Effectiveness of the internet-based Unified Protocol transdiagnostic intervention for the treatment of depression, anxiety and related disorders in a primary care setting: a randomized controlled trial
Open accessAbstract
Background: Research has shown that internet-based cognitive behavioural therapy (iCBT) can be a very promising solution to increase access to and the dissemination of evidence-based treatments to all of the population in need. However, iCBT is still underutilized in clinical contexts, such as primary care. In order to achieve the effective implementation of these protocols, more studies in ecological settings are needed. The Unified Protocol (UP) is a transdiagnostic CBT protocol for the treatment of emotional disorders, which includes depression, anxiety and related disorders, that has shown its efficacy across different contexts and populations. An internet-based UP (iUP) programme has recently been developed as an emerging internet-based treatment for emotional disorders. However, the internet-delivered version of the UP (iUP) has not yet been examined empirically. The current project seeks to analyse the effectiveness of the iUP as a treatment for depression, anxiety and related emotional disorders in a primary care public health setting. Methods: The current study will employ a parallel-group, randomized controlled trial design. Participants will be randomly assigned to (a) the internet-based Unified Protocol (iUP), or (b) enhanced waiting list control (eWLC). Randomization will follow a 2:1 allocation ratio, with sample size calculations suggesting a required sample of 120 (iUP=80; eWLC=40). The Mini-International Neuropsychiatric Interview (M.I.N.I.) will be used for assessing potential participants. The Overall Anxiety Severity and Impairment Scale (OASIS) and the Overall Depression Severity and Impairment Scale (ODSIS) as well as other standardized questionnaires will be used for assessments at baseline, 4 weeks, 8 weeks and 12 weeks from baseline and for the iUP condition during the follow-up. Discussion: Combining the advantages of a transdiagnostic treatment with an online delivery format may have the potential to significantly lower the burden of emotional disorders in public health primary care setting. Anxiety and depression, often comorbid, are the most prevalent psychological disorders in primary care. Because the iUP allows for the treatment of different disorders and comorbidity, this treatment could represent an adequate choice for patients that demand mental health care in a primary care setting. Trial registration: ISRCTN18056450 https://doi.org/10.1186/ISRCTN18056450.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Previous research on online UP and online interventions for AjD revealed a between-group effect size of d = 0.5 and a within-group effect size of d = 0.63.
“Previous research on an online UP intervention and online interventions for AjD has revealed a between-group effect size at the level of d = 0.5 and a within-group effect size at the level of d = 0.63 [42, 87].”
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 [87]
The Method > Sample size section uses a post-treatment between-group effect size of d = 0.5 for its power calculation, describing it as in line with previous research. The paper does not report a within-group effect size of d = 0.63 or link that figure to online interventions for adjustment disorder. No page number is available in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
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
The PHQ-9: Validity of a brief depression severity measure
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2001.016009606.x · Cited by 44,910 · see citing works
A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006) · Archives of Internal Medicine · doi:10.1001/archinte.166.10.1092 · Cited by 31,765 · see citing works
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005) · Archives of General Psychiatry · doi:10.1001/archpsyc.62.6.593 · Cited by 20,391 · see citing works
CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials
the CONSORT Group, Schulz, K. F., Altman, D. G., & Moher, D. (2010) · BMC Medicine · doi:10.1186/1741-7015-8-18 · Cited by 13,371 · see citing works
SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials
Chan, A.-W., Tetzlaff, J. M., Gotzsche, P. C., Altman, D. G., Mann, H., Berlin, J. A., Dickersin, K., Hrobjartsson, A., Schulz, K. F., Parulekar, W. R., et al. (2013) · BMJ · doi:10.1136/bmj.e7586 · Cited by 6,251 · see citing works
The Obsessive-Compulsive Inventory: Development and validation of a short version.
Foa, E. B., Huppert, J. D., Leiberg, S., Langner, R., Kichic, R., Hajcak, G., & Salkovskis, P. M. (2002) · Psychological Assessment · doi:10.1037/1040-3590.14.4.485 · Cited by 2,959 · see citing works
The Work and Social Adjustment Scale: a simple measure of impairment in functioning
Mundt, J. C., Marks, I. M., Shear, M. K., & Greist, J. M. (2002) · British Journal of Psychiatry · doi:10.1192/bjp.180.5.461 · Cited by 2,515 · see citing works
Eysenbach, G., & CONSORT-EHEALTH Group (2011) · Journal of Medical Internet Research · doi:10.2196/jmir.1923 · Cited by 1,863 · see citing works
Psychometric properties of the Social Phobia Inventory (SPIN): New self-rating scale
Connor, K. M., Davidson, J. R. T., Churchill, L. E., Sherwood, A., Weisler, R. H., & Foa, E. (2000) · British Journal of Psychiatry · doi:10.1192/bjp.176.4.379 · Cited by 1,624 · see citing works
Scaling-up treatment of depression and anxiety: a global return on investment analysis
Chisholm, D., Sweeny, K., Sheehan, P., Rasmussen, B., Smit, F., Cuijpers, P., & Saxena, S. (2016) · The Lancet Psychiatry · doi:10.1016/s2215-0366(16)30024-4 · Cited by 1,451 · see citing works
Findings from the Global Burden of Disease Study 2021
Murray, C. J. L. (2024) · The Lancet · doi:10.1016/s0140-6736(24)00769-4 · Cited by 1,071 · see citing works
Multicenter Collaborative Panic Disorder Severity Scale
Shear, M. K., Brown, T. A., Barlow, D. H., Money, R., Sholomskas, D. E., Woods, S. W., Gorman, J. M., & Papp, L. A. (1997) · American Journal of Psychiatry · doi:10.1176/ajp.154.11.1571 · Cited by 1,001 · see citing works
Self-citationAndrews, G., Basu, A., Cuijpers, P., Craske, M. G., McEvoy, P., English, C. L., & Newby, J. M. (2018) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2018.01.001 · Cited by 922 · see citing works
McHugh, R. K., & Barlow, D. H. (2010) · American Psychologist · doi:10.1037/a0018121 · Cited by 909 · see citing works
Self-citationBarlow, 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
Self-citationFeingold, A. (2009) · Psychological Methods · doi:10.1037/a0014699 · Cited by 851 · see citing works
The National Collaborating Centre for Mental Health
Kendall, T., & Pilling, S. (2004) · UCL Discovery (University College London) · Cited by 840 · see citing works
McHugh, R. K., Whitton, S. W., Peckham, A. D., Welge, J. A., & Otto, M. W. (2013) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.12r07757 · Cited by 800 · see citing works
Clinical Handbook of Psychological Disorders: A Step-by-Step Treatment Manual
Barlow, D. H. (2001) · Cited by 782 · see citing works
Self-citationDevelopment and validation of an Overall Anxiety Severity and Impairment Scale (OASIS)
Norman, S. B., Hami Cissell, S., Means-Christensen, A. J., & Stein, M. B. (2006) · Depression and Anxiety · doi:10.1002/da.20182 · Cited by 770 · see citing works
Cuijpers, P., Noma, H., Karyotaki, E., Vinkers, C. H., Cipriani, A., & Furukawa, T. A. (2020) · World Psychiatry · doi:10.1002/wps.20701 · Cited by 540 · see citing works
Campbell-Sills, L., Norman, S. B., Craske, M. G., Sullivan, G., Lang, A. J., Chavira, D. A., Bystritsky, A., Sherbourne, C., Roy-Byrne, P., & Stein, M. B. (2009) · Journal of Affective Disorders · doi:10.1016/j.jad.2008.03.014 · Cited by 382 · see citing works
Sakiris, N., & Berle, D. (2019) · Clinical Psychology Review · doi:10.1016/j.cpr.2019.101751 · Cited by 369 · see citing works
Development and validation of the overall depression severity and impairment scale
Bentley, K. H., Gallagher, M. W., Carl, J. R., & Barlow, D. H. (2014) · Psychological Assessment · doi:10.1037/a0036216 · Cited by 365 · see citing works
Self-citationAndersson, G., Carlbring, P., Titov, N., & Lindefors, N. (2019) · The Canadian Journal of Psychiatry · doi:10.1177/0706743719839381 · Cited by 324 · see citing works
Carlucci, L., Saggino, A., & Balsamo, M. (2021) · Clinical Psychology Review · doi:10.1016/j.cpr.2021.101999 · Cited by 234 · see citing works
McNicholas, F., Kelleher, I., Hedderman, E., Lynch, F., Healy, E., Thornton, T., Barry, E., Kelly, L. S., McDonald, J., Holmes, K., et al. (2021) · BJPsych Open · doi:10.1192/bjo.2021.48 · Cited by 209 · 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
Self-citationCassiello-Robbins, C., Southward, M. W., Tirpak, J. W., & Sauer-Zavala, S. (2020) · Clinical Psychology Review · doi:10.1016/j.cpr.2020.101852 · Cited by 179 · see citing works
Richards, D., Enrique, A., Eilert, N., Franklin, M., Palacios, J., Duffy, D., Earley, C., Chapman, J., Jell, G., Sollesse, S., et al. (2020) · npj Digital Medicine · doi:10.1038/s41746-020-0293-8 · Cited by 154 · see citing works
Self-citationUnified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide
Barlow, D. H., Farchione, T. J., Sauer-Zavala, S., Murray Latin, H., Ellard, K. K., Bullis, J. R., Bentley, K. H., Boettcher, H. T., & Cassiello-Robbins, C. (2017) · doi:10.1093/med-psych/9780190685973.001.0001 · Cited by 124 · see citing works
Self-citationThrive: the power of evidence-based psychological therapies
Rustin, M. (2015) · European Journal of Psychotherapy & Counselling · doi:10.1080/13642537.2014.1001163 · Cited by 119 · see citing works
Neuroticism and disorders of emotion: a new synthesis
Barlow, D. H., Curreri, A. J., & Woodard, L. S. (2021) · Current Directions in Psychological Science · doi:10.1177/09637214211030253 · Cited by 117 · see citing works
Self-citationBullis, J. R., Boettcher, H. T., Sauer-Zavala, S. E., Farchione, T. J., & Barlow, D. H. (2019) · Clinical Psychology Science and Practice · doi:10.1037/h0101755 · Cited by 113 · see citing works
Self-citationSteele, S. J., Farchione, T. J., Cassiello-Robbins, C., Ametaj, A., Sbi, S., Sauer-Zavala, S., & Barlow, D. H. (2018) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2018.08.005 · Cited by 97 · see citing works
Self-citationThrive: The Power of Evidence-Based Psychological Therapies
Layard, R. (2014) · Cited by 89 · see citing works
Ahern, E., Kinsella, S., & Semkovska, M. (2018) · Expert review of pharmacoeconomics & outcomes research · doi:10.1080/14737167.2018.1407245 · Cited by 68 · see citing works
Eilert, N., Enrique, A., Wogan, R., Mooney, O., Timulak, L., & Richards, D. (2021) · Depression and Anxiety · doi:10.1002/da.23115 · Cited by 60 · see citing works
Self-citationTulbure, B. T., Rusu, A., Sava, F. A., Sălăgean, N., & Farchione, T. J. (2018) · JMIR Mental Health · doi:10.2196/mental.8901 · Cited by 43 · see citing works
Self-citationGonzález-Robles, A., Díaz-García, A., García-Palacios, A., Roca, P., Ramos-Quiroga, J. A., & Botella, C. (2020) · Journal of Medical Internet Research · doi:10.2196/18220 · Cited by 40 · see citing works
Self-citationSchaeuffele, C., Homeyer, S. L., Perea, L., Scharf, L., Schulz, A., Knaevelsrud, C., Renneberg, B., & Boettcher, J. (2022) · PLoS ONE · doi:10.1371/journal.pone.0270178 · Cited by 39 · see citing works
Eustis, E. H., Gallagher, M. W., Wilner, J. G., Nauphal, M., Farchione, T. J., & Barlow, D. H. (2020) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2020.08.012 · Cited by 30 · see citing works
Self-citationSimon, N. A., Ploszajski, M., Lewis, C., Smallman, K., Roberts, N. P., Kitchiner, N., Brookes‐Howell, L., & Bisson, J. I. (2021) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12341 · Cited by 19 · see citing works
The prevalence and treatment of mental health conditions documented in general practice in Ireland
O’Doherty, J., Hannigan, A., Hickey, L., Meagher, D. J., Cullen, W., O’Connor, R., & O’Regan, A. (2018) · Irish Journal of Psychological Medicine · doi:10.1017/ipm.2018.48 · Cited by 8 · see citing works
The Handbook of Brief Therapies:A practical guide
Parry, S. L. (2019) · Cited by 4 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- [36]Barlow DH Farchione TJ Sauer-Zavala S Latin HM Ellard KK Bullis JR Unified protocol for transdiagnostic treatment of emotional disorders: Workbook (2nd ed) 2018 New York Oxford University Press
Cited by
Sorted by citations
State of the Science: The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders
Farchione, T. J., Long, L. J., Spencer-Laitt, D., Moreno-Villamizar, J. D., & Barlow, D. H. (2024) · Behavior Therapy · doi:10.1016/j.beth.2024.04.007 · Cited by 51 · see citing works
Self-citationQiu, Y.-F., Wu, M., Liu, J.-L., Li, C., Yu, Y.-Q., Zeng, L.-J., Yang, B.-X., & Yang, F. (2024) · Psychiatry Research · doi:10.1016/j.psychres.2024.116166 · Cited by 22 · see citing works
Screening tools assessing mental illness in primary care: A systematic review
Neulinger, B., Ebert, C., Lochbühler, K., Bergmann, A., Gensichen, J., & Lukaschek, K. (2024) · European Journal of General Practice · doi:10.1080/13814788.2024.2418299 · Cited by 16 · see citing works
Espinosa, V., Valiente, R. M., García-Escalera, J., Chorot, P., Arnáez, S., Schmitt, J. C., & Sandín, B. (2024) · Behaviour Research and Therapy · doi:10.1016/j.brat.2024.104560 · Cited by 15 · see citing works
Eustis, E. H., Nauphal, M., Jaso, B. A., Spencer-Laitt, D., Woodard, L. S., Farchione, T. J., & Barlow, D. H. (2024) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2024.07.003 · Cited by 5 · see citing works
Self-citationJuszczyk-Kalina, A., Holas, P., & Farchione, T. J. (2023) · Trials · doi:10.1186/s13063-023-07744-9 · Cited by 4 · see citing works
Self-citationBelanger, H. G., Long, L. J., Winsberg, M. E., Sullivan, S., Farchione, T. J., & O’Callaghan, E. (2023) · Psychotherapy Research · doi:10.1080/10503307.2023.2174460 · Cited by 3 · see citing works
Self-citationKarpov, B., Lipsanen, J. O., Ritola, V., Rosenström, T. H., Saarni, S. E., Pihlaja, S., Stenberg, J., Laizane, P., & Joffe, G. (2023) · Journal of Medical Internet Research · doi:10.2196/45362 · Cited by 3 · see citing works
Long, L. J., Cardona, N. D., Hey, A. J., Moreno-Villamizar, J. D., Barlow, D. H., & Farchione, T. J. (2025) · Psychotherapy Research · doi:10.1080/10503307.2025.2523479 · Cited by 2 · see citing works
Self-citationMirtabar, S. M., Barat, S., Kheirkhah, F., Mostafazadeh, A., Shirafkan, H., Pahlavan, Z., & Faramarzi, M. (2024) · Iranian Journal of Psychiatry and Behavioral Sciences · doi:10.5812/ijpbs-147292 · Cited by 2 · see citing works
Feasibility and acceptability of a brief, online transdiagnostic psychotherapy for young adults.
Dimitropoulos, G., Lindenbach, D., Rowbotham, M., Devoe, D. J. A., Richardson, A., Mogan, T., Patten, S. B., Ehrenreich, J. T., & Arnold, P. D. (2023) · PubMed Central · Cited by 2 · see citing works
Péris-Baquero, Ó., Fadrique‐Jiménez, A., Martínez-García, L., Prieto‐Rollan, I., & Osma, J. (2025) · Current Psychology · doi:10.1007/s12144-025-07715-0 · Cited by 1 · see citing works
Ebert, C., Vogel, M., Gensichen, J., Reif, H., Junker, L., Grögor, L., Padberg, F., Falkai, P., Ehring, T. W., Hasan, A., et al. (2026) · BMC Family Practice · doi:10.1186/s12875-026-03377-4 · Cited by 1 · see citing works
Anxiety, for better or for worse
Herrera-Solís, A., Hernández-Lira, A., Ruiz‐Contreras, A. E., Ostos‐Valverde, A., Sánchez‐Zavaleta, R., Arellano-García, L., & Prospero-Garcia, O. E. (2026) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2026.111748 · Cited by 1 · see citing works
Exploring service user attitudes towards mental health technologies
Fitzpatrick, P. J., Dhondt, N., Thuery, G., O’Brien, D., Ledden, K., Young, G. W., Gillan, C. M., Harkin, A., & Kelly, J. R. (2026) · Irish Journal of Psychological Medicine · doi:10.1017/ipm.2026.10170
Evaluating Hope as a Mechanism of Change in the Treatment of Depression
Teplow, D. A., Long, L. J., Williams, A., Moreno-Villamizar, J. D., Hey, A. J., BOSCHULTE, M., Spencer-Laitt, D., & Farchione, T. J. (2026) · Cognitive Therapy and Research · doi:10.1007/s10608-026-10721-6
Self-citationMoreno, E. M., Gálvez‐Lara, M., Carrasco, R. B., Jurado-González, F. J., Moriana, J. A., & Corpas, J. (2026) · Acta Psychologica · doi:10.1016/j.actpsy.2026.106638
Yacoub, M. (2026) · Clinical Gerontologist · doi:10.1080/07317115.2026.2679577
Timulák, L., Griffin, L., Healy, P., O'Brien, S., Rice, C., Ke, Q., Kearney, A., Byrne, G., Connon, G., Ruane, S., et al. (2026) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2026.2749791
Self-citation
- Authors
- Timulak, L., Richards, D., Bhandal-Griffin, L., Healy, P., Azevedo, J., Connon, G., Martin, E., Kearney, A., O’Kelly, C., Enrique, A., Eilert, N., O’Brien, S., Harty, S., González-Robles, A., Eustis, E. H., Barlow, D. H., & Farchione, T. J.
- Affiliations
- Trinity College Dublin (IE)
- Health Service Executive (IE)
- Universidad de Zaragoza (ES)
- Boston University (US)
- ORCID
- Venue
- Trials
- Published
- 2022-08-31
- Volume
- 23
- Issue
- 1
- Pages
- 721-721
- ISSN
- 1745-6215 (ISSN-L)
- PMC
- PMC9429701
- OpenAlex
- W4293767748
- Cited by
- 19
- References
- 46
- Citations by year
- 2026: 7 · 2025: 2 · 2024: 6 · 2023: 4
- Type
- conference abstract
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Trials (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Trinity's Access to Research Output (TARA) (Trinity College Dublin) (submittedVersion, cc-by)
- Zaguan (University of Zaragoza Repository) (submittedVersion, cc-by)
- Funders
- SilverCloud Health
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- internet-based cognitive behavioral therapy, Unified Protocol, transdiagnostic treatment, depression, anxiety, primary care, online intervention, emotional disorders, comorbidities, waitlist control
- MeSH terms
- Internet-Based Intervention, Anxiety, Anxiety Disorders, Depression, Humans, Primary Health Care, Treatment Outcome, Internet
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
