Investigating the Effects of the Unified Protocol on Common and Specific Factors in a Comorbid Insomniac Sample: A Single-Case Experimental Design

Abstract

Background: Insomnia and emotional disorders share common factors that underlie and perpetuate these disorders. The Unified Protocol (UP) for transdiagnostic treatment of emotional disorders is a new treatment approach designed to target core processes of emotional disorders. Objectives: The present study examined the effects of UP on behavioral inhibition/behavioral activation, anxiety sensitivity, and emotion dysregulation as transdiagnostic factors, as well as cognition and behaviors specific to insomnia, in a small sample of patients (N = 6) with comorbid insomnia and emotional disorders. Methods: A multiple-baseline across subjects single-case experimental design with a 3-month follow-up was used. Participants were allocated to 2, 4, and 6 baseline periods and then received 14 weekly individual sessions of UP. The outcome measures were Behavioral Inhibition/Behavioral Activation Scales (BIS/BAS), Anxiety Sensitivity Index-3 (ASI-3), Difficulties in Emotion Regulation Scale (DERS), Dysfunctional Beliefs and Attitudes about Sleep Scale-10 (DBAS-10), and Sleep-Related Behaviors Questionnaire (SRBQ). Data were analyzed using visual inspection, mixed model analysis, and reliable change index (RCI). Results: Mixed model analysis showed significant changes in BIS/BAS, ASI-3, DERS, DBAS-10, and SRBQ from pre-treatment to post-treatment. Most participants achieved a reliable change in BIS, ASI-3, DERS, DBAS-10, and SRBQ at a 3-month follow-up. Conclusions: This preliminary study provides empirical evidence on the utility of UP for reducing common vulnerability and sleep-specific factors in chronic insomnia comorbid with emotional disorders. Further research is needed to test these findings in randomized controlled studies.