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Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders: Protocol Development and Initial Outcome Data
Open accessAbstract
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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“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: Research Article: An Open Trial of Emotion Regulation Therapy (2015) · cites this paper as [78]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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 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]
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“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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“The UP addresses heightened negative reactivity to emotions by identifying maladaptive responses to emotions and developing more effective strategies to manage these experiences (Ellard et al., 2010).”
From The role of negative affectivity and negative reactivity to emotions in predicting outcomes in the unified protocol for the transdiagnostic treatment of emotional disorders (2012) · cites this paper as Ellard et al., 2010
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“The UP has been demonstrated to lead to robust effects on anxiety and depression symptoms in two uncontrolled trials (Ellard et al., 2010;Wilamowska et al., 2010)”
From Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood (2015) · cites this paper as Ellard et al., 2010
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“Using a transdiagnostic, emotion-focused cognitive-behavioral treatment (CBT), applicable across anxiety and mood disorders, (Ellard et al., 2010) has shown improvement in social adjustment and social relationships in depressed patients.”
From Social functioning in major depressive disorder (2016) · cites this paper as Ellard et al., 2010
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“psychosocial treatments that address these shared pathways have been shown to be effective across psychosocial problems (e.g., Ellard, Fairholme, Boisseau, Farchione, & Barlow 2010; Farchione et al., 2012)”
From A transdiagnostic minority stress treatment approach for gay and bisexual men's syndemic health conditions (2015) · cites this paper as Ellard et al., 2010
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“Transdiagnostic approaches to psychiatric disorders suggest that there may be common underlying mechanisms which may serve as either predisposing or perpetuating factors”
From Comparison between obsessive compulsive disorder and panic disorder on metacognitive beliefs, emotional schemas, and cognitive flexibility (2019) · cites this paper as Ellard et al. 2010
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“This finding is consistent with the underlying theories and therapeutic goals of the UP as well as previous studies (Ellard et al., 2010; Farchione et al., 2012; Pearl & Norton, 2016) and has provided other empirical evidence to support the efficacy of UP in the treatment of emotional disorders.”
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“8 A key challenge therefore is how we can build on and extend beyond the current psychological treatments for CMHP to increase efficacy, and sustained recovery, particularly for those with comorbid, recurrent and complex presentations.(9) Over the past decade, there has been a major shift in the conceptualisation of C…”
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Skill Acquisition During Transdiagnostic Treatment With the Unified Protocol
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Metadata
- 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.
- Venue
- Cognitive and Behavioral Practice
- Publisher
- Elsevier BV
- Published
- 2010-02
- Volume
- 17
- Issue
- 1
- Pages
- 88-101
- ISSN
- 1077-7229 (ISSN-L)
- PMC
- PMC7986982
- OpenAlex
- W2057628070
- Cited by
- 523
- References
- 103
- 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
- green
- www.ncbi.nlm.nih.gov
- 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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