Treatment also focused on identifying EDBs and facilitating incompatible behavioral responding. The patient’s most prominent EDB when feeling anxious was hypervigilance to his surroundings, including his internal state. When eating, for instance, he would repeatedly scan or check for physiological signs that he had ingested a dangerous substance. In social situations, he would prematurely excuse himself from social interactions when he felt anxious or fearful.
During treatment, he was instructed to engage in an opposing, and more adaptive, response (to “do the opposite”). We worked on adopting a more laissez-faire attitude toward eating, prolonged his exposure to anxiety-provoking situations, and established behaviors that made escape more difficult.
Specific physical sensations and situations J had avoided were identified and a behavioral plan for gradually confronting them was developed. He experienced an intense anxious reaction to interoceptive exposures, specifically hyperventilation, that diminished over time. We also had him elicit physical sensations more naturally by drinking energy drinks, coffee, and small amounts of alcohol(Drug information on alcohol). Here again, he initially experienced a noticeable physical (excessive leg shaking and involuntary movement of his upper torso) and emotional reaction to these tasks, but over time he became more comfortable with the feelings produced during these tasks and the emotion gradually abated.
An emotion-avoidance hierarchy was created, including situations he avoided because of his obsessive concerns and social fears. OCD-related exposures included consuming food and drinks that had been left unattended in public areas, eating at “sketchy” restaurants, and shaking hands with people he felt were contaminated without washing his hands. His social fears were addressed through exposures focused on increasing social interactions and promoting more adaptive professional behaviors such as doing presentations at meetings, speaking with his boss, and presenting ideas to coworkers. Over the course of treatment, J learned to respond more adaptively to his emotions and, in the end, noted a significant improvement in his anxiety and no longer met diagnostic criteria for an emotional disorder.
The UP is in the final stages of development and testing. We are currently completing a randomized controlled trial to examine the effectiveness of UP treatment. Consistent with the case vignette, participants in this trial have at least 1 (and frequently more than 1) diagnosed anxiety or mood disorder. Preliminary data look promising. We hope that over time the UP and other transdiagnostic psychosocial treatments that focus on recently identified core aspects of psychopathology will improve dissemination of effective treatments and provide new and useful tools for clinicians to integrate into their practice.
Dr Farchione is assistant research professor in the department of psychology, Center for Anxiety and Related Disorders, Boston University; Ms Boisseau, Ms Ellard, and Mr Fairholme are advanced doctoral students in the clinical psychology program at Boston University; and Dr Barlow is professor of psychology, research professor of psychiatry, and founder and director emeritus of the Center for Anxiety and Related Disorders. The authors report no conflicts of interest concerning the subject matter of this article.