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Cited by 523Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPersonality Disorders and PsychopathologyPsychotherapy Techniques and Applications

Unified protocol for the transdiagnostic treatment of emotional disorders: protocol development and initial outcome data

Open access
Ellard, Kristen K., Fairholme, Christopher P., Boisseau, Christina L., Farchione, Todd J., Barlow, David H.·2010·Cognitive and Behavioral Practice
DOI 10.1016/j.cbpra.2009.06.002PMC PMC7986982
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Abstract

Two studies present preliminary support for the Unified Protocol (UP), a transdiagnostic, emotion-focused cognitive-behavioral treatment developed to be applicable across the emotional disorders. Study 1 presents data from an open clinical trial of the initial version of the UP in a heterogeneous clinical sample, yielding large pre- to post-treatment effect sizes across disorders on measures of DSM-IV diagnostic category severity, and medium to large effect sizes on general measures of depression and anxiety, social adjustment, and levels of negative and positive affect. Following a period of further manual development resulting in specific modifications and enhancements to core treatment components, Study 2 presents data from an additional pilot study of this revised version of the UP. Results from Study 2 demonstrated more robust treatment effect sizes and greater changes across measures of depression, anxiety, positive and negative affect, social adjustment, and quality of life. Relatively similar treatment effects were again demonstrated across a full range of anxiety and mood disorders, suggesting roughly equivalent transdiagnostic efficacy. Implications for the treatment of emotional disorders, clinical practice, and dimensional conceptualizations of psychopathology are discussed.

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Crossref · 10.1016/j.cbpra.2009.06.002

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  • Recent CBT interventions have integrated both less and more elaborate training components by synthesizing mindfulness and attention training with traditional CBT techniques, resulting in high endstate functioning achieved and maintained through follow-up while also sampling patients with prominent depression features at baseline.

    “recent CBT interventions have integrated both less and more elaborate training components by synthesizing mindfulness and attention training with traditional CBT techniques78–80, resulting in high endstate functioning which is achieved and maintained through follow-up periods, while also sampling patients evidencing prominent depression features at baseline78–80.”

    From AN OPEN TRIAL OF EMOTION REGULATION THERAPY FOR GENERALIZED ANXIETY DISORDER AND COOCCURRING DEPRESSION. (2015) · cites this paper as [78]

    Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

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  • Results of studies support the efficacy of UP in the treatment of emotional disorders in Iran and other countries.

    “The results of studies support the efficacy of UP in the treatment of emotional disorders in Iran and other countries [2, 10, 14, 15, 23, 32].”

    From Internet-based UP-A intervention on treatment of stress, anxiety, depression, and psychological flexibility among adolescents with sub-clinical diagnosis of emotional disorders during the COVID-19 pandemic: a clinical trial (2024) · cites this paper as [14]

    The Discussion reports preliminary support for the UP’s efficacy across anxiety and mood disorders. The Methods describe participants recruited through Boston University; this paper does not provide evidence about treatment in Iran. Other citations in the sentence may address Iran, but this source alone does not. (LLM, conf=0.84)

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  • Individuals with low distress tolerance tend to perceive negative emotions as intolerable and resort to avoidance and suppression strategies, hindering habituation and self-efficacy development, ultimately leading to heightened anxiety and depression.

    “Theoretically, individuals with low distress tolerance tend to perceive negative emotions as intolerable and resort to avoidance and suppression strategies, hindering habituation and self-efficacy development, ultimately leading to heightened anxiety and depression (Barlow et al., 2010; Ellard et al., 2010).”

    From Distress tolerance as a mediator of mindfulness-based intervention for anxiety and depression: Evidence from two randomized controlled trials (2024) · cites this paper as Ellard et al., 2010

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  • Disseminating evidence-based psychological treatments has become a challenge because of their cost, duration, and lack of well-qualified professionals, which can explain why they are underutilized in clinical practice settings.

    “disseminating EBTs has become a real challenge because of their cost, the duration of the treatments, and the lack of well-qualified professionals [5], which can explain why EBTs are underutilized in clinical practice settings [6].”

    From Negative and positive affect regulation in a transdiagnostic internet-based protocol for emotional disorders: Randomized controlled trial (2021) · cites this paper as [5]

    The Introduction says that disorder-specific manuals burden clinicians and hamper dissemination; the Discussion identifies the time and cost of training in multiple manuals as barriers. Neither passage identifies the cost or duration of treatment, or a shortage of well-qualified professionals, as the barriers. The underutilization clause is attached to a different citation [6], so it is not judged here. (LLM, conf=0.87)

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  • A few participants in mechanistically transdiagnostic studies had primary or comorbid PTSD, but no study has focused on applying this approach to patients with primary PTSD.

    “Whereas a handful of participants in mechanistically transdiagnostic studies [13, 14] have presented with primary or comorbid PTSD; no study to date has focused on applying this approach to patients who present with primary PTSD.”

    From Emergence of Transdiagnostic Treatments for PTSD and Posttraumatic Distress (2016) · cites this paper as [13]

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Research works printed but not linked: 4

  1. Beck AT, Rush AJ, Shaw BF, & Emery G (1987). Cognitive therapy of depression. New York: Guilford Press.
  2. Cohen J (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.
  3. Di Nardo PA, Brown TA, & Barlow DH (1994). Anxiety Disorders Interview Schedule for DSM-IV: Lifetime Version (ADIS-IV-L). New York: Oxford University Press.
  4. Waters AM, & Craske MG (2005). Generalized anxiety disorder. In Antony MM, Ledley DR, & Heimbert RG (Eds.), Improving outcomes and preventing relapse in cognitive-behavioral therapy (pp. 77– 127). New York: Guilford Press.

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Authors
Ellard, K. K., Fairholme, C. P., Boisseau, C. L., Farchione, T. J., & Barlow, D. H.
Affiliations
Boston University (US)
Corresponding author
Ellard, Kristen K.
ORCID
Venue
Cognitive and Behavioral Practice
Publisher
Elsevier BV
Published
2010-02
Volume
17
Issue
1
Pages
88-101
ISSN
1077-7229 (ISSN-L)
DOI
10.1016/j.cbpra.2009.06.002
PMC
PMC7986982
OpenAlex
W2057628070
Cited by
523
References
104
Citations by year
2026: 11 · 2025: 19 · 2024: 22 · 2023: 25 · 2022: 43 · 2021: 32 · 2020: 30 · 2019: 39 · 2018: 42 · 2017: 57 · 2016: 38 · 2015: 41 · 2014: 53 · 2013: 32 · 2012: 21
FWCI
27.63
Type
journal article
Language
en
Open access
Licence
Locations
  • Cognitive and Behavioral Practice (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (R34MH070693)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
Unified Protocol, transdiagnostic treatment, emotional disorders, depression, anxiety, mood disorders, social adaptation, affect, quality of life, treatment efficacy

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