The unified protocol for transdiagnostic treatment of Emotional Disorders compared with diagnosis-specific protocols for anxiety disorders: A randomized clinical trial

David H. Barlow, Todd J. Farchione, Jacqueline R. Bullis, Matthew W. Gallagher, Heather Murray-Latin, Shannon Sauer-Zavala, Kate H. Bentley, Johanna Thompson-Hollands, Laren R. Conklin, James F. Boswell, Amantia Ametaj, Jenna R. Carl, Hannah T. Boettcher, Clair Cassiello-Robbins

Research output: Contribution to journalArticlepeer-review

495 Scopus citations


Importance: Transdiagnostic interventions have been developed to address barriers to the dissemination of evidence-based psychological treatments, but only a few preliminary studies have compared these approaches with existing evidence-based psychological treatments. Objective: To determine whether the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) is at least as efficacious as single-disorder protocols (SDPs) in the treatment of anxiety disorders. Design, Setting, and Participants: From June 23, 2011, to March 5, 2015, a total of 223 patients at an outpatient treatment center with a principal diagnosis of panic disorder with or without agoraphobia, generalized anxiety disorder, obsessive-compulsive disorder, or social anxiety disorder were randomly assigned by principal diagnosis to the UP, an SDP, or a waitlist control condition. Patients received up to 16 sessions of the UP or an SDP for 16 to 21 weeks. Outcomes were assessed at baseline, after treatment, and at 6-month follow-up. Analysis in this equivalence trial was based on intention to treat. Interventions: The UP or SDPs. Main Outcomes and Measures: Blinded evaluations of principal diagnosis clinical severity rating were used to evaluate an a priori hypothesis of equivalence between the UP and SDPs. Results: Among the 223 patients (124 women and 99 men; mean [SD] age, 31.1 [11.0] years), 88 were randomized to receive the UP, 91 to receive an SDP, and 44 to the waitlist control condition. Patients were more likely to complete treatment with the UP than with SDPs (odds ratio, 3.11; 95%CI, 1.44-6.74). Both the UP (Cohen d, -0.93; 95%CI, -1.29 to -0.57) and SDPs (Cohen d, -1.08; 95%CI, -1.43 to -0.73) were superior to the waitlist control condition at acute outcome. Reductions in clinical severity rating from baseline to the end of treatment (β, 0.25; 95%CI, -0.26 to 0.75) and from baseline to the 6-month follow-up (β, 0.16; 95%CI, -0.39 to 0.70) indicated statistical equivalence between the UP and SDPs. Conclusions and Relevance: The UP produces symptom reduction equivalent to criterion standard evidence-based psychological treatments for anxiety disorders with less attrition. Thus, it may be possible to use 1 protocol instead of multiple SDPs to more efficiently treat the most commonly occurring anxiety and depressive disorders.

Original languageEnglish
Pages (from-to)875-884
Number of pages10
JournalJAMA Psychiatry
Issue number9
StatePublished - Sep 2017

Bibliographical note

Funding Information:
Funding/Support: This study was funded by grant R01 MH090053 from the National Institute of Mental Health.

Funding Information:
reported receiving royalties from Oxford University Press (which includes royalties for all 5 treatment manuals included in this study), Guilford Publications Inc, Cengage Learning, and Pearson Publishing; receiving grants from the National Institute of Mental Health, the National Institute of Alcohol and Alcohol Abuse, and Colciencias (Government of Columbia Initiative for Science, Technology, and Health Innovation); serving as a consultant for and receiving honoraria 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. Dr Farchione reported receiving royalties from Oxford University Press for one of the treatment manuals included in this study. No other disclosures were reported.

Publisher Copyright:
© 2017 American Medical Association. All rights reserved.

ASJC Scopus subject areas

  • Psychiatry and Mental health


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