Skill Acquisition During Transdiagnostic Treatment With the Unified Protocol

Youths with or at high risk for serious mental illness (SMI; i.e., psychotic or bipolar disorders) have heterogeneous psychiatric symptoms, including significant overlap with more common depressive and anxiety disorders. There are also heterogeneous illness trajectories, as some youth go on to develop chronic and debilitating SMIs while a large proportion have symptoms that remit or remain relatively milder. This chapter presents the rationale for using the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) as a first-line, transdiagnostic, cognitive-behavioral treatment for youth with early SMI symptoms. This treatment is delivered in a group format including parents in an effort to reduce stigma, increase social support, and improve skill acquisition. Preliminary feasibility and efficacy data are presented as well as a case vignette. Recommendations are offered on how to deliver this treatment and troubleshoot common difficulties.

Transdiagnostic Treatment of Bipolar Disorder and Comorbid Anxiety With the Unified Protocol: A Clinical Replication Series

Behavior Modification ◽

10.1177/0145445512451272 ◽

2012 ◽

Vol 36 (4) ◽

pp. 482-508 ◽

Cited By ~ 42

Author(s):

K. K. Ellard ◽

T. Deckersbach ◽

L. G. Sylvia ◽

A. A. Nierenberg ◽

D. H. Barlow

Keyword(s):

Bipolar Disorder ◽

Comorbid Anxiety ◽

Initial Effectiveness Evaluation of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders for Homeless Women

Behavior Modification ◽

10.1177/0145445520982562 ◽

2020 ◽

pp. 014544552098256

Author(s):

Sara Rodriguez-Moreno ◽

Todd J. Farchione ◽

Pablo Roca ◽

Carolina Marín ◽

Ana I. Guillén ◽

...

Keyword(s):

Negative Affect ◽

Emotional Disorders ◽

Group Treatment ◽

Linear Trend ◽

Control Period ◽

Well Being ◽

Homeless Women ◽

Depression And Anxiety ◽

The purpose of this study is to evaluate the effectiveness of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders adapted for homeless women (UPHW). Eighty-one homeless women participated in this single-blinded quasi-experimental clinical trial, involving up to 12 sessions of group treatment, and 3-and 6-month follow-ups. The participants received either immediate treatment with the UPHW ( n = 46) or delayed treatment, following a 12-week wait-list control period (WLC; n = 35). Primary outcomes included depression and anxiety. Secondary measures comprised positive and negative affect, psychological well-being, health perception, and social support. The UPHW resulted in significant improvement on measures of anxiety, depression and negative affect. Improvements in anxiety and depression were maintained over a 3-month follow-up period, but not at 6-month. The reliability of the clinical changes showed significant differences between UPHW and WLC for depression. Moreover, the inter-session assessment in the UPHW group showed a linear trend reduction for depression and anxiety scores along the 12 sessions. The clinical implications on the UPHW in social settings are also discussed.

Effectiveness of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders Among Veterans With Posttraumatic Stress Disorder: A Pilot Study

Behavior Modification ◽

10.1177/0145445517724539 ◽

2017 ◽

Vol 42 (2) ◽

pp. 210-230 ◽

Cited By ~ 7

Author(s):

Ruth L. Varkovitzky ◽

Andrew M. Sherrill ◽

Greg M. Reger

Keyword(s):

Posttraumatic Stress Disorder ◽

Emotion Regulation ◽

Depressive Symptoms ◽

Pilot Study ◽

Posttraumatic Stress ◽

Emotional Disorders ◽

Symptom Severity ◽

Stress Disorder ◽

Effective treatment options are needed for veterans who do not participate in trauma-focused psychotherapy. Research has yet to examine the effectiveness of transdiagnostic psychotherapy in veterans with posttraumatic stress disorder (PTSD) and co-occurring psychological disorders. This pilot study examined the effectiveness of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) delivered in a 16-week group format. We examined treatment outcomes in male and female veterans ( n = 52) in an outpatient specialty PTSD clinic at a large Veterans Affairs (VA) medical center. We hypothesized significant decreases in emotion regulation difficulty (Difficulties in Emotion Regulation Scale), PTSD symptom severity (PTSD Checklist for DSM-5), and depressive symptom severity (Patient Health Questionnaire–9). In addition, we hypothesized that reductions in emotion regulation difficulty across treatment would negatively predict PTSD and depressive symptoms at posttreatment. PTSD symptoms, depressive symptoms, and emotion regulation difficulty all evidenced significant improvements at the end of treatment relative to baseline ( ps < .001). In addition, reductions in emotion regulation across treatment were associated with lower PTSD and depressive symptoms at posttreatment ( ps < .001). This pilot study provides preliminary evidence supporting use of UP among veterans with PTSD and co-occurring disorders. Well-designed clinical trials evaluating efficacy of UP among veterans are needed.

Changes in neuroticism-related constructs over the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in patients on an optimal dose of SSRI.

Personality Disorders Theory Research and Treatment ◽

10.1037/per0000482 ◽

2021 ◽

Author(s):

Mehdi Zemestani ◽

Pegah Ommati ◽

Farzin Rezaei ◽

Matthew W. Gallagher

Keyword(s):

Emotional Disorders ◽

Optimal Dose ◽

Culturally and Linguistically Sensitive Applications in Other Countries

10.1093/med-psych/9780197527931.003.0012 ◽

2021 ◽

pp. 180-194

Author(s):

Hiroko Fujisato ◽

Noriko Kato ◽

Dominique Phillips ◽

Estefany Sáez-Clarke

Keyword(s):

Children And Adolescents ◽

Emotional Disorders ◽

Cultural Context ◽

Japanese Culture ◽

Cultural Groups ◽

Cultural Adaptations ◽

Unified Protocol ◽

Intervention Protocol

Cultural adaptation can help maintain a balance between scientifically rigorous interventions and culturally sensitive, effective practice. When introducing the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C/A) into a new cultural context, translating the treatment may be sufficient in some countries and regions, while others may require more systematic modification. This chapter discusses specific steps that were taken for adapting the UP-C/A in the context of Japanese culture and presents a case study in Japan. When introducing the UP-C/A into the Japanese context, modifications were made to increase the treatment’s acceptability and comprehension, but there were no significant modifications in the content of the intervention protocol. In the future, as the UP-C/A is introduced into other cultures, its effectiveness will be further evaluated and the cultural adaptations needed to accommodate new cultural groups will become increasingly apparent.

Introduction

The Renfrew Unified Treatment for Eating Disorders and Comorbidity ◽

10.1093/med-psych/9780190946425.003.0001 ◽

2021 ◽

pp. 3-36

Author(s):

Heather Thompson-Brenner ◽

Melanie Smith ◽

Gayle Brooks ◽

Rebecca Berman ◽

Angela Kaloudis ◽

...

Keyword(s):

Eating Disorders ◽

Negative Affect ◽

Emotional Disorders ◽

Emotional Functioning ◽

The Renfrew Unified Treatment for Eating Disorders and Co-occurring Emotional Disorders (UT) is an integrative, transdiagnostic, principle-based approach to address patterns of emotion avoidance, emotion sensitivity, and negative affect that produce and maintain the symptoms of eating disorders and co-occurring emotional disorders. The UT model was developed through an extensive process of adapting the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) for use with patients with severe and diverse eating disorders. The modules of the UT are distinct from other approaches due to their cohesive (internal and collective) focus on how each module addresses these shared maintaining mechanisms. There is extensive evidence that eating disorders typically co-occur with other emotional disorders. There is also extensive evidence that eating disorders and other emotional disorders share common maintaining mechanisms, reflecting aspects of emotional functioning.

Pediatric Irritability and Disruptive Behaviors

10.1093/med-psych/9780197527931.003.0005 ◽

2021 ◽

pp. 61-78

Author(s):

Jessica Lyn Hawks ◽

Sarah M. Kennedy ◽

Jacob Benjamin ◽

Westrick Holzman

Keyword(s):

Treatment Strategies ◽

Clinical Importance ◽

Disruptive Behaviors ◽

Interpersonal Processes ◽

Unified Protocol ◽

Opposite Action ◽

Evidence Based Treatments ◽

Action Strategies ◽

Effective Use

This chapter describes adaptations made to the Unified Protocol for Transdiagnostic Treatment of Children (UP-C) when treating youth with chronic irritability and/or disruptive behaviors. Despite increased recognition of the clinical importance of pediatric irritability as a transdiagnostic symptom dimension, there is a lack of evidence-based treatments for this population that simultaneously and equitably address both child and contextual (e.g., parental) factors implicated in the development and maintenance of emotional and behavioral difficulties. In this chapter, the authors summarize current treatments available for this patient population, highlighting the advantages of using the UP-C, as it supports the parent–child dyad in addressing coercive interpersonal processes through use of opposite action strategies. A detailed description of how to adapt the UP-C for irritability is provided, including guidance on effective use of frustration exposures to develop mastery of treatment strategies. The chapter concludes with a case example to further illustrate this treatment approach.

Basic Principles Underlying Treatment and Outline of the Treatment Procedures

Unified Protocol for Transdiagnostic Treatment of Emotional Disorders ◽

10.1093/med-psych/9780190685973.003.0002 ◽

2017 ◽

pp. 9-20

Author(s):

David H. Barlow ◽

Todd J. Farchione ◽

Shannon Sauer-Zavala ◽

Heather Murray Latin ◽

Kristen K. Ellard ◽

...

Keyword(s):

Emotional Disorders ◽

Automatic Thoughts ◽

Psychological Mechanisms ◽

External Threats ◽

Unified Protocol ◽

Core Skills ◽

Emotional Processes ◽

Treatment Procedures ◽

Action Tendencies

Chapter 2 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide notes that the Unified Protocol (UP) is based on traditional cognitive-behavioral principles, but the particular emphasis on the way individuals experience and respond to their emotions is unique in that it brings emotional processes to the forefront, making them available to fundamental psychological mechanisms of change. Core skills of the UP are introduced. These include mindful emotion awareness, which involves the practice of nonjudgmental, present-focused attention toward emotional experiences; challenging automatic thoughts related to external threats and internal threats and increasing cognitive flexibility; identifying and modifying problematic action tendencies, or emotional behaviors; increasing awareness and tolerance of physical sensations through interoceptive exposures; and engagement in emotion exercises. The chapter concludes with a description of the treatment modules.

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

The Unified Protocol

10.1093/med-psych/9780190255541.003.0017 ◽

2017 ◽

pp. 291-302

Author(s):

Clair Cassiello-Robbins ◽

Heather Murray Latin ◽

Shannon Sauer-Zavala

Keyword(s):

Emotional Disorders ◽

Individual Treatment ◽

Compelling Evidence ◽

Future Directions ◽

Treatment Delivery ◽

New Methods ◽

Unified Protocol ◽

Effective Care ◽

Methods Of Treatment

Previous chapters in this book have been dedicated to exploring the use of the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP) with a variety of emotional disorders, and those chapters present compelling evidence for the efficacy of the UP across the range of these disorders. This evidence has now inspired further research efforts to better understand the contribution of individual treatment components, as well as to evaluate new methods of treatment delivery with the goal of furthering dissemination. The purpose of this chapter is to describe future directions and projects related to the UP, including dismantling studies, dissemination efforts, and the development of an Internet-delivered form of the intervention. Further, we discuss how these projects will enhance our understanding of the UP and how these endeavors will further a clinician’s ability to provide efficient, effective care.