Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders: Protocol Development and Initial Outcome Data

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Abstract

The Unified Protocol (UP) is a transdiagnostic, emotion-focused cognitive-behavioral treatment developed to be applicable across the emotional disorders. The UP consists of 4 core modules: increasing emotional awareness, facilitating flexibility in appraisals, identifying and preventing behavioral and emotional avoidance, and situational and interoceptive exposure to emotion cues. Here we present data from 2 open clinical trials. In the first trial, an initial version of the UP was administered to a heterogeneous clinical sample, yielding significant pre- to posttreatment effects across disorders on a variety of measures. Analyses of clinical significance demonstrated modest results, with 56% of participants achieving responder status and 33% achieving high end-state functioning. Further manual development ensued, resulting in specific modifications and enhancements to core treatment components, and a second trial presents data from an additional pilot study of this revised version of the UP. Results from this trial demonstrated more robust treatment effects, with 73% achieving responder status and 60% achieving high end-state functioning. Results improved further at 6-month follow-up, with 85% classified as treatment responders and 69% achieving high end-state functioning. Implications for the treatment of emotional disorders as well as dimensional conceptualizations of psychopathology are discussed.

Section snippets

Development of the Unified Transdiagnostic Treatment for Emotional Disorders

In response to these advances, we developed the Unified Protocol for the Treatment of Emotional Disorders (UP), a transdiagnostic, emotion-focused cognitive-behavioral treatment (CBT) (Barlow, Boisseau, Ellard, Fairholme, & Farchione, 2008). The UP was developed to be applicable across anxiety and mood disorders, as well as other disorders in which anxiety and emotion dysregulation play a significant role, such as many somatoform and dissociative disorders. The focus in the UP on common

Study 1: Pilot-Test of Initial Version of the UP

The initial version of the UP was pilot-tested in a sample of patients whose principal diagnoses spanned the anxiety disorders, including GAD, OCD, SAD, PTSD, and PDA, as well as major depressive disorder (MDD) and dysthymia. Consistent with epidemiological accounts (Kessler et al., 2005), and prior research (Brown, Campbell, Lehman, Grisham, & Mancill, 2001), the sample evidenced high rates of comorbidity (see below). We hypothesized that treatment using the UP would result in reductions in

Study 2: Pilot-Test of the Revised UP

Following the initial pilot-test presented in Study 1, and prior to advancing to a more complex randomized controlled trial (RCT), the UP manual underwent several modifications in an effort to improve upon these initial promising results. As suggested by Rounsaville, Carroll, and Onken (2001), this additional treatment manual development phase and further pilot testing allows for thorough testing of the theoretical rationale behind treatment components, and allows for important modifications

Key Modifications to the UP

The revised version of the UP treatment manual was modified to anchor treatment concepts more explicitly within the three-component, modal model of emotion (see Fairholme, Boisseau, Ellard, Ehrenreich, & Barlow, 2009), and to place a greater emphasis upon increasing patient awareness of the interaction of each of these components within the context of present-moment experience. As the treatment proceeds in the revised manual, the domains of thoughts, feelings, and behaviors are each explored in

Discussion

In this article, we present preliminary data on outcomes from the UP, a transdiagnostic treatment designed to be applicable across anxiety and mood disorders. Results from a pilot-study of the initial version of the treatment manual, represented in Study 1, provided preliminary support for the efficacy (albeit modest) of the UP in the treatment of a range of anxiety and mood disorders including GAD, SAD, PDA, OCD, PTSD, and depression. After further manual development and modifications to

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