Research emerging from the field of emotion science suggests that individuals who have anxiety and mood disorders tend to experience negative affect more frequently and more intensely than do healthy individuals, and they tend to view these experiences as more aversive, representing a common diathesis across anxiety and mood disorders.1-5 Deficits in the ability to regulate emotional experiences that result from unsuccessful efforts to avoid or dampen the intensity of uncomfortable emotions, have also been found across the emotional disorders and are a key target for therapeutic change.1,3,4,6
Consistent with this research, we have developed the Unified Protocol for the Treatment of Emotional Disorders (UP), a transdiagnostic, emotion-focused cognitive-behavioral therapy that holds emotional processes as a central target of treatment (Table) (D. H. Barlow, PhD, et al, unpublished data, June 2009). The UP is applicable across anxiety and mood disorders and possibly other disorders with strong emotional components, such as many somatoform and dissociative disorders. These developments reflect the fact that scientific advances are leading to more dimensional concepts of psychopathology, which highlights higher-order factors that underlie anxiety, mood, and related emotional disorders.7,8 This advance will move us away from the extreme splitting evident in DSM-IV and should produce a more valid and useful nosology in the “neurotic spectrum” of emotional disorders.
A number of specific psychological treatments have gained empirical support for the treatment of emotional disorders.9 However, many patients who receive these treatments fail to respond or experience a less than optimal response.10 Furthermore, successful psychological treatments are specifically targeted to individual disorders and require separate and somewhat disparate protocols, raising barriers to dissemination and limiting clinician access to these treatments. The UP offers an exciting alternative to existing treatments. This protocol distills common cognitive-behavioral principles among existing, individualized empirically supported treatments and attends to new findings on common emotion-dysregulation processes in the emotional disorders to create a transdiagnostic protocol applicable to each of these disorders.
The UP is specifically designed to help patients learn how to confront and experience uncomfortable emotions and develop ways to respond to those emotions more adaptively. Thus, the focus of treatment moves away from the external contexts that may trigger excessive, maladaptive emotional responses to modified processing of internal experience. It also renders moot the issue of extensive comorbidity among the emotional disorders. By adjusting patients’ emotion-regulation habits, this treatment aims to increase emotional tolerance and reduce maladaptive patterns of response to emotions that leads to functional impairment across the emotional disorders. In this article, we briefly outline key components of the UP before turning to a case vignette that illustrates how the UP is applied in practice (D. H. Barlow, PhD, et al, unpublished data, June 2009).
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5. Brown TA, Chorpita BF, Barlow DH. Structural relationships among dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and autonomic arousal. J Abnorm Psychol. 1998;107:179-192.
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8. Kupfer DJ, First MB, Regier DA, eds. A Research Agenda for DSM-V. Arlington, VA: American Psychiatric Publishing, Inc; 2002.
9. Barlow DH. Psychological treatments. Am Psychol. 2004;59:869-878.
10. Barlow DH. Unraveling the mysteries of anxiety and its disorders from the perspective of emotion theory. Am Psychol. 2000;55:1247-1263.
11. Barlow DH. Anxiety and Its Disorders: The Nature and Treatment of Anxiety and Panic. New York: Guilford Press; 1988.
12. Barlow DH. Anxiety and Its Disorders: The Nature and Treatment of Anxiety and Panic. 2nd ed. New York: Guilford Press; 2002.
13. Allen LB, McHugh RK, Barlow DH. Emotional disorders: A unified protocol. In: Barlow DH, ed. Clinical Handbook of Psychological Disorders: A Step-By-Step Treatment Manual. 4th ed. New York: Guilford Press; 2008.
Barlow DH. Unraveling the mysteries of anxiety and its disorders from the perspective of emotion theory. Am Psychol. 2000;55:1247-1263.
Brown TA, Chorpita BF, Barlow DH. Structural relationships among dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and autonomic arousal. J Abnorm Psychol. 1998;107:179-192.