The effects of the Unified Protocol and Unified Protocol skills on loneliness in the COVID‐19 pandemic
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Abstract
Background Loneliness is a significant public health concern with no established first-line intervention although modular, transdiagnostic, cognitive-behavioral interventions, such as the Unified Protocol (UP), are promising candidates. The UP contains skill modules to target anxiety, depression, and related conditions, although it is unclear if the UP can reduce loneliness and if UP skill use contributes to these reductions. Methods Using data from the first-stage randomization of a sequential multiple assignment randomized trial, we tested whether the UP led to reductions in loneliness and whether specific dimensions of UP skill use predicted session-to-session changes in loneliness. Participants (N = 70; Mage = 33.74, 67% female, 74% white) completed six sessions of core UP modules, reporting how frequently they felt lonely and used UP skills before each session. Using hierarchical linear modeling, we examined the trajectory of change in loneliness and disaggregated between- from within-person variability to test session-to-session effects of skill use. Results Loneliness significantly decreased during treatment with the UP. Using more UP skills than one's personal average, but not frequency of skill use, predicted session-to-session decreases in loneliness. Conclusions Therapists may be encouraged to guide patients toward using a large quantity of different skills to specifically address loneliness.
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Preliminary data show that the UP during the pandemic improved loneliness, anxiety, and emotion regulation.
“Preliminary data on the efficacy of the UP during the pandemic is encouraging as it has demonstrated improvements in many difficulties, including loneliness, anxiety, and emotion regulation (Ferreres-Galán et al., 2022;Southward et al., 2022;Yan et al., 2022).”
From RESILIENCE, COPING, AND THE COVID-19 PANDEMIC ACROSS THE GLOBE – AN UPDATE: WHAT HAVE WE LEARNED? (2023) · cites this paper as Southward et al., 2022
The Results report decreased loneliness during UP treatment in the pandemic, and Methods §5.2 says the UP reduced anxiety in the current sample, citing the parent trial. Results §6.1 also reports increased use of UP skills, but does not establish improved emotion regulation as a measured outcome. (LLM, conf=0.85)
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- Authors
- Southward, M. W., Terrill, D. R., & Sauer‐Zavala, S.
- Affiliations
- University of Kentucky (US)
- Department of Psychology University of Kentucky Lexington Kentucky USA
- Corresponding author
- Southward, Matthew W.
- Venue
- Depression and Anxiety
- Publisher
- Wiley
- Published
- 2022-11-13
- Volume
- 39
- Issue
- 12
- Pages
- 913-921
- ISSN
- 1091-4269 (ISSN-L)
- 1520-6394
- PMC
- PMC9877890
- OpenAlex
- W4308957029
- Cited by
- 8
- References
- 46
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 2 · 2022: 1
- FWCI
- 1.61
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- Depression and Anxiety (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (K23MH126211)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- loneliness, Unified Protocol, skill utilization, COVID-19 pandemic, within-person variability, loneliness trajectories, anxiety, depression
- MeSH terms
- COVID-19, Adult, Anxiety, Depression, Female, Humans, Loneliness, Male, Cognitive Behavioral Therapy, Pandemics
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