Associations between improvements in aversive reactions to negative emotions and increased quality of life in the unified protocol

Emotional disorders are thought to be maintained by the transaction between frequent experiences of strong, negative emotions (i.e., neuroticism) and aversive reactions to those emotions. The Unified Protocol (UP) is an efficacious treatment for transdiagnostic emotional disorders designed to target specific forms of aversive reactivity to negative emotions. In addition to symptom change, the UP has also been shown to lead to increases in quality of life. However, it remains unclear which specific mechanisms targeted in the UP are related to improvements in quality of life. We explored the relations between changes in five aspects of aversive reactivity included in the UP (i.e., non-acceptance of emotions, [lack of] mindfulness, cognitive rigidity, behavioral avoidance, and anxiety sensitivity) and overall quality of life during treatment. Person-specific regression slopes revealed that improvements in emotional non-acceptance, behavioral avoidance, and mindfulness were each significantly associated with increases in quality of life over the six sessions of treatment. Although in the expected direction, improvements in anxiety sensitivity and cognitive flexibility were not significantly associated with increases in quality of life. These findings generally suggest a model of equifinality in which improvements in most aspects of aversive reactivity are similarly related to changes in quality of life. Clinical trials registration number: NCT04584879.