The effects of the Unified Protocol and Unified Protocol skills on loneliness in the COVID-19 pandemic

Matthew W. Southward, Douglas R. Terrill, Shannon Sauer-Zavala

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: Loneliness is a significant public health concern with no established first-line intervention although modular, transdiagnostic, cognitive-behavioral interventions, such as the Unified Protocol (UP), are promising candidates. The UP contains skill modules to target anxiety, depression, and related conditions, although it is unclear if the UP can reduce loneliness and if UP skill use contributes to these reductions. Methods: Using data from the first-stage randomization of a sequential multiple assignment randomized trial, we tested whether the UP led to reductions in loneliness and whether specific dimensions of UP skill use predicted session-to-session changes in loneliness. Participants (N = 70; Mage = 33.74, 67% female, 74% white) completed six sessions of core UP modules, reporting how frequently they felt lonely and used UP skills before each session. Using hierarchical linear modeling, we examined the trajectory of change in loneliness and disaggregated between- from within-person variability to test session-to-session effects of skill use. Results: Loneliness significantly decreased during treatment with the UP. Using more UP skills than one's personal average, but not frequency of skill use, predicted session-to-session decreases in loneliness. Conclusions: Therapists may be encouraged to guide patients toward using a large quantity of different skills to specifically address loneliness.

Original languageEnglish
Pages (from-to)913-921
Number of pages9
JournalDepression and Anxiety
Issue number12
StatePublished - Dec 2022

Bibliographical note

Funding Information:
The authors would like to thank Patrick Goh, Caitlyn Hood, Stephen Semcho, and Nicole Stumpp for conducting therapy session and assessments. The authors would also like to thank Destiney MacLean, Anna Garlock, and Alex Urs for their project assistance throughout the study. This research did not receive any specific grant from funding agencies in the public, commercial, or not‐for‐profit sectors. The first author's efforts were supported by NIMH K23 MH126211. The funding source had no involvement in the conduct or preparation of the research.

Publisher Copyright:
© 2022 Wiley Periodicals LLC.


  • Unified Protocol
  • loneliness
  • skills
  • transdiagnostic

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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