Unified protocol for the Transdiagnostic treatment of emotional disorders in medical conditions: a systematic review
Open accessAbstract
Emotional disorders are those that most commonly present comorbidly with medical conditions. The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP), a cognitive-behavioral emotion-based intervention, has proven efficacy and versatility. The aim of this systematic review is to know the current (research studies) and future research interest (study protocols) in using the UP for the transdiagnostic treatment of emotional symptoms or disorders (EDs) in people with a medical condition. Using the PRISMA guidelines, a literature search was conducted in Web of Science, PubMed, Medline, and Dialnet. The nine research studies included in this review indicated that the UP is effective in treating emotional symptomatology in a population with a medical condition (effect sizes ranging from d = −3.34 to d = 2.16). The three included study protocols suggest interest in the future UP application to different medical conditions, and also in distinct application formats. Our review results are encouraging, and conducting more controlled studies is advised to recommend the UP to treat and/or prevent EDs in medical conditions, especially in children and youths.
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The majority of studies examining the effectiveness of psychological interventions for emotional distress in CID focus on one emotional disorder within one specific disease or condition.
“the majority of studies examining the effectiveness of psychological interventions for emotional distress in CID focus on one emotional disorder (e.g., depression, anxiety) within one specific disease or condition (Osma, Martínez-García, Quilez-Orden, & Peris- Baquero, 2021).”
From Attachment insecurity predicts outcomes in an ACT-CBT group therapy for adults in a physical rehabilitation centre (2022) · cites this paper as Osma, Martínez-García, Quilez-Orden, & Peris- Baquero, 2021
The Introduction (page unavailable) discusses protocols designed to treat specific emotional disorders and reports intervention evidence for patients with medical conditions. It does not say that a majority of effectiveness studies focus on one emotional disorder within one specific disease or condition. The Results (§3.2; page unavailable) describe only the transdiagnostic studies included in this review, not the broader distribution of psychological-intervention studies. (LLM, conf=0.79)
Experimental — accuracy not yet measuredThe UP could help manage EDs in individuals with comorbid medical conditions such as HIV, cancer, chronic pain or multiple sclerosis.
“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 Osma et al., 2021
The Spanish version of ODSIS has excellent internal consistency (α = 0.94).
“Excellent internal consistency was found in the Spanish version of this instrument (α = 0.94; Osma et al., 2021).”
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 Osma et al., 2021
The Methods (section 2.3) describe collecting studies’ measures and outcomes, but the retrieved passages do not discuss the Spanish ODSIS’s reliability. Searches for ODSIS, internal consistency, and α = 0.94 found no passage supporting the claimed value. (LLM, conf=0.75)
Experimental — accuracy not yet measuredThe Spanish validation of MEDI has excellent internal consistency (0.74 ≥ α ≤ 0.92).
“Excellent internal consistency was found in the Spanish validation (0.74 ≥ α ≤ 0.92; Osma et al., 2021).”
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 Osma et al., 2021
The Methods and Results passages concern a systematic review of Unified Protocol treatment studies, not a Spanish validation of MEDI. Searches for MEDI, Spanish validation, internal consistency, and the reported alpha values found no passage in our copy addressing the claim. (LLM, conf=0.76)
Experimental — accuracy not yet measuredThe Spanish version of OASIS has good internal consistency (α = 0.87).
“Good internal consistency was found in the Spanish version of this instrument (α = 0.87; Osma et al., 2021).”
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 Osma et al., 2021
The Methods section discusses assessment of study quality, and the Results section reports risk-of-bias ratings, not the reliability of OASIS. Searches for OASIS, its full name, and α = 0.87 found no passage in our copy addressing the Spanish instrument’s internal consistency. (LLM, conf=0.76)
Experimental — accuracy not yet measured
Some evidence supports transdiagnostic psychological interventions for emotional distress in CID-specific groups.
“Some evidence supports transdiagnostic psychological interventions for emotional distress in CID-specific groups (see Osma et al., 2021 for a systematic review of nine studies and three protocols)”
From Attachment insecurity predicts outcomes in an ACT-CBT group therapy for adults in a physical rehabilitation centre (2022) · cites this paper as Osma et al., 2021
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Botchway-Commey, E. N., Burton, C., Pace, C. C., Ehrenreich, J. T., Kennedy, S. M., Williams, J. S., Poulakis, Z., DPsychClin, A. M., Anderson, V. A., & Crowe, L. M. (2025) · BMC Psychology · doi:10.1186/s40359-025-03052-w
Nateghi, N., Younesi, S. J., Khanjani, M. S., Saed, O., Rasouli, A., & Baytamar, J. M. (2025) · Journal of Diabetes & Metabolic Disorders · doi:10.1007/s40200-025-01815-1
la Rosa-Gómez, A. D., Valencia, P. D., Flores-Plata, L. A., Hernández-Orduña, O., Hernández-Posadas, A., & Rodríguez, A. D. (2026) · Springer eBooks · doi:10.1007/978-3-032-08980-9_18
Mirtabar, S. M., Barat, S., Kheirkhah, F., Mostafazadeh, A., Shirafkan, H., Pahlavan, Z., & Faramarzi, M. (2026) · Counselling and Psychotherapy Research · doi:10.1002/capr.70173
- Authors
- Osma, J., Martínez-García, L., Quilez-Orden, A., & Peris-Baquero, Ó.
- Affiliations
- Universidad de Zaragoza (ES)
- Department of Psychology and Sociology, Universidad de Zaragoza, C/Atarazanas, 4, 44003 Teruel, Spain
- Corresponding author
- Osma, Jorge
- Venue
- International Journal of Environmental Research and Public Health
- Publisher
- MDPI AG
- Published
- 2021-05-11
- Volume
- 18
- Issue
- 10
- Pages
- 5077
- ISSN
- 1660-4601 (ISSN-L)
- PMC
- PMC8151777
- OpenAlex
- W3163816147
- Cited by
- 34
- References
- 55
- Citations by year
- 2026: 3 · 2025: 10 · 2024: 7 · 2023: 9 · 2022: 5
- FWCI
- 0.86
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- International Journal of Environmental Research and Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Zaguan (University of Zaragoza Repository) (publishedVersion, other-oa)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Gobierno de Aragón (Departamento de Ciencia, Universidad y Sociedad del Conocimiento) y FEDER "Construyendo Europa desde Aragón" (Research team S31_20D)
- 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 › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- Unified Protocol, transdiagnostic treatment, emotional disorders, health conditions, comorbidities, emotion-focused interventions, children and adolescents, treatment efficacy, prevention
- MeSH terms
- Adolescent, Child, Clinical Protocols, Emotions, Humans, Cognitive Behavioral Therapy, Treatment Outcome, Mood Disorders
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