Investigating the Effects of the Unified Protocol on Common and Specific Factors in a Comorbid Insomniac Sample: A Single-Case Experimental Design
Open accessAbstract
Background: Insomnia and emotional disorders share common factors that underlie and perpetuate these disorders. The Unified Protocol (UP) for transdiagnostic treatment of emotional disorders is a new treatment approach designed to target core processes of emotional disorders. Objectives: The present study examined the effects of UP on behavioral inhibition/behavioral activation, anxiety sensitivity, and emotion dysregulation as transdiagnostic factors, as well as cognition and behaviors specific to insomnia, in a small sample of patients (N = 6) with comorbid insomnia and emotional disorders. Methods: A multiple-baseline across subjects single-case experimental design with a 3-month follow-up was used. Participants were allocated to 2, 4, and 6 baseline periods and then received 14 weekly individual sessions of UP. The outcome measures were Behavioral Inhibition/Behavioral Activation Scales (BIS/BAS), Anxiety Sensitivity Index-3 (ASI-3), Difficulties in Emotion Regulation Scale (DERS), Dysfunctional Beliefs and Attitudes about Sleep Scale-10 (DBAS-10), and Sleep-Related Behaviors Questionnaire (SRBQ). Data were analyzed using visual inspection, mixed model analysis, and reliable change index (RCI). Results: Mixed model analysis showed significant changes in BIS/BAS, ASI-3, DERS, DBAS-10, and SRBQ from pre-treatment to post-treatment. Most participants achieved a reliable change in BIS, ASI-3, DERS, DBAS-10, and SRBQ at a 3-month follow-up. Conclusions: This preliminary study provides empirical evidence on the utility of UP for reducing common vulnerability and sleep-specific factors in chronic insomnia comorbid with emotional disorders. Further research is needed to test these findings in randomized controlled studies.
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One case study and one single case experimental design study both reported improvements in sleep onset latency and sleep quality.
“One case study and one single case experimental design study both reported improvements in sleep onset latency and sleep quality (39, 40)”
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 [40]
The Discussion (section 5; page unavailable) identifies this as a single-case experimental study and reports improvements in sleep-related beliefs and behaviors. It does not report improvements in sleep onset latency or sleep quality, the two outcomes attributed to the studies in the citing sentence. This paper also cannot establish what the separately cited case study found. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThe latter single case experimental design study also reported concomitant improvements in emotion regulation and negative emotionality/neuroticism.
“which the latter study also reported concomitant improvements in emotion regulation and negative emotionality/neuroticism (NNE).”
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 [40]
The Discussion reports significant reductions in emotion dysregulation and improvements in the temperamental measures BIS and BAS. But the study assessed temperament using BIS/BAS, not a measure of negative emotionality or neuroticism; the authors caution that their temperament findings may be limited to that measure. Thus the emotion-regulation improvement is supported, while the specific negative emotionality/neuroticism improvement is not established. (LLM, conf=0.88)
Experimental — accuracy not yet measuredResults of studies support the efficacy of UP in the treatment of emotional disorders in Iran and other countries.
“The results of studies support the efficacy of UP in the treatment of emotional disorders in Iran and other countries [2, 10, 14, 15, 23, 32].”
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References 70 · Cited by 7
Part of this paper’s reference list could not be split into single entries.
Research works printed but not linked: 3
- [37]37. First MB, Spitzer RL, Gibbon M, Williams JBW. Structured clinical interview for DSM-IV axis I disorders, clinician version (SCID-CV). Washington, D.C: American Psychiatric Press; 1996.
- [45]45. Khanzadeh M, Saeediyan M, Hosseinchari M, Edrissi F. Factor structure and psychometric properties of difficulties in emotion regulation scale. JBS. 2012;6(1):23-4.
- [48]48. Doos Ali Vand H, Gharraee B, Asgharnejad Farid AA, Rezvanifar S. Psychometric Properties of Short Form Persian Version of the Dysfunctional Beliefs and Attitudes about Sleep Scale. IJPCP. 2014;20(3):264-75. Persian.
- Authors
- Doos Ali Vand, H., Gharraee, B., Asgharnejad Farid, A.-A., Ghaleh Bandi, M. F., & Habibi, M.
- Affiliations
- Iran University of Medical Sciences (IR)
- Corresponding author
- Gharraee, Banafsheh
- Venue
- Iranian Journal of Psychiatry and Behavioral Sciences
- Publisher
- Brieflands
- Published
- 2018-07-23
- Volume
- In Press
- Issue
- In Press
- ISSN
- 1735-8639 (ISSN-L)
- 1735-9287
- OpenAlex
- W2884054602
- Cited by
- 7
- References
- 70
- Citations by year
- 2025: 2 · 2024: 1 · 2023: 1 · 2022: 2 · 2021: 1
- FWCI
- 0.33
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by-nc
- Locations
- Iranian Journal of Psychiatry and Behavioral Sciences (publishedVersion, cc-by-nc)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- Unified Protocol, transdiagnostic treatment, insomnia, emotional disorders, comorbidities, behavioral inhibition, behavioral activation, anxiety sensitivity, emotional dysregulation, dysfunctional beliefs about sleep, sleep-related behaviors, single-case experimental design
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