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Psychotherapeut

, Volume 63, Issue 3, pp 182–187 | Cite as

Das Unified Protocol zur Behandlung emotionaler Störungen

One size fits all?
  • Johanna Boettcher
  • Carmen Schaeuffele
  • Babette Renneberg
Schwerpunkt: Angst - Übersichten

Zusammenfassung

Transdiagnostische Behandlungsansätze berücksichtigen die hohe Komorbidität psychischer Störungen und bieten Interventionen, die auf mehrere psychische Störungen gleichermaßen anwendbar sind. Sie adressieren pathologische Prozesse, die zu Entstehung und Aufrechterhaltung psychischer Vulnerabilität allgemein beitragen, unabhängig von der aktuellen spezifischen Störung. So basiert das Unified Protocol (UP), entwickelt von der Arbeitsgruppe um David Barlow, auf der Annahme, dass alle Betroffenen von emotionalen Störungen (z. B. Angst-, depressive und somatische Belastungsstörungen) einen dysfunktionalen Umgang mit negativen Gefühlen zeigen. Eine höhere Akzeptanz negativer Gefühle und die Reduktion von Emotionsvermeidung erleichtern die Remission psychischer Symptome aus unterschiedlichen Störungsbereichen. Der vorliegende Beitrag beschreibt die theoretische Grundlage des UP und gibt detaillierten Einblick in die Interventionen. Zwei randomisierte kontrollierte Studien weisen auf die Wirksamkeit des UP für Angststörungen hin. Belastbare Ergebnisse zur Wirksamkeit bei depressiven oder somatoformen Störungen stehen noch aus. Sollte sich das UP in weiteren Studien als wirksam erweisen, könnte es eine wertvolle Alternative zur Anwendung unzähliger störungsspezifischer Behandlungsmanuale darstellen. Die Ökonomie eines einzigen Manuals für emotionale Störungen könnte die Implementation evidenzbasierter Programme in der Praxis erleichtern.

Schlüsselwörter

Transdiagnostisch Kognitive Verhaltenstherapie Somatische Belastungsstörung Angststörung Depressive Störung 

Unified protocol for the treatment of emotional disorders

One size fits all?

Abstract

Transdiagnostic treatment approaches address the problem of high comorbidity of mental disorders and provide interventions which are equally suitable for several mental disorders. Transdiagnostic interventions target pathological processes relevant for the etiology and maintenance of mental distress, regardless of a specific mental disorder. For example, David Barlow and colleagues developed the unified protocol (UP). The UP is based on the assumption that all patients with emotional disorders (e.g. anxiety, depressive and somatic symptom disorders) experience maladaptive reactions to negative emotions. An increase in the acceptance of negative emotions and a reduction of emotion avoidance facilitate the remission of symptoms of various disorders. The present article describes the theoretical basis of the UP and gives a detailed account of the interventions used. The results of two randomized controlled studies suggest that the UP is effective in treating anxiety disorders but no reliable results on the effectiveness for depressive or somatoform complaints are currently available. Should the UP prove effective in further studies, it could present a valid alternative to implementing multiple disorder-specific manuals. The UP could thus facilitate the integration of evidence-based treatment into routine clinical care.

Keywords

Transdiagnostic Cognitive behavior therapy Somatic symptom disorder Anxiety disorder Depressive disorder 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

J. Boettcher, C. Schaeuffele und B. Renneberg geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autorinnen durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. Barlow DH, Allen LB, Choate ML (2004) Toward a unified treatment for emotional disorders. Behav Ther 35(2):205–230.  https://doi.org/10.1016/S0005-7894(04)80036-4 CrossRefGoogle Scholar
  2. Barlow DH, Farchione TJ, Bullis JR et al (2017) The unified protocol for transdiagnostic treatment of emotional disorders compared with diagnosis-specific protocols for anxiety disorders: a randomized clinical trial. JAMA Psychiatry 74(9):875–884.  https://doi.org/10.1001/jamapsychiatry.2017.2164 CrossRefPubMedGoogle Scholar
  3. Barlow DH, Farchione TJ, Sauer-Zavala SE et al (2017) Unified Protocol for Transdiagnostic Treatment of Emotional Disorders - Therapist Guide. Oxford University Press, New YorkCrossRefGoogle Scholar
  4. Barlow DH, Farchione TJ, Sauer-Zavala S, Latin HM, Ellard KK, Bullis JR, Cassiello-Robbins C (2018) Unified protocol for transdiagnostic treatment of emotional disorders, 2. Aufl. Oxford University Press, New YorkGoogle Scholar
  5. Barlow DH, Farchione TJ, Fairholme CP, Ellard KK, Boisseau CL, Allen LB, Ehrenreich-May JT (2018) Transdiagnostische Behandlung emotionaler Störungen. Hogrefe, Göttingen (F. Caspar, Ed.)Google Scholar
  6. Bentley KH, Sauer-Zavala S, Cassiello-Robbins CF, Conklin LR, Vento S, Homer D (2017) Treating suicidal thoughts and behaviors within an emotional disorders framework: acceptability and feasibility of the unified protocol in an inpatient setting. Behav Modif 41(4):529–557.  https://doi.org/10.1177/0145445516689661 CrossRefPubMedGoogle Scholar
  7. Boswell JF (2014) An idiographic analysis of change processes in the unified transdiagnostic treatment of depression. J Consult Clin Psychol 82(6):1060–1071.  https://doi.org/10.1037/a0037403 CrossRefPubMedGoogle Scholar
  8. Boswell JF, Farchione TJ, Sauer-Zavala S, Murray HW, Fortune MR, Barlow DH (2013) Anxiety sensitivity and interoceptive exposure: a transdiagnostic construct and change strategy. Behav Ther 44(3):417–431.  https://doi.org/10.1016/j.beth.2013.03.006 CrossRefPubMedPubMedCentralGoogle Scholar
  9. Boswell JF, Thompson-Hollands J, Farchione TJ, Barlow DH (2013) Intolerance of uncertainty: a common factor in the treatment of emotional disorders. J Clin Psychol 69(6):630–645.  https://doi.org/10.1002/jclp.21965 CrossRefPubMedGoogle Scholar
  10. 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 CrossRefPubMedPubMedCentralGoogle Scholar
  11. Busch FN, Milrod BL, Sandberg LS (2009) A study demonstrating efficacy of a psychoanalytic psychotherapy for panic disorder: implications for psychoanalytic research, theory, and practice. J Am Psychoanal Assoc 57(1):131–148.  https://doi.org/10.1177/0003065108329677 CrossRefPubMedPubMedCentralGoogle Scholar
  12. Clark DA, Taylor S (2009) The transdiagnostic perspective on cognitive-behavioral therapy for anxiety and depression: new wine for old wineskins? J Cogn Psychother 23(1):60–66.  https://doi.org/10.1891/0889-8391.23.1.60 CrossRefGoogle Scholar
  13. 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 CrossRefPubMedGoogle Scholar
  14. Ellard KK, Bernstein EE, Hearing C, Baek JH, Sylvia LG, Nierenberg AA, Deckersbach T (2017) Transdiagnostic treatment of bipolar disorder and comorbid anxiety using the unified protocol for emotional disorders: a pilot feasibility and acceptability trial. J Affect Disord 219:209–221.  https://doi.org/10.1016/j.jad.2017.05.011 CrossRefPubMedGoogle Scholar
  15. 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 CrossRefPubMedPubMedCentralGoogle Scholar
  16. Fehm L, Fehm-Wolfsdorf G (2001) Hausaufgaben in der Psychotherapie. Hausaufgaben als therapeutische Intervention: Ausnahme oder Alltag? TT—Homework as therapeutic intervention: exception or everyday practice? Psychotherapeut 46(6):386–390.  https://doi.org/10.1007/s002780100168 CrossRefGoogle Scholar
  17. Gutiérrez E, Carrera O (2018) Anorexia nervosa treatments and Occam’s razor. Psychol Med.  https://doi.org/10.1017/S0033291717003944 PubMedGoogle Scholar
  18. Hayes SC, Strosahl KD, Wilson KG (1999) Acceptance and commitment therapy: an experiential approach to behavior change. Guilford, New YorkGoogle Scholar
  19. Ingram RE (1990) Self-focused attention in clinical disorders: review and a conceptual model. Psychol Bull 107(2):156–176.  https://doi.org/10.1037/0033-2909.107.2.156 CrossRefPubMedGoogle Scholar
  20. Jacobi F, Höfler M, Strehle J, Mack S, Gerschler A, Scholl L, Wittchen H‑U (2014) Psychische Störungen in der Allgemeinbevölkerung. Nervenarzt 85:77–87.  https://doi.org/10.1007/s00115-013-3961-y CrossRefPubMedGoogle Scholar
  21. Kabat-Zinn J, Massion AO, Kristeller J, Peterson LG (1992) Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. Am J Psychiatry 149(7):936–943CrossRefPubMedGoogle Scholar
  22. Lamers F, van Oppen P, Comijs HC, Smit JH, Spinhoven P, van Balkom AJLM, Penninx BWJH (2011) Comorbidity patterns of anxiety and depressive disorders in a large cohort study: the Netherlands Study of Depression and Anxiety (NESDA). J Clin Psychiatry 72(3):341–348.  https://doi.org/10.4088/JCP.10m06176blu CrossRefPubMedGoogle Scholar
  23. Laposa JM, Mancuso E, Abraham G, Loli-Dano L (2017) Unified protocol transdiagnostic treatment in group format: a preliminary investigation with anxious individuals. Behav Modif 41(2):253–268.  https://doi.org/10.1177/0145445516667664 CrossRefPubMedGoogle Scholar
  24. Leichsenring F, Klein S (2014) Evidence for psychodynamic psychotherapy in specific mental disorders: a systematic review. Psychoanal Psychother 28(1):4–32.  https://doi.org/10.1080/02668734.2013.865428 CrossRefGoogle Scholar
  25. Lopez ME, Stoddard JA, Noorollah A, Zerbi G, Payne LA, Hitchcock CA, Ray DB (2014) 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 CrossRefGoogle Scholar
  26. Martell C, Addis ME, Jacobson NS (2001) Depression in context: strategies for guided action. Norton, New YorkGoogle Scholar
  27. Miller WR, Rollnick S (2015) Motivierende Gesprächsführung: Motivational Interviewing, 3. Aufl. Lambertus, Freiburg im BreisgauGoogle Scholar
  28. Norton PJ, Paulus DJ (2016) Toward a unified treatment for emotional disorders: update on the science and practice. Behav Ther 47(6):854–868.  https://doi.org/10.1016/j.beth.2015.07.002 CrossRefPubMedGoogle Scholar
  29. de Ornelas MACC, Sanford J, Boettcher H, Nardi AE, Barlow D (2017) Improvement in quality of life and sexual functioning in a comorbid sample after the unified protocol transdiagnostic group treatment. J Psychiatr Res 93:30–36.  https://doi.org/10.1016/j.jpsychires.2017.05.013 CrossRefGoogle Scholar
  30. Reinholt N, Aharoni R, Winding C, Rosenberg N, Rosenbaum B, Arnfred S (2017) Transdiagnostic group CBT for anxiety disorders: the unified protocol in mental health services. Cogn Behav Ther 46(1):29–43.  https://doi.org/10.1080/16506073.2016.1227360 CrossRefPubMedGoogle Scholar
  31. Rief W, Hofmann SG (2018) Some problems with non-inferiority tests in psychotherapy research: psychodynamic therapies as an example. Psychol Med.  https://doi.org/10.1017/S0033291718000247 PubMedGoogle Scholar
  32. Roth C, Siegl J, Aufdermauer N, Reinecker H (2004) Therapie von Angst- und Zwangspatienten in der verhaltenstherapeutischen Praxis TT—Behavioral treatment of anxiety and obsessive-compulsive disorder in behavior therapists’ private practices. Verhaltenstherapie 14(1):16–21.  https://doi.org/10.1159/000078027 CrossRefGoogle Scholar
  33. Sauer-Zavala S, Boswell JF, 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 CrossRefPubMedPubMedCentralGoogle Scholar
  34. Thompson-Hollands J, Bentley KH, Gallagher MW, Boswell JF, Barlow DH (2014) Credibility and outcome expectancy in the unified protocol: relationship to outcomes. J Exp Psychopathol 5(1):72–82.  https://doi.org/10.5127/jep.033712 CrossRefGoogle Scholar
  35. Waller G, Turner H (2016) Therapist drift redux: why well-meaning clinicians fail to deliver evidence-based therapy, and how to get back on track. Behav Res Ther 77:129–137.  https://doi.org/10.1016/j.brat.2015.12.005 CrossRefPubMedGoogle Scholar
  36. Warnock-Parkes E, Wild J, Stott R, Grey N, Ehlers A, Clark DM (2017) Seeing is believing: using video feedback in cognitive therapy for social anxiety disorder. Cogn Behav Pract 24(2):245–255.  https://doi.org/10.1016/j.cbpra.2016.03.007 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  • Johanna Boettcher
    • 1
  • Carmen Schaeuffele
    • 1
  • Babette Renneberg
    • 1
  1. 1.Arbeitsbereich Klinische Psychologie und PsychotherapieFreie Universität BerlinBerlinDeutschland

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