A preliminary evaluation of the unified protocol among trauma-exposed adults with and without PTSD
Open accessAbstract
The purpose of this study was to evaluate whether the Unified Protocol (UP)-a mechanistically transdiagnostic psychological treatment-provides benefit to individuals with a range of trauma histories, psychological difficulties, and diagnostic comorbidity. Using data from a sequential multiple-assignment randomized trial (SMART), this exploratory analysis included a sample of 69 community-recruited adults seeking outpatient mental health treatment. We examined reductions in anxiety and depressive symptoms and changes in aversive and avoidant reactions to intense emotions-the UP's putative mechanism-first by comparing individuals with and without trauma histories and then specifically among participants with PTSD. Findings suggest that the UP may lead to similar improvements in clinical diagnostic severity, anxiety, and depression among patients with trauma exposure as those without trauma exposure. Roughly half of participants with PTSD demonstrated reductions in PTSD clinical severity, anxiety, depression, and distress aversion, suggesting the UP may be an efficacious treatment for people with PTSD and comorbid conditions.
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?
A growing evidence base supports the utility of the UP for improving emotional and emotion-adjacent symptoms, including anxiety, depression, anger, substance misuse, self-injury, somatization, obsessive-compulsive symptoms, and trauma-related symptoms.
“A growing evidence base supports the utility of the UP for improving emotional and emotion-adjacent symptoms, including anxiety, depression, anger, substance misuse, self-injury, somatization, obsessive-compulsive symptoms, and trauma-related symptoms (26, 31–37).”
From Pilot outcomes and exploration of treatment mechanisms using a culturally adapted version of the unified protocol for transdiagnostic treatment of emotional disorders to improve mental health symptoms, alcohol misuse, functional outcomes, and sleep quality in emergency responders (2025) · cites this paper as [34]
The Results (§3.2, page not provided) report improvements in PTSD severity, anxiety, and depression after UP treatment, supporting those parts of the sentence. Our copy does not report UP-related improvements in anger, substance misuse, self-injury, somatization, or obsessive-compulsive symptoms. (LLM, conf=0.88)
Experimental — accuracy not yet measuredFour pilot studies have examined the UP as a treatment for PTSD, with all four demonstrating that the UP was associated with reductions in PTSD and other mental health symptoms.
“To date, four pilot studies have examined the UP as a treatment for PTSD, with all four demonstrating that the UP was associated with reductions in PTSD and other mental health symptoms (26, 34, 35, 37).”
From Pilot outcomes and exploration of treatment mechanisms using a culturally adapted version of the unified protocol for transdiagnostic treatment of emotional disorders to improve mental health symptoms, alcohol misuse, functional outcomes, and sleep quality in emergency responders (2025) · cites this paper as [34]
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
Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2008.08.010 · Cited by 51,384 · see citing works
Jacobson, N. S., & Truax, P. (1991) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.59.1.12 · Cited by 7,770 · see citing works
Blevins, C. A., Weathers, F. W., Davis, M. T., Witte, T. K., & Domino, J. L. (2015) · Journal of Traumatic Stress · doi:10.1002/jts.22059 · Cited by 5,233 · see citing works
Weathers, F. W., Bovin, M. J., Lee, D. J., Sloan, D. M., Schnurr, P. P., Kaloupek, D. G., Keane, T. M., & Marx, B. P. (2018) · Psychological Assessment · doi:10.1037/pas0000486 · Cited by 1,799 · see citing works
Trauma and PTSD in the WHO World Mental Health Surveys
Kessler, R. C., Aguilar-Gaxiola, S., Alonso, J., Benjet, C., Bromet, E. J., Cardoso, G., Degenhardt, L., de Girolamo, G., Dinolova, R. V., Ferry, F., et al. (2017) · European Journal of Psychotraumatology · doi:10.1080/20008198.2017.1353383 · Cited by 1,661 · 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 Psychiatric Sequelae of Traumatic Injury
Bryant, R. A., O'Donnell, M. L., Creamer, M., McFarlane, A. C., Clark, C. R., & Silove, D. (2010) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2009.09050617 · Cited by 843 · see citing works
Development 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
Gámez, W., Chmielewski, M., Kotov, R., Ruggero, C., & Watson, D. (2011) · Psychological Assessment · doi:10.1037/a0023242 · Cited by 524 · see citing works
Ursano, R. J. (2002) · American Journal of Psychiatry · doi:10.1176/appi.ajp.159.10.1805-a · Cited by 463 · see citing works
Emotion regulation and posttraumatic stress symptoms: a meta-analysis
Seligowski, A. V., Lee, D. J., Bardeen, J. R., & Orcutt, H. K. (2015) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2014.980753 · Cited by 408 · see citing works
Current Definitions of “Transdiagnostic” in Treatment Development: A Search for Consensus
Sauer-Zavala, S., Gutner, C. A., Farchione, T. J., Boettcher, H. T., Bullis, J. R., & Barlow, D. H. (2017) · Behavior Therapy · doi:10.1016/j.beth.2016.09.004 · Cited by 371 · 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
Tolin, D. F., Gilliam, C., Wootton, B. M., Bowe, W., Bragdon, L. B., Davis, E., Hannan, S. E., Steinman, S. A., Worden, B., & Hallion, L. S. (2018) · Assessment · doi:10.1177/1073191116638410 · Cited by 345 · 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
Thompson, B. L., & Waltz, J. (2010) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2010.02.005 · Cited by 264 · see citing works
Kessler, R. C., Rose, S., Koenen, K. C., Karam, E. G., Stang, P. E., Stein, D. J., Heeringa, S. G., Hill, E. D., Liberzon, I., McLaughlin, K. A., et al. (2014) · World Psychiatry · doi:10.1002/wps.20150 · Cited by 255 · see citing works
Maladaptive self-appraisals before trauma exposure predict posttraumatic stress disorder.
Bryant, R. A., & Guthrie, R. M. (2007) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.75.5.812 · Cited by 250 · see citing works
Cassiello-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
Mechanisms of anger and treatment outcome in combat veterans with posttraumatic stress disorder
Forbes, D., Parslow, R., Creamer, M. C., Allen, N. B., McHugh, T., & Hopwood, M. (2008) · Journal of Traumatic Stress · doi:10.1002/jts.20315 · Cited by 158 · see citing works
Remission from post-traumatic stress disorder in the general population
Chapman, C., Mills, K. L., Slade, T. N., McFARLANE, A. C., Bryant, R. A., Creamer, M., Silove, D. M., & Teesson, M. (2011) · Psychological Medicine · doi:10.1017/s0033291711002856 · Cited by 157 · see citing works
Ashamed and Afraid: A Scoping Review of the Role of Shame in Post-Traumatic Stress Disorder (PTSD)
Saraiya, T. C., & López‐Castro, T. (2016) · Journal of Clinical Medicine · doi:10.3390/jcm5110094 · Cited by 147 · see citing works
Au, T., Sauer-Zavala, S., King, M., Petrocchi, N., Barlow, D., & Litz, B. (2017) · The Behavior Therapist · doi:10.1016/j.beth.2016.11.012 · Cited by 142 · see citing works
Unified 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
Emergence of Transdiagnostic Treatments for PTSD and Posttraumatic Distress
Gutner, C. A., Galovski, T., Bovin, M. J., & Schnurr, P. P. (2016) · Current Psychiatry Reports · doi:10.1007/s11920-016-0734-x · Cited by 70 · see citing works
Murphy, D., & Smith, K. V. (2018) · Journal of Traumatic Stress · doi:10.1002/jts.22333 · Cited by 66 · see citing works
Distress tolerance and posttraumatic stress disorder: a systematic review and meta-analysis
Akbari, M., Hosseini, Z. S., Seydavi, M., Zegel, M., Zvolensky, M. J., & Vujanovic, A. A. (2021) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2021.1942541 · Cited by 65 · see citing works
Transdiagnostic mechanisms of change and cognitive-behavioral treatments for PTSD
Gallagher, M. W. (2016) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2016.12.002 · Cited by 61 · see citing works
Varkovitzky, R. L., Sherrill, A. M., & Reger, G. M. (2018) · Behavior Modification · doi:10.1177/0145445517724539 · Cited by 55 · see citing works
O'Donnell, M. L., Lau, W., Chisholm, K., Agathos, J., Little, J., Terhaag, S., Brand, R., Putica, A., Holmes, A. C. N., Katona, L., et al. (2021) · Journal of Traumatic Stress · doi:10.1002/jts.22650 · Cited by 49 · see citing works
Phelps, A. J., Steel, Z., Metcalf, O., Alkemade, N., Kerr, K., O'Donnell, M. L., Nursey, J., Cooper, J. A., Howard, A., Armstrong, R., et al. (2017) · Psychological Medicine · doi:10.1017/s0033291717001404 · Cited by 44 · see citing works
Posttraumatic Stress Disorder and Comorbidity: Untangling the Gordian Knot
Lockwood, E., & Forbes, D. (2014) · Psychological Injury and Law · doi:10.1007/s12207-014-9189-8 · Cited by 41 · see citing works
Gutner, C. A., Pedersen, E. R., & Drummond, S. P. A. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.02.045 · Cited by 40 · see citing works
Sauer-Zavala, S. E., Southward, M. W., Stumpp, N. E., Semcho, S., Hood, C. O., Garlock, A., & Urs, A. (2022) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2022.2053571 · Cited by 33 · see citing works
Norman, S. B., Allard, C. B., Trim, R. S., Thorp, S. R., Behrooznia, M., Masino, T. T., & Stein, M. B. (2013) · Archives of Women s Mental Health · doi:10.1007/s00737-012-0325-8 · Cited by 31 · see citing works
Gallagher, M. W., & Brown, T. A. (2014) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-014-9436-z · Cited by 27 · see citing works
Dimensions of skill use in the unified protocol: Exploring unique effects on anxiety and depression.
Southward, M. W., & Sauer-Zavala, S. E. (2021) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000701 · Cited by 27 · see citing works
Dealing with Complexity and Comorbidity: Opportunity for Transdiagnostic Treatment for PTSD
Gutner, C. A., & Presseau, C. (2019) · Current Treatment Options in Psychiatry · doi:10.1007/s40501-019-00170-2 · Cited by 25 · see citing works
Experimental Manipulations to Test Theory-Driven Mechanisms of Cognitive Behavior Therapy
Southward, M. W., & Sauer-Zavala, S. E. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.603009 · Cited by 17 · see citing works
Southward, M. W., Cassiello-Robbins, C. F., Zelkowitz, R. L., & Rosenthal, M. Z. (2020) · doi:10.31234/osf.io/rvbzn · Cited by 9 · see citing works
Hood, C. O., Jones, A. C., Flores, J., Badour, C. L., & Feldner, M. T. (2020) · Traumatology An International Journal · doi:10.1037/trm0000279 · Cited by 2 · see citing works
Flagged first, then by citations
1 of the 44 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Treatment of Posttraumatic Stress Disorder: A State-of-the-art Review
Burback, L., Brémault‐Phillips, S., Nijdam, M. J., McFARLANE, A. C., & Vermetten, E. H. G. J. M. (2023) · Current Neuropharmacology · doi:10.2174/1570159x21666230428091433 · Cited by 232 · see citing works
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
Unified protocol vs trauma-focused cognitive behavioral therapy among adolescents with PTSD
Mohajerin, B., Lynn, S. J., & Cassiello-Robbins, C. (2023) · Behavior Therapy · doi:10.1016/j.beth.2023.03.003 · Cited by 35 · see citing works
Castro-Camacho, L., Barlow, D. H., Mejía, N. G., Farchione, T. J., Idrobo, F., Rattner, M., Quant, D. M., González, L., & Moreno-Villamizar, J. D. (2023) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2023.2392 · Cited by 34 · see citing works
Elhusseini, S. A., Cravens, L. E., Southward, M. W., & Sauer-Zavala, S. (2022) · Journal of Behavioral and Cognitive Therapy · doi:10.1016/j.jbct.2021.12.001 · Cited by 7 · see citing works
Agathos, J. A., Putica, A., Steward, T., Felmingham, K. L., O'Donnell, M. L., Davey, C. G., & Harrison, B. J. (2024) · Psychiatry Research Neuroimaging · doi:10.1016/j.pscychresns.2024.111888 · Cited by 10 · see citing works
Southward, M. W., Lane, S. P., Shroyer, S. E., & Sauer-Zavala, S. (2023) · Journal of Mood & Anxiety Disorders · doi:10.1016/j.xjmad.2023.100022 · Cited by 6 · see citing works
Hood, C. O., Southward, M. W., Badour, C. L., & Sauer-Zavala, S. E. (2024) · Journal of Traumatic Stress · doi:10.1002/jts.23024 · Cited by 5 · see citing works
Putica, A., Agathos, J. A., & Felmingham, K. L. (2025) · Nature Reviews Psychology · doi:10.1038/s44159-025-00479-1 · Cited by 5 · see citing works
Torres, V. A., Coe, E., Jackson, J. E., Leonard, K., Rostockyj, J. A., Swensen, K., Meyer, E. C., Gulliver, S. B., & Jones, S. (2025) · Journal of Traumatic Stress · doi:10.1002/jts.23133 · Cited by 3 · see citing works
Meyer, E. C., Roth, S. G., Coe, E., Taylor, D. J., & Gulliver, S. B. (2025) · Frontiers in Health Services · doi:10.3389/frhs.2025.1452976 · Cited by 2 · see citing works
Jia, Y., Xu, Z., Yang, J.-M., Chai, J.-B., Li, W., Xu, H., & Li, X.-H. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1737322 · Cited by 3 · see citing works
Weinzimmer, S. A., Goetz, A. R., Guzick, A. G., Hana, L. M., Cepeda, S. L., Schneider, S. C., Kennedy, S. M., Nwankwo, G. N. A., Christian, C. C., Shaw, A. M., et al. (2022) · Community Mental Health Journal · doi:10.1007/s10597-022-00967-1 · Cited by 2 · see citing works
la Rosa-Gómez, A. D., Valencia, P. D., Díaz-Sosa, D. M., Flores-Plata, L. A., Flores, R. G., Torija, C. S. T., Portillo, A. M., Leal, A. M., Elvira, A. I. F., Esquivel-Santoveña, E. E., et al. (2026) · Contemporary Clinical Trials · doi:10.1016/j.cct.2026.108229 · Cited by 1 · see citing works
Meyer, E. C., Farchione, T. J., Kimbrel, N. A., Kwok, O., Pennington, M. L., Rostockyj, J. A., & Gulliver, S. B. (2025) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2025.101537 · Cited by 1 · see citing works
Grös, D. F., & Allan, N. P. (2025) · Behavior Therapy · doi:10.1016/j.beth.2025.09.012 · Cited by 1 · see citing works
Karlsson, A., Bäccman, C., Hallerbäck, M. U., & Støre, S. J. (2026) · European Journal of Trauma & Dissociation · doi:10.1016/j.ejtd.2026.100685
Jaipuriyar, 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
- Authors
- Hood, C. O., Southward, M. W., Bugher, C., & Sauer-Zavala, S.
- Affiliations
- University of Kentucky (US)
- Corresponding author
- Hood, Caitlyn O.
- Venue
- International Journal of Environmental Research and Public Health
- Publisher
- MDPI AG
- Published
- 2021-11-08
- Volume
- 18
- Issue
- 21
- Pages
- 11729
- ISSN
- 1660-4601 (ISSN-L)
- PMC
- PMC8583442
- OpenAlex
- W3211700575
- Cited by
- 18
- References
- 44
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 3 · 2023: 4 · 2022: 2
- FWCI
- 1.53
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- International Journal of Environmental Research and Public Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UKnowledge (University of Kentucky) (submittedVersion, cc-by)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Institute on Drug Abuse (T32 DA035200)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- Unified Protocol, trauma exposure, post-traumatic stress disorder, transdiagnostic treatment, emotion regulation, anxiety, depression, comorbidities, sequential multiple assignment randomized trial, outpatient psychiatric care
- MeSH terms
- Adult, Anxiety Disorders, Emotions, Humans, Psychotherapy, Stress Disorders, Post-Traumatic, Comorbidity
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
