Transdiagnostic Treatment Of Emotional Disorders Research Articles

The Unified Protocol for Transdiagnostic Treatment of Perinatal Depression: A Case Study

This case study aims to present the application of the Unified Protocol (UP) for the Transdiagnostic Treatment of Emotional Disorders in the case of a 38-year-old pregnant woman with a peripartum onset of major depressive disorder and anxiety symptoms. The UP is a cognitive-behavioral intervention based on the shared etiological and maintenance mechanisms of emotional disorders (i.e., mood, anxiety, and related disorders). The UP helps to modify maladaptive emotion-regulation strategies and enhance tolerance of unpleasant and intense emotions (sadness, anxiety, anger, etc.). Whereas previous studies demonstrate the efficacy of the UP in different emotional disorders, to our knowledge, none of them have used the UP to treat perinatal emotional disorders. After the eight UP modules of individual treatment, a significant decrease in anxiety, depression, negative affect, and anxiety sensitivity, and also an increase in positive affect were observed. These results were maintained at the 12-month follow-up. In addition to its clinical utility and acceptance, these results indicate that the UP can be adapted and personalized for the treatment of perinatal emotional disorders. Future studies with larger samples and controlled experimental designs should be developed to demonstrate its efficacy. Furthermore, as the UP seems to be useful in a group format, future efforts should be focused on the UP with perinatal women in a group format.

Expressive suppression of emotion is a moderator of anxiety in a unified protocol for transdiagnostic treatment of anxiety and depressive disorders: A secondary analysis

BackgroundExpressive suppression (ES) of emotion is considered a moderator that reduces the efficacy of cognitive behavioural therapy (CBT); however, whether and how ES moderates the efficacy of the unified protocol for transdiagnostic treatment of emotional disorders (UP), a version of CBT targeting aversive/avoidant responses to emotions, including ES, remain unclear. We investigated whether and how emotion regulation, especially ES, moderates UP efficacy for anxiety symptoms in patients with anxiety and depressive disorders. MethodsWe conducted a secondary analysis of data from a previous trial. Seventeen patients with anxiety and/or depressive disorders were included. Changes (slope estimates) in the Structured Interview Guide for the Hamilton Anxiety Rating Scale from pre-treatment to post-treatment were measured using a latent growth curve model with empirical Bayesian estimation. Pre-treatment ES, cognitive reappraisal, and depressive symptoms were used as slope factor predictors. ResultsOnly pre-treatment ES significantly predicted the slope in the latent growth curve model (estimate value = 0.45; standard deviation = 0.21; 95% credible interval = 0.03–0.87, one-tailed p-value = 0.004), and an inverse correlation between pre-treatment ES levels and improvement magnitude of anxiety symptoms was demonstrated. LimitationsBecause the data were obtained from a single-arm trial, this study did not have controls, and most participants received pharmacotherapy in addition to UP. Therefore, generalisability of the present findings might be compromised. ConclusionsLow ES before UP was an effective predictor of greater improvement in anxiety symptoms after UP. The findings suggest that interventions intended to improve ES may improve UP efficacy.

Development and Implementation of a Transdiagnostic, Stepped-Care Approach to Treating Emotional Disorders in Children via Telehealth

Stepped-care interventions may increase the accessibility of evidence-based treatments but remain relatively underexplored in the child mental health literature. Further, while the feasibility and efficacy of stepped-care interventions have been examined for specific diagnoses or classes or disorders, transdiagnostic stepped-care interventions have not yet been developed. We discuss the development and initial implementation of a transdiagnostic approach to emotional disorders using the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C; Ehrenreich-May et al., 2018). A case series is presented to illustrate the delivery of UP-C stepped care (UPC-SC) via telehealth, using a collaborative decision-making process to inform step-up/step-down decisions. Lessons learned are discussed to guide refinements of UPC-SC and inform a larger trial.

Investigating the mediational role of Intolerance of Uncertainty and its components in reducing symptoms of emotional disorders: A double-blind randomized clinical trial

Aim of the studyIntolerance of uncertainty (IU) is a transdiagnostic structure that plays an important role in developing and maintaining symptoms of emotional disorders. The current study was aimed to investigate the mediational role of IU and its components in reducing symptoms of emotional disorders.Subject or material and methodsThis was a double-blind randomized clinical trial. Based on the Beck anxiety inventory and Beck depression inventory 26 individuals were selected. They were randomly assigned into two groups of control and treatment (n=13) using random number generator 3.1.v software. The treatment group received 20 one-hour sessions of Unified Protocol (UP) for the transdiagnostic treatment of emotional disorders. Beck depression inventory, the Beck anxiety inventory, and Intolerance of uncertainty scale were performed in pre, post and three months follow-up. Data were analyzed by SPSS-20 software.ResultsAfter controlling the effect of IU, the results of one-way analysis of covariance (ANCOVA) showed a significant reduction in the difference between the two groups (P<0.05); which means that IU can be considered as a mediator of reductions in anxiety and depression in UP. The results of the stepwise regression analysis indicated that prospective IU and inhibitory IU could explain 61.4% and 8.2% of variances in anxiety scores, respectively. In predicting changes in depression score, only inhibitory IU could explain depression variance (43.3%).DiscussionThe best predictor of the changes in the anxiety and depression are, respectively, prospective IU and inhibitory IU.ConclusionsThis study shows that UP may exert its effect by improving different components of IU.

The effect of transdiagnostic emotion-focused treatment on obsessive-compulsive symptoms in children and adolescents

Obsessive-compulsive disorder (OCD) commonly onsets in childhood. Given OCD's high comorbidity with other emotional disorders (e.g., depression, anxiety), transdiagnostic treatment that aims to enhance youth's tolerance and regulation of various negative emotions before starting exposure may facilitate simultaneous treatment of multiple comorbid symptoms. The current study examined the effects of transdiagnostic treatment in an open trial of clinical youth. Children and adolescents (N = 170) with any primary emotional disorder (e.g., an anxiety, depressive, or obsessive-compulsive spectrum disorder) started Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP–C/A) treatment. Youth (M age = 12; 50% female) were primarily white and Hispanic/Latinx. Youth and their parent(s) completed an intake and follow-up assessments (8, 16, and 24 weeks). The outcome measures were self- and parent-reported obsessive-compulsive symptoms (OCS), treatment engagement, and client satisfaction. Over the course of the UP-C/A, youths' OCS decreased significantly, across reporters, regardless of child age or gender. These findings provide preliminary support for utilizing the UP-C/A to treat OCS in youth. While these results do not imply equivalence with existent, exposure and response prevention treatments for pediatric OCD, it is possible that the flexible structure of the UP-C/A may be applied successfully to OCS.

The unified protocol for transdiagnostic treatment of emotional disorders.

The unified protocol for transdiagnostic treatment of emotional disorders.

Improved quality of life and reduced depressive symptoms in medical students after a single-session intervention.

Objective:Anxiety and depression are prevalent among medical students. Brazilian medical students have higher levels of depression and lower quality of life than their U.S. counterparts, and no preventive intervention exists for this risk group in Brazil. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP), a cognitive-behavioral treatment protocol for neuroticism, was recently adapted into a single-session, preventive intervention. This study tested the impact of this protocol on psychiatric symptoms and quality of life in Brazilian medical students.Methods:In this open trial, the intervention protocol was translated and adapted to Brazilian Portuguese. Medical students over 18 years of age without psychotic symptoms, severe depressive episodes, or acute psychiatric risk were included, undergoing a psychiatric clinical interview (Mini-International Neuropsychiatric Interview [MINI]) and evaluation at baseline and at 7 and 30 days after a single-session UP that included experimental avoidance, quality of life, self-esteem, empathy, and anxiety symptom scales. A new evaluation was performed 90 days after the intervention.Results:Sixty-two students participated. Ninety days after the intervention, there were significant reductions in the number of students who met the criteria for social anxiety disorder (p = 0.013) or panic disorder (p = 0.001). There were also significant improvements in depressive symptoms (Beck Depression Inventory, p < 0.001) and quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire, p < 0.001).Conclusion:UP improved anxiety and depressive symptoms in medical students. The single-session group format could reduce costs and facilitate application. Future placebo-controlled studies are necessary to confirm these findings.

Trajectories of Change and Intermediate Indicators of Non-Response to Transdiagnostic Treatment for Children and Adolescents

ABSTRACT Objective: In the current study, we sought to identify distinct trajectories of symptom change and mid-treatment tailoring variables for the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C) and Adolescents (UP-A), with the goal of providing empirical data to guide the implementation of adaptive and personalized interventions using this approach. Method: Participants were 94 youth ages 7–17 (M = 13.36, 56.40% female) who completed the UP-C or UP-A. Participants received a diagnostic assessment at baseline and completed symptoms measures at mid-treatment and post-treatment assessments. Results: Growth mixture modeling revealed three distinct classes of responders based on youth-reported and parent-reported symptoms of anxiety and depression, with two of these classes exhibiting significant slope variability. Overall baseline global severity, age, and comorbid social anxiety were significantly associated with class membership, while gender and presence of a comorbid obsessive-compulsive spectrum disorder were marginally associated with class membership. An 8–12% reduction in emotion disorder symptoms best predicted likelihood of post-treatment response. Conclusions: Results enhance our understanding of trajectories of response to transdiagnostic treatment and help to inform the development and implementation of more streamlined and personalized treatment approaches.

Aplicación individual del tratamiento transdiagnóstico a un caso de ansiedad generalizada

ObjectiveThe clinical case of a 22-year-old woman, C.G, with generalized anxiety disorder is described, with the purpose of evaluating the effect of the Unified Protocol for the Transdiagnostic Treatment of emotional disorders to reduce anxiety. MethodThis is a single case design, pre-post treatment. The evaluation instruments used for the diagnosis and subsequent establishment of the treatment were the State-Trait Anxiety Inventory (Spielberger, Gorusch, and Lushene), the Hamilton Anxiety Assessment Scale (Hamilton, 1959; Lobo et al., 2002), the Pennsylvania State Concerns Questionnaire (Comeche, Díaz, and Vallejo, 1995; Meyer, Miller, Metzger and Borkovec, 1990), and the Beck Depression Inventory (Beck, Steer, and Brown, 2011). ResultsAccording to post-treatment tests, specifically Pennsylvania State Concerns Questionnaire (Comeche, Díaz, and Vallejo, 1995; Meyer, Miller, Metzger and Borkovec, 1990), C.G. It no longer meets the criteria or reaches the score (from 77 to 40) for the diagnosis of generalized anxiety disorder. ConclusionsAfter the treatment, a clear improvement is observed with a significant reduction in the number of anticipations, which confirms the effectiveness of the transdiagnosis treatment for this case.

Changes in Risk Factors During the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents

This study aimed to assess whether changes in potentially modifiable risk factors associated with the construct of neuroticism and common to emotional disorders (i.e., poor distress tolerance and heightened avoidance) occur in concordance with the administration of different treatment components of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) and with reductions in emotional disorder symptoms (i.e., anxiety and depressive symptoms) overall. Using single-case analytic strategies, including multiple-baseline design and modeling techniques, the authors treated 8 adolescents with emotional disorder diagnoses and evaluated trajectories of change in distress tolerance and experiential avoidance as well as in the sequencing of such change in regard to change in anxiety and depressive symptoms. Clinical outcomes were favorable based on parent, adolescent, and clinician-rated measures. Treatment-based change was demonstrated, at both group and individual levels, and at expected points in treatment, in regard to facets of neuroticism. Overall, self-reported change in experiential avoidance and distress tolerance tended to occur simultaneously to reductions in emotional disorder symptoms. This study helps to clarify the course of expected change in variables believed to be common among a range of emotional disorders during a transdiagnostic treatment and provides initial information regarding tailoring the UP-A for individuals with different clinical profiles.

Evaluating the Unified Protocol in the Treatment of Dissociative Identify Disorder

The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP; Barlow, Allen, & Choate, 2004) is a transdiagnostic cognitive behavior therapy for emotional disorders that addresses mood, anxiety, somatoform, and borderline personality disorders. Patients diagnosed with dissociative identity disorder (DID) form a nontrivial subset of patients. Extant treatment guidelines (ISSTD, 2011) emphasize the need to strive for fusion of identities (i.e., the creation of a unified sense of self). In contrast, the UP strives to inculcate an array of adaptive emotion skills, including cognitive reappraisal, emotional awareness, and affect tolerance, prior to planned exposure to traumatic memories. In this study, we provide the first assessment of the effectiveness of the UP with 5 individuals diagnosed with DID and co-occurring disorders and symptoms tracked at multiple time points. After 18–22 sessions, 4 patients exhibited significant reductions in anxiety, depression, and dissociative symptoms, and increases in emotional regulation, with significant improvements in symptomatology maintained after follow-ups of 1, 3, and 6 months. A fifth participant with prominent suicidal ideation was treated for 42 sessions and achieved comparable reductions in symptoms. None of the patients met criteria for DID or any other disorder at 6-month follow-up.

Treating depressive disorders with the Unified Protocol: A preliminary randomized evaluation

ObjectivesThis study aims to examine the efficacy of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) for individuals diagnosed with a depressive disorder. MethodParticipants included 44 adults who met criteria for major depressive disorder, persistent depressive disorder, or another specified depressive disorder according to the Anxiety Disorder Interview Schedule (ADIS). These individuals represent a subset of patients from a larger clinical trial comparing the UP to single-disorder protocols (SDPs) for discrete anxiety disorders and a waitlist control (WLC) condition (Barlow et al., 2017); inclusion criteria for the parent study required participants to have a principal anxiety disorder. ResultsSignificant reductions in depressive symptoms were observed within the UP condition across clinician-rated and self-report measures of depression from baseline to post-treatment, as well as to the 12-month follow-up assessment. Compared to the WLC group, individuals in the UP condition demonstrated significantly lower levels on our continuous, clinician-rated measure of depressive symptoms at post-treatment. There were no differences between the UP and SDP conditions on depressive symptoms at post-treatment or at the 12-month follow-up timepoint. ConclusionsIn this exploratory set of analyses, the UP evidenced efficacy for reduction of depressive symptoms, adding to the growing support for its utility in treating depression.

Augmenting the unified protocol for transdiagnostic treatment of emotional disorders with transcranial direct current stimulation in individuals with generalized anxiety disorder and comorbid depression: A randomized controlled trial

BackgroundThe aim of the current study was to compare the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) with and without transcranial direct current stimulation (tDCS) in individuals suffering from generalized anxiety disorder (GAD) and comorbid depression. MethodsA total of 43 individuals diagnosed with GAD and comorbid depression enrolled in a randomized controlled trial (IRCT20140929019334N1). Participants were randomly assigned to three groups including UP with tDCS (UP+tDCS; n = 15), UP alone (UP; n = 13) or wait-list control (n = 15). GAD and depression symptoms, worry severity, anxiety sensitivity, and intolerance of uncertainty were assessed at baseline, post-treatment and 3-month follow-up. ResultsTreatment with both UP+tDCS and UP alone resulted in significant lower ratings across all measures relative to wait-list controls at post-treatment and 3-month follow-up (all p-values <0.001). UP+tDCS showed significantly greater reductions in anxiety (p = 0.001 post-treatment; p = 0.003 follow-up), worry (p = 0.001 post-treatment; p = 0.002 follow-up), and anxiety sensitivity (p = 0.003 post-treatment; p = 0.002 follow-up) relative to UP alone. LimitationsThe present study had some limitations. First, the sample size was low. Another limitation was the use of a short-term follow-up. ConclusionsThese results suggest augmenting UP treatment with tDCS may be an efficacious strategy to improve treatment outcomes in GAD with comorbid depression.Trial registration reference is IRCT20140929019334N1 (see https://irct.ir/trial/27988).

An ARFID case report combining family-based treatment with the unified protocol for Transdiagnostic treatment of emotional disorders in children

BackgroundThis case report discusses the presentation and treatment of a nine-year-old female with a history of significant weight loss and food refusal using a combined approach of Family-Based Treatment (FBT) and the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C).Case presentationThe patient was diagnosed with avoidant/restrictive food intake disorder (ARFID), separation anxiety disorder, and a specific phobia of choking, and subsequently treated with a modified version of FBT, in conjunction with the UP-C. At the end of treatment, improvements were seen in the patient’s weight and willingness to eat a full range of foods. Decreases in anxiety regarding eating/choking, fears of food being contaminated with gluten, and fears of eating while being away from parents were also observed.ConclusionsThese findings highlight promising results from this combined treatment approach, referred to as FBT + UP for ARFID. Further research is needed to evaluate the use of this treatment in patients presenting with a variety of ARFID symptoms.

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.

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.

The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) Adapted as a School-Based Anxiety and Depression Prevention Program: An Initial Cluster Randomized Wait-List-Controlled Trial

Anxiety and depression are common debilitating conditions that show high comorbidity rates in adolescence. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A; Ehrenreich-May et al., 2018) is one of the few existing resources aimed at applying transdiagnostic treatment principles across the core dysfunctions implicated in the development of both anxiety and depression using a single protocol. This is the first known controlled study to examine the efficacy of the UP-A adapted as a nine-session universal preventive intervention program delivered in a school setting. A total of 151 students (mean age: 15.05) participated in this randomized wait-list-controlled trial conducted in Madrid, Spain. An unexpected decline in anxiety and depression levels from pre- to posttreatment and follow-up was found in both groups (p = .009, d = –0.22), and overall differences between conditions did not reach significance. Exploratory analyses of baseline emotional symptom severity as a potential predictor trended toward a significantly greater decrease in symptoms of depression for those with greater baseline emotional symptoms in the UP-A group compared to the wait-list-control group. Future trials with larger samples are justified to estimate the effect of the UP-A adapted as a selective prevention program for anxiety and depression.

Applying a Transdiagnostic Cognitive-Behavioral Treatment to Adolescents at High Risk for Serious Mental Illness: Rationale and Preliminary Findings

Given the chronic and deleterious course of serious mental illness (SMI; schizophrenia and bipolar disorder), significant efforts have been undertaken to improve prediction of SMI and provide treatment for adolescents in the early, putatively prodromal stage of these illnesses. While risk assessments and disorder-specific treatments for adolescents at risk for SMI have shown some efficacy, significant issues remain around disorder-specific treatments for these youth. There is substantial heterogeneity of psychopathology within adolescents at high risk for SMI that leads to many false-positives and varying diagnostic outcomes. As a result, initial treatment focusing on broad symptoms and skills has been proposed in place of disorder-specific treatments. We discuss the rationale for providing an already-developed and empirically supported transdiagnostic treatment for emotional disorders (termed the Unified Protocol) as a first-line staging of treatment for adolescents experiencing early SMI symptoms. Additionally, we outline the open trial we are piloting using this transdiagnostic treatment in adolescents between the ages of 13 – 17 who have begun experiencing distressing yet subsyndromal psychosis or bipolar mood symptoms. Preliminary findings suggest feasibility and acceptability as well as initial efficacy in improving psychiatric symptoms, quality of life, and difficulties regulating emotions. We also present case studies from our open trial. A unified, cognitive-behavioral treatment for early presentations of SMI has important clinical and public health benefits, including streamlining treatment and providing broad skills that are applicable to a wide range of psychopathology.

Development and Application of an Innovative Transdiagnostic Treatment Approach for Pediatric Irritability

Recent work has drawn attention to the previously underrecognized role that irritability plays in childhood psychopathology. Despite increased recognition of the clinical importance of pediatric irritability as a transdiagnostic symptom dimension, there is a lack of evidence-based treatments for this population that simultaneously and equitably addresses both child and contextual (e.g., parental) factors implicated in the development and maintenance of associated emotional and behavioral difficulties. In the current pilot study, we adapted the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C) for the treatment of pediatric irritability in a sample of 19 children (ages 8 to 12) with primary presenting concerns of irritability and/or disruptive behaviors. Results supported the feasibility and acceptability of this treatment and provided preliminary evidence that such an approach may yield improved outcomes for symptoms of pediatric irritability and disruptive behaviors. Implications of these findings for future research and clinical interventions for pediatric irritability are discussed.

Using the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders With Youth Exhibiting Anger and Irritability

The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C and UP-A) are evidence-based treatment programs with cognitive-behavioral and third-wave behavior therapy elements, aimed at extinguishing distress to intense emotion states and reducing unhelpful action tendencies in such states among youth with emotional disorders. A growing body of literature demonstrates the high prevalence of problematic anger and irritability among youth with emotional disorders, yet evidence-based treatments to address anger and irritability are typically developed more exclusively for youth with externalizing disorders. Given this need, a clinical case example of the UP-C applied to a child with anger and irritability is presented. Application of transdiagnostic theory to both conventional anxiety concerns and to irritability concerns is discussed. We demonstrate the flexibility and utility of a transdiagnostic approach like the UP-A and UP-C for addressing concerns across a range of emotions.

Stakeholder Preferences on Transdiagnostic Psychosocial Treatment for Trauma-Exposed Veterans.

While modular and transdiagnostic approaches may address implementation challenges, there remains limited investigation into the fit within large healthcare systems. The current study examines qualitative interviews from patients, clinicians and administrative stakeholders in the Veterans Administration about experiences with, and views of, the Unified Protocol (UP; Barlow et al. in The unified protocol for transdiagnostic treatment of emotional disorders: therapist guide, Oxford University Press, New York, 2011) to understand potential for implementation. Qualitative interviews were conducted based on an established implementation framework and speak to implementation of transdiagnostic treatment in veterans, including insight into barriers, facilitators, intervention characteristics, patient characteristics, and system level variables. The UP demonstrated promise for improving efficiency, satisfaction and personalizing mental healthcare.