Transdiagnostic Treatment Personalization: The Feasibility of Ordering Unified Protocol Modules According to Patient Strengths and Weaknesses
Abstract
Most patients in community practice attend significantly fewer sessions than are recommended by treatment protocols that have demonstrated efficacy in addressing emotional disorders. Personalized interventions that target the core processes thought to maintain a wide range of disorders may serve to increase treatment efficiency, addressing this gap. This study sought to evaluate the feasibility and acceptability of the personalized delivery of a mechanistically transdiagnostic intervention, the Unified Protocol (UP) for Transdiagnostic Treatment of Emotional Disorders. Using an AB phase change design in accordance with the single-case reporting guideline for behavioral interventions (SCRIBE), 18 individuals with heterogeneous emotional disorders were randomly assigned to receive UP treatment modules ordered according to either their pretreatment strengths or weaknesses. Results support the feasibility of reordering the treatment modules as the majority of patients presented with marked differences in skill levels, as well as the acceptability of this approach as patients in both conditions reported satisfaction with their assigned treatment order. Furthermore, the majority of patients demonstrated symptom improvement consistent with previously reported effects of the standard-order UP. Finally, there is preliminary evidence to suggest that those in the strengths condition displayed improvements in outcomes earlier in treatment than those in the weaknesses condition. Taken together, these findings offer preliminary support for improving treatment efficiency through the utilization of a personalized, strengths-based, transdiagnostic approach.
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The UP is a flexible treatment that allows modules to be adapted and tailored to the objectives and needs of each patient.
“Another advantage of the UP is that it is a flexible treatment that allows the modules to be adapted and tailored to the objectives and needs of each patient (Sauer-Zavala et al., 2019).”
From The Unified Protocol for Transdiagnostic Treatment of Perinatal Depression: A Case Study (2020) · cites this paper as Sauer-Zavala et al., 2019
Several transdiagnostic treatments have been developed to provide patients with a set of skills geared specifically toward common vulnerabilities.
“several transdiagnostic treatments have been developed to provide patients with a set of skills geared specifically toward common vulnerabilities [10].”
From Negative and positive affect regulation in a transdiagnostic internet-based protocol for emotional disorders: Randomized controlled trial (2021) · cites this paper as [10]
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“For example, psychological interventions for people with mental health disorders emphasize either identifying and remedying clients ’ de fi cits, or fi nding and leveraging their strengths (Sauer-Zavala et al. 2019).”
Péris-Baquero, Ó., Osma, J., & Martínez-Segura, V. (2022) · Anales de Psicología · doi:10.6018/analesps.484101 · Cited by 4 · see citing works
“Regarding patients, different studies on the acceptability of the UP in clinical samples have found high levels of acceptance and satisfaction (Bentley et al., 2018; Osma et al., 2019; Sauer-Zavala et al., 2019).”
BackgroundWhen and Under What Circumstances Does Neuroticism Change in the Unified Protocol?
Stumpp, N. E., Southward, M. W., Hines, A., Kushner, M. L., Schaeuffele, C., Fruhbauerova, M., Bridges, E., Rahman, A., & Sauer-Zavala, S. E. (2025) · Psychotherapy Research · doi:10.1080/10503307.2025.2521779 · Cited by 3 · see citing works
Self-citationHarnas, S. J., Booij, S. H., Csorba, I., Nieuwkerk, P. T., Knoop, H., & Braamse, A. M. J. (2023) · Journal of Cancer Survivorship · doi:10.1007/s11764-023-01423-z · Cited by 3 · see citing works
“A similar approach provided preliminary evidence that treatment based on this approach may be more efficient [27, 28].”
BackgroundPedro, L. M. R., de Oliveira, M. C. S., Pereira, M., Fonseca, A., & Canavarro, M. C. (2024) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-024-01391-1 · Cited by 4 · see citing works
“For example, studies suggest that individuals’ expectancies about treatment efficacy are associated with treatment outcomes (Constantino et al., 2012 ; Sauer-Zavala et al., 2018).”
BackgroundResultNassif, Y. B., Hamonnière, T., Rahioui, H., & Varescon, I. (2024) · Clinical Case Studies · doi:10.1177/15346501241307220 · Cited by 2 · see citing works
Ebert, C., Vogel, M., Gensichen, J., Reif, H., Grögor, L., Junker, L., Ehring, T. W., Hasan, A., Leucht, S., Lochbühler, K., et al. (2025) · Pilot and Feasibility Studies · doi:10.1186/s40814-025-01597-6 · Cited by 2 · see citing works
Must We Always Go Idiographic?
Kaiser, T., Herzog, P., Brakemeier, E.-L., & Golino, H. F. (2025) · Cognitive Therapy and Research · doi:10.1007/s10608-025-10672-4 · Cited by 2 · see citing works
Grasa, E., Corripio, I., Péris-Baquero, Ó., Roldán, A., Selma‐González, J., & Osma, J. (2023) · Clinical Case Studies · doi:10.1177/15346501231190912 · Cited by 3 · see citing works
Cognitive Reappraisal as a Potential Mechanism of Unified Protocol for Emotional Disorders
Tang, M., Long, L. J., Torre, M., Spencer-Laitt, D., Moreno-Villamizar, J. D., Barlow, D. H., & Farchione, T. J. (2025) · Behavior Therapy · doi:10.1016/j.beth.2025.04.005 · Cited by 2 · see citing works
Benuto, L. T., Reyes, S. R., Ramirez, V., Falcon-Ruiz, N., Villar, G., & Perez, O. F. R. (2025) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-025-02509-3 · Cited by 2 · see citing works
“Treatment was delivered in 16 sessions among two studies [26, 48]; another two articles delivered the UP within 12 sessions [42, 50] while two articles provided 5 treatment sessions [26, 51].”
Rivas-García, S., Paúl, N., Catena, A., & Caracuel, A. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1195765 · Cited by 1 · see citing works
“, 2020), and even when it is stated that this guide has been taken into account in the study design, the considered items are not specified (Sauer-Zavala et al., 2019; Sniewski et al., 2022).”
BackgroundReassessing Gender Bias in Borderline Personality Disorder Diagnoses
Holmes, M., & Hughes, J. S. (2025) · Women & Therapy · doi:10.1080/02703149.2025.2515014 · Cited by 1 · see citing works
Péris-Baquero, Ó., Moreno, J. D., Martínez‐García, L., González, J. P., & Osma, J. (2025) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.70154 · Cited by 1 · see citing works
Transdiagnostic Cognitive Behavioral Psychotherapy: Unified Protocol as an Example
Batmaz, S. (2023) · Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry · doi:10.18863/pgy.1064590 · Cited by 1 · see citing works
Schaeuffele, C., Bär, J., Buengener, I., Grafiadeli, R., Heuthaler, E., Strieder, J., Ziehn, P., Knaevelsrud, C., Renneberg, B., & Boettcher, J. (2021) · doi:10.31234/osf.io/fs4x8 · Cited by 1 · see citing works
Unified Protocol for Treatment of Depression
Bentley, K. H., Conklin, L. R., Boswell, J. F., Shapero, B. G., & Olesnycky, O. S. (2018) · Springer eBooks · doi:10.1007/978-3-319-97241-1_12
TRANSDİYAGNOSTİK BİLİŞSEL DAVRANIŞÇI TERAPİ: BİR ÖRNEK OLARAK BÜTÜNLEŞİK PROTOKOLPreprint
Batmaz, S. (2020) · doi:10.31234/osf.io/fvy83
Southward, M. W., Terrill, D. R., & Sauer-Zavala, S. E. (2022) · doi:10.31234/osf.io/h87em
Self-citationApplication of the Unified Protocol in Patients Who Have Undergone Bariatric Surgery
Ferreres-Galán, V., Quilez-Orden, A. B., Péris-Baquero, Ó., & Osma, J. (2023) · doi:10.1093/oso/9780197564295.003.0007
Individualized Psychotherapy: A Review
Uzun, N., & Yorulmaz, O. (2024) · Psikiyatride Guncel Yaklasimlar · doi:10.18863/pgy.1518900
Direct mapping of intervention to thought features: A Bayesian proof-of-concept study
Zainal, N. H., Webb, C. A., & Hallion, L. S. (2025) · Behaviour Research and Therapy · doi:10.1016/j.brat.2025.104717
Croom, H. E., Southward, M. W., & Sauer-Zavala, S. E. (2025) · Behavior Therapy · doi:10.31234/osf.io/4gwy5_v2
Self-citationJaipuriyar, V., Behari, K., Rashkovsky, K. T., Girard, R., Sherman, A. L., Chasten, N. T., Epshteyn, G., Lee, J., Helminen, E. C., & Scheer, J. R. (2026) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2026.101666
“…the emotional and interpersonal functions alcohol serves, increase awareness of emotion-driven drinking patterns, strengthen cognitive and behavioral flexibility, and develop alternative strategies for accessing connection, affirmation, and other valued emotional experiences [56,60 – 62,110 ,115 ].”
- Authors
- Sauer-Zavala, S., Cassiello-Robbins, C., Ametaj, A. A., Wilner, J. G., & Pagan, D.
- Affiliations
- Boston University (US)
- Corresponding author
- Sauer-Zavala, Shannon
- Venue
- Behavior Modification
- Publisher
- SAGE Publications
- Published
- 2018-05-10
- Volume
- 43
- Issue
- 4
- Pages
- 518-543
- ISSN
- 0145-4455 (ISSN-L)
- 1552-4167
- OpenAlex
- W2802949001
- Cited by
- 67
- References
- 50
- Citations by year
- 2026: 1 · 2025: 9 · 2024: 10 · 2023: 6 · 2022: 14 · 2021: 10 · 2020: 9 · 2019: 3 · 2018: 4 · 2017: 1
- FWCI
- 8.51
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behavior Modification (publishedVersion)
- PubMed (publishedVersion)
- 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
- transdiagnostic treatment, Unified Protocol, personalized treatment, strengths-based intervention, emotional disorders, treatment efficiency, treatment order, treatment acceptability, feasibility, single-case experimental design, community mental health
- MeSH terms
- Adolescent, Adult, Aged, Mental Disorders, Clinical Protocols, Feasibility Studies, Female, Humans, Male, Middle Aged, Cognitive Behavioral Therapy, Patient Satisfaction, Young Adult, Precision Medicine
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