behaviors in self-reported eating disorders. J Eat Disord, 11:19.
• Miller ML, McGuire JF (2023) Targeting intolerance of uncertainty in treatment: a meta-analysis of therapeutic effects, treatment moderators, and underlying mechanisms. J Affect Disord, 341:283-295.
• Mohammadi R, Taghipuor B, Barzegaran R, Solhjou S, Rahimi S, Jokar S (2023) The effectiveness of emotion regulation training on rumination and perception of anxiety control in students with social anxiety disorder. Journal of School Psychology and Institutions, 11:130-141.
• Moonen AJ, Mulders A, Defebvre L, Duits A, Flinois B, Köhler S (2021) Cognitive behavioral therapy for anxiety in Parkinsonʼs disease: a randomized controlled trial. Mov Disord, 36:2539-2548.
• Moritz S, Klein JP, Lysaker PH, Mehl S (2019) Metacognitive and cognitive-behavioral interventions for psychosis: new developments. Dialogues Clin Neurosci, 21:309-317.
• Moulds ML, Bisby MA, Wild J, Bryant RA (2020) Rumination in posttraumatic stress disorder: A systematic review. Clin Psychol Rev, 82:101910.
• Naragon-Gainey K (2010) Meta-analysis of the relations of anxiety sensitivity to the depressive and anxiety disorders. Psychol Bull, 136:128-150.
• Neff K (2021) Öz-şefkat: Kendine Nazik Olmanın Kanıtlanmış Gücü (Çeviri Ed. E Güldemler). İstanbul, Diyojen Yayınları.
• Newby JM, Twomey C, Li SSY, Andrews G (2016) Transdiagnostic computerised cognitive behavioural therapy for depression and anxiety: A systematic review and meta-analysis. J Affect Disord, 199:30-41.
• Newby JM, Twomey C, Yuan Li S, Andrews G, Mohlman J (2015) Transdiagnostic psychological treatments for depressive and anxiety disorders: A systematic review and meta‐analysis. J Affect Disord, 179:45-52.
• Newman MG, Rackoff GN, Zhu Y, Kim H (2023) A transdiagnostic evaluation of contrast avoidance across generalized anxiety disorder, major depressive disorder, and social anxiety disorder. J Anxiety Disord, 93:102662.
• Nolen-Hoeksema S (1991) Responses to depression and their effects on the duration of depressive episodes. J Abnorm Psychol, 100:569-582.
• Nolen-Hoeksema S, Watkins ER (2011) A heuristic for developing transdiagnostic models of psychopathology: explaining multifinality and divergent trajectories. Perspect Psychol Sci, 6:589-609.
• Norcross JC, Pfund RA, Cook DM (2022) The predicted future of psychotherapy: A decennial e-Delphi poll. Prof Psychol Res Pr, 53:109-115.
• Normann N, Emmerik AA, Morina N (2014) The efficacy of metacognitive therapy for anxiety and depression: A meta-analytic review. Depress Anxiety, 31:402-411.
• Normann N, Morina N (2018) The efficacy of metacognitive therapy: A systematic review and meta-analysis. Front Psychol, 9:2211.
• Norton PJ, Barrera TL (2012) Transdiagnostic versus diagnosis‐specific CBT for anxiety disorders: A preliminary randomized controlled noninferiority trial. Depress Anxiety, 29:874-882.
• Norton PJ, Hope D (2005) Preliminary evaluation of a broad-spectrum cognitive-behavioral group therapy for anxiety. J Behav Ther Exp Psychiatry, 36:79-97.
• Norton PJ, Philipp LM (2008) Transdiagnostic approaches to the treatment of anxiety disorders: A quantitative review. Psychotherapy (Chic), 45:214-226.
• O’Connell ME, Boat T, Warner KE (2009) Preventing Mental, Emotional, and Behavioral Disorders among Young People: Progress and Possibilities. Washington, National Academies Press.
• Oberoi S, Yang J, Woodgate RL, Niraula S, Banerji S, Israels SJ et al. (2020) Association of mindfulness-based interventions with anxiety severity in adults with cancer: A systematic review and meta-analysis. JAMA Netw Open, 3:e2012598.
• Oglesby ME, Allan NP, Schimdt NB (2017) Randomized control trial investigating the efficacy of a computer-based intolerance of uncertainty intervention. Behav Res Ther, 95:50-57.
• Olatunji BO, Cisler JM, Tolin DF (2007) Quality of life in the anxiety disorders: A meta-analytic review. Clin Psychol Rev, 27:572-581.
• Olatunji BO, Naragon-Gainey K, Wolitzky-Taylor KB (2013) Specificity of rumination in anxiety and depression: A multimodal meta‐analysis. Clin Psychol (New York), 20:225-257.
• Olatunji BO, Wolitzky-Taylor KB (2009) Anxiety sensitivity and the anxiety disorders: A meta-analytic review and synthesis. Psychol Bull, 135:974-999.
• Owens JS, Lyon AR, Brandt NE, Masia Warner C, Nadeem E, Spiel C et al. (2014) Implementation science in school mental health: Key constructs in a developing research agenda. School Ment Health, 6:99-111.
• Özdel K, Türkçapar MH (2025) Tridimensional model of CBT: A transdiagnostic and transtheoretical pragmatic model. Front Psychol, 16:1555047.
• Papola D, Miguel C, Mazzaglia M, Franco P, Tedeschi F, Romero SA et al. (2024) Psychotherapies for generalized anxiety disorder in adults: A systematic review and network meta-analysis of randomized clinical trials. JAMA Psychiatry, 81:250-259.
• Patel V, Saxena S, Lund C, Thornicroft G, Baingana F, Bolton P, et al. (2018) The Lancet Commission on global mental health and sustainable development. Lancet, 392:1553-1598.
• Paul S, Zhu L, Mizevich J, Slater L (2024) Depression, anxiety, and personal recovery outcomes after group vs individual transdiagnostic therapy: A brief report. Sci Rep, 14:4855.
• Pearl SB, Norton PJ (2017) Transdiagnostic versus diagnosis specific cognitive behavioural therapies for anxiety: A meta-analysis. J Anxiety Disord, 46:11-24.
• Poletti S, Radaelli D, Cucchi M, Ricci L, Vai B, Smeraldi E et al. (2015) Neural correlates of anxiety sensitivity in panic disorder: A functional magnetic resonance imaging study. Psychiatry Res Neuroimaging, 233:95-101.
• Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A et al. (2011) Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health, 38:65-76.
• Racine N, McArthur BA, Cooke JE, Eirich R, Zhu J, Madigan S (2021) Global prevalence of depressive and anxiety symptoms in children and adolescents during COVID-19: A meta-analysis. JAMA Pediatr, 175:1142-1150.
• Rai D, Skapinakis P, Wiles N, Lewis G, Araya R (2010) Common mental disorders, subthreshold symptoms and disability: Longitudinal study. Br J Psychiatry, 197:411-412.
• Raines AM, Vidaurri DN, Portero AK, Schmidt NB (2017) Associations between rumination and obsessive-compulsive symptom dimensions. Pers Individ Dif, 113:63-67.
• Ramnerö J, Törneke N (2021) İnsan Davranışının ABC’si (Çeviri Ed. KF Yavuz, HT Karatepe). İstanbul, Litera Yayıncılık.
• Rapee RM, Heimberg RG (1997) A cognitive-behavioral model of anxiety in social phobia. Behav Res Ther, 35:741-756.
• Reiss S, Peterson RA, Gursky DM, McNally RJ (1986) Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behav Res Ther, 24:1-8.
• Ren Z, Zhang Y, Jiang G (2018) Effectiveness of mindfulness meditation in intervention for anxiety: A meta-analysis. Acta Psychol Sinica, 50:283-305.
• Robinaugh DJ, Hoekstra RH, Toner ER, Borsboom D (2019) The network approach to psychopathology: A review of the literature 2008-2018 and an agenda for future research. Psychol Med, 50:353-366.
• Rochat L, Manolov R, Billieux J (2018) Efficacy of metacognitive therapy in improving mental health: A meta-analysis of single-case studies. J Clin Psychol, 74:896-915
• Ródenas‐Perea G, Pérez‐Esteban A, Pérez‐Albéniz A, Al‐Halabí S, Fonseca‐Pedrero E (2025) Network structure of transdiagnostic dimensions of emotional disorders in adolescents with subthreshold anxiety and depression: Links with psychopathology and socio‐emotional adjustment. Early Interv Psychiatry, 19:e13636.
• Roemer L, Williston SK, Eustis EH, Orsillo SM (2013) Mindfulness and acceptance-based behavioral therapies for anxiety disorders. Curr Psychiatry Rep, 15:410.
• Sakiris N, Berle D (2019) A systematic review and meta-analysis of the Unified Protocol as a transdiagnostic emotion regulation-based intervention. Clin Psychol Rev, 72:101751.
• Salamanca-Sanabria A, Richards D, Timulak L (2019) Adapting an internet-delivered intervention for depression for a Colombian college student population: An illustration of an integrative empirical approach. Internet Interv, 15:76-86.
• Salamanca-Sanabria A, Richards D, Timulak L, Castro-Camacho L, Mojica-Perilla M, Parra-Villa Y (2018) Assessing the efficacy of a culturally adapted cognitive behavioural internet-delivered treatment for depression: protocol for a randomised controlled trial. BMC Psychiatry, 18:53.
• Salkovskis PM (1991) The importance of behaviour in the maintenance of anxiety and panic: A cognitive account. Behav Cogn Psychother, 19:6-19.
• Sandín B, Chorot P, Valiente RM (2012) Transdiagnóstico: Nueva frontera en psicología clínica. Revista de Psicopatología y Psicología Clínica, 17:185-203.
• Sarı S, Dağ İ (2009) Belirsizliğe Tahammülsüzlük Ölçeği, Endişe ile ilgili Olumlu İnançlar Ölçeği ve Endişenin Sonuçları Ölçeği’nin Türkçeye uyarlanması, geçerliliği ve güvenilirliği. Anadolu Psikiyatri Derg, 10:261-270.
• Sauer-Zavala S, Gutner CA, Farchione TJ, Boettcher HT, Bullis JR, Barlow DH (2017) Current definitions of “transdiagnostic” in treatment development: A search for consensus. Behav Ther, 48:128-138.
• Schäfer JÖ, Naumann E, Holmes EA, Tuschen-Caffier B, Samson AC (2017) Emotion regulation strategies in depressive and anxiety symptoms in youth: A meta-analytic review. J Youth Adolesc, 46:261-276.
• Seyfi F, Poudel KC, Yasuoka J, Otsuka K, Jimba M (2013) Intention to seek professional psychological help among college students in Turkey: Influence of help-seeking attitudes. BMC Res Notes, 6:519.
• Shafran R, Mansell W (2001) Perfectionism and psychopathology: A review of research and treatment. Clin Psychol Rev, 21:879-906.
• Sharma P, Rosário MC, Ferrão YA, Albertella L, Miguel EC, Fontenelle LF (2021a) The impact of generalized anxiety disorder in obsessive-compulsive disorder patients. Psychiatry Res, 300:113898.
• Sharma E, Sharma LP, Balachander S, Lin B, Manohar H, Khanna P et al. (2021b) Comorbidities in obsessive-compulsive disorder across the lifespan: A systematic review and meta-analysis. Front Psychiatry, 12:703701.
• Short NA, Van Rooij SJ, Murty, VP, Stevens JS, An X, Ji Y, Mclean AS et al. (2022) Anxiety sensitivity as a transdiagnostic risk factor for trajectories of adverse posttraumatic neuropsychiatric sequelae in the AURORA study. J Psychiatr Res, 156:45-54.
• Smith MM, Sherry, SB, Ray C, Hewitt PL, Flett GL (2021) Is perfectionism a vulnerability factor for depressive symptoms, a complication of depressive symptoms, or both? A meta-analytic test of 67 longitudinal studies. Clin Psychol Rev, 84:101982.
• Smith MM, Vidovic V, Sherry SB, Stewart SH, Saklofske DH (2017) Are perfectionism dimensions risk factors for anxiety symptoms? A meta-analysis of 11 longitudinal studies. Anxiety Stress Coping, 31:4-20.
• Talkovsky AM, Norton PJ (2016) Intolerance of uncertainty and transdiagnostic group cognitive behavioral therapy for anxiety. J Anxiety Disord, 41:108-114.
• Taylor J, McLean L, Korner A, Stratton E, Glozier N (2020) Mindfulness and yoga for psychological trauma: systematic review and meta-analysis. J Trauma Dissociation, 21:536-573.
• Tolan ÖÇ, Kara BC (2023) The mediating role of cognitive flexibility in the relationship between social anxiety and general self-efficacy. E-International Journal of Educational Research, 14:229-244.
• Tulbure BT, Dudău DP, Marian Ș, Watkins E (2025) An internet-delivered rumination-focused cbt intervention for adults with depression and anxiety: A randomized controlled trial. Behav Ther, 56:785-798.
• Uddin LQ (2021) Cognitive and behavioural flexibility: Neural mechanisms and clinical considerations. Nat Rev Neurosci, 22:167-179.
• Urcelay GP (2024) A psychological mechanism for the development of anxiety. Behav Neurosci, 138:281-290.
• Van Der Bruggen CO, Stams GJJ, Bögels SM (2008) Research review: The relation between child and parent anxiety and parental control: A meta‐analytic review. J Child Psychol Psychiatry, 49:1257-1269.
• Van Minnen A, Zoellner LA, Harned MS, Mills K (2015) Changes in comorbid conditions after prolonged exposure for PTSD: A literature review. Curr Psychiatry Rep, 17:549.
• Venturo-Conerly KE, Ehrenreich-May J (2023) An overview of transdiagnostic, modular approaches to emotional disorder treatment. In Handbook of Child and Adolescent Psychology Treatment Modules, (Eds LJ Farrell, RC Murrihy, CA Essau):3-15. London, UK, Academic Press.
• Wake S, Morriss J, Johnstone T, van Reekum CM, Dodd H (2021) Intolerance of uncertainty, and not social anxiety, is associated with compromised extinction of social threat. Behav Res Ther, 139:103818.
• Wang J, Fang S, Yang C, Tang X, Zhu L, Nie Y (2023) The relationship between psychological flexibility and depression, anxiety and stress: A latent profile analysis. Psychol Res Behav Manag, 16:997-1007.
• Warriner-Gallyer G (2019) Examining the relationship between cognitive flexibility and constructs of anxiety (Doctoral dissertation). Southampton, University of Southampton.
• Watkins ER (2008) Constructive and unconstructive repetitive thought. Psychol Bull, 134:163-206.
• Weisberg RB, Magidson JF (2014) Integrating cognitive behavioral therapy into primary care settings. Cogn Behav Pract, 21:247-251.
• WHO (2023) Anxiety disorders. https://www.who.int/news-room/fact-sheets/detail/anxiety-disorders (Accessed 12.07.2025).
• WHO (2025) World Health Statistics 2025: Monitoring Health for the SDGs, Sustainable Development Goals. Geneva, World Health Organization.
• WHO (2026) International Classification of Diseases 11th Revision. Geneva, World Health Organization.
• Williams M, Honan C, Skromanis S, Sanderson B, Matthews AJ (2024) Psychological outcomes and mechanisms of mindfulness-based training for generalised anxiety disorder: A systematic review and meta-analysis. Curr Psychol, 43:5318-5340.
• Wilson EJ, Abbott MJ, Norton AR (2023) The impact of psychological treatment on intolerance of uncertainty in generalized anxiety disorder: A systematic review and meta-analysis. J Anxiety Disord, 97:102729.
• Wiltsey Stirman S, Baumann AA, Miller CJ (2019) The FRAME: An expanded framework for reporting adaptations and modifications to evidence-based interventions. Implement Sci, 14:58.
• Yadavaia JE, Hayes SC, Vilardaga R (2014) Using acceptance and commitment therapy to increase self-compassion: A randomized controlled trial. J Contextual Behav Sci, 3:248-257.
• Yao X, Xu X, Chan KL, Chen S, Assink M, Gao S (2023) Associations between psychological inflexibility and mental health problems during the COVID-19 pandemic: A three-level meta-analytic review. J Affect Disord, 320:148-160.
• Yook K, Kim KH, Suh SY, Lee KS (2010) Intolerance of uncertainty, worry, and rumination in major depressive disorder and generalized anxiety disorder. J Anxiety Disord, 24:623-628.
• Young KS, Sandman CF, Craske MG (2019) Positive and negative emotion regulation in adolescence: Links to anxiety and depression. Brain Sci, 9:76.
• Zhong Q, Niu L, Chen K, Lee TM, Zhang R (2024) Prevalence and risk of subthreshold anxiety developing into threshold anxiety disorder in the general population. J Affect Disord, 367:815-822.
• Zvolensky MJ, Clausen BK, Shepherd JM, Kabel KE, Kauffman B, Garey L (2022) Anxiety sensitivity in relation to post-traumatic stress disorder symptom clusters among young adults with probable post-traumatic stress disorder. Cogn Behav Ther, 51:470-485.