Skill Acquisition During Transdiagnostic Treatment With the Unified Protocol
Open accessAbstract
The Unified Protocol (UP) for Transdiagnostic Treatment of Emotional Disorders is an emotion-focused, cognitive-behavioral intervention developed to address the full range of anxiety, depressive, and related disorders. The UP consists of core therapeutic skills that, though unique in focus, are each designed to promote an approach-oriented stance toward emotional experiences. The goal of the present investigation was to characterize changes in these skills for patients that received a course of treatment with the UP, as well as to examine associations between skills and symptoms changes. Patients with principal anxiety disorders, assigned to receive treatment with the UP (N = 88) as part of a randomized controlled trial, were included in this study. They completed validated self-report measures of UP skills (Understanding Emotions, Mindful Emotion Awareness, Cognitive Flexibility, Countering Emotional Behaviors, and Interoceptive Awareness and Tolerance), as well as clinician-rated measures of psychological symptoms. Skill measures improved significantly over the course of 12 to 16 UP treatment sessions and changes in these skills measures were associated with improvements in anxiety symptoms. Determining whether improvement on all the skills learned during a course of treatment with UP is associated with symptom remission is critical to establishing the most streamlined and efficient interventions that may ultimately be best suited to widespread dissemination.
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The degree of change in aspects of aversive reactivity over 6 sessions in the current study was 50-70% as large as that obtained from 12-16 sessions of the UP.
“the degree of change in aspects of aversive reactivity over 6 sessions in the current study was 50-70% as large as that obtained from 12-16 sessions of the UP (Sauer-Zavala et al., 2021)”
From Within-person changes in aversive reactivity predict session-to-session reductions in anxiety and depression in the unified protocol. (2024) · cites this paper as Sauer-Zavala et al., 2021
Early improvements in mindfulness, cognitive flexibility, behavioral avoidance, and interoceptive tolerance were related to decreased anxiety at post-treatment.
“For example, early improvements in mindfulness, cognitive flexibility, behavioral avoidance, and interoceptive tolerance were related to decreased anxiety at post-treatment (Sauer-Zavala et al., 2021).”
From Within-person changes in aversive reactivity predict session-to-session reductions in anxiety and depression in the unified protocol. (2024) · cites this paper as Sauer-Zavala et al., 2021
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“This is to some extent consistent with the results of Sauer-Zavala et al. [34].”
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“…suggests that, when the UP modules are presented in isolation, they engage their corresponding form of aversive reactivity (i.e., Mindful Emotion Awareness is associated with increased levels of nonjudgmental, present-focused attention; Cassiello-Robbins et al., 2020; Sauer-Zavala et al., 2021).”
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- Authors
- Sauer-Zavala, S., Rosellini, A. J., Bentley, K. H., Ametaj, A. A., Boswell, J. F., Cassiello-Robbins, C., Wilner Tirpak, J., Farchione, T. J., & Barlow, D. H.
- Affiliations
- University of Kentucky (US)
- Boston University (US)
- Harvard University (US)
- University at Albany, State University of New York (US)
- Duke Medical Center (US)
- Corresponding author
- Sauer-Zavala, Shannon
- ORCID
- Venue
- Behavior Therapy
- Publisher
- Elsevier BV
- Published
- 2021-11
- Volume
- 52
- Issue
- 6
- Pages
- 1325-1338
- ISSN
- 0005-7894 (ISSN-L)
- PMC
- PMC12912188
- OpenAlex
- W3138338340
- Cited by
- 22
- References
- 49
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 4 · 2023: 5 · 2021: 1
- FWCI
- 2.26
- Type
- journal article
- Language
- en
- Open access
- green
- pmc.ncbi.nlm.nih.gov
- Locations
- Behavior Therapy (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion)
- Funders
- National Institute of Mental Health
- Agency for Healthcare Research and Quality
- Mayo Clinic
- Chinese University of Hong Kong
- U.S. Department of Defense
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- Unified Protocol, transdiagnostic treatment, emotion-focused therapy, cognitive behavioral therapy, anxiety disorders, skill acquisition, emotional awareness, cognitive flexibility, interoceptive awareness, symptom change, treatment dissemination
- MeSH terms
- Anxiety, Anxiety Disorders, Emotions, Humans, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Treatment Outcome, Mindfulness
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