Changes in neuroticism-related constructs over the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in patients on an optimal dose of SSRI.

Abstract

Recent advances in clinical practice emphasize the utility of Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP) as an effective intervention for targeting core processes underlying comorbid disorders. This study aimed to evaluate changes in psychopathological risk factors associated with the construct of neuroticism (i.e., negative affect, anxiety sensitivity, experiential avoidance, intolerance of uncertainty) within the UP to adults already on an optimal and stable dose of SSRIs. In a randomized controlled trial, a total of 39 adults (M age = 27.51 [68.43]; 56.4% female) on SSRIs with a diagnosis of comorbid anxiety and depressive disorder were randomly assigned to either UP þ SSRI (n = 18) or continued SSRI-only (n = 21). Neuroticism dimensions were assessed at baseline, posttreatment, and 1-month follow-up. UP þ SSRI condition demonstrated medium to large effect sizes for changes over time on facets of neuroticism including negative affect (Cohen's d = 1.12, 95% confidence interval [CI; 0.44, 1.80]), anxiety sensitivity (Cohen's d = 1.21, 95% CI [0.53, 1.90]), experiential avoidance (Cohen's d = 0.74, 95% CI [0.09, 1.04]), and intolerance of uncertainty (Cohen's d = 1.66, 95% CI [0.93, 2.39]). Post hoc analyses showed reductions in variables that were maintained at followup. Results adds to the growing body of literature and provide cross-cultural support for the utility of UP in targeting pathological risk factors as adjuncts to SSRI. Implications for future studies and limitations are discussed.

A preliminary evaluation of unified protocol in anxiety disorders in India: a multiple baseline study protocol

“…Among the few studies that look at the effect of UP on transdiagnostic variables, most studies employ a pre-post design. 41 The study would also be first of its kind in India examining the effect of Unified Protocol on transdiagnostic variables during the course of intervention using a multiple baseline design. The strengths of the study are employment of multiple assessments conducted by an independent rater to track the trajectory of change.…”

Neuroticism/negative emotionality is associated with increased reactivity to uncertain threat in the bed nucleus of the stria terminalis, not the amygdala

“…A key challenge for the future will be to clarify causation. There is compelling evidence that N/NE can be dampened through both psychological and pharmacological interventions (60)(61)(62)(63). It would be fruitful to test whether these effects reflect attenuated BST reactivity to uncertain threat.…”

“…Although the mechanistic contribution of the BST to dispositional fear and anxiety has yet to be explored in primates, work in rodents shows that the BST exerts bi-directional control over defensive behaviors triggered by uncertain-threat anticipation ( Jennings et al, 2013 ; Kim et al, 2013 ; Glangetas et al, 2017 ; Ahrens et al, 2018 ; Mazzone et al, 2018 ). Among humans, N/NE is stable, but can change in response to experience, providing opportunities for understanding causation ( Stieger et al, 2021 ; Zemestani et al, 2022 ). In a comprehensive meta-analysis, Roberts and colleagues documented substantial N/NE reductions following treatment for internalizing disorders ( Roberts et al, 2017 ).…”

The Applicability of Acceptance and Commitment Therapy for Obsessive-Compulsive Disorder: A Systematic Review and Meta-Analysis

“…. [32], Vakili and Gharraee (2014) [33], Baghooli (2014) [34], Izadi (2014) [35], Esfahani (2015) [36], Vakili (2015) [37], Rohani (2017) [38], Twohig (2018) [39], Ong (2019) [40], Thompson (2020) [41], Davazdahemanni (2020) [42], Zemestani (2021) [43].…”