Efficacy of the Unified Protocol for transdiagnostic treatment of comorbid psychopathology accompanying emotional disorders compared to treatments targeting single disorders

Stephanie Jarvi Steele; Todd J Farchione; Clair Cassiello-Robbins; Amantia Ametaj; Sophia Sbi; Shannon Sauer-Zavala; David H Barlow

doi:10.1016/j.jpsychires.2018.08.005

Efficacy of the Unified Protocol for transdiagnostic treatment of comorbid psychopathology accompanying emotional disorders compared to treatments targeting single disorders

J Psychiatr Res. 2018 Sep:104:211-216. doi: 10.1016/j.jpsychires.2018.08.005. Epub 2018 Aug 3.

Authors

Stephanie Jarvi Steele¹, Todd J Farchione², Clair Cassiello-Robbins³, Amantia Ametaj⁴, Sophia Sbi⁵, Shannon Sauer-Zavala⁶, David H Barlow⁷

Affiliations

¹ Boston University, Center for Anxiety and Related Disorders, 648 Beacon Street, 6th Floor, Boston, MA, 02215, USA. Electronic address: sjsteele@bu.edu.
² Boston University, Center for Anxiety and Related Disorders, 648 Beacon Street, 6th Floor, Boston, MA, 02215, USA. Electronic address: tfarchio@bu.edu.
³ Boston University, Center for Anxiety and Related Disorders, 648 Beacon Street, 6th Floor, Boston, MA, 02215, USA. Electronic address: ccassiel@bu.edu.
⁴ Boston University, Center for Anxiety and Related Disorders, 648 Beacon Street, 6th Floor, Boston, MA, 02215, USA. Electronic address: amantiaa@bu.edu.
⁵ Boston University, Center for Anxiety and Related Disorders, 648 Beacon Street, 6th Floor, Boston, MA, 02215, USA. Electronic address: ssbi@bu.edu.
⁶ Boston University, Center for Anxiety and Related Disorders, 648 Beacon Street, 6th Floor, Boston, MA, 02215, USA. Electronic address: ssauer@bu.edu.
⁷ Boston University, Center for Anxiety and Related Disorders, 648 Beacon Street, 6th Floor, Boston, MA, 02215, USA. Electronic address: dhbarlow@bu.edu.

Abstract

Objective: This study aimed to examine whether the Unified Protocol (UP), a transdiagnostic cognitive-behavioral therapy for emotional disorders (i.e., anxiety, mood, and related disorders), is efficacious in the treatment of co-occurring emotional disorders compared to established single disorder protocols (SDPs) that target specific disorders (e.g., panic disorder).

Method: Participants included 179 adults seeking outpatient psychotherapy. Participant age ranged from 18 to 66 years, with an average of 30.66 years (SD = 10.77). The sample was 55% female and mostly Caucasian (83%). Diagnostic assessments were completed with the Anxiety Disorder Interview Schedule (ADIS), and disorder-specific, clinician-rated measures for the comorbid diagnoses of interest.

Results: In both treatment conditions, participants' mean number of diagnoses dropped significantly from baseline to posttreatment, and baseline to 12-month follow-up. Additionally, large effects were observed for changes in comorbid generalized anxiety (ES_SG: UP = -1.72; SDP = -1.98), social anxiety (ES_SG: UP = -1.33, -0.86; SDP = -1.60, -1.54), and depression (ES_SG: UP = -0.83; SDP = -0.84). Significant differences were not observed in between-group comparisons.

Conclusions: Results suggest that both the UP and SDPs are efficacious in reducing symptoms of comorbid emotional disorders. The clinical, practical, and cost-effective advantages of transdiagnostic CBT are discussed.

Keywords: Cognitive-behavioral therapy; Comorbidity; Emotional disorders; Transdiagnostic treatment; Unified protocol.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adolescent
Adult
Aged
Agoraphobia
Antisocial Personality Disorder / epidemiology*
Antisocial Personality Disorder / rehabilitation*
Cognitive Behavioral Therapy / methods*
Comorbidity
Female
Follow-Up Studies
Humans
Male
Middle Aged
Mood Disorders / epidemiology*
Mood Disorders / rehabilitation*
Obsessive-Compulsive Disorder
Panic Disorder
Phobia, Social
Psychiatric Status Rating Scales
Treatment Outcome*
Young Adult

Grants and funding

R01 MH090053/MH/NIMH NIH HHS/United States