Emotional disorders, particularly anxiety disorders and depression are common, chronic, costly, and can be severely impairing. We have developed increased understanding of the nature and causes of these emotional disorders during the past decade with evidence pointing to very similar biological and psychological vulnerabilities that interact with specific learning and, often, stressful life events to cause emotional disorders. Treatments, both drug and psychological, have been proven effective in the short term, but leave plenty of room for improvement in terms of outcome. Effective psychological treatments, many of which have been developed only in the past five to ten years, have been targeted very specifically to each IDSM-IV emotional disorder. This has resulted in a plethora of protocols, that has retarded training and dissemination of these efficacious treatments. The purpose of this application is to create a unified psychological approach to emotional disorders. To develop this unified protocol (UP) we will distill the major ingredients of current efficacious approaches in light of our advancing knowledge of modern learning theory and cognitive neuroscience and emotion regulation. This has led us to a focus on antecedent cognitive reappraisal, emotional avoidance, and modifying emotion driven action tendencies as basic approaches in the treatment of any emotional disorder. Thus, the first phase of the study will focus on treatment development and protocol writing. In the second phase of the study twenty-four patients will be treated and the manual will be refined through patient, therapist, investigator and consultant feedback. Adherence and competency ratings will also be developed and raters will be trained to reliably administer them. In the third phase, the pilot study, forty patients with a principal diagnosis of the major emotional disorders (panic disorder with or without agoraphobia, social phobia, obsessive compulsive disorder, generalized anxiety disorder, and major depressive disorder, as well as other emotional disorders if they are available, such as post-traumatic stress disorder and dysthymia) will be randomly assigned to receive the newly developed intervention or to a twelve-week wait list condition. Therapeutic gains will be assessed in several domains, including emotional symptomatology, and quality of life. If successful, this will be the first step towards a large scale treatment study validating a unified psychosocial approach to the emotional disorders.
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