Skip to main content

Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents

  • Protocol
  • First Online:
Cognitive Behavioral Therapy in Youth: Tradition and Innovation

Part of the book series: Neuromethods ((NM,volume 156))

Abstract

Treatment for emotional disorders in children and adolescents is increasingly being applied in a transdiagnostic manner to address the need for more broadly applicable, yet mechanism-focused psychotherapy. The Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C/A) are modular, flexible, evidence-based treatment manuals that utilize empirically supported, largely cognitive and behavioral strategies to treat anxiety, mood, and other emotional disorders. In this chapter, we describe the rationale and empirical support for the use of the UP-C/A, provide a pragmatic overview of its contents, and briefly discuss application of core intervention components.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Protocol
USD 49.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Ehrenreich-May J, Kennedy SM, Sherman JA, Bennett SM, Barlow DH (2018) Unified protocol for transdiagnostic treatment of emotional disorders in children and adolescents: therapist guide. Oxford University Press, New York, NY

    Google Scholar 

  2. Ehrenreich-May J, Kennedy SM, Sherman JA, Bilek EL, Barlow DH (2018) Unified protocol for transdiagnostic treatment of emotional disorders in adolescents: workbook. Oxford University Press, New York, NY

    Google Scholar 

  3. Ehrenreich-May J, Kennedy SM, Sherman JA, Bilek EL, Barlow DH (2018) Unified protocol for transdiagnostic treatment of emotional disorders in children: workbook. Oxford University Press, New York, NY

    Google Scholar 

  4. Barlow DH, Farchione TJ, Fairholme CP, Ellard KK, Boisseau CL, Allen LB, Ehrenreich-May J (2011) Unified protocol for transdiagnostic treatment of emotional disorders: therapist guide. Oxford University Press, New York, NY

    Google Scholar 

  5. Barlow DH, Farchione TJ, Sauer-Zavala S, Murray Latin H, Ellard KK, Bullis JR, Bentley KH, Boettcher HT, Cassiello-Robbins C (2018) Unified protocol for transdiagnostic treatment of emotional disorders: therapist guide (Rev. edn). Oxford University Press, New York, NY

    Google Scholar 

  6. Barlow DH, Ellard KK, Sauer-Zavala S, Bullis JR, Carl JR (2014) The origins of neuroticism. Perspect Psychol Sci 9(5):481–496. https://doi.org/10.1177/1745691614544528

    Article  PubMed  Google Scholar 

  7. Lopez ME, Stoddard JA, Noorollah A, Zerbi G, Payne LA, Hitchcock CA et al (2015) Examining the efficacy of the unified protocol for transdiagnostic treatment of emotional disorders in the treatment of individuals with borderline personality disorder. Cogn Behav Pract 22(4):522–533. https://doi.org/10.1016/j.cbpra.2014.06.006

    Article  Google Scholar 

  8. Bentley KH (2017) Applying the unified protocol transdiagnostic treatment to nonsuicidal self-injury and co-occurring emotional disorders: a case illustration. J Clin Psychol 73(5):547–558. https://doi.org/10.1002/jclp.22452

    Article  PubMed  Google Scholar 

  9. Thompson-Brenner H, Boswell JF, Espel-Huynh H, Brooks G, Lowe MR (2018) Implementation of transdiagnostic treatment for emotional disorders in residential eating disorder programs: a preliminary pre-post evaluation. Psychother Res 2018:1–17. https://doi.org/10.1080/10503307.2018.1446563

    Article  Google Scholar 

  10. Boisseau CL, Boswell JF (2018) The unified protocol for eating disorders. In: Barlow DH, Farchione TJ (eds) Applications of the unified protocol for transdiagnostic treatment of emotional disorder. Oxford University Press, New York, NY, pp 150–163

    Google Scholar 

  11. Weintraub MJ, Zinberg J, Bearden CE, Miklowitz DJ (2019) Applying a transdiagnostic unified treatment to adolescents at high risk for serious mental illness: rationale and initial case studies. https://doi.org/10.1016/j.cbpra.2019.07.007

  12. Malmberg J, Kennedy SM, Holzman J, Ehrenreich-May J (2020) Development and application of an innovative transdiagnostic treatment approach for pediatric irritability. Behav Ther 51(2):334–349

    Article  Google Scholar 

  13. Angold A, Costello EJ, Erkanli A (1999) Comorbidity. J Child Psychol Psychiatry 40:57–87. https://doi.org/10.1111/1469-7610.00424

    Article  CAS  PubMed  Google Scholar 

  14. Brady EU, Kendall PC (1992) Comorbidity of anxiety and depression in children and adolescents. Psychol Bull 111(2):244–255. https://doi.org/10.1037/0033-2909.111.2.24

    Article  CAS  PubMed  Google Scholar 

  15. Cummings CM, Caporino NE, Kendall PC (2014) Comorbidity of anxiety and depression in children and adolescents: 20 years after. Psychol Bull 140(3):816–845. https://doi.org/10.1037/a0034733

    Article  PubMed  Google Scholar 

  16. Leyfer O, Gallo KP, Cooper-Vince C, Pincus DB (2013) Patterns and predictors of comorbidity of DSM-IV anxiety disorders in a clinical sample of children and adolescents. J Anxiety Disord 27(3):306–311. https://doi.org/10.1016/j.janxdis.2013.01.010

    Article  PubMed  Google Scholar 

  17. Boomsma DI, Van Beijsterveldt CEM, Hudziak JJ (2005) Genetic and environmental influences on anxious/depression during childhood: a study from the Netherlands Twin Register. Genes Brain Behavor 4(8):466–481. https://doi.org/10.1111/j.1601-183X.2005.00141.x

    Article  CAS  Google Scholar 

  18. Eley TC, Bolton D, O’Connor TG, Perrin S, Smith P, Plomin R (2003) A twin study of anxiety-related behaviours in pre-school children. J Child Psychol Psychiatry 44:945–960

    Article  PubMed  Google Scholar 

  19. Middeldorp CM, Cath DC, Van Dyck R, Boomsma DI (2005) The co-morbidity of anxiety and depression in the perspective of genetic epidemiology. A review of twin and family studies. Psychol Med 35(5):611–624. https://doi.org/10.1017/s003329170400412x

    Article  CAS  PubMed  Google Scholar 

  20. Wilamowska ZA, Thompson-Hollands J, Fairholme CP, Ellard KK, Farchione TJ, Barlow DH (2010) Conceptual background, development, and preliminary data from the unified protocol for transdiagnostic treatment of emotional disorders. Depress Anxiety 27:882–890. https://doi.org/10.1002/da.20735

    Article  PubMed  Google Scholar 

  21. Martin P, Murray LK, Darnell D, Dorsey S (2018) Transdiagnostic treatment approaches for greater public health impact: Implementing principles of evidence-based mental health interventions. Clin Psychol Sci Pract. https://doi.org/10.1111/cpsp.12270

  22. Marchette L, Weisz JR (2017) Practitioner review: empirical evolution of youth psychotherapy toward transdiagnostic approaches. J Child Psychol Psychiatry. https://doi.org/10.1111/jcpp.12747

  23. Chorpita BF, Barlow DH (1998) The development of anxiety: the role of control in the early environment. Psychol Bull 124(1):3–21. https://doi.org/10.1037/0033-2909.124.1.3

    Article  CAS  PubMed  Google Scholar 

  24. Bullis JR, Sauer-Zavala S, Bentley KH, Thompson-Hollands J, Carl JR, Barlow DH (2015) The unified protocol for transdiagnostic treatment of emotional disorders: preliminary exploration of effectiveness for group delivery. Behav Modif 39(2):295–321. https://doi.org/10.1177/0145445514553094

    Article  PubMed  Google Scholar 

  25. Barlow DH, Farchione TJ, Bullis JR, Gallagher MW, Murray-Latin H, Sauer-Zavala S et al (2017) The unified protocol for transdiagnostic treatment of emotional disorders compared with diagnosis-specific protocols for anxiety disorders: a randomized clinical trial. AMA Psychiatry. https://doi.org/10.1001/jamapsychiatry.2017.2164

  26. Conklin LR, Cassiello-Robbins C, Brake CA, Sauer-Zavala S, Farchione TJ, Ciraulo DA, Barlow DH (2015) Relationships among adaptive and maladaptive emotion regulation strategies and psychopathology during the treatment of comorbid anxiety and alcohol use disorders. Behav Res Ther 73:124–130. https://doi.org/10.1016/j.brat.2015.08

    Article  PubMed  PubMed Central  Google Scholar 

  27. Farchione TJ, Fairholme CP, Ellard KK, Boisseau CL, Thompson-Hollands J, Carl JR, Barlow DH (2012) Unified protocol for transdiagnostic treatment of emotional disorders: a randomized controlled trial. Behav Ther 43(3):666–678. https://doi.org/10.1016/j.beth.2012.01.001

    Article  PubMed  PubMed Central  Google Scholar 

  28. Sauer-Zavala S, Boswell F, Gallagher MW, Bentley KH, Ametaj A, Barlow DH (2012) The role of negative affectivity and negative reactivity to emotions in predicting outcomes in the unified protocol for the transdiagnostic treatment of emotional disorders. Behav Res Ther 50(9):551–557. https://doi.org/10.1016/j.brat.2012.05.005

    Article  PubMed  PubMed Central  Google Scholar 

  29. Bullis JR, Fortune MR, Farchione TJ, Barlow DH (2014) A preliminary investigation of the long-term outcome of the unified protocol for transdiagnostic treatment of emotional disorders. Compr Psychiatry 55(8):1920–1927. https://doi.org/10.1016/j.comppsych.2014.07.016

    Article  PubMed  PubMed Central  Google Scholar 

  30. Ehrenreich JT, Goldstein CR, Wright LR, Barlow DH (2009) Development of a unified protocol for the treatment of emotional disorders in youth. Child Fam Behav Ther 31(1):20–37

    Article  PubMed  PubMed Central  Google Scholar 

  31. Trosper SE, Buzzella BA, Bennett SM, Ehrenreich JT (2009) Emotion regulation in youth with emotional disorders: implications for a unified treatment approach. Clin Child Fam Psychol Rev 12:234–254

    Article  PubMed  Google Scholar 

  32. Ehrenreich-May J, Rosenfield D, Queen AH, Kennedy SM, Remmes CS, Barlow DH (2017) An initial waitlist-controlled trial of the unified protocol for the treatment of emotional disorders in adolescents. J Anxiety Disord 46:46–55. https://doi.org/10.1016/j.janxdis.2016.10.006

    Article  PubMed  Google Scholar 

  33. Queen AH, Barlow DH, Ehrenreich-May J (2014) The trajectories of adolescent anxiety and depressive symptoms over the course of a transdiagnostic treatment. J Anxiety Disord 28(6):511–521. https://doi.org/10.1016/j.janxdis.2014.05.007

    Article  PubMed  Google Scholar 

  34. Ehrenreich-May J, Bilek EL (2012) The development of a transdiagnostic cognitive behavioral group intervention for childhood anxiety disorders and co-occurring depression symptoms. Cogn Behav Pract 19(1):41–55. https://doi.org/10.1016/j.cbpra.2011.02.003

    Article  Google Scholar 

  35. Kennedy SM, Bilek EL, Ehrenreich-May J (2018) A randomized controlled pilot trial of the unified protocol for transdiagnostic treatment of emotional disorders in children. Behav Modif Adv. https://doi.org/10.1177/0145445517753940

  36. Weisz JR, Chorpita BF (2012) “Mod squad” for youth psychotherapy: Restructuring evidence-based treatment for clinical practice. In: Kendall PC (ed) Child and adolescent therapy: cognitive-behavioral procedures, 4th edn. Guilford Press, New York, NY, pp 379–397

    Google Scholar 

  37. Kolko DJ, Baumann BL, Bukstein OG, Brown EJ (2007) Internalizing symptoms and affective reactivity in relation to the severity of aggression in clinically referred, behavior-disordered children. J Child Fam Stud 16(6):745–759. https://doi.org/10.1007/s10826-006-9120-3

    Article  Google Scholar 

  38. Kolko DJ, Dorn LD, Bukstein OG, Pardini D, Holden EA, Hart J (2009) Community vs clinic-based modular treatment of children with early-onset ODD or CD: a clinical trial with 3-year follow-up. J Abnorm Child Psychol 37(5):591–609. https://doi.org/10.1007/s10802-009-9303-7

    Article  PubMed  PubMed Central  Google Scholar 

  39. Kolko DJ, Pardini DA (2010) ODD dimensions, ADHD, and callous–unemotional traits as predictors of treatment response in children with disruptive behavior disorders. J Abnorm Psychol 119(4):713–725. https://doi.org/10.1037/a0020910

    Article  PubMed  Google Scholar 

  40. Shaffer A, Lindhiem O, Kolko DJ, Trentacosta CJ (2013) Bidirectional relations between parenting practices and child externalizing behavior: a cross-lagged panel analysis in the context of a psychosocial treatment and 3-year follow-up. J Abnorm Child Psychol 41(2):199–210. https://doi.org/10.1007/s10802-012-9670-3

    Article  PubMed  PubMed Central  Google Scholar 

  41. Chorpita BF (2007) Modular cognitive-behavioral therapy for childhood anxiety disorders. Guilford Press, New York, NY

    Google Scholar 

  42. Borntrager CF, Chorpita BF, Higa-McMillan C, Weisz JR (2009) Provider attitudes toward evidence-based practices: are the concerns with the evidence or with the manuals? Psychiatr Serv 60(5):677–681. https://doi.org/10.1176/appi.ps.60.5.677

    Article  PubMed  Google Scholar 

  43. Wiltsey Stirman S, Comer JS (2018) What are we even trying to implement? Considering the relative merits of promoting evidence-based protocols, principles, practices, or policies. Clin Psychol Sci Pract. https://doi.org/10.1111/cpsp.12269

  44. Weisz JR, Chorpita BF, Palinkas LA, Schoenwald SK, Miranda J, Bearman SK et al (2012) Testing standard and modular designs for psychotherapy treating depression, anxiety, and conduct problems in youth: a randomized effectiveness trial. Arch Gen Psychiatry 69(3):274–282. https://doi.org/10.1001/archgenpsychiatry.2011.147

    Article  PubMed  Google Scholar 

  45. Tonarely NA, Halliday ER, Ehrenreich-May J (2019, November) Comparing individual and group administration of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C). Poster presented at the meeting of the Association for Behavioral and Cognitive Therapies Convention, Atlanta, G.A.

    Google Scholar 

  46. Hudson JL, Rapee RM (2002) Parent-child interactions in clinically anxious children and their siblings. J Clin Child Adolesc Psychol 31(4):548–555. https://doi.org/10.1207/153744202320802214

    Article  PubMed  Google Scholar 

  47. Weisz JR, Chorpita BF, Frye A, Ng MY, Lau N, Bearman SK, Hoagwood KE (2011) Youth top problems: using idiographic, consumer-guided assessment to identify treatment needs and to track change during psychotherapy. J Consult Clin Psychol 9(3):369–380. https://doi.org/10.1037/a0023307

    Article  Google Scholar 

  48. Linehan MM, Korslund KE, Harned MS, Gallop RJ, Lungu A, Neacsiu AD et al (2015) Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: a randomized clinical trial and component analysis. JAMA Psychiat 72(5):475–482. https://doi.org/10.1001/jamapsychiatry.2014.3039

    Article  CAS  Google Scholar 

  49. Williams JM, Teasdale J, Segal Z, Kabai-Zinn J (2007) The mindful way through depression: freeing yourself from chronic unhappiness. Guilford Press, New York, NY

    Google Scholar 

  50. Peris TS, Compton SN, Kendall PC, Birmaher B, Sherrill J, March J et al (2015) Trajectories of change in youth anxiety during cognitive—behavior therapy. J Consult Clin Psychol 83(2):239–252. https://doi.org/10.1037/a0038402.supp

    Article  PubMed  Google Scholar 

  51. Foa EB, Liebowitz MR, Kozak MJ, Davies S, Campeas R, Franklin ME et al (2005) Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. Am J Psychiatry 162(1):151–161. https://doi.org/10.1176/appi.ajp.162.1.151

    Article  PubMed  Google Scholar 

  52. Raggi VL, Samson JG, Felton JW, Loffredo HR, Berghorst LH (2018) Exposure therapy for treating anxiety in children and adolescents: a comprehensive guide. New Harbinger Publications, Oakland, CA

    Google Scholar 

  53. Barlow DH, Conklin LR, Bentley KH (2015) Psychological treatments for panic disorders, phobias, and social and generalized anxiety disorders. In: Nathan PE, Gorman JM (eds) A guide to treatments that work, 4th edn. Oxford University Press, New York, NY, pp 409–461

    Google Scholar 

  54. Bouton ME (1993) Context, time, and memory retrieval in the interference paradigms of Pavlovian learning. Psychol Bull 114:80–99. https://doi.org/10.1037/0033-2909.114.1.80

    Article  CAS  PubMed  Google Scholar 

  55. Miller RR, Matzel LD (1988) Contingency and relative associative strength. In: Klein SB, Mowrer RR (eds) Contemporary learning theories: Pavlovian conditioning and the status of traditional learning theory. Lawrence Erlbaum Associates, Hillsdale, NJ, pp 61–84

    Google Scholar 

  56. Wagner AR (1981) SOP: a model of automatic memory processing in animal behavior. In: Spear NE, Miller RR (eds) Information processing in animals: memory mechanisms. Erlbaum, Hillsdale, NJ

    Google Scholar 

  57. Baker A, Mystkowski J, Culver N, Yi R, Mortazavi A, Craske MG (2010) Does habituation matter? Emotional processing theory and exposure therapy for acrophobia. Behav Res Ther 48:1139–1143. https://doi.org/10.1016/j.brat.2010.07.009

    Article  PubMed  PubMed Central  Google Scholar 

  58. Abramowitz JS, Arch JJ (2014) Strategies for improving long-term outcomes in cognitive behavioral therapy for obsessive-compulsive disorder: Insights from learning theory. Cogn Behav Pract 21(1):20–31. https://doi.org/10.1016/j.cbpra.2013.06.004

    Article  Google Scholar 

  59. Craske MG, Kircanski K, Zelikowsky M, Mystkowski J, Chowdhury N, Baker A (2008) Optimizing inhibitory learning during exposure therapy. Behav Res Ther 46(1):5–27. https://doi.org/10.1016/j.brat.2007.10.003

    Article  PubMed  Google Scholar 

  60. Craske MG, Treanor M, Conway CC, Zbozinek T, Vervliet B (2014) Maximizing exposure therapy: an inhibitory learning approach. Behav Res Ther 58:10–23

    Article  PubMed  PubMed Central  Google Scholar 

  61. Weck F, Neng JMB, Richtberg S, Jakob M, Stangier U (2015) Cognitive therapy versus exposure therapy for hypochondriasis (health anxiety): a randomized controlled trial. J Consult Clin Psychol 83(4):665–676. https://doi.org/10.1037/ccp000001

    Article  PubMed  Google Scholar 

  62. Wolpe J (1969) The practice of behavior therapy. Pergamon, Oxford

    Google Scholar 

  63. Hayes SC, Hofmann SG (2018) Process-based CBT: the science and core clinical competencies of cognitive behavioral therapy. New Harbinger Publications, Oakland, CA

    Google Scholar 

Download references

Acknowledgement

Disclosure statement: Dr. Jill Ehrenreich-May receives royalties from sale of the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C and UP-A). She also receives payments for UP-C and UP-A clinical trainings, consultation and implementation support services.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jill Ehrenreich-May .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Science+Business Media, LLC, part of Springer Nature

About this protocol

Check for updates. Verify currency and authenticity via CrossMark

Cite this protocol

Halliday, E.R., Ehrenreich-May, J. (2020). Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents. In: Friedberg, R., Nakamura, B. (eds) Cognitive Behavioral Therapy in Youth: Tradition and Innovation. Neuromethods, vol 156. Humana, New York, NY. https://doi.org/10.1007/978-1-0716-0700-8_13

Download citation

  • DOI: https://doi.org/10.1007/978-1-0716-0700-8_13

  • Published:

  • Publisher Name: Humana, New York, NY

  • Print ISBN: 978-1-0716-0699-5

  • Online ISBN: 978-1-0716-0700-8

  • eBook Packages: Springer Protocols

Publish with us

Policies and ethics