Treating Multiple Anxiety Issues with a Single Treatment
The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) is a transdiagnostic treatment for emotional disorders, meaning it was designed to be used for all issues of emotion, including all forms of depression and anxiety. This treatment is administered in 16 sessions, and, according to the creators, represents “a more efficient and possibly a more effective strategy in treating emotional disorders” over single disorder treatments (Barlow, Allen, & Choate, 2016).
The rationale behind this design is the theory that all emotional disorders share certain characteristics and underlying processes which manifest differently for different persons. By targeting those processes, you reduce both the current symptoms (such as panic) while reducing the likelihood other symptoms will emerge (such as generalized anxiety or depression). In addition, the UP has a major advantage over single-diagnosis treatments: clinicians need only learn this one treatment for all emotional disorders, rather than separate treatments for each. This makes it easier, and cheaper to learn. It also gives clinicians more practice (since they are using it with many more clients), leading to quicker proficiency, and then mastery.
The UP contains seven modules (usually delivered in 1-3 weeks) that are taught in order. The modules consistent of CBT concepts and exercises which have been shown to be beneficial across diagnoses. The modules are: motivational enhancement, psychoeducation on emotions, emotion tracking, mindfulness of emotions, thought challenging, psychoeducation on avoidance, exposure to physical sensations, and exposure to emotion-provoking situations.
Previous studies have shown this intervention to be effective at treating generalized anxiety disorder (GAD). One study of 223 persons with GAD found the UP lead to a significant reduction of anxiety symptoms over the waitlist control condition after 16 sessions, and at a 6 month follow up (Barlow, et al., 2017). The UP has also been shown to be effective at reducing symptoms of depression on both subject and clinician measures after 16 sessions, and at 12 months post-treatment (Sauer-Zavala, 2020).
One meta-analysis of the Unified Protocol examined 15 studies totaling 1244 participants (Sakiris & Berle, 2019). This study found the UP yielded a reduction of symptoms with large effect sizes for: anxiety, depression, generalized anxiety disorder, obsessive-compulsive disorder, panic disorder (both with and without agoraphobia), and social anxiety disorder. There were also significant improvements seen in measures of emotional regulation, functional impairment, and quality of life.
Another study found the Unified Protocol to be an effective treatment for some persons diagnosed with borderline personality disorder (BPD)(Lopez et al., 2015). In this study of eight individuals with BPD who received the UP, three showed clear reductions in BPD symptoms, while four others demonstrated small reductions. While these results were not as impressive when compared to persons with anxiety or depression, the UP is much shorter, cheaper, and easier to deliver than other BPD treatments.
Significantly, clients also tend to see reductions in symptoms that are not the primary target of treatment (Reinholt et al., 2017). For example, clients who are primarily seeking treatment for anxiety also see reductions in depression, and vice versa. This suggests the UP is especially beneficial for persons with co-morbid mood disorders and unclear or shifting symptomology.
The Unified Protocol has also been shown to be effective in clients presenting with a complex combination of symptoms. One case study by Bentley (2017) used the UP to treat a client who met criteria for social anxiety disorder and generalized anxiety disorder that was also regularly engaging in nonsuicidal self-injury (NSSI). This client was also experiencing symptoms of depression, PTSD, and an eating disorder. After 16 weeks of the UP, the client reported moderate drops in anxiety, with a significant increase in their ability to regulate intense emotions, and a significant decrease in NSSI behavior.
How does the Unified Protocol, which is designed to treat a wide range of disorders, compare to disorder specific treatments? One study to examine this question compared the use of disorder specific CBT treatments to the UP (Steele at al., 2018). The authors found that both groups showed significant drops in symptoms and improvements on measures of anxiety, social anxiety, and depression, each with large effect sizes. However, there were no significant between-groups differences. This suggests the UP was just as effective. In addition, it has the added benefit of being easier to learn and master (compared to learning many different disorder specific treatments).
One study examined the use of the UP modules separately, to determine if each is beneficial and necessary (Sauer-Zavala et al., 2017). This study found that five of eight participants showed improvement on each individual skill when they received the modules separately. This suggests the program is well designed without significant overlap, that each module is necessary, and that overall symptom improvement is likely the product of a synergistic effect achieved by learning all of the modules.
Research indicates that the UP is an excellent treatment for emotional issues, including generalized anxiety, worry, panic, and depression. Contact us today to learn if the UP is the best treatment for your anxiety or depression.
