Efficacy of the Unified Protocol for transdiagnostic treatment of comorbid psychopathology accompanying emotional disorders compared to treatments targeting single disorders
Open accessAbstract
Objective This study aimed to examine whether the Unified Protocol (UP), a transdiagnostic cognitive-behavioral therapy for emotional disorders (i.e., anxiety, mood, and related disorders), is efficacious in the treatment of co-occurring emotional disorders compared to established single disorder protocols (SDPs) that target specific disorders (e.g., panic disorder).Method Participants included 179 adults seeking outpatient psychotherapy. Participant age ranged from 18 to 66 years, with an average of 30.66 years (SD = 10.77). The sample was 55% female and mostly Caucasian (83%). Diagnostic assessments were completed with the Anxiety Disorder Interview Schedule (ADIS), and disorder-specific, clinician-rated measures for the comorbid diagnoses of interest.Results In both treatment conditions, participants' mean number of diagnoses dropped significantly from baseline to posttreatment, and baseline to 12-month follow-up. Additionally, large effects were observed for changes in comorbid generalized anxiety (ES SG: UP = -1.72; SDP = -1.98), social anxiety (ES SG: UP = -1.33, -0.86; SDP = -1.60, -1.54), and depression (ES SG: UP = -0.83; SDP = -0.84). Significant differences were not observed in between-group comparisons.Conclusions Results suggest that both the UP and SDPs are efficacious in reducing symptoms of comorbid emotional disorders. The clinical, practical, and cost-effective advantages of transdiagnostic CBT are discussed.
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In that study, there were no significant between-group differences in mean number of diagnoses and decline in symptoms of co-occurring conditions on generalized anxiety disorder-specific measures (g=-0.29, 95% CI -1.12 to 0.54).
“However, results showed no significant between-group differences in mean number of diagnoses and decline in symptoms of co-occurring conditions on GAD specific measures (g = − 0.29, 95% CI [− 1.12, 0.54]), suggesting that the UP and SDPs may be similarly efficacious for both GAD and co-occurring emotional disorders [96].”
From Psychotherapeutic treatments for generalized anxiety disorder: cognitive and behavioral therapies, enhancement strategies, and emerging efforts (2022) · cites this paper as [96]
Results, Aim 3 (page unavailable) reports no significant UP–SDP differences in mean number of diagnoses or in comorbid GAD symptoms measured with the GADSS. It gives a range of nonsignificant GADSS effect sizes, but the passages in our copy do not verify the quoted g = −0.29 or its 95% confidence interval. (LLM, conf=0.82)
Experimental — accuracy not yet measuredIn another study comparing the unified protocol to single disorder protocols for comorbid disorders, unified protocol participants had significant decreases in mean number of clinical diagnoses from baseline to posttreatment and to 12-month follow-up.
“In another study comparing the UP to SDPs for comorbid disorders, participants in the UP condition evidenced significant decreases in mean number of clinical diagnoses from baseline to post treatment and baseline to 12-month follow-up [96].”
From Psychotherapeutic treatments for generalized anxiety disorder: cognitive and behavioral therapies, enhancement strategies, and emerging efforts (2022) · cites this paper as [96]
The unified protocol has shown efficacy in both individual and group formats.
“In fact, this approach has shown its efficacy both in individual [9,10] and group [11,12] formats.”
From What format of treatment do patients with emotional disorders prefer and why? Implications for public mental health settings and policies (2019) · cites this paper as [10]
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- Authors
- Steele, S. J., Farchione, T. J., Cassiello-Robbins, C., Ametaj, A., Sbi, S., Sauer-Zavala, S., & Barlow, D. H.
- Affiliations
- Boston University (US)
- Corresponding author
- Steele, Stephanie Jarvi
- Venue
- Journal of Psychiatric Research
- Publisher
- Elsevier BV
- Published
- 2018-09
- Volume
- 104
- Pages
- 211-216
- ISSN
- 0022-3956 (ISSN-L)
- PMC
- PMC6219859
- OpenAlex
- W2885228589
- Cited by
- 97
- References
- 51
- Citations by year
- 2026: 10 · 2025: 9 · 2024: 9 · 2023: 11 · 2022: 19 · 2021: 14 · 2020: 13 · 2019: 8 · 2018: 4
- FWCI
- 13.09
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.elsevier.com/tdm/userlicense/1.0/ (tdm)
- www.elsevier.com/legal/tdmrep-license (tdm)
- www.elsevier.com/open-access/userlicense/1.0/ (am, 343 d)
- doi.org/10.15223/policy-017 (stm-asf)
- doi.org/10.15223/policy-037 (stm-asf)
- doi.org/10.15223/policy-012 (stm-asf)
- doi.org/10.15223/policy-029 (stm-asf)
- doi.org/10.15223/policy-004 (stm-asf)
- Locations
- Journal of Psychiatric Research (acceptedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- OpenBU (Boston University) (acceptedVersion)
- Smith ScholarWorks (Smith College) (submittedVersion)
- OpenBU (Boston University) (submittedVersion)
- Funders
- Oxford University Press, United Kingdom
- Guilford Publications Inc., United States
- Cengage Learning, United States
- Pearson Publishing, United Kingdom
- National Institute of Mental Health, United States (R01 MH090053)
- National Institute of Alcohol and Alcohol Abuse, United States (R01 AA023676)
- Agency for Healthcare Research and Quality, United States
- Foundation for Informed Medical Decision Making, United States
- Department of Defense, United States
- Renfrew Center, United States
- Chinese University of Hong Kong, Hong Kong
- Universidad Catolica de Santa Maria, Peru
- New Zealand Psychological Association, New Zealand
- Hebrew University of Jerusalem, Israel
- Mayo Clinic, United States
- 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 cognitive behavioral therapy, generalized anxiety disorder, social anxiety disorder, depression, panic disorder, treatment efficacy, outpatient psychotherapy, symptom relief
- MeSH terms
- Phobia, Social, Adolescent, Adult, Aged, Agoraphobia, Antisocial Personality Disorder, Female, Follow-Up Studies, Humans, Male, Middle Aged, Obsessive-Compulsive Disorder, Psychiatric Status Rating Scales, Comorbidity, Cognitive Behavioral Therapy, Panic Disorder, Treatment Outcome, Mood Disorders, Young Adult
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