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Mediators and Moderators of Therapeutic Change in the Unified Protocol for Women Experiencing Homelessness

Cognitive Therapy and Research volume 47, pages 209–221 (2023)Cite this article

Abstract

Background

The general aim of the study was to examine potential mediators and moderators in an adaptation of the Unified Protocol for Homeless Women (UPHW).

Methods

We conducted a secondary analysis in a sample of 80 homeless women participated in the study: 37 in the UPHW and 43 in the waitlist control condition. The assessment before and after the program included primary outcomes (anxiety and depression) and secondary outcomes, including different mediators (positive and negative affect, well-being, and social support) and moderators (demographics, homelessness, physical function, drug and alcohol abuse).

Results

The UPHW showed significant improvements on anxiety and depression outcomes at post-intervention compared to waitlist control condition. Negative affect was the only significant mediator of the relationship between the UPHW and reductions in anxiety and depression symptoms. Physical functioning was the only significant moderator of the relationship between the UPHW and depression symptoms.

Conclusion

To our knowledge this is the first study examining potential mediators and moderators of change in an evidence-based psychological treatment in a population experiencing homelessness. Findings suggest that transdiagnostic protocols may be a promising approach to improving psychological outcomes in this population.

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Acknowledgements

The authors want to thank all women experiencing homelessness for their generosity to participate in the study.

Funding

Declaration: This work was supported by the “Agencia Estatal de Investigación” of the “Ministerio de Economía y Competitividad” of Spain (Ref. FEM2016-75317-R).

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Authors and Affiliations

  1. Department of Psychology, Villanueva University, 28034, Madrid, Spain

    Sara Rodriguez-Moreno

  2. Clinical Psychology Department, School of Psychology, Complutense University of Madrid, 28223, Madrid, Spain

    Ana I. Guillén, Carolina Marín & Sonia Panadero

  3. Center for Anxiety and Related Disorders, Department of Psychology, Boston University, 900 Commonwealth Avenue 2nd Floor, 02215, Boston, MA, USA

    Julianne W. Tirpak, Nicole D. Cardona, Elizabeth H. Eustis, Todd J. Farchione & David H. Barlow

Authors
  1. Sara Rodriguez-Moreno
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  2. Ana I. Guillén
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  3. Julianne W. Tirpak
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  4. Carolina Marín
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  5. Nicole D. Cardona
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  6. Elizabeth H. Eustis
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  7. Todd J. Farchione
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  8. David H. Barlow
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  9. Sonia Panadero
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Contributions

SRM, SP, and JGW developed the study conception and design of the article. Data analysis and interpretation were performed by AIG. The introduction section was written by CM, JGW, and NDC. The Method section was written by AIG and SRM. The Results sections was written by AIG. The discussion section was written by SRM. SRM put together the different sections. DHB, TJF, and EHE did the final review of the manuscript and contributed to the discussion. SP was the principal investigator of the project. All the authors approved the final version of the manuscript for submission.

Corresponding author

Correspondence to Sara Rodriguez-Moreno.

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Ethics Approval

statement: The research was approved by the university ethics committee before participant recruitment (Ref. 2017/18 − 004) and was registered at ClinicalTrial.org (NCT04392856).

Author Agreement

All authors have seen and approved the final version of the manuscript being submitted.

Conflict of Interest

Dr. Barlow receives royalties from Oxford University Press, Guilford Publications Inc., Cengage Learning, and Pearson Publishing. Grant monies for various projects including this one come from the National Institute of Mental Health, the National Institute of Alcohol and Alcohol Abuse, the Templeton foundation, and Colciencias (Government of Columbia Initiative for Science, Technology, and Health Innovation). Consulting and honoraria during the past several years have come from the Agency for Healthcare Research and Quality, the Foundation for Informed Medical Decision Making, the Department of Defense, the Renfrew Center, the Chinese University of Hong Kong, Universidad Católica de Santa Maria (Arequipa, Peru), New Zealand Psychological Association, Hebrew University of Jerusalem, Mayo Clinic, and various American Universities and Institutes. Dr. Farchione reported receiving royalties from Oxford University Press as one of the authors of the Unified Protocol. He also receives research support from the National Institute of Health.

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Rodriguez-Moreno, S., Guillén, A.I., Tirpak, J.W. et al. Mediators and Moderators of Therapeutic Change in the Unified Protocol for Women Experiencing Homelessness. Cogn Ther Res 47, 209–221 (2023). https://doi.org/10.1007/s10608-022-10335-8

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Keywords

  • Homelessness
  • Homeless women
  • Unified protocol
  • Mechanism of change
  • Moderators