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.

Sahel Khakpoor,Omid Saed,Alireza Armani Kian

doi:10.1590/2237-6089-2018-0074

Abstract

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. 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. 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. Emotion regulation can be considered as a potential mediating factor and as predictive of outcomes of transdiagnostic treatment based on the UP. Iranian Registry of Clinical Trials, IRCT2017072335245N1.

Highlights

Research shows that anxiety disorders, with oneyear prevalence of 18%, and mood disorders, with a one-year prevalence of 9.5%, are among the most common psychological disorders.[1]
The results show that the Unified Protocol (UP) produced strong reductions in anxiety (Hedges’ g = 1.23) and depression (Hedges’ g = 0.87) in the treatment group from pre-test to post-test
Considering the research hypothesis that emotion regulation plays a mediating role in the efficacy of the UP for reducing anxiety and depression, in the second phase, in addition to controlling for the effect of pre-test results, difficulties in emotion regulation change scores were controlled. These results showed that there was no significant difference between treatment and control groups after controlling for the effect of emotion regulation (p > 0.05), which suggests that emotion does play a mediating role in this treatment (Table 3)

Summary

Introduction

Research shows that anxiety disorders, with oneyear prevalence of 18%, and mood disorders, with a one-year prevalence of 9.5%, are among the most common psychological disorders.[1] Surveys in the field of “emotional disorders” (including anxiety disorders, mood disorders, and other related disorders) indicate that these disorders and psychological problems are related to people’s social status, economic status, education, health, and quality of life.[2,3]. Significant advances have been made in treatment of emotional disorders over recent decades. Clinicians have a variety of protocols for individual and group therapies and many clinical trials have confirmed their effectiveness.[4] these evidence-based treatments are challenged by certain limitations, such as little attention to comorbidities, the existence of multiple protocols, the inability to address multiple problems using a single protocol, and restricted access to the most effective treatment for patients

Results

Discussion

Conclusion