Transdiagnostic Treatment of Anxiety Disorders in a Group Format Based on the Principles of the Unified Protocol: a Preliminary Intensive Measurement Examination of Process and Outcome
- 11 Downloads
We describe a transdiagnostic treatment for anxiety disorders in community mental health centers (CMHCs), based on the Unified Protocol (Barlow et al. 2011), and adapted to a group format (UP-G). Participants were 13 CMHC patients in an intensive measurement design. Participants were interviewed for anxiety severity at pre- and post-treatment and completed weekly self-reports of distress, emotion dysregulation, valued living, fear of bodily sensations, and therapeutic alliance. We observed significant improvements in all measures except for valued living. Improvements in emotion regulation preceded and predicted subsequent reductions in distress as well as the other way around. Improvements in alliance co-occurred with reductions in distress. The UP-G is a flexible intervention that is suitable for CMHCs and may assist in reducing the burden of anxiety disorders and improving dissemination. These preliminary findings suggest that improvements in emotion regulation may play an important role in facilitating change in the UP-G.
KeywordsCognitive-behavioral therapy Unified protocol Anxiety disorders Group therapy Transdiagnostic protocol
The authors would like to thank Michal Master-Barak for conducting clinical assessments for the study.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- Barlow, D. H., Farchione, T. J., Bullis, J. R., Gallagher, M. W., Murray-Latin, H., Sauer-Zavala, S., et al. (2017). The Unified Protocol for transdiagnostic treatment of emotional disorders compared with diagnosis-specific protocols for anxiety disorders: a randomized clinical trial. JAMA Psychiatry, 74(9), 875–884.PubMedPubMedCentralCrossRefGoogle Scholar
- Barlow, D. H., Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L., Allen, L. B., & Ehrenreich-May, J. (2011). The unified protocol for transdiagnostic treatment of emotional disorders: therapist guide. New York: Oxford University Press.Google Scholar
- Bolger, N., & Laurenceau, J. P. (2013). Intensive longitudinal methods: an introduction to diary and experience sampling research. New York, NY: Guilford.Google Scholar
- Bullis, J. R., Sauer-Zavala, S., Bentley, K. H., Thompson-Hollands, J., Carl, J. R., & Barlow, D. H. (2015). The unified protocol for transdiagnostic treatment of emotional disorders: Preliminary exploration of effectiveness for group delivery. Behavior Modification, 39(2), 295–321.PubMedCrossRefGoogle Scholar
- Burlingame, G. M., Seebeck, J. D., Janis, R. A., Whitcomb, K. E., Barkowski, S., Rosendahl, J., & Strauss, B. (2016). Outcome differences between individual and group formats when identical and nonidentical treatments, patients, and doses are compared: A 25-year meta-analytic perspective. Psychotherapy, 53(4), 446–461.PubMedCrossRefGoogle Scholar
- Carpenter, J. K., Andrews, L. A., Witcraft, S. M., Powers, M. B., Smits, J. A., & Hofmann, S. G. (2018). Cognitive behavioral therapy for anxiety and related disorders: A meta-analysis of randomized placebo-controlled trials. Depression and Anxiety, 35(6), 502–514.PubMedPubMedCentralCrossRefGoogle Scholar
- Jaeger, B. (2016). r2glmm: Computes R squared for mixed (multilevel) models, R package version 0.1.2 [Computer software]. Retrieved from https://cran.r-project.org/package=r2glmm.
- Osma, J., Castellano, C., Crespo, E., & García-Palacios, A. (2015). The unified protocol for transdiagnostic treatment of emotional disorders in group format in a Spanish public mental health setting. Behavioral Psychology, 23(3), 447–466.Google Scholar
- Pinheiro, J., Bates, D., DebRoy, S., Sarkar, D., & R Core Team. (2016). nlme: Linear and nonlinear mixed effects models, R package version 3.1-128 [Computer software]. Retrieved from http://CRAN.R-project.org/package=nlme.
- Raudenbush, S. W., & Bryk, A. S. (2002). Hierarchical linear models: Applications and data analysis methods (2nd ed.). Thousand Oaks: Sage Publications, Inc..Google Scholar
- Sauer-Zavala, S., Boswell, J. F., Gallagher, M. W., Bentley, K. H., Ametaj, A., & Barlow, D. H. (2012). The role of negative affectivity and negative reactivity to emotions in predicting outcomes in the unified protocol for the transdiagnostic treatment of emotional disorders. Behaviour Research and Therapy, 50(9), 551–557.PubMedPubMedCentralCrossRefGoogle Scholar
- Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., et al. (1998). The Mini-International Neuropsychiatric Interview (MINI): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59, 22–33.PubMedGoogle Scholar
- Suárez, L., Bennett, S., Goldstein, C., & Barlow, D. H. (2009). Understanding anxiety disorders from a “triple vulnerability” framework. In M. M. Antony & M. B. Stein (Eds.), Oxford handbook of anxiety and related disorders (pp. 153–172). New York: Oxford University Press.Google Scholar