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

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 for Posttraumatic Stress Disorder

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

10.1093/med-psych/9780190255541.003.0007 ◽

2017 ◽

pp. 111-126 ◽

Cited By ~ 1

Author(s):

Matthew W. Gallagher

Keyword(s):

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

Emotional Disorders ◽

Cognitive Processing ◽

Stress Disorder ◽

Full Range ◽

Case Series ◽

Cognitive Processing Therapy ◽

Comorbid Conditions ◽

Unified Protocol

With the publication of DSM-5, posttraumatic stress disorder (PTSD) is no longer considered an anxiety disorder, but there is extensive evidence that PTSD is associated with high levels of comorbid mood and anxiety disorders. Although effective treatments exist for PTSD (e.g., Cognitive Processing Therapy), current treatments were not designed to target the full range of comorbid conditions associated with this disorder, and it is unclear whether these treatments are effective for comorbid conditions for individuals with PTSD. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP), therefore, has great promise as a potential treatment for PTSD. This chapter reports the results of a case series of the UP for three individuals with a primary diagnosis of PTSD. Results of the UP were promising, with all three reporting a significant drop in symptoms of PTSD, anxiety, and depression. Implications for evaluating the UP as an alternative treatment for PTSD are also discussed.

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A pilot study examining roles of cognitions and affect between positive memory processing and posttraumatic stress disorder symptom severity.

Psychological Trauma Theory Research Practice and Policy ◽

10.1037/tra0000625 ◽

2021 ◽

Author(s):

Ateka A. Contractor ◽

Stephanie V. Caldas ◽

Anne N. Banducci ◽

Cherie Armour

Keyword(s):

Posttraumatic Stress Disorder ◽

Pilot Study ◽

Posttraumatic Stress ◽

Symptom Severity ◽

Stress Disorder ◽

Memory Processing ◽

Disorder Symptom

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Posttraumatic stress disorder (PTSD) and depression severity in sexually assaulted women: hypothalamic-pituitary-adrenal (HPA) axis alterations

BMC Psychiatry ◽

10.1186/s12888-021-03170-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ana Teresa D. D’Elia ◽

Mario F. Juruena ◽

Bruno M. Coimbra ◽

Marcelo F. Mello ◽

Andrea F. Mello

Keyword(s):

Posttraumatic Stress Disorder ◽

Depressive Symptoms ◽

Sexual Assault ◽

Posttraumatic Stress ◽

Hpa Axis ◽

Symptom Severity ◽

Stress Disorder ◽

Control Group ◽

Cortisol Levels ◽

Ptsd Group

Abstract Background Sexual assault is implicated in several adverse psychological and physical health outcomes, including posttraumatic stress disorder (PTSD) and depression. Neurobiological research has shown variations related to the hypothalamic-pituitary-adrenal (HPA) axis, immune alterations, metabolic function, and brain circuitry. Although these mechanisms have been extensively studied, the results have demonstrated different outcomes in PTSD. Methods We compared the plasma adrenocorticotropin (ACTH) and salivary cortisol levels of fifty-eight women with PTSD developed after sexual assault to those of forty-four female controls with no history of trauma. We also evaluated the psychiatric diagnosis and symptom severity of PTSD and depression. The participants’ clinical conditions were associated with their hormonal levels to assess whether symptom severity was related to hormonal imbalance. Results A large percentage of sexually assaulted women had PTSD and comorbid depression. The ACTH levels were higher in the PTSD group than the control group and increased as PTSD severity increased, considering depressive symptoms, measured by the Beck Depression Inventory (BDI) (p < 0.0001), as well as PTSD symptoms, measured by subscale D of the Clinician-Administered PTSD Scale (CAPS-5) (p = 0.045) and the CAPS-5 total scale (p = 0.026). Cortisol levels measured at 10 pm were higher for the PTSD group than the control group (p = 0.045, p = 0.037, respectively), and the cortisol awakening response showed elevated cortisol levels for the PTSD group. Conclusions These results show a correlation between symptom severity and HPA axis imbalance in patients with PTSD. Elevated ACTH and an elevated cortisol response in patients with comorbid depressive symptoms were the opposite of the expected response for patients with PTSD only. This association leads to the hypothesis that the neurobiological alterations of PTSD are related to the type of symptoms presented and their severity. These manifestations likely influence the disease course, prognosis and response to treatment. These outcomes highlight the need to discuss particular neurobiological alterations in patients with PTSD developed after sexual assault, mainly those with severe depressive symptoms.

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