LAUSR

World Psychiatry 19:2 June 2020 gets specific psychopathological mechanisms (e.g., neuroticism) shared across a defined class of disorders. The unified protocol for transdiagnostic treatment of emotional disorders (UP) is an emotion focused cognitive-behavioral intervention consisting of five “core” modules or components based on cognitive behavior therapy (CBT) elements of proven effectiveness that target negative emotionality and aversive reactions to emotions when they occur. These modules are preceded by an introductory session that reviews the patient’s presenting symptoms and provides a therapeutic rationale, a module on motivational enhancement, and a module focusing on psychoeducation about emotions. A final module consists of relapse prevention. As the treatment proceeds, the domains of thoughts, physical sensations, and behaviors are each explored in detail, focusing specifically on elucidating dysfunctional emotion regulation strategies that the patient has developed over time within each of these domains, and teaching patients more adaptive emotion regulation skills. The UP has accrued substantial support for its efficacy in the treatment of anxiety and depression. In fact, a recent systematic review and meta-analysis examined 15 studies with a total of 1,244 participants and found large effect sizes across studies for symptoms of anxiety and depression when UP was delivered in both individual and group format. Following two small open trials and an initial randomized controlled trial comparing the UP to a waitlist control condition, our group conducted a large randomized controlled equivalence trial (N=223) comparing the efficacy of the UP to established single-disorder protocols (SDPs) and a waitlist control condition. The UP was equally effective as SDPs in reducing symptom severity ratings across disorders, as well as decreasing symptoms of anxiety and depression, both at the end of treatment and at 6-month follow-up. In addition, the UP condition exhibited lower rates of attrition over the course of the study. Meanwhile, other researchers have examined the efficacy of the UP in both individual and group contexts globally, including countries in South America, Asia and Europe. In general, these studies have also found the UP to be efficacious in the treatment of emotional disorders. While all humans experience emotions, culture can impact the messages one receives about the experience and expression of emotions, and the relevance of emotion regulation. Given that the majority of research has been conducted in Europe and the US to date, further research in other global contexts is warranted. As with any CBT, cultural competence is critical when using the UP. A promising recent pilot study conducted in Japan with the UP found significant reductions in symptoms of anxiety and depression that were large in magnitude. The authors did not find any difference in emotion suppression from preto post-treatment, which they state is consistent with existing literature showing a lack of association between suppression and psychopathology in Japan, and may represent an important cultural difference to consider when delivering the UP. In another example, the UP has been adapted to fit the uniquely broad spectrum of cultures, education levels and backgrounds of victims of Colombia’s armed conflict. The UP has been translated into numerous languages, including Chinese, Dutch, German, Japanese, Korean and Spanish. An Internet-delivered version of the protocol has recently been developed. In summary, the UP provides a transdiagnostic psychological treatment that targets shared underlying mechanisms of all emotional disorders, thereby offering a single treatment that can be used across the most common clinical presentations. This treatment is equally effective as gold-standard SDPs, but may confer additional benefits with regard to efficiency, dropout, and training therapists. Given the unmet global demand for mental health care, combined with the lack of clinicians trained in evidence-based treatments, we believe that transdiagnostic treatments are the future of mental health care, and represent one approach to increasing access to evidence-based care and impacting global mental health.