Anxiety disorders are common, chronic, costly, debilitating to quality of life, and are more prevalent than any other class of disorders in every country in the world where surveys have been taken. Deepening understanding of the nature of anxiety and related emotional disorders during the last decade has revealed that commonalities in etiology and latent structure among these disorders supersedes differences. At the same time, examination of extant single diagnosis psychological treatment protocols (SDPs) for these disorders underscores mechanistic similarities. These findings suggested the possibility of distilling a set of psychological procedures that would comprise an innovative Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP), and this protocol has now been developed. If efficacious, the UP may represent a more efficient and possibly more effective strategy which would render treatment implications of comorbidity, not otherwise specified (NOS) and subdefinitional threshold anxiety disorder conditions moot. We now propose an evaluation of the efficacy of the UP in a group of patients with heterogeneous anxiety disorders by way of rigorous comparisons to existing evidence based SDPs benchmarked against a wait list control condition, using both statistical equivalence and superiority analyses. Additional aims include determining the durability of the UP relative to comparison conditions after treatment discontinuation, and ascertaining the differential impact of treatments on disorder specific symptoms vs. higher-order temperamental variables. Further analyses will indicate if changes in these higher order temperamental variables mediate long-term outcome as preliminary data suggests, and if this mechanism of action differs among treatments.

Public Health Relevance

This study addresses an important public health issue by evaluating a novel and promising new transdiagnostic treatment strategy for common and disabling mental disorders, specifically the anxiety disorders. This information will answer important theoretical questions about the mechanism of treatment change, and might lead to more efficacious, cost-effective, and easily disseminable treatment strategies for some of the most prevalent mental disorders.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Interventions Committee for Adult Disorders (ITVA)
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Pearson, Jane L
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Boston University
Schools of Arts and Sciences
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Sauer-Zavala, Shannon; Boswell, James F; Bentley, Kate H et al. (2018) Expectancies, working alliance, and outcome in transdiagnostic and single diagnosis treatment for anxiety disorders: An investigation of mediation. Cognit Ther Res 42:135-145
Steele, Stephanie Jarvi; Farchione, Todd J; Cassiello-Robbins, Clair et al. (2018) Efficacy of the Unified Protocol for transdiagnostic treatment of comorbid psychopathology accompanying emotional disorders compared to treatments targeting single disorders. J Psychiatr Res 104:211-216
Cassiello-Robbins, Clair; Sauer-Zavala, Shannon; Wilner, Julianne G et al. (2018) A Preliminary Examination of the Effects of Transdiagnostic Versus Single Diagnosis Protocols on Anger During the Treatment of Anxiety Disorders. J Nerv Ment Dis 206:549-554
Barlow, David H; Farchione, Todd J; Bullis, Jacqueline R 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 74:875-884
Brake, C Alex; Sauer-Zavala, Shannon; Boswell, James F et al. (2016) Mindfulness-Based Exposure Strategies as a Transdiagnostic Mechanism of Change: An Exploratory Alternating Treatment Design. Behav Ther 47:225-38
Cassiello-Robbins, Clair; Conklin, Laren R; Anakwenze, Ujunwa et al. (2015) The effects of aggression on symptom severity and treatment response in a trial of cognitive behavioral therapy for panic disorder. Compr Psychiatry 60:1-8
Carl, Jenna R; Gallagher, Matthew W; Sauer-Zavala, Shannon E et al. (2014) A preliminary investigation of the effects of the unified protocol on temperament. Compr Psychiatry 55:1426-34
Bullis, Jacqueline R; Fortune, Meghan R; Farchione, Todd J et al. (2014) A preliminary investigation of the long-term outcome of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders. Compr Psychiatry 55:1920-7
Thompson-Hollands, Johanna; Farchione, Todd J; Barlow, David H (2013) Thought-action fusion across anxiety disorder diagnoses: specificity and treatment effects. J Nerv Ment Dis 201:407-13
Boswell, James F; Thompson-Hollands, Johanna; Farchione, Todd J et al. (2013) Intolerance of uncertainty: a common factor in the treatment of emotional disorders. J Clin Psychol 69:630-45

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