Modifiable Transdiagnostic Risk and Protective Factors as Potential CBT Augmentation Targets for Eating Disorders: An Updated Umbrella Review.

Abstract

A focus on transdiagnostic targets is one of the key strategies for developing effective, efficient, and scalable treatments for mental health conditions. We conducted an umbrella review of recent meta-analyses (August 2022 to May 2026) to update our understanding of critical transdiagnostic intervention targets that could inform cognitive behavioral therapy augmentation. We included prospective cohort, randomized controlled trials, and longitudinal data adopting the search strategy in Hazzard et al. (2023), who previously identified concern over mistakes, perfectionism, and low self-esteem as transdiagnostic targets across depression, anxiety and eating disorders. Six databases were searched including MEDLINE, PsycINFO, Scopus, JBI Database of Systematic Reviews and Implementation Reports, Cochrane Database of Systematic Reviews, and ProQuest Dissertations & Theses Global. The protocol for this review was registered with PROSPERO (CRD420261295232). One hundred and fifty-two meta-analyses were included in this review, of which 44 (29%) contributed to 13 meta-meta-analyses. The remaining findings were synthesized narratively. Despite a plethora of meta-analyses since 2022, no new transdiagnostic targets have emerged. Significant meta-meta-analytic findings were confined to depression, where physical activity (prospective cohort data) was associated with reduced depressive symptoms, and cognitive biases (longitudinal data) were associated with increased depressive symptoms. A disproportionate dominance of depression research may stymie the progress of identifying transdiagnostic targets that are also of relevance to eating disorders. A strong emphasis on physical activity may be contraindicated for eating disorder prevention, especially among youth. Further research effort should be directed toward identifying psychological targets across domains beyond depression. No new transdiagnostic targets emerged since 2022. Eating disorder is underrepresented in the transdiagnostic literature. Cognitive biases emerged as the only transdiagnostic target with both strong theoretical coherence and empirical support within the depression literature, warranting replication across broader outcome domains. Popularity in using physical activity to address mood may pose an unintended risk for young people at risk of developing an eating disorder.