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On the efficacy of the unified protocol for transdiagnostic treatment of emotional disorders: A systematic review and meta-analysis
Abstract
In recent years a large array of treatment protocols conceptualized as transdiagnostic have been developed with clinical and practical advantages compared to traditional single-disorder protocols. Within this panorama, the Transdiagnostic Unified Protocol (UP) of Emotional Disorders was developed aimed at treating the negative affective processes underlying several diagnostic categories, and accounting for the covariance of different emotional disorders. The UP has been found to efficiently target the roots of these disorders leading to a reduction in symptoms of co-occurring disorders. However, several questions have marginally addressed in the previous studies, and some UP features still remain unexplored. The present meta-analysis aims at evaluating whether the UP results to significant changes in anxiety and depression symptoms severity in children, adolescents, and adults. 19 RCTs and 13 uncontrolled pre-post trials comprising 2183 patients/clients met inclusion criteria for meta-analysis. Large to moderate combined overall effect size for both depression plus anxiety were detected in the uncontrolled pre-post studies (g = 0.756) and in RTCs studies (g = 0.452), respectively. Large effect size at pre-treatment to 3-6-month follow-up was observed for combined depression plus anxiety (g = 1.113). Subgroup analysis suggested that UP treatment does not differ across the anxiety and depression self-report measures. Moreover, UP intervention outperformed both passive and active control conditions to treat negative affective syndromes. Meta-regression confirmed the moderate effects of therapist level of experience, the sample characteristics, and the UP-protocol adaptations. The findings indicate that the manualized UP treatment has potential to contribute to improving mental health outcomes, particularly of anxiety and depression.
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In the citing paper
“findings were substantially stronger at follow-up in the 12 RCTs for which follow-up data were available (between-groups g = 1.13).”
From Pilot outcomes and exploration of treatment mechanisms using a culturally adapted version of the unified protocol for transdiagnostic treatment of emotional disorders to improve mental health symptoms, alcohol misuse, functional outcomes, and sleep quality in emergency responders (2025) · cites this paper as [32]
In the citing paper
“In a meta-analysis of 19 randomized trials (32), there was a medium effect of the UP on pooled anxiety and depression symptoms from pre- to post-treatment (between-groups Hedges' g = .45).”
From Pilot outcomes and exploration of treatment mechanisms using a culturally adapted version of the unified protocol for transdiagnostic treatment of emotional disorders to improve mental health symptoms, alcohol misuse, functional outcomes, and sleep quality in emergency responders (2025) · cites this paper as [32]
In the citing paper
“A growing evidence base supports the utility of the UP for improving emotional and emotion-adjacent symptoms, including anxiety, depression, anger, substance misuse, self-injury, somatization, obsessive-compulsive symptoms, and trauma-related symptoms (26, 31–37).”
From Pilot outcomes and exploration of treatment mechanisms using a culturally adapted version of the unified protocol for transdiagnostic treatment of emotional disorders to improve mental health symptoms, alcohol misuse, functional outcomes, and sleep quality in emergency responders (2025) · cites this paper as [32]
In the citing paper
“Recent systematic reviews and meta-analysis evidence that the UP could help to manage EDs in the general population (Sakiris and Berle, 2019; Cassiello-Robbins et al., 2020; Carlucci et al., 2021; Longley and Gleiser, 2023) and also in individuals with comorbid medical conditions such as those living with Human Immunodeficiency Virus (HIV), cancer, chronic pain or multiple sclerosis, among others”
From Unified Protocol for the transdiagnostic treatment of emotional disorders in people with post COVID-19 condition: study protocol for a multiple baseline n-of-1 trial (2023) · cites this paper as Carlucci et al., 2021
In the citing paper
“Three systematic reviews, with two meta-analyses, have been conducted to evaluate the efficacy of the UP. These reviews reveal that the UP significantly improves anxious and depressive symptoms with moderate to large effect sizes [51, 52].”
From Effectiveness and mediators of change of an online CBT intervention for students with adjustment disorder—study protocol for a randomized controlled trial (2023) · cites this paper as [51]
In the citing paper
“a growing body of empirical research points to the efficacy of transdiagnostic interventions in multiple disorders (e.g. [25–30])”
From Acceptance and commitment therapy as a transdiagnostic approach to adolescents with different anxiety disorders: study protocol. (2025) · cites this paper as [26]
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Metadata
- Authors
- Carlucci, L., Saggino, A., & Balsamo, M.
- Affiliations
- University of Chieti-Pescara (IT)
- Corresponding author
- Carlucci, Leonardo
- Venue
- Clinical Psychology Review
- Publisher
- Elsevier BV
- Published
- 2021-07
- Volume
- 87
- Pages
- 101999
- ISSN
- 0272-7358 (ISSN-L)
- OpenAlex
- W3134743031
- Cited by
- 234
- References
- 140
- Citations by year
- 2026: 45 · 2025: 50 · 2024: 43 · 2023: 61 · 2022: 31 · 2021: 3
- FWCI
- 5.67
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Clinical Psychology Review (publishedVersion)
- PubMed (publishedVersion)
- 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
- transdiagnostic treatment, emotional disorders, anxiety, depression, negative affect, treatment efficacy, children and adolescents, adults, manualized psychotherapy, therapist experience
- MeSH terms
- Adolescent, Adult, Anxiety, Anxiety Disorders, Child, Clinical Protocols, Humans, Cognitive Behavioral Therapy, Mood Disorders
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