The Unified Protocol for Complex, Highly Comorbid Cases

2017 ◽  
pp. 231-251
Author(s):  
Heather Murray Latin ◽  
Clair Cassiello-Robbins
Keyword(s):  
Emotional Disorders ◽  
Clinical Settings ◽  
Obsessive Compulsive ◽  
Transdiagnostic Treatment ◽  
Compulsive Disorder ◽  
Hyperactivity Disorder ◽  
Unified Protocol ◽  
Evidence Based Treatments ◽  
Transdiagnostic Factors ◽  
High Comorbidity

Given the high comorbidity rates among the emotional disorders, effective evidence-based treatments need to be able to address the presence of comorbid disorders in an integrated fashion. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) was created in part to address the comorbidity often seen in clinical settings and may be uniquely suited to do so, given its emphasis on transdiagnostic factors that contribute to the development and maintenance of emotional disorders (i.e., experience of strong negative emotions, aversive reactions to these emotions, and attempts to avoid or suppress these experiences). This chapter illustrates the use of the UP with a patient who presented with panic disorder, agoraphobia, generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), major depressive disorder (MDD), and other specified attention deficit hyperactivity disorder (ADHD). This case is used to illustrate the application of the UP transdiagnostic framework to a case with extensive comorbidity.

The Unified Protocol for Obsessive-Compulsive and Related Disorders

2017 ◽  
pp. 53-66
Author(s):  
Johanna Thompson-Hollands
Keyword(s):  
Emotional Disorders ◽  
Obsessive Compulsive Disorder ◽  
Cognitive Reappraisal ◽  
Family Members ◽  
Intrusive Thoughts ◽  
Obsessive Compulsive ◽  
Transdiagnostic Treatment ◽  
Compulsive Disorder ◽  
Unified Protocol

The case of a 25-year-old male with obsessive-compulsive disorder (OCD) is presented in this chapter. The patient, “Luke,” had primary obsessions related to harm befalling his family and girlfriend, as well as fears of contamination. His primary compulsions included mental “undoing,” in his words, and repeating actions. He engaged in significant avoidance around potential contaminants. The text reviews Luke’s course of treatment with the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP), including the application of each treatment module and attention to challenging issues that arose in this case. Specific attention is devoted to the use of cognitive reappraisal in the UP for OCD, managing symptom accommodation by family members, and exposure in the context of intrusive thoughts and mental rituals.

Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children

2017 ◽  
Author(s):  
Jill Ehrenreich-May ◽  
Sarah M. Kennedy ◽  
Jamie A. Sherman ◽  
Emily L. Bilek ◽  
David H. Barlow
Keyword(s):  
Emotional Disorders ◽  
Treatment Strategies ◽  
Obsessive Compulsive ◽  
Emotional Challenges ◽  
Transdiagnostic Treatment ◽  
Unified Protocol ◽  
Making Choices ◽  
Age Range ◽  
Anxiety Depression

Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children: Workbook (UP-C) provides evidence-based treatment strategies to assist child clients to function better in their lives. This treatment is designed for children ages 7 to 13 (although some children just outside this age range may also benefit) who are experiencing feelings of sadness, anxiety, worry, anger, or other emotions that get in the way of their ability to enjoy their lives and feel successful. The workbook is written for children (with corresponding parent sessions presented later in the book) and guides them through each week of the program with education, activities, and examples that will help families to understand the role that emotions play in everyday actions. Children are taught helpful strategies for dealing with strong emotions and will receive support in making choices that will move them closer to their long-term goals. The UP-C takes a transdiagnostic approach to the treatment of emotional disorders and the skills presented are appropriate for children with a large range of emotional challenges, including anxiety, depression, obsessive-compulsive symptoms, and other related concerns.

Targeting Comorbid Anxiety and Depression Using the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents

2018 ◽  
Vol 17 (2) ◽  
pp. 59-76 ◽  
Author(s):  
Jamie A. Sherman ◽  
Niza A. Tonarely ◽  
Jill Ehrenreich-May
Keyword(s):  
Emotional Disorders ◽  
Emotional Disorder ◽  
Adolescent Male ◽  
Individual Treatment ◽  
Obsessive Compulsive ◽  
Transdiagnostic Treatment ◽  
Unified Protocol ◽  
Wide Range ◽  
Core Features

This article presents the use of an emotion-focused, transdiagnostic therapy approach designed for adolescents with a range of anxiety, obsessive-compulsive, depressive, and related disorders, referred to here as emotional disorders. Preliminary work suggests that emotional disorders share underlying temperament factors, such as high neuroticism and low extroversion in adults and adolescents, possibly influencing the development and maintenance of emotional disorders across the life span. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) and similar core dysfunction-focused, transdiagnostic therapy approaches may lead to successful treatment by targeting higher order factors that cut across an array of emotional disorders The utility of UP-A for adolescents experiencing a variety of emotional disorder symptoms is demonstrated here through the case illustration of Tony, a 15-year-old adolescent male with severe social and generalized anxiety and mild levels of depression. After 16 individual treatment sessions, Tony demonstrated significant reductions in anxiety and depressive symptoms, as well as an ability to respond more adaptively to a range of emotional experiences. This case study illustrates how short-term, transdiagnostic treatment using the UP-A can effectively ameliorate a wide range of emotional disorder symptoms in adolescents and may also lead to changes in core features of neuroticism, potentially preventing development of further emotional difficulties over time.

Introduction to the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C)

2017 ◽  
pp. 171-180
Author(s):  
Jill Ehrenreich-May ◽  
Sarah M. Kennedy ◽  
Jamie A. Sherman ◽  
Emily L. Bilek ◽  
Brian A. Buzzella ◽  
...  
Keyword(s):  
Emotional Disorders ◽  
Treatment Strategies ◽  
Evidence Based ◽  
Age Group ◽  
Emotional Experiences ◽  
Obsessive Compulsive ◽  
Transdiagnostic Treatment ◽  
Unified Protocol ◽  
Wide Range ◽  
Anxiety Depression

Chapter 10 introduces the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C). This is also called the “Emotion Detectives” program, which reflects the guiding treatment metaphor: teaching children to “solve the mystery of their emotions,” as detectives might. The UP-C is intended to reduce the intensity and frequency of symptoms common to youth with emotional disorders by using core evidence-based treatment strategies in a broad manner that applies to a wide range of aversive emotional experiences characteristic of youth emotional disorders (i.e., anxiety, depression, other internalizing disorders). Many anxiety, depression, adjustment, traumatic stress-related, or obsessive-compulsive or related disorders would be appropriate targets for this intervention. The UP-C is intended for children between the ages of 7 and 13, although children slightly above or below this age group may benefit from this format.

Treating a Cluster of Internalizing Disorders With the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: A Case Study

2020 ◽  
pp. 153465012096799
Author(s):  
Brianna R. Altman ◽  
Mitch Earleywine
Keyword(s):  
Emotional Disorders ◽  
Emotion Dysregulation ◽  
Romantic Relationship ◽  
Treatment Manual ◽  
Obsessive Compulsive ◽  
Current Case ◽  
Transdiagnostic Treatment ◽  
Unified Protocol ◽  
Treatment Manuals

Psychotherapy outcome research rarely focuses on the ideographic application of treatment manuals, though some modules might prove markedly more important for a client than others. Clients in need of psychoeducation, emotion regulation skills, and changes in maladaptive patterns of thinking might balk at portions of the Unified Protocol for the Treatment of Emotional Disorders that seem irrelevant to their concerns. The current case study focused on emotion dysregulation and perfectionism given their role in anxiety, depression, obsessions, and compulsions. The Overall Anxiety Severity and Impairment Scale (OASIS), Overall Depression Severity and Impairment Scale (ODSIS), and Yale-Brown Obsessive Compulsive Scale (Y-BOCS) confirmed qualitative reports and therapist observations of improvement. Additional sessions focused on fostering self-compassion and processing the termination of a romantic relationship rather than completing every section of the manual. This case demonstrates that flexible adaptation of a transdiagnostic treatment manual, in conjunction with a strong working alliance and other non-specifics of therapy, can produce beneficial outcomes even when other modules are not applied. These results might support ideographic application of select modules from treatment manuals and support a symptoms approach to psychotherapy.

Applications of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders

2017 ◽  
Keyword(s):  
Emotional Disorders ◽  
Treatment Protocol ◽  
Empirical Support ◽  
Psychological Disorders ◽  
Evidence Based ◽  
Case Formulation ◽  
Transdiagnostic Treatment ◽  
Unified Protocol ◽  
Evidence Based Treatments ◽  
Health Need

In recent years, there has been a movement away from traditional disorder-specific manuals for the treatment of psychological disorders and toward treatment approaches that focus on addressing psychological processes that appear to cut across disorders. These “transdiagnostic” evidence-based treatments may prove to be more cost-efficient and have the potential to increase availability of evidence-based treatments to meet a significant public-health need. Among clinicians, the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP), developed by Dr. David Barlow and colleagues, is the most recognizable and widely used transdiagnostic treatment protocol with empirical support for its use. This book provides clinicians with a “how to” guide for using the UP to treat a broad range of commonly encountered psychological disorders in adults. Each chapter covers a specific emotional disorder but important transdiagnostic processes are highlighted and discussed in relation to treatment. Case studies are employed throughout to illustrate the real-world application of this unique cognitive behavioral protocol and to instruct clinicians in the nuts and bolts of assessment, case formulation, and treatment in accordance with a transdiagnostic perspective. Most of the chapters are authored by current or former unified protocol team members who are all thoroughly familiar with the UP and will be writing about cases they themselves have treated.

Obsessive-Compulsive Disorder and Tic Disorder/Tourette Syndrome

2021 ◽  
pp. 41-60
Author(s):  
Ashley M. Shaw ◽  
Elizabeth R. Halliday
Keyword(s):  
Randomized Controlled Trial ◽  
Emotional Disorders ◽  
Obsessive Compulsive Disorder ◽  
Tourette Syndrome ◽  
Controlled Trial ◽  
Habit Reversal ◽  
Obsessive Compulsive ◽  
Tic Disorder ◽  
Transdiagnostic Treatment ◽  
Compulsive Disorder

The Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C/A) have clinical relevance for youth with obsessive-compulsive disorder (OCD) and Tourette syndrome, particularly when comorbid anxiety and depression are present. Within this population, the UP-C/A can be applied either as standalone interventions or in conjunction with exposure and response prevention or habit reversal techniques. However, their efficacy and utility in these populations have never been examined in a randomized controlled trial. This chapter outlines recommendations for how to apply the UP-C/A to youth with OCD and related disorders. For example, applying module content in a flexible order is recommended, such as generating a list of emotional behaviors early in treatment, and checking in about opposite actions throughout treatment. Introducing nonjudgmental awareness and exposures early in treatment is also recommended.

scholarly journals Elevated Expression of SLC6A4 Encoding the Serotonin Transporter (SERT) in Gilles de la Tourette Syndrome

Genes ◽  
2021 ◽  
Vol 12 (1) ◽  
pp. 86
Author(s):  
Mathis Hildonen ◽  
Amanda M. Levy ◽  
Christina Dahl ◽  
Victoria A. Bjerregaard ◽  
Lisbeth Birk Møller ◽  
...  
Keyword(s):  
Tourette Syndrome ◽  
Serotonin Transporter ◽  
Neurodevelopmental Disorder ◽  
Control Group ◽  
Obsessive Compulsive ◽  
Expression Levels ◽  
Compulsive Disorder ◽  
Hyperactivity Disorder ◽  
Elevated Expression ◽  
Gene Expression Levels

Gilles de la Tourette syndrome (GTS) is a complex neurodevelopmental disorder characterized by motor and vocal tics. Most of the GTS individuals have comorbid diagnoses, of which obsessive-compulsive disorder (OCD) and attention deficit-hyperactivity disorder (ADHD) are the most common. Several neurotransmitter systems have been implicated in disease pathogenesis, and amongst these, the dopaminergic and the serotonergic pathways are the most widely studied. In this study, we aimed to investigate whether the serotonin transporter (SERT) gene (SLC6A4) was differentially expressed among GTS individuals compared to healthy controls, and whether DNA variants (the SERT-linked polymorphic region 5-HTTLPR, together with the associated rs25531 and rs25532 variants, and the rare Ile425Val variant) or promoter methylation of SLC6A4 were associated with gene expression levels or with the presence of OCD as comorbidity. We observed that SLC6A4 expression is upregulated in GTS individuals compared to controls. Although no specific genotype, allele or haplotype was overrepresented in GTS individuals compared to controls, we observed that the LAC/LAC genotype of the 5-HTTLPR/rs25531/rs25532 three-locus haplotype was associated with higher SLC6A4 mRNA expression levels in GTS individuals, but not in the control group.

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