Targeting Comorbid Anxiety and Depression Using the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents
Abstract
This article presents the use of an emotion-focused, transdiagnostic therapy approach designed for adolescents with a range of anxiety, obsessive-compulsive, depressive, and related disorders, referred to here as emotional disorders. Preliminary work suggests that emotional disorders share underlying temperament factors, such as high neuroticism and low extroversion in adults and adolescents, possibly influencing the development and maintenance of emotional disorders across the life span. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) and similar core dysfunction-focused, transdiagnostic therapy approaches may lead to successful treatment by targeting higher order factors that cut across an array of emotional disorders The utility of UP-A for adolescents experiencing a variety of emotional disorder symptoms is demonstrated here through the case illustration of Tony, a 15-year-old adolescent male with severe social and generalized anxiety and mild levels of depression. After 16 individual treatment sessions, Tony demonstrated significant reductions in anxiety and depressive symptoms, as well as an ability to respond more adaptively to a range of emotional experiences. This case study illustrates how short-term, transdiagnostic treatment using the UP-A can effectively ameliorate a wide range of emotional disorder symptoms in adolescents and may also lead to changes in core features of neuroticism, potentially preventing development of further emotional difficulties over time.
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Some shared mechanisms of emotional disorders are high neuroticism, low extraversion, anxiety sensitivity, intolerance of uncertainty, avoidance behaviors, and rumination.
“Some of these mechanisms are the personality dimensions of high neuroticism and low extraversion, anxiety sensitivity, intolerance of uncertainty, avoidance behaviors, and rumination, among others (Sherman et al., 2018).”
From The Unified Protocol for Transdiagnostic Treatment of Perinatal Depression: A Case Study (2020) · cites this paper as Sherman et al., 2018
The UP has been shown to be a valid intervention for the treatment of emotional disturbance in previous studies.
“The UP, based on shared temperamental factors (Sherman et al., 2018), has been shown to be a valid intervention for the treatment of emotional disturbance in previous studies (Barlow et al., 2017).”
From The Unified Protocol for Transdiagnostic Treatment of Perinatal Depression: A Case Study (2020) · cites this paper as Sherman et al., 2018
Adolescents who experience anxiety symptoms are more likely to be at risk for an anxiety disorder or depression.
“Adolescents who experience anxiety symptoms are more likely to be at risk for an anxiety disorder or depression [37].”
Cites
Diagnostic and Statistical Manual of Mental Disorders
American Psychiatric Association (2013) · doi:10.1176/appi.books.9780890425596 · Cited by 116,369 · see citing works
Development and validation of brief measures of positive and negative affect: The PANAS scales.
Watson, D., Clark, L. A., & Tellegen, A. (1988) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.54.6.1063 · Cited by 32,433 · see citing works
(1976) · Medical Entomology and Zoology · Cited by 8,899 · see citing works
Motivational interviewing: preparing people for change.
Miller, W. R., & Rollnick, S. (2002) · Cited by 7,002 · see citing works
The empirical status of cognitive-behavioral therapy: A review of meta-analyses
Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006) · Clinical Psychology Review · doi:10.1016/j.cpr.2005.07.003 · Cited by 3,215 · see citing works
Chorpita, B. F., Yim, L., Moffitt, C., Umemoto, L. A., & Francis, S. E. (2000) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(99)00130-8 · Cited by 1,966 · see citing works
Angold, A., Costello, E. J., & Erkanli, A. (1999) · Journal of Child Psychology and Psychiatry · doi:10.1111/1469-7610.00424 · Cited by 1,872 · see citing works
The Distress Tolerance Scale: Development and Validation of a Self-Report Measure
Simons, J. S., & Gaher, R. M. (2005) · Motivation and Emotion · doi:10.1007/s11031-005-7955-3 · Cited by 1,730 · see citing works
Cognitive Therapy of Depression
Fischer, H. (1980) · Psychosomatics · doi:10.1016/s0033-3182(80)73639-3 · Cited by 1,612 · see citing works
(2014) · Cited by 1,541 · see citing works
SILVERMAN, W. K., SAAVEDRA, L. M., & PINA, A. A. (2001) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-200108000-00016 · Cited by 1,190 · see citing works
Evidence‐Based Psychotherapies for Children and Adolescents
Woolgar, M. (2011) · Child and Adolescent Mental Health · doi:10.1111/j.1475-3588.2011.00617_11.x · Cited by 1,094 · see citing works
Comorbidity of anxiety and depression in children and adolescents: 20 years after
Cummings, C. M., Caporino, N. E., & Kendall, P. C. (2014) · Psychological Bulletin · doi:10.1037/a0034733 · Cited by 1,028 · see citing works
Barlow, D. H., Farchione, T. J., Bullis, J. R., Gallagher, M. W., Murray-Latin, H., Sauer-Zavala, S., Bentley, K. H., Thompson-Hollands, J., Conklin, L. R., Boswell, J. F., et al. (2017) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2017.2164 · Cited by 853 · see citing works
The Nature, Diagnosis, and Treatment of Neuroticism: Back to the Future
Barlow, D. H., Sauer-Zavala, S., Carl, J. R., Bullis, J. R., & Ellard, K. K. (2014) · Clinical Psychological Science · doi:10.1177/2167702613505532 · Cited by 850 · see citing works
Comorbidity of anxiety and depression in children and adolescents
Brady, E. U., & Kendall, P. C. (1992) · Psychological Bulletin · doi:10.1037/0033-2909.111.2.244 · Cited by 748 · see citing works
Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: A Randomized Controlled Trial
Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L., Thompson-Hollands, J., Carl, J. R., Gallagher, M. W., & Barlow, D. H. (2012) · Behavior Therapy · doi:10.1016/j.beth.2012.01.001 · Cited by 746 · see citing works
Wood, J. J., Piacentini, J. C., Bergman, R. L., McCracken, J., & Barrios, V. (2002) · Journal of Clinical Child & Adolescent Psychology · doi:10.1207/s15374424jccp3103_05 · Cited by 594 · see citing works
Weisz, J. R., Chorpita, B. F., Frye, A. A., Ng, M. Y., Lau, N., Bearman, S. K., Ugueto, A. M., Langer, D. A., & Hoagwood, K. (2011) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0023307 · Cited by 385 · see citing works
Journal of Psychopathology and Behavioral Assessment
(2013) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/10862.1573-3505 · Cited by 376 · see citing works
A twin study of anxiety-related behaviours in pre-school children
Eley, T. C., Bolton, D., O'Connor, T. G., Perrin, S., Smith, P., & Plomin, R. (2003) · Journal of Child Psychology and Psychiatry · doi:10.1111/1469-7610.00179 · Cited by 318 · see citing works
MIDDELDORP, C. M., CATH, D. C., VAN DYCK, R., & BOOMSMA, D. I. (2005) · Psychological Medicine · doi:10.1017/s003329170400412x · Cited by 316 · see citing works
Wilamowska, Z. A., Thompson-Hollands, J., Fairholme, C. P., Ellard, K. K., Farchione, T. J., & Barlow, D. H. (2010) · Depression and Anxiety · doi:10.1002/da.20735 · Cited by 314 · see citing works
LYNEHAM, H. J., ABBOTT, M. J., & RAPEE, R. M. (2007) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/chi.0b013e3180465a09 · Cited by 307 · see citing works
Ehrenreich-May, J., Rosenfield, D., Queen, A. H., Kennedy, S. M., Remmes, C. S., & Barlow, D. H. (2017) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.10.006 · Cited by 208 · see citing works
Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide
Barlow, D. H., Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L., Allen, L. B., & Ehrenreich May, J. T. (2010) · doi:10.1093/med:psych/9780199772667.001.0001 · Cited by 208 · see citing works
Development of a Unified Protocol for the Treatment of Emotional Disorders in Youth
Ehrenreich, J. T., Goldstein, C. R., Wright, L. R., & Barlow, D. H. (2009) · Child & Family Behavior Therapy · doi:10.1080/07317100802701228 · Cited by 197 · see citing works
Self-citationCognitive behavioural therapy for anxiety disorders in children and adolescents: a meta-analysis
Ishikawa, S., Okajima, I., Matsuoka, H., & Sakano, Y. (2007) · Child and Adolescent Mental Health · doi:10.1111/j.1475-3588.2006.00433.x · Cited by 176 · see citing works
Preliminary Validation of the Positive and Negative Affect Schedule with Adolescents
Huebner, E. S., & Dew, T. (1995) · Journal of Psychoeducational Assessment · doi:10.1177/073428299501300307 · Cited by 172 · see citing works
Practitioner Review: Empirical evolution of youth psychotherapy toward transdiagnostic approaches
Marchette, L. K., & Weisz, J. R. (2017) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12747 · Cited by 156 · see citing works
Boomsma, D. I., Beijsterveldt, C. E. M. V., & Hudziak, J. J. (2005) · Genes Brain & Behavior · doi:10.1111/j.1601-183x.2005.00141.x · Cited by 133 · see citing works
Bullis, J. R., Fortune, M. R., Farchione, T. J., & Barlow, D. H. (2014) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2014.07.016 · Cited by 130 · see citing works
Distress Tolerance Scale: A confirmatory factor analysis among daily cigarette smokers
Leyro, T. M., Bernstein, A., Vujanovic, A. A., McLeish, A. C., & Zvolensky, M. J. (2011) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-010-9197-2 · Cited by 130 · see citing works
(2014) · Cited by 125 · see citing works
Preadolescent Clues to Understanding Depression in Girls
Keenan, K., & Hipwell, A. E. (2005) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-005-4750-3 · Cited by 118 · see citing works
Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents
Ehrenreich, J. T., Kennedy, S. M., Sherman, J. A., Bilek, E. L., Buzzella, B. A., Bennett, S. M., & Barlow, D. H. (2017) · Oxford University Press eBooks · doi:10.1093/med-psych/9780199340989.001.0001 · Cited by 112 · see citing works
Self-citationBilek, E. L., & Ehrenreich-May, J. (2012) · Behavior Therapy · doi:10.1016/j.beth.2012.04.007 · Cited by 108 · see citing works
Mindfulness‐Integrated CBT: Principles and Practice
Cayoun, B. A. (2011) · doi:10.1002/9781119993162 · Cited by 86 · see citing works
Queen, A. H., Barlow, D. H., & Ehrenreich-May, J. (2014) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2014.05.007 · Cited by 73 · see citing works
Zigarelli, J. C., Jones, J. M., Palomino, C. I., & Kawamura, R. (2016) · Clinical Case Studies · doi:10.1177/1534650116664984 · Cited by 45 · see citing works
Kennedy, S. M., & Ehrenreich, J. T. (2016) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-016-9581-7 · Cited by 23 · see citing works
Using motivational interviewing techniques to talk with clients about their alcohol use
Sobell, L. C., & Sobell, M. B. (2003) · Cognitive and Behavioral Practice · doi:10.1016/s1077-7229(03)80033-0 · Cited by 15 · see citing works
Brief Behavioral Activation for Adolescent Depression
Pass, L., Whitney, H., & Reynolds, S. A. (2016) · Clinical Case Studies · doi:10.1177/1534650116645402 · Cited by 13 · see citing works
Flagged first, then by citations
1 of the 45 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Yan, K., Yusufi, M. H., & Nazari, N. (2022) · World Journal of Clinical Cases · doi:10.12998/wjcc.v10.i24.8599 · Cited by 16 · see citing works
The Unified Protocol for Transdiagnostic Treatment of Perinatal Depression: A Case Study
Crespo-Delgado, E., Martínez-Borba, V., & Osma, J. (2020) · Clinical Case Studies · doi:10.1177/1534650120951266 · Cited by 14 · see citing works
“The UP, based on shared temperamental factors (Sherman et al., 2018), has been shown to be a valid intervention for the treatment of emotional disturbance in previous studies (Barlow et al., 2017).”
BackgroundJavadi, V., Ahmadi, F., Ebrahimi, L. S., Dadashi, M., & Mousavi, S. E. (2024) · BMC Psychology · doi:10.1186/s40359-024-01735-4 · Cited by 15 · see citing works
“Adolescents who experience anxiety symptoms are more likely to be at risk for an anxiety disorder or depression [37].”
BackgroundResultHarris, K. R., & Norton, P. J. (2019) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2019.101487 · Cited by 12 · see citing works
Alaee, E. Q., Saed, O., Khakpoor, S., Ahmadi, R., Mohammadi, M. A., Afrashteh, M. Y., & Morovati, Z. (2022) · Research in Psychotherapy Psychopathology Process and Outcome · doi:10.4081/ripppo.2022.588 · Cited by 12 · see citing works
Dimitropoulos, G., Lindenbach, D., Anderson, A., Rowbotham, M., Wang, E., Heintz, M., Ehrenreich, J. T., & Arnold, P. D. (2023) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2023.106487 · Cited by 9 · see citing works
Harris, K. R., & Norton, P. J. (2018) · Clinical Case Studies · doi:10.1177/1534650118793938 · Cited by 7 · see citing works
Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents
Roberts, A. G., Taylor-Cavelier, S. J., Díaz, K. I., Codd, E. L., Hawks, J. L., & Kennedy, S. M. (2025) · Advances in Psychiatry and Behavioral Health · doi:10.1016/j.ypsc.2025.02.004 · Cited by 5 · see citing works
Naeimijoo, P., Arani, A. M., Bakhtiari, M., & Farsani, G. M. (2022) · Medical Science · doi:10.54905/disssi/v26i119/ms38e1978 · Cited by 2 · see citing works
Gutzweiler, R., Schwarz, D., & In‐Albon, T. (2020) · Verhaltenstherapie · doi:10.1159/000508454 · Cited by 2 · see citing works
D'Arcy, S., & Norton, P. J. (2021) · Behaviour Change · doi:10.1017/bec.2020.20 · Cited by 2 · see citing works
Kelner, W. C., Bush, J. B., & Elledge, L. C. (2024) · Clinical Case Studies · doi:10.1177/15346501241231830 · Cited by 1 · see citing works
Muhammad, A., Ali, S., Afaq, R. M., & Shabbir, H. (2026) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000454 · Cited by 1 · see citing works
Use of the C.A.T. Project for a Socially Anxious Teenager: Lessons Learned From Manual Modification
McClain, C. M., Bolden, J., & Elledge, L. C. (2019) · Clinical Case Studies · doi:10.1177/1534650119874398 · Cited by 1 · see citing works
Javadi, V., Ahmadi, F., Ebrahimi, L. S., Dadashi, M., & Mousavi, S. E. (2023) · Research Square · doi:10.21203/rs.3.rs-2511046/v1
Zavareh, M. H., Isfahani, M. B., & Sajjadian, I. (2025) · International Journal of Preventive Medicine · doi:10.4103/ijpvm.ijpvm_163_24
- Authors
- Sherman, J. A., Tonarely, N. A., & Ehrenreich-May, J.
- Affiliations
- University of Miami (US)
- University of Miami, Coral Gables, FL, USA
- Corresponding author
- Sherman, Jamie A.
- ORCID
- Sherman, Jamie A.
- Venue
- Clinical Case Studies
- Publisher
- SAGE Publications
- Published
- 2018-01-24
- Volume
- 17
- Issue
- 2
- Pages
- 59-76
- ISSN
- 1534-6501 (ISSN-L)
- 1552-3802
- OpenAlex
- W2791570362
- Cited by
- 16
- References
- 45
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 2 · 2022: 3 · 2021: 1 · 2020: 2 · 2019: 2 · 2018: 1
- FWCI
- 1.96
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Case Studies (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- transdiagnostic treatment, comorbid depression and anxiety, adolescents, social anxiety, generalized anxiety disorder, obsessive-compulsive disorder, neuroticism, temperament, emotion-focused therapy, brief psychotherapy, case examples
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