Abstract
The purpose of this study was to evaluate whether the Unified Protocol (UP)—a mechanistically transdiagnostic psychological treatment—provides benefit to individuals with a range of trauma histories, psychological difficulties, and diagnostic comorbidity. Using data from a sequential multiple-assignment randomized trial (SMART), this exploratory analysis included a sample of 69 community-recruited adults seeking outpatient mental health treatment. We examined reductions in anxiety and depressive symptoms and changes in aversive and avoidant reactions to intense emotions—the UP’s putative mechanism—first by comparing individuals with and without trauma histories and then specifically among participants with PTSD. Findings suggest that the UP may lead to similar improvements in clinical diagnostic severity, anxiety, and depression among patients with trauma exposure as those without trauma exposure. Roughly half of participants with PTSD demonstrated reductions in PTSD clinical severity, anxiety, depression, and distress aversion, suggesting the UP may be an efficacious treatment for people with PTSD and comorbid conditions.
Highlights
Most adults will experience at least one potentially traumatic event involving exposure to actual or threatened death, serious injury, or sexual violence in their lifetime [1,2]
Individuals were eligible for the parent study if they met criteria for at least one of the following Diagnostic and Statistical Manual-5 (DSM-5) disorders [1]: Posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), major depressive disorder (MDD), panic disorder (PD), persistent depressive disorder (PDD), or social anxiety disorder (SAD)
We examined whether the effects of a transdiagnostic treatment for emotional disorders differed between people with and without a history of trauma exposure and whether this treatment would lead to significant improvements in diagnostic, symptomatic, and mechanistic outcomes among those with PTSD
Summary
Most adults will experience at least one potentially traumatic event involving exposure to actual or threatened death, serious injury, or sexual violence in their lifetime [1,2]. Posttraumatic stress disorder (PTSD) occurs when an individual exhibits persistent re-experiencing symptoms, efforts to avoid trauma reminders, negative changes in mood and cognition, and heightened arousal and reactivity [1]. Trauma exposure is associated with a range of mood and anxiety disorders beyond PTSD [4]. Evidence-based trauma-focused protocols (e.g., Cognitive Processing Therapy, Prolonged Exposure) are consistently recommended as the “gold standard” treatment approaches for PTSD [7]. Some studies suggest that the efficacy of PTSD treatments may be compromised when diagnostic comorbidities or persistent and intense negative emotions are present. It should be noted that other studies suggest mood and anxiety comorbidities do not moderate outcomes for trauma-focused treatments and may even improve along with PTSD symptoms [7]. Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations
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