scholarly journals Efficacy of the unified protocol for transdiagnostic cognitive-behavioral treatment for depressive and anxiety disorders: a randomized controlled trial

2022 ◽  
pp. 1-12
Author(s):  
Masaya Ito ◽  
Masaru Horikoshi ◽  
Noriko Kato ◽  
Yuki Oe ◽  
Hiroko Fujisato ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Anxiety Disorders ◽  
Emotional Disorders ◽  
Behavioral Treatment ◽  
Depressive Disorders ◽  
Rating Scale ◽  
Controlled Trial ◽  
Principal Diagnosis ◽  
Treatment As Usual ◽  
Unified Protocol

Abstract Background The efficacy of the unified protocol of the transdiagnostic treatment for emotional disorders (UP) has been poorly studied in patients with depressive disorders. This study aimed to examine the efficacy of UP for improving depressive symptoms in patients with depressive and/or anxiety-related disorders. Methods This assessor-blinded, randomized, 20-week, parallel-group, superiority study compared the efficacy of the UP with treatment-as-usual (UP-TAU) v. wait-list with treatment-as-usual (WL-TAU). Patients diagnosed with depressive and/or anxiety disorders and with depressive symptoms participated. The primary outcome was depressive symptoms assessed by GRID-Hamilton depression rating scale (GRID-HAMD) at 21 weeks. The secondary outcomes included assessor-rated anxiety symptoms, severity and improvement of clinical global impression, responder and remission status, and loss of principal diagnosis. Results In total, 104 patients participated and were subjected to intention-to-treat analysis [mean age = 37.4, s.d. = 11.5, 63 female (61%), 54 (51.9%) with a principal diagnosis of depressive disorders]. The mean GRID-HAMD scores in the UP-TAU and WL-TAU groups were 16.15 (s.d. = 4.90) and 17.06 (s.d. = 6.46) at baseline and 12.14 (s.d. = 5.47) and 17.34 (s.d. = 5.78) at 21 weeks, with a significant adjusted mean change difference of −3.99 (95% CI −6.10 to −1.87). Patients in the UP-TAU group showed significant superiority in anxiety and clinical global impressions. The improvement in the UP-TAU group was maintained in all outcomes at 43 weeks. No serious adverse events were observed in the UP-TAU group. Conclusions The UP is an effective approach for patients with depressive and/or anxiety disorders.

scholarly journals Telephone-based cognitive behavioral therapy for depression in Parkinson disease

Neurology ◽  
2020 ◽  
Vol 94 (16) ◽  
pp. e1764-e1773 ◽  
Author(s):  
Roseanne D. Dobkin ◽  
Sarah L. Mann ◽  
Michael A. Gara ◽  
Alejandro Interian ◽  
Kailyn M. Rodriguez ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Parkinson Disease ◽  
Behavioral Treatment ◽  
Rating Scale ◽  
Controlled Trial ◽  
Cognitive Behavioral ◽  
Cognitive Behavioral Treatment ◽  
Treatment As Usual ◽  
Negative Thoughts

ObjectiveTo determine whether, for patients with depression and Parkinson disease (PD), telephone-based cognitive-behavioral treatment (T-CBT) alleviates depressive symptoms significantly more than treatment as usual (TAU), we conducted a randomized controlled trial to evaluate the efficacy of a 10-session T-CBT intervention for depression in PD, compared to TAU.MethodsSeventy-two people with PD (PWP) were randomized to T-CBT + TAU or TAU only. T-CBT tailored to PWPs’ unique needs was provided weekly for 3 months, then monthly during 6-month follow-up. CBT targeted negative thoughts (e.g., “I have no control”; “I am helpless”) and behaviors (e.g., social withdrawal, excessive worry). It also trained care partners to help PWP practice healthy habits. Blind raters assessed outcomes at baseline, midtreatment, treatment end, and 1 and 6 months post-treatment. Analyses were intent to treat.ResultsT-CBT outperformed TAU on all depression, anxiety, and quality of life measures. The primary outcome (Hamilton Depression Rating Scale score) improved significantly in T-CBT compared to TAU by treatment end. Mean improvement from baseline was 6.53 points for T-CBT and −0.27 points for TAU (p < 0.0001); gains persisted over 6-month follow-up (p < 0.0001). Improvements were moderated by a reduction in negative thoughts in the T-CBT group only, reflecting treatment target engagement.ConclusionsT-CBT may be an effective depression intervention that addresses a significant unmet PD treatment need and bypasses access barriers to multidisciplinary, evidence-based care.Clinicaltrials.gov identifierNCT02505737.Classification of evidenceThis study provides Class I evidence that for patients with depression and PD, T-CBT significantly alleviated depressive symptoms compared to usual care.

scholarly journals The Unified Protocol as an Internet-based Intervention for Emotional Disorders: Randomized Controlled Trial

2020 ◽  
Author(s):  
Carmen Schaeuffele ◽  
Sophie Luise Homeyer ◽  
Luis Perea ◽  
Lisa Scharf ◽  
Ava Schulz ◽  
...  
Keyword(s):  
Emotional Disorders ◽  
Somatic Symptom ◽  
Depressive Disorders ◽  
Satisfaction With Life ◽  
Controlled Trial ◽  
Symptom Burden ◽  
Symptom Distress ◽  
Significant Treatment ◽  
Mixed Effect ◽  
Unified Protocol

The Unified Protocol (UP) as a transdiagnostic intervention has primarily been applied in the treatment of anxiety disorders and in face-to-face-settings. The current study investigated the efficacy of a 10-week internet-based adaptation of the UP for anxiety, depressive, and somatic symptom disorders. N=132 participants were randomized to treatment or waitlist control. Linear mixed effect models revealed significant treatment effects for symptom distress, satisfaction with life, positive/negative affect and markers of anxiety, depression, and somatic symptom burden (within-group Hedges’ g = 0.32-1.38 and between-group g = 0.20-1.11). Treatment gains were maintained at 1- and 6-month-follow-up. Subgroup analyses showed comparable effects in participants with anxiety and depressive disorders. The results strengthen the application of the UP as an internet-based treatment for alleviating symptom distress across emotional disorders. More research on the applicability for single disorders and the mechanisms underlying the effects is needed.

Emotion Regulation and Anxiety

2017 ◽  
pp. 154-170
Author(s):  
Dagmar Kr. Hannesdóttir ◽  
Thomas H. Ollendick
Keyword(s):  
Emotion Regulation ◽  
Anxiety Disorders ◽  
Emotional Disorders ◽  
Behavioral Therapy ◽  
Future Research ◽  
Childhood And Adolescence ◽  
Success Rates ◽  
Treatment As Usual ◽  
Unified Protocol ◽  
Clinically Significant

Chapter 8 reviews anxiety disorders of childhood and adolescence, investigating the role of emotion regulation in onset, maintenance and propagation. Based on DSM-5 criteria anxiety disorders have the following core features: Excessive, persisting anxious arousal and clinically significant symptoms causing distress or dysfunction in social, academic or other domains of functioning. Currently, CBT interventions have been created for school-aged children with anxiety including the Coping Cat and the Cool Kids programs. Despite relatively high success rates, children remaining symptomatic after treatment may benefit from emotion-focused approaches, such as Emotion-Focused Cognitive-Behavioral Therapy and the Unified Protocol for the Treatment of Emotional Disorders in Youth. In addition, novel therapies have been devised targeting parents and their emotion regulation deficits like the Supportive Parenting for Anxious Childhood Emotions (SPACE) program. Future research should employ randomized control trials comparing the novel treatment approaches, treatment as usual, and standard CBT determining best practice protocols.

scholarly journals Enhancing Social Interaction in Depression (SIDE study): protocol of a randomised controlled trial on the effects of a Cognitively Based Compassion Training (CBCT) for couples

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e020448 ◽  
Author(s):  
Corina Aguilar-Raab ◽  
Marc N Jarczok ◽  
Marco Warth ◽  
Martin Stoffel ◽  
Friederike Winter ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Social Interaction ◽  
Eye Tracking ◽  
Relationship Quality ◽  
Social Functioning ◽  
Rating Scale ◽  
Depressive Symptomatology ◽  
Controlled Trial ◽  
Post Intervention ◽  
Treatment As Usual

IntroductionPositive social interactions (PSIs) and stable relationships can exert substantial benefits on health. However, patients suffering from depression benefit less from these health-promoting effects. Moreover, relationship quality and even partners’ health has been found to be negatively affected by depressive symptomatology, which may result in overall impairments in social functioning of a romantic couple. Psychobiological research indicates that these impairments may be accompanied by a maladaptive regulation of the patient’s neuroendocrine response to external stressors. Concerning the improvement of social functioning, first studies showed promising results of “Cognitively Based Compassion Training (CBCT®)”. However, randomised trials are still scarce. Previous programmes did not involve participation of the patient’s romantic partner. Therefore, the present study aims to investigate whether a CBCT® programme adapted for couples (CBCT®-fC) can improve depressive symptoms, distress, social interaction skills and the neurobiological regulation of stress.Methods and analysisCouples with the female partner suffering from depression will be invited to participate in a pre-to-post intervention assessment on two consecutive days, respectively, involving a standardised PSI task, eye-tracking, ECG recordings, saliva-sampling, blood-sampling and questionnaire data. After baseline assessment, participating couples will be randomised to either a 10 week CBCT®-fC or to a treatment as usual control condition. The primary endpoint is the reduction of depressive symptoms measured by the Hamilton Depression Rating Scale. Secondary outcomes encompass self-rated depression (Beck Depression Inventory), attention towards the partners face during PSI (eye tracking), stress-related biomarkers (cortisol, α-amylase, interleukin (IL)-1ß/IL-6, heart rate variability), methylation of oxytocin-receptor-genes and serotonin-transporter-genes and self-ratings of psychological constructs such as relationship quality and empathy.Ethics and disseminationEthical approval has been obtained by the Ethics Committee of the Medical Faculty Heidelberg. Results will be presented in international, peer-reviewed journals and on conferences in the field of clinical psychology and psychiatry.Trial registration numberNCT03080025.

scholarly journals Implementation, efficacy and cost effectiveness of the unified protocol in a blended format for the transdiagnostic treatment of emotional disorders: a study protocol for a multicentre, randomised, superiority controlled trial in the Spanish National Health System

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e054286
Author(s):  
J Osma ◽  
Laura Martínez-García ◽  
Óscar Peris-Baquero ◽  
María Vicenta Navarro-Haro ◽  
Alberto González-Pérez ◽  
...  
Keyword(s):  
Emotional Disorders ◽  
Controlled Trial ◽  
National Health System ◽  
Research Committee ◽  
Treatment As Usual ◽  
Adequate Treatment ◽  
Transdiagnostic Treatment ◽  
Face To Face ◽  
Unified Protocol ◽  
Ethics Research

IntroductionEmotional disorders (EDs) have become the most prevalent psychological disorders in the general population, which has boosted the economic burden associated with their management. Approximately half of the individuals do not receive adequate treatment. Consequently, finding solutions to deliver cost-effective treatments for EDs has become a key goal of today’s clinical psychology. Blended treatments, a combination of face-to-face and online interventions, have emerged as a potential solution to the previous. The Unified Protocol for the Transdiagnostic Treatment of EDs (UP) might serve this purpose, as it can be applied to a variety of disorders simultaneously and its manualised format makes it suitable for blended interventions.Methods and analysisThe study is a multicentre, randomised, superiority, clinical trial. Participants will be 310 individuals with a diagnosis of an ED. They will be randomised to a treatment as usual (individual cognitive behavioural therapy) or a UP condition in a blended format (face-to-face individual UP +online, app-based UP). Primary outcomes will be ED diagnostic criteria and depression and anxiety symptoms. Cost efficiency of the intervention, app usability, as well as opinion and confidence in the treatment will also be evaluated. Assessment points will include baseline and 3 months, 6 months and 12 months after UP treatment.Ethics and disseminationThe study has received approvals by the Ethics Research Committee of Navarra, Castellón, Euskadi, Castilla y León, Extremadura, Lleida and Aragón. The study is currently under an approval process by the Ethics Research Committees of all the remaining collaborating centres. Outcomes will be disseminated through publication in peer-reviewed journals and presentations at international conference meetings.Trial registration numberNCT04304911.

scholarly journals Pragmatic Quasi-Experimental Controlled Trial Evaluating the Outcomes of Blended CBT Compared to Face-to-Face CBT and Treatment as Usual for Adolescents with Depressive Disorders

2021 ◽  
Vol 18 (6) ◽  
pp. 3102
Author(s):  
Sanne P.A. Rasing ◽  
Yvonne A.J. Stikkelbroek ◽  
Wouter den Hollander ◽  
Heleen Riper ◽  
Maja Deković ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Depressive Disorders ◽  
Controlled Trial ◽  
Post Intervention ◽  
Global Functioning ◽  
Treatment As Usual ◽  
Face To Face ◽  
Quasi Experimental ◽  
Secondary Outcomes

Depression is a major problem in youth mental health. Current treatment is on average effective, but adolescents are hesitant to seek help. Blended treatment could lower the barriers to seeking treatment. Evidence on effectiveness is, however, scarce. The present pragmatic quasi-experimental controlled trial aimed to compare the outcomes of blended cognitive behavioral therapy (CBT) to face-to-face CBT and treatment as usual. A total of 129 adolescents with clinical depression (82.2% female), aged 13–22 (M = 16.60, SD = 2.03) received blended CBT, face-to-face CBT or treatment as usual. Clinical diagnosis, depressive symptoms, and secondary outcomes were assessed at baseline, post-intervention, and six-months follow-up. Participants receiving blended CBT were, compared to participants receiving face-to-face CBT and treatment as usual, evenly likely to be in remission from their depressive disorder at post-intervention and at six-month follow-up. Depressive symptoms decreased significantly over time in all three conditions, and changes were not significantly different between conditions. Other secondary outcomes (suicide risk, internalizing and externalizing symptoms, severity of depression, and global functioning) did not differ between treatment conditions at post-intervention and six-month follow-up. Since there was no evidence for favorable outcomes for face-to-face therapies above blended CBT, blended CBT may also be an effective treatment format in clinical practice.

scholarly journals The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders Among Japanese Children: A Pilot Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Hiroko Fujisato ◽  
Noriko Kato ◽  
Hikari Namatame ◽  
Masaya Ito ◽  
Masahide Usami ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Functional Status ◽  
Emotional Disorders ◽  
Depressive Disorders ◽  
Anxiety Symptoms ◽  
Japanese Children ◽  
Transdiagnostic Treatment ◽  
Unified Protocol ◽  
Pre Treatment

At present, there is no established cognitive behavioral therapy (CBT) for treating emotional disorders in Japanese children. Therefore, we introduced the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C) in Japan and adapted it to the Japanese context. We then examined its feasibility and preliminary efficacy using a single-arm pretest, posttest, follow-up design. Seventeen Japanese children aged between 8 and 12 years (female n = 11; male n = 6; M = 10.06 ± 0.97 years) with a principal diagnosis of anxiety, obsessive-compulsive, or depressive disorders, and their parents were enrolled in the study. The primary outcome was the overall severity of emotional disorders as assessed by psychiatrists using the Clinical Global Impression-Severity Scale. Secondary outcomes included child- and parent-reported anxiety symptoms, depressive symptoms, and functional status. No severe adverse events were observed. The feasibility was confirmed by the low dropout proportion (11.76%), high attendance proportion (children: 95.6%; parents: 94.6%), and sufficient participant satisfaction. Linear mixed models (LMMs) showed that the overall severity of emotional disorders and child- and parent-reported anxiety symptoms improved from pre-treatment to post-treatment, and that these treatment effects were maintained during the 3-month follow-up period. Additionally, child- and parent-reported functional status improved from pre-treatment to the 3-month follow-up. In contrast, child-reported depressive symptoms improved from pre-treatment to follow-up, but there was no significant change in parent-reported depressive symptoms between pre-treatment and other time points. These findings demonstrate the feasibility and preliminary efficacy of the Japanese version of the UP-C, suggesting that future randomized controlled trials (RCTs) are warranted (Clinical trial registration: UMIN000026911).

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

2017 ◽  
Vol 42 (2) ◽  
pp. 210-230 ◽  
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 ◽  
Transdiagnostic Treatment ◽  
Unified Protocol

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.

The Unified Protocol for Major Depressive Disorder

2017 ◽  
pp. 67-85
Author(s):  
James F. Boswell ◽  
Laren R. Conklin ◽  
Jennifer M. Oswald ◽  
Matteo Bugatti
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Emotional Disorders ◽  
Clinical Case ◽  
Depressive Disorders ◽  
Major Depressive ◽  
Transdiagnostic Treatment ◽  
Unified Protocol ◽  
High Level ◽  
Future Work

Major depressive disorder (MDD) can be a chronic, debilitating condition that for many individuals waxes and wanes over time. In addition, MDD and other unipolar depressive disorders demonstrate a high level of comorbidity with anxiety disorders. This chapter describes the application of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) to MDD and other unipolar depressive disorders. We first review research supporting the association between depression and higher-order constructs such as neuroticism. Next, we present a clinical case that, combined with module-specific recommendations, further illustrates how UP principles and strategies are implemented in the treatment of primary depression. Finally, we offer recommendations for future work involving the UP for major depression and other depressive disorders.

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