Development of a Unified Protocol for the Treatment of Emotional Disorders in Youth

Abstract

This article reviews the development and initial trial of a treatment for adolescents that targets negative emotionality and associated psychological difficulties—particularly anxiety and depressive disorders—as a more singular entity by utilizing an approach rooted in both emotion science and theory. The rationale for such an approach is based upon the perceived need for novel treatment approaches that target commonalities in emotional disorder symptom presentation and their intervention. Utilizing the Unified Protocol for the Treatment of Emotional Disorders originally developed for adults (Barlow, Allen, & Choate, 2004), we conducted a multiple-baseline design study of a slightly modified version of this protocol with three adolescents presenting an array of anxiety and depression symptoms. Adolescent participants in this preliminary investigation evidenced symptom reductions across disorders at posttreatment, with greater improvements noted at a 6-month follow-up. Based on these findings and research regarding the association between emotion science and developmental psychopathology, we detail a more extensive set of modifications to the protocol, undertaken in preparation for a subsequent open-trial investigation of the revised treatment.

KEYWORDS:

• adolescents
• anxiety
• depression
• emotional disorders
• unified protocol

Preparation of this article was supported by National Institute of Mental Health Grant MH073946 to Jill T. Ehrenreich.

Notes

Note: Out-of-session assignments were reported under the description of the session in which they were assigned. Sessions were designed to occur weekly with the exception of a 2-week break between sessions 11 and 12 and between sessions 12 and 13 in order to allow extended time for exposure practice and engagement of behavioral activation. With the exception of the additional parent sessions in weeks 1 and 6, parents were intended to be included during the last 10 to 15 minutes of each session, during which participants were asked to review with their parent(s) the material they learned during the session.

Note: CSR presented in parentheses. AnxNOS = Anxiety Disorder, Not Otherwise Specified; Soc = Social Phobia; GAD = Generalized Anxiety Disorder; MDD = Major Depressive Disorder.