A SMART approach to personalized care: preliminary data on how to select and sequence skills in transdiagnostic CBT

Shannon Sauer-Zavala, Matthew W. Southward, Nicole E. Stumpp, Stephen A. Semcho, Caitlyn O. Hood, Anna Garlock, Alex Urs

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Given that over 20 million adults each year do not receive care for their mental health difficulties, it is imperative to improve system-level capacity issues by increasing treatment efficiency. The present study aimed to collect feasibility/acceptability data on two strategies for increasing the efficiency of cognitive behavioral therapy: (1) personalized skill sequences and (2) personalized skill selections. Participants (N = 70) with anxiety and depressive disorders were enrolled in a pilot sequential multiple assignment randomized trial (SMART). Patients were randomly assigned to receive skill modules from the Unified Protocol in one of three sequencing conditions: standard, sequences that prioritized patients’ relative strengths, and sequences that prioritized relative deficits. Participants also underwent a second-stage randomization to either receive 6 sessions or 12 sessions of treatment. Participants were generally satisfied with the treatment they received, though significant differences favored the Capitalization and Full duration conditions. There were no differences in trajectories of improvement as a function of sequencing condition. There were also no differences in end-of-study outcomes between brief personalized treatment and full standard treatment. Thus, it may be feasible to deliver CBT for personalized durations, though this may not substantially impact trajectories of change in anxiety or depressive symptoms.

Original languageEnglish
Pages (from-to)435-455
Number of pages21
JournalCognitive Behaviour Therapy
Issue number6
StatePublished - 2022

Bibliographical note

Funding Information:
Effort on this project was supported by the National Institute on Drug Abuse (T32 DA035200) through the National Institutes of Health (NIH). This publication’s contents are solely the responsibility of the authors and do not necessarily represent the official views of NIH.

Publisher Copyright:
© 2022 Swedish Association for Behaviour Therapy.


  • Treatment personalization
  • modular treatment
  • transdiagnostic
  • unified protocol

ASJC Scopus subject areas

  • Clinical Psychology


Dive into the research topics of 'A SMART approach to personalized care: preliminary data on how to select and sequence skills in transdiagnostic CBT'. Together they form a unique fingerprint.

Cite this