Treatment Of Emotional Disorders Research Articles

State of the Science: The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders

Before the development of the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP), evidence-based treatment options for commonly co-occurring anxiety, mood, and related disorders consisted of numerous single-disorder protocols that shared many similarities, reflecting the overlap among these disorders themselves. The UP distilled common elements of cognitive behavioral protocols into a unified intervention directly targeting core temperamental features underlying these disorders of emotion, namely neuroticism and associated emotion dysregulation. The UP has since become a leading “transdiagnostic” treatment for emotional disorders, which is now available in several formats (e.g., individual, group, digital) and has accumulated a strong evidence base, leading to international implementation. There is now also research evidence that the UP can be flexibly applied to a range of clinical presentations, including borderline personality disorder, trauma- and stressor-related disorders, eating disorders, alcohol use disorder, and comorbid chronic physical health conditions. Yet additional research is needed to evaluate the UP in routine clinical settings, with more heterogeneous patient populations, and under circumstances that mirror actual clinical practice. Thus, we must also continue to explore the benefits of large-scale UP training initiatives and implementation in major healthcare systems.

Child- and Parent-Report Measures of Behavioral Avoidance (CAMS/CAMP): Portuguese Validation in Clinical and Non-Clinical Samples

ObjectiveBehavioral avoidance is a core component in the understanding and treatment of emotional disorders. The Child Avoidance Measure–Self Report (CAMS) and Child Avoidance Measure–Parent Report (CAMP) are two 8-item measures that assess a child’s behavioral avoidance from the child’s and parent´s perspectives, respectively. The present study aimed to analyze the factor structure and psychometric properties of the CAMS and CAMP in clinical and nonclinical samples of Portuguese school-aged children and their parents.MethodsThe clinical sample included 172 parent–child dyads (children: aged 6–13 years; parents: 89% mothers) in which the child had a primary diagnosis of an anxiety or anxiety-related disorder. The nonclinical sample included independent subsamples of 288 children (aged 8–13 years) and 210 parents (93.3% mothers). In both samples, participants completed the CAMS and CAMP; the clinical sample additionally completed a self-report questionnaire assessing anxiety symptoms.ResultsA one-factor structure of the CAMS and CAMP was confirmed in both samples using confirmatory factor analysis. The CAMS and CAMP presented good internal consistency in clinical and nonclinical samples. The convergent validity of the scales was supported by significant correlations with each other and with a measure of anxiety symptomatology. Furthermore, both scales could distinguish between clinical and nonclinical participants. In the clinical sample, the scales demonstrated sensitivity to changes in response to exposure-focused CBT.ConclusionsThe CAMS and CAMP have adequate psychometric properties and provide a multi-informant assessment of children’s behavioral avoidance in clinical and nonclinical samples.

Exploring trajectories in transdiagnostic behavior therapy.

Transdiagnostic treatments have been designed to target common processes for clusters of disorders. One such treatment, transdiagnostic behavior therapy (TBT), targets avoidance across emotional disorders, including posttraumatic stress disorder (PTSD), depressive disorders, and anxiety disorders, and has demonstrated efficacy in randomized controlled trials. The current study was designed to examine whether distinct treatment trajectories would emerge in a sample of 112 veterans receiving TBT and whether diagnostic comorbidity, baseline levels of several transdiagnostic risk factors, or treatment engagement influence trajectory membership. Growth mixture modeling revealed three distinct trajectories across depression, ds = 0.55-1.09; PTSD ds = -0.07-1.43; and panic disorder symptoms, ds = -0.13-1.09. Notably, for PTSD and panic disorder symptoms, separate classes for responders and nonresponders emerged among participants with high baseline symptom levels. Findings for the risk factors suggested that PTSD and panic nonresponders evidenced significantly higher behavioral avoidance at baseline and reduced engagement in treatment procedures and homework completion compared to responders. Together, the findings provide additional support for the use of TBT in the treatment of emotional disorders, including PTSD. Potential adaptations are discussed for patients with significantly elevated behavioral avoidance to improve treatment engagement and related outcomes.

Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders in Group Format in Spain: Results of a Noninferiority Randomized Controlled Trial at 15 Months after Treatment Onset

Evidence-based psychological treatments (EBPT) are an effective and efficient solution for the treatment of emotional disorders (EDs). However, their implementation and dissemination are not yet widespread. The Unified Protocol for Transdiagnostic Treatment of EDs (UP), applied in a group format, could be an effective option to be implemented in specialized public mental health services in Spain. The sample consisted of 533 users of public specialized mental health centers (77.3% women), with a mean age of 42.0 years ( SD = 12.62 ), who were randomized to the UP in group format condition ( n = 277 ) or treatment as usual (specific cognitive behavioral therapy for each disorder in individual format, n = 256 ). Assessments were performed at preintervention (T1) and at 3, 6, 9 and 15 months after treatment onset (T2, T3, T4, and T5, respectively). The results showed a main effect of time in both conditions for all primary outcomes ( p < 0.05 ) and no statistically significant Time ∗ Condition interaction. Similarly, the noninferiority tests showed that UP results were statistically noninferior compared to TAU. Effect sizes for psychological variables were higher in the UP condition at T5, even though the differences were not statistically significant. Statistically significant differences ( p < 0.05 ) in the evolution of the diagnostic criteria and comorbidity were found, with the highest percentage of patients no longer meeting main and secondary diagnosis criteria in the UP condition at all assessment moments (except for secondary diagnosis at T3). The results showed statistically significant differences in treatment retention between conditions at T5, being the UP condition the one with less dropouts. Finally, participants in the group UP condition showed high satisfaction with the treatment. The UP is an EBPT that has been shown to be effective when applied in groups and may represent an efficient option for its implementation in public mental health services in Spain. This trial is registered with NCT03064477.

Latent herpes simplex virus type 1 reactivation increases the susceptibility of neurodegenerative diseases: intervention with traditional Chinese medicine

Owing to environmental and lifestyle changes in modern society, physical and mental stress is on the rise among the population in attempting to compensate for the changes. Stress, defined as a series of non-specific responses to abnormal internal and external stimuli, has long been recognized to increase susceptibility to various diseases, including neurodegenerative diseases (NDs). Herpes simplex virus type 1 (HSV-1), a neurotropic herpes virus, establishes latent infections in the trigeminal ganglia for the lifetime of the host. Upon reactivation, the latent HSV-1 enters the lytic cycle, which not only causes a substantial production of reactive oxygen species (ROS) in the neurons, but also induces glial cells to produce inflammatory mediators, eventually resulting in neuronal damage and occurrence of NDs. Remarkably, both physical and psychological stress are common stimuli leading to latent HSV-1 reactivation. Acyclovir is a classic antiviral drug for the treatment of HSV-1 infection and recurrence, but acyclovir cannot reverse neuronal damage caused by HSV-1 reactivation. Recent studies have shown that traditional Chinese medicine (TCM) has advantages in the treatment of NDs. In addition, TCM is thought to prevent latent HSV-1 reactivation and NDs, which may involve regulation of the neuro-endocrine-immune network, treatment of emotional disorders, and modulation of oxidative stress. Understanding the mechanism underlying stress-induced reactivation of latent HSV-1 and the potential consequences of NDs is needed. TCM may be a promising alternative therapy for related diseases.

Evaluation of cognitive, emotional, and social trans-diagnostic structures in severe predictions in adolescents with and without sub-clinical symptoms of emotional disorders

Background. The purpose of this study was to compare the meta-diagnostic constructs of emotion regulation, negative repetitive thoughts, cognitive flexibility, and social adjustment in two groups of adolescents with and without preclinical symptoms of emotional disorders. Methods. The samples of this cross-sectional and comparative research includes included 140 teenagers who were divided into two groups. Adolescents were divided into two groups based on the diagnostic interview and DASS-21 questionnaire. Statistical analysis of the data was done using the Mann-Whitney and Chi- 2 square tests. Results. Cognitive flexibility and emotion regulation in the group of healthy adolescents was significantly higher than the group of adolescents with preclinical symptoms. However, the level of social adjustment was not significantly different between the two groups of adolescents with preclinical symptoms and healthy adolescents. Conclusion. The significant difference between the two groups of teenagers in meta-diagnostic structures shows the importance of these factors in the process of prevention, diagnosis, and treatment of emotional disorders and symptoms such as anxiety and depression. Practical Implications. Considering the existence of significant differences in the two groups of adolescents in meta-diagnostic cognitive and emotional structures, effective measures can be taken in order toto prevent the complete clinical manifestation of emotional disorders; . As a result of these measures, he took an important step can be taken in to reducing reduce the financial, psychological, and social costs caused by these disorders

« Retrouver le chemin de l’autre », évaluation de l’hospitalisation en soins/études de 33 adolescents

ObjectiveThe “care and studies” hospitalisation at the Dupré Clinic (Fondation Santé des étudiants de France; Students Health French Foundation) is an original setting that integrate a therapeutic and eco systemic residential approach with schooling for adolescents suffering from psychiatrics disorders. MethodA selection of standardised questionaries’ was proposed to a group of 70 adolescents hospitalized in “care and study”. The final sample of the group was composed of 33 adolescents at the entrance and 9 months later. We compared the results between T0 and T9. The battery of questionaries’ is composed of: YSR (Youth Self report), ADRS (Adolescent depression rating scale), RSQ (Relationship scale questionnaire), IPPA (Inventory of Parent and Peer Attachment), FACES IV (Family adaptability and cohesion evaluation scale), Rosenberg self esteem scale, LEAS (Level of emotional awareness scale) and a self subjective evaluation of psychological functioning. A committee of ethics and deontology approved the methodology. ResultsThe results (YSR, ADRS) show a significant effect on reduction of internalised disorder at 9 months, especially in the measures of anxiety, depression and withdrawal. The RSQ results confirm significative less anxiety in the patient's relationship with others. Adolescents witness a feeling of a better global functioning. On the other hand, no evolution was observed in the measure of emotional consciousness (LEAS) and in the family functioning form an adolescent's perspective. ConclusionsThis study offers new clinical perspective based on the results. We proposed a few reflexions in the treatment of emotional disorder and in the domain of family therapy intervention.

How a transdiagnostic approach can improve the treatment of emotional disorders: Insights from clinical psychology and neuroimaging.

Multiple psychological treatments for emotional disorders have been developed and implemented, improving the quality of life of individuals. Nevertheless, relapse and poor response to psychotherapy are common. This article argues that a greater understanding of both the psychological and neurobiological mechanisms of change in psychotherapy is essential to improve treatment for emotional disorders. It aims to demonstrate how an understanding of these mechanisms provides a basis for (i) reconceptualizing some mental disorders, (ii) refining and establishing the evidence for existing therapeutic techniques and (iii) designing new techniques that precisely target the processes that maintain these disorders. Possible future directions for researchers and practitioners working at the intersection of neuropsychology and clinical psychology are discussed.

Effectiveness of adaptol in the treatment of emotional disorders in patients with physical illnesses

Effectiveness of adaptol in the treatment of emotional disorders in patients with physical illnesses

Innovative moments in recovered cases treated with the unified protocol for transdiagnostic treatment of emotional disorders

ABSTRACT Objective Innovative moments (IMs) are moments in which the previous problematic pattern of meaning is challenged. Studies have shown that IMs are associated with good psychotherapy outcomes. A three-level hierarchy of IMs was observed in recent studies, with level 1 IMs being more elementary and levels 2 and 3 being more complex and associated with treatment success. However, studies with manualized protocol treatments are thus far lacking. This study analyzed the longitudinal progression of IMs in the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) and explored its associations with changes in psychological distress. Methods Data were collected from a Portuguese university-based outpatient clinic and included 18 cases with positive outcomes. Nine sessions of each case were coded with the IM coding system (N=162). Results Multilevel analyses showed a significant increase in all IM levels across treatments. The decrease in psychological distress predicted an increase in level 2 IMs in the same session. Conclusion The evolution of IMs is similar to what was found previously in other studies. Contrary to what was found in previous studies, IMs did not predict outcomes in the following session, whereas the reduction in psychological distress predicted the emergence of level 2 IMs.

Moderators and predictors of treatment outcome in transdiagnostic group cognitive-behavioral therapy for primary care patients with emotional disorders.

Transdiagnostic group cognitive behavior therapy (TD-GCBT) has shown to be efficacious in the treatment of emotional disorders in primary care. However, little is known about possible moderators or predictors of treatment outcome. We aimed to explore the potential predictors and moderators of outcome in a large multicentre randomized controlled trial comparing TD-GCBT plus treatment as usual (TAU) to TAU alone. Putative demographic and baseline clinical variables were examined using the PROCESS macro as potential predictors/moderators of depressive and anxiety symptoms at posttreatment and 1-year follow-up. Analyses were based on a study completer sample of 1061 participants randomized to TD-CBT + TAU (n = 527) or TAU alone (n = 534), with 631 participants assessed at the posttreatment evaluation and 388 at the 1-year follow-up. Individuals working or with a partner among sociodemographic variables, and higher baseline comorbidities and more severity of symptoms among clinical variables obtained more benefits from adding TDCBT to TAU. Those taking medication before treatment obtained less benefits from the TD-GCBT than those without prescribed antidepressant medications, after controlling for baseline severity of symptoms. Overall, the moderating effect of clinical (but not sociodemographic) variables remained at 1-year follow-up. Findings support largely the generalization of the TD-GCBT for emotional disorders in primary care to a variety of sociodemographic and clinical groups. However, TD-GCBT seems to work to a greater extent for those individuals with a more severe clinical profile. Providing TD-GCBT before prescribing antidepressant medication and while people are still working may enhance the effects of adding this psychological treatment to TAU in primary care.

REVIEW OF THE BOOK “EMBODIED HOT COGNITIVE VULNERABILITY TO EMOTIONAL DISORDERS. FROM THEORY TO TREATMENT”, WRITTEN BY ALEXANDRU TIBA

This review presents a book that brings a fresh perspective on emotional disorders. The author of the book starts from renowned models in psychological counseling and psychotherapy and identifies the need for a different focus on factors that lead to vulnerability, namely the embodied hot cognition. Each chapter of the book carefully indicates the current state of research in the field (hot cognitions, distorted hot cognition, stress-related neuroadaptations, disturbed motivation, irrational beliefs), including recent neuropsychological findings. The final chapter presents an evidence-based treatment of emotional disorders. The book could be challenging for the beginners in psychological counseling, but also a delight for professionals in this field.

Predicting and Moderating the Response to the Unified Protocol: Do Baseline Personality and Affective Profiles Matter?

Neuroticism (N), extraversion (E), and negative/positive affect (NA/PA) are personality/affective characteristics highly related to the etiology and maintenance of emotional disorders (EDs). This study aims at exploring the moderating role of baseline personality/ and affectivity profiles in the response to a transdiagnostic psychological treatment for EDs. Outcomes were N, E, NA, PA, depression, and anxiety. These were assessed at baseline, post-treatment, and 3-month follow-up in 157 participants with EDs who received the Unified Protocol (UP) in group format in the Spanish Health System. A linear mixed model analysis was carried out to investigate different recovery trajectories as a function of baseline personality and affective profiles Significant changes occurred in all variables after the UP. Medium and high baseline scores in N and NA moderate the largest changes on N, NA and E while lower baseline scores in PA and E moderate the largest changes on E and PA. Changes over time on depression and anxiety symptoms were not predicted from personality/affect baseline scores. The study results support the short-medium term utility of the UP to address all study outcomes. Moreover, personalizing interventions according to baseline personality/affect might be a sensible strategy to enhance the UP effectiveness. Trial registration number NCT03064477 (March 10, 2017).

Activación Conductual en formato grupal para ansiedad y depresión. Una revisión sistemática

Dada la alta prevalencia de los Trastornos Mentales Comunes (TMC), la aplicación grupal de la Activación Conductual (AC) puede ser un abordaje eficaz, efectivo y más eficiente. El objetivo del presente trabajo es revisar los estudios publicados sobre la utilidad de la AC grupal para el tratamiento de la ansiedad y/o depresión. Método: Revisión sistemática. Resultados: Se incluyeron 17 estudios. Los pacientes que recibieron AC experimentaron mejoras en ansiedad y/o depresión y se informa de una mayor eficacia de AC frente a grupos control sin intervención. Conclusiones: La AC es útil para la prevención y el tratamiento de trastornos emocionales. No obstante, la heterogeneidad y limitaciones de los estudios impiden determinar los ingredientes terapéuticos exactos, y si éstos son específicos del enfoque y procedimiento de esta terapia. Sería necesario más investigación, de mayor calidad metodológica, y que evalúe los cambios en los patrones de activación/evitación objeto de intervención.

A Multiple-Baseline Evaluation of Acceptance and Commitment Therapy Focused on Repetitive Negative Thinking for Comorbid Generalized Anxiety Disorder and Depression.

Repetitive negative thinking (RNT) is a core feature of generalized anxiety disorder (GAD) and depression. Recently, some studies have shown promising results with brief protocols of acceptance and commitment therapy (ACT) focused on RNT in the treatment of emotional disorders in adults. The current study analyzes the effect of an individual, 3-session, RNT-focused ACT protocol in the treatment of severe and comorbid GAD and depression. Six adults meeting criteria for both disorders and showing severe symptoms of at least one of them participated in the study. A delayed multiple-baseline design was implemented. All participants completed a 5-week baseline without showing improvement trends in emotional symptoms (Depression Anxiety and Stress Scale – 21; DASS-21) and pathological worry (Penn State Worry Questionnaire; PSWQ). The ACT protocol was then implemented, and a 3-month follow-up was conducted. Five of the six participants showed clinically significant changes in the DASS-21 and the PSWQ. The standardized mean difference effect sizes for single-case experimental design were very large for emotional symptoms (d = 3.34), pathological worry (d = 4.52), experiential avoidance (d = 3.46), cognitive fusion (d = 3.90), repetitive thinking (d = 4.52), and valued living (d = 0.92 and d = 1.98). No adverse events were observed. Brief, RNT-focused ACT protocols for treating comorbid GAD and depression deserve further empirical tests.

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.

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.

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.

Role of Intolerance of Uncertainty (IU) in the etiology and treatment of emotional disorder: A mini review

Role of Intolerance of Uncertainty (IU) in the etiology and treatment of emotional disorder: A mini review

A meta-analysis and systematic review of Memory Specificity Training (MeST) in the treatment of emotional disorders

The tendency to recall events from one's past in a non-specific and overgeneral way has been found to predict the onset and severity of a range of emotional disorders. Memory Specificity Training (MeST) was devised a decade ago in order to target and modify this tendency so as to reduce the symptoms of emotional disorder or to reduce the risk that such disorders might emerge over time. We present a meta-analytical review of research into the effects of MeST on autobiographical memory specificity in the context of emotional disorders (k = 13). MeST was associated with substantial improvement in memory specificity (d = −1.21) and depressive symptoms (d = 0.47) and MeST groups outperformed control groups at post-intervention in terms of specificity (d = 1.08) and depressive symptoms (d = −0.29). However, these effects were transitory and the benefit of MeST over control groups was mostly lost by follow-up assessment. There was mixed evidence in terms of MeST's effects on other processes associated with reduced specificity but MeST showed evidence of improving problem solving abilities and hopelessness. MeST holds promise as a novel intervention targeting reduced specificity but future studies are warranted with control groups that enable the investigation of MeST's mechanism of action and in studies with larger and more varied samples.