A Developmental Adaptation of the Unified Protocol for the Treatment of Emotional Disorders Is Effective in Reducing Anxiety and Depression in Adolescents

AbstractThis study used a single case experimental design to investigate the use of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) among a sample of individuals with depression and anxiety who also presented with borderline personality disorder (BPD). Eight women received individual treatment with the UP over the course of 14–16 treatment sessions, and were assessed for anxiety and depression severity on a weekly basis over a 2–6 week baseline period and throughout treatment. Three of the eight participants demonstrated reliable pre- to post-treatment clinical improvements on depression and stress scales, and one participant demonstrated a reliable reduction on an anxiety scale. Two participants demonstrated a reliable improvement in overall anxiety. The results indicate that the UP applied to individuals diagnosed with primary BPD may lead to clinical improvement in depression, stress and anxiety for some individuals. However, the majority of individuals with BPD in our sample did not show strong improvement, and this suggests the need for additional sessions of UP or an intervention that focuses on the symptoms of BPD specifically for some women.Key learning aims (1)To describe the applicability of the Unified Protocol in the treatment of individuals with borderline personality and co-occurring anxiety or depression.(2)To understand the value of utilizing a transdiagnostic approach as an alternative to diagnosis-specific approaches to treatment.(3)To identify the four core modules of the Unified Protocol and describe the general format for individual treatment.

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Emotion regulation as the mediator of reductions in anxiety and depression in the Unified Protocol (UP) for transdiagnostic treatment of emotional disorders: double-blind randomized clinical trial

Trends in Psychiatry and Psychotherapy ◽

10.1590/2237-6089-2018-0074 ◽

2019 ◽

Vol 41 (3) ◽

pp. 227-236

Author(s):

Sahel Khakpoor ◽

Omid Saed ◽

Alireza Armani Kian

Keyword(s):

Clinical Trial ◽

Emotion Regulation ◽

Randomized Clinical Trial ◽

Emotional Disorders ◽

Beck Anxiety Inventory ◽

Anxiety And Depression ◽

Double Blind ◽

Transdiagnostic Treatment ◽

Unified Protocol ◽

Goal Directed Behavior

Abstract Objective: An important subject in evaluation of the efficacy of treatments is to examine how the intervention is effective and to identify the consequences of that treatment. In this regard, the current study investigates the role of emotion regulation as the mediator of the treatment outcomes of therapy using the Unified Protocol (UP) for transdiagnostic treatment of emotional disorders. Method: This article describes a double-blind randomized clinical trial. A sample of 26 individuals was selected based on cut-off scores for the Beck Depression Inventory and Beck Anxiety Inventory and their final diagnoses were confirmed with the Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV). The sample was randomly divided into two groups: control and treatment (13 patients each). The treatment group received 20 one-hour UP sessions. The Beck Depression Inventory, the Beck Anxiety Inventory, and the Difficulties in Emotion Regulation Scale were administered at two stages, pre-treatment and post-treatment. Results: The UP reduced anxiety and depression in patients through improvement in emotion regulation. Furthermore, the results showed that the difficulty engaging in goal-directed behavior and non-acceptance of emotional response subscales were capable of predicting 62% of variance in anxiety scores. In turn, two subscales, difficulty engaging in goal-directed behavior and lack of emotional clarity, predicted 72% of variance in depression scores. Conclusion: Emotion regulation can be considered as a potential mediating factor and as predictive of outcomes of transdiagnostic treatment based on the UP. Clinical trial registration: Iranian Registry of Clinical Trials, IRCT2017072335245N1.

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The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) Adapted as a School-Based Anxiety and Depression Prevention Program: An Initial Cluster Randomized Wait-List-Controlled Trial

Behavior Therapy ◽

10.1016/j.beth.2019.08.003 ◽

2020 ◽

Vol 51 (3) ◽

pp. 461-473 ◽

Cited By ~ 3

Author(s):

Julia García-Escalera ◽

Rosa M. Valiente ◽

Bonifacio Sandín ◽

Jill Ehrenreich-May ◽

Antonio Prieto ◽

...

Keyword(s):

Emotional Disorders ◽

Controlled Trial ◽

Anxiety And Depression ◽

Wait List ◽

Depression Prevention ◽

Transdiagnostic Treatment ◽

Unified Protocol ◽

School Based ◽

Initial Cluster ◽

Cluster Randomized

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Targeting Common Factors Across Anxiety and Depression Using the Unified Protocol for the Treatment of Emotional Disorders in Adolescents

Journal of Rational-Emotive & Cognitive-Behavior Therapy ◽

10.1007/s10942-014-0185-4 ◽

2014 ◽

Vol 32 (1) ◽

pp. 67-83 ◽

Cited By ~ 7

Author(s):

Ilana Seager ◽

Amelia M. Rowley ◽

Jill Ehrenreich-May

Keyword(s):

Emotional Disorders ◽

Common Factors ◽

Anxiety And Depression ◽

Unified Protocol

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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 ◽

Transdiagnostic Treatment ◽

Unified Protocol

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.

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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 ◽

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.

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

10.31234/osf.io/528tw ◽

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.

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Lower levels of directed exploration and reflective thinking are associated with greater anxiety and depression

10.31234/osf.io/3w4je ◽

2021 ◽

Author(s):

Ryan Smith ◽

Samuel Taylor ◽

Robert C Wilson ◽

Annie E. Chuning ◽

Michelle Persich ◽

...

Keyword(s):

Emotional Disorders ◽

Information Seeking ◽

Ambiguity Aversion ◽

Community Sample ◽

Well Being ◽

Anxiety And Depression ◽

Information Seeking Behavior ◽

Depression Symptoms ◽

Seeking Behavior ◽

Reflective Cognition

Anxiety and depression are often associated with strong beliefs that entering specific situations will lead to aversive outcomes – even when these situations are objectively safe and avoiding them reduces well-being. A possible mechanism underlying this maladaptive avoidance behavior is a failure to reflect on: 1) appropriate levels of uncertainty about the situation, and 2) how this uncertainty could be reduced by seeking further information (i.e., exploration). To test this hypothesis, we asked a community sample of 417 individuals to complete measures of reflective cognition, exploration, and symptoms of anxiety and depression. Consistent with our hypotheses, we found significant associations between each of these measures in expected directions (i.e., positive relationships between reflective cognition and strategic information-seeking behavior or “directed exploration”, and negative relationships between these measures and anxiety/depression symptoms). Further analyses suggested that the relationship between directed exploration and depression/anxiety was due to an ambiguity aversion promoting exploration in conditions where information-seeking was not beneficial (as opposed to under-exploration when more information would aid future choices). In contrast, reflectiveness was associated with greater exploration in appropriate settings and separately accounted for differences in reaction times, decision noise, and choice accuracy in expected directions. These results shed light on the mechanisms underlying information-seeking behavior and how they may contribute to symptoms of emotional disorders. They also highlight the possibility that reflectiveness and exploration could represent novel treatment targets for those who show low levels of these tendencies – consistent with the need to develop individualized precision medicine approaches within computational psychiatry.

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