Transdiagnostic Processes as Mediators of Change in an Internet-Delivered Intervention Based on the Unified Protocol

Abstract Background Transdiagnostic treatments target shared mechanisms between disorders to facilitate change across diagnoses. The Unified Protocol (UP) aims at changing dysfunctional reactions towards emotions by increasing mindful emotion awareness and cognitive flexibility, as well as decreasing anxiety sensitivity and emotion avoidance. Method We investigated whether these transdiagnostic processes were malleable by treatment and mediated the relationship between treatment and outcome in an internet-delivered adaptation of the UP. N = 129 participants with mixed anxiety, depressive, and somatic symptom disorders were randomized to treatment or waitlist. Results The treatment yielded significant changes in all transdiagnostic processes over time in comparison to a waitlist condition. In separate mediator models, significant mediating effects were found for mindfulness, cognitive flexibility, behavioral activation, and experiential avoidance. When all mediators were combined in a multiple mediator model, the indirect effects through mindfulness and cognitive flexibility emerged as significant. Conclusion These findings add to the growing body of research on transdiagnostic processes as mediators of change and emphasize mindfulness and cognitive flexibility as a transdiagnostic treatment target. However, these results should be interpreted cautiously, as temporal precedence could not be established.

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Transdiagnostic Processes as Mediators of Change in an Internet-delivered Intervention based on the Unified Protocol

10.31234/osf.io/fs4x8 ◽

2021 ◽

Author(s):

Carmen Schaeuffele ◽

Jonathan Baer ◽

Inken Buengener ◽

Raphaela Grafiadeli ◽

Eva Heuthaler ◽

...

Keyword(s):

Cognitive Flexibility ◽

Experiential Avoidance ◽

Behavioral Activation ◽

Treatment Target ◽

Transdiagnostic Treatment ◽

Unified Protocol ◽

Multiple Mediator Model ◽

The Relationship ◽

Somatic Symptom Disorders ◽

Mediators Of Change

Background: Transdiagnostic treatments target shared mechanisms between disorders to facilitate change across diagnoses. The Unified Protocol (UP) aims at changing dysfunctional reactions towards emotions by increasing mindful emotion awareness and cognitive flexibility, as well as decreasing anxiety sensitivity and emotion avoidance. Method: We investigated whether these transdiagnostic processes were malleable by treatment and mediated the relationship between treatment and outcome in an internet-delivered adaptation of the UP. N=129 participants with mixed anxiety, depressive, and somatic symptom disorders were randomized to treatment or waitlist. Results: The treatment yielded significant changes in all transdiagnostic processes over time in comparison to a waitlist condition. In single mediator models, significant mediating effects were found for mindfulness, cognitive flexibility, behavioral activation, and experiential avoidance. When all mediators were combined in a multiple mediator model, only mindfulness emerged as a significant mediator. Conclusion: These findings add to the growing body of research on transdiagnostic processes as mediators of change and emphasize mindfulness as a transdiagnostic treatment target. However, these results should be interpreted cautiously, as temporal precedence could not be established.

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The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders

Applications of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders ◽

10.1093/med-psych/9780190255541.003.0001 ◽

2017 ◽

pp. 1-16 ◽

Cited By ~ 1

Author(s):

Katherine A. Kennedy ◽

David H. Barlow

Keyword(s):

Clinical Trial ◽

Emotional Disorders ◽

Anxiety Sensitivity ◽

Experiential Avoidance ◽

Large Clinical Trial ◽

Transdiagnostic Treatment ◽

The Core ◽

Unified Protocol ◽

Core Elements ◽

Negative Appraisals

This chapter recounts the origins of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) as it developed over a period of several decades. The rationale for developing it was derived from research emerging over this period of time that highlighted commonalities among anxiety, depressive, and related disorders, focusing on emotional disruption and dysregulation, as well as research highlighting common underlying temperamental factors associated with all these disorders. With a particular emphasis on the temperament of neuroticism, transdiagnostic constructs in emotional disorders that are fundamental aspects of neuroticism, such as increased anxiety sensitivity, decreased mindfulness, experiential avoidance, and negative appraisals and attributions, were identified and became targets for treatment. After presentation of the core elements comprising the UP, research supporting its efficacy, including a recently completed large clinical trial, is presented.

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Cognitive Flexibility

Unified Protocol for Transdiagnostic Treatment of Emotional Disorders ◽

10.1093/med-psych/9780190686017.003.0008 ◽

2017 ◽

pp. 77-94

Author(s):

David H. Barlow ◽

Shannon Sauer-Zavala ◽

Todd J. Farchione ◽

Heather Murray Latin ◽

Kristen K. Ellard ◽

...

Keyword(s):

Emotional Disorders ◽

Cognitive Flexibility ◽

Emotional Experiences ◽

Transdiagnostic Treatment ◽

Negative Thinking ◽

Jumping To Conclusions ◽

Unified Protocol

Chapter 8 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook looks at one part of our emotional experiences—our thoughts—and describes how thoughts are very important for influencing how we feel. The chapter describes our tendency to get stuck in automatic patterns of thinking, which we refer to as thinking traps. This treatment describes two specific types of thinking traps: jumping to conclusions and thinking the worst. Next, readers are encouraged to identify their own patterns of negative thinking to generate alternative interpretations. The overall goal is to be more flexible in our thinking, referred to as cognitive flexibility.

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Module 4: Cognitive Flexibility

Unified Protocol for Transdiagnostic Treatment of Emotional Disorders ◽

10.1093/med-psych/9780190685973.003.0009 ◽

2017 ◽

pp. 97-112

Author(s):

David H. Barlow ◽

Todd J. Farchione ◽

Shannon Sauer-Zavala ◽

Heather Murray Latin ◽

Kristen K. Ellard ◽

...

Keyword(s):

Emotional Disorders ◽

Cognitive Flexibility ◽

Emotional Experiences ◽

Transdiagnostic Treatment ◽

Negative Thinking ◽

Unified Protocol

Chapter 9 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide focuses on one very important component of emotional experiences: thoughts. Specifically, therapists will teach their patients to develop a greater awareness of how patient thoughts (or interpretations) influence their emotions, to learn to identify their negative thinking patterns, and to increase flexibility in interpreting different situations. The concepts introduced in this chapter are aimed to facilitate patients’ ability to approach emotion-provoking situations and respond to their emotions in more helpful, adaptive ways.

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About This Treatment

Unified Protocol for Transdiagnostic Treatment of Emotional Disorders ◽

10.1093/med-psych/9780190686017.003.0002 ◽

2017 ◽

pp. 11-16

Author(s):

David H. Barlow ◽

Shannon Sauer-Zavala ◽

Todd J. Farchione ◽

Heather Murray Latin ◽

Kristen K. Ellard ◽

...

Keyword(s):

Emotional Disorders ◽

Cognitive Flexibility ◽

Transdiagnostic Treatment ◽

Unified Protocol ◽

Understanding Emotions ◽

The Right

Chapter 2 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook provides an overview of the skills that will be learned in this treatment and discusses the importance of practicing these skills. Specifically, this treatment includes the following skills: Setting Goals and Maintaining Motivation , Understanding Emotions, Mindful Emotion Awareness, Cognitive Flexibility, Countering Emotional Behaviors, Understanding and Confronting Physical Sensations, and Emotion Exposures. The chapter describes how this treatment can be used in combination with other treatments like medication and other types of therapy, and it helps readers determine if now is the right time for them to begin the UP program.

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The Mediating Effects of Multidimentional Experiential Avoidance in The Relationship Between Parenting Stress and Smartphone Addiction of Mothers with Infants

Journal of Parent Education ◽

10.36431/jpe.11.3.8 ◽

2019 ◽

Vol 11 (3) ◽

pp. 151-174

Author(s):

Joengmin Yoon ◽

Jungsoon Hong

Keyword(s):

Parenting Stress ◽

Experiential Avoidance ◽

Smartphone Addiction ◽

Mediating Effects ◽

The Relationship

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The effect of ambidextrous leadership on employee voice: A moderated mediation model

Social Behavior and Personality An International Journal ◽

10.2224/sbp.9304 ◽

2020 ◽

Vol 48 (10) ◽

pp. 1-11

Author(s):

Gui-Liang Peng

Keyword(s):

Cognitive Flexibility ◽

Social Identity Theory ◽

Employee Voice ◽

Hierarchical Regression ◽

Mediating Role ◽

Moderated Mediation Model ◽

Knowledge Intensive ◽

Knowledge Intensive Business Service ◽

The Relationship ◽

Ambidextrous Leadership

I drew on social identity theory to explore the influence of ambidextrous leadership on employee voice. Participants were 208 employees at 5 knowledge-intensive business service enterprises in China. Hierarchical regression analysis and bootstrapping analysis results show that ambidextrous leadership was positively correlated with employee voice, and leader identification played a partial mediating role in this relationship. Further, this mediating role was positively moderated by cognitive flexibility, which also positively moderated the relationship between leader identification and employee voice. These findings support a positive link between ambidextrous leadership and employee voice, with leader identification mediating, and cognitive flexibility moderating this relationship. Theoretical and practical implications are discussed.

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Skill Acquisition During Transdiagnostic Treatment With the Unified Protocol

Behavior Therapy ◽

10.1016/j.beth.2021.03.001 ◽

2021 ◽

Author(s):

Shannon Sauer-Zavala ◽

Anthony J. Rosellini ◽

Kate H. Bentley ◽

Amantia A. Ametaj ◽

James F. Boswell ◽

...

Keyword(s):

Skill Acquisition ◽

Transdiagnostic Treatment ◽

Unified Protocol

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The Effect of State Gratitude on Cognitive Flexibility: A Within-Subject Experimental Approach

Brain Sciences ◽

10.3390/brainsci10070413 ◽

2020 ◽

Vol 10 (7) ◽

pp. 413

Author(s):

Andree Hartanto ◽

Nadia C. H. Ong ◽

Wee Qin Ng ◽

Nadyanna M. Majeed

Keyword(s):

Pilot Study ◽

Cognitive Functioning ◽

Cognitive Flexibility ◽

Positive Emotion ◽

Positive Emotions ◽

Experimental Approach ◽

Main Study ◽

Considerable Research ◽

Potential Benefits ◽

The Relationship

Considerable research has examined the relationship between positive emotion and cognitive flexibility. Less is known, however, about the causal relationship between discrete positive emotions, specifically gratitude, and cognitive flexibility. Given that different positive emotions may dissimilarly affect cognitive functioning, we sought to examine the effect of state gratitude on cognitive flexibility. A pilot study with ninety-five participants was employed to ensure the effectiveness of our gratitude manipulation. One hundred and thirteen participants were recruited for the main study, which utilized a within-subject experimental approach. After the manipulation, participants completed a well-established task-switching paradigm, which was used to measure cognitive flexibility. Contrary to our hypotheses, we did not find any evidence that state gratitude may enhance cognitive flexibility. The current study identified some boundary conditions around the potential benefits of the experience of gratitude.

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