Isolating the Effects of Mindfulness Training Across Anxiety Disorder Diagnoses in the Unified Protocol

Woods, Brittany K.; Sauer‐Zavala, Shannon; Farchione, Todd J.; Barlow, David H.

doi:10.1016/j.beth.2020.01.001

Cited by 15 publications

(14 citation statements)

References 24 publications

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“…Once patients have been instructed in how to use skills, they are encouraged to use them frequently in response to stressors. In the UP, patients who used mindfulness skills more frequently during treatment were rated by clinicians as having lower post-treatment global clinical severity (Woods et al, 2020) and anxiety but not depression . Among patients who used maladaptive responses (e.g., self-blame, denial, substance use) more frequently at baseline in the UP, 1 increases in the frequency with which they used adaptive strategies (e.g., acceptance, cognitive reappraisal) over treatment were associated with decreases in anxiety and depression symptoms (Conklin et al, 2015).…”

Section: Frequency Of Skill Usementioning

confidence: 99%

Dimensions of Skill Use in the Unified Protocol: Exploring Unique Effects on Anxiety and Depression

Southward¹,

Sauer‐Zavala²

2021

Preprint

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Objective: Although the Unified Protocol contains multiple distinct skills to target anxiety, depression, and related conditions, researchers have yet to establish if patients' use of these skills contributes to symptom change. Using data from the first-stage randomization of a sequential multiple assignment randomized trial, we tested whether general skillfulness, defined by skill knowledge, frequency, quality, and effectiveness, predicted within- or between-person changes in anxiety and depression. We further tested whether use of particular UP skills (e.g., mindfulness, behavior change) predicted changes in these outcomes. Method: Participants (N = 70; Mage = 33.74, 67% female, 74% white) completed six sessions of core UP modules and reported on their skillfulness and specific skill use using two novel measures, along with their symptoms of anxiety (OASIS) and depression (ODSIS) before each session, and their alliance (WAI) after each session. We disaggregated between- from within-person effects to test session- to-session effects of skillfulness, skill use, and the alliance on symptom change. Results: Greater within-person skillfulness predicted decreases in anxiety and depression. More frequent within- person use of all UP skills predicted decreases in anxiety, whereas more frequent within-person use of alternative actions specifically predicted decreases in depression. Conclusions: This pattern of results provides guidance on the specific aspects of skill training to prioritize in transdiagnostic treatments depending on whether therapists are targeting anxiety or depression.

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Section: Frequency Of Skill Usementioning

confidence: 99%

Dimensions of Skill Use in the Unified Protocol: Exploring Unique Effects on Anxiety and Depression

Southward¹,

Sauer‐Zavala²

2021

Preprint

Self Cite

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“…Anxiety sensitivity -while increasingly conceptualized as a transdiagnostic process and found to be associated with symptom change in the UP (Boettcher et al, 2016;Boswell et al, 2013) -might play a lesser role in depressive disorders and thus, may not be related to outcome to the same extent in our fairly depressed sample. Future studies should investigate whether these findings on transdiagnostic processes are dependent on diagnosis, as suggested by a recent study on mindfulness as a predictor of outcome in the UP (Woods et al, 2020). The non-significant finding on anxiety sensitivity also raises the question of whether all participants benefit from the interoceptive exposure module that targets anxiety sensitivity.…”

Section: Discussionmentioning

confidence: 94%

Transdiagnostic Processes as Mediators of Change in an Internet-delivered Intervention based on the Unified Protocol

Schaeuffele¹,

Bär²,

Buengener³

et al. 2021

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Background: Transdiagnostic treatments target shared mechanisms between disorders to facilitate change across diagnoses. The Unified Protocol (UP) aims at changing dysfunctional reactions towards emotions by increasing mindful emotion awareness and cognitive flexibility, as well as decreasing anxiety sensitivity and emotion avoidance. Method: We investigated whether these transdiagnostic processes were malleable by treatment and mediated the relationship between treatment and outcome in an internet-delivered adaptation of the UP. N=129 participants with mixed anxiety, depressive, and somatic symptom disorders were randomized to treatment or waitlist. Results: The treatment yielded significant changes in all transdiagnostic processes over time in comparison to a waitlist condition. In single mediator models, significant mediating effects were found for mindfulness, cognitive flexibility, behavioral activation, and experiential avoidance. When all mediators were combined in a multiple mediator model, only mindfulness emerged as a significant mediator. Conclusion: These findings add to the growing body of research on transdiagnostic processes as mediators of change and emphasize mindfulness as a transdiagnostic treatment target. However, these results should be interpreted cautiously, as temporal precedence could not be established.

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“…Using the third-wave behavior therapies, process-based technique (i.e., mindfulness) UP targets suppressive/avoidant reactivity by helping patients use more adaptive emotion regulation strategies to accept and endure the negative emotions rather than resort to maladaptive avoidance and suppressive strategies (Woods et al, 2020). The impact of mindfulness on stress-related cortisol secretion has been associated with attenuated amygdala activation in response to threat (Creswell et al, 2007).…”

Section: Discussionmentioning

confidence: 99%

“…This is also the cause of superiority of UP to SSRIs in follow-up and relapse prevention. Most recent evidence also indicates that because the UP is unique from the single-disorder protocols for its main focuses on underlying mechanisms by process-based techniques, it is effective in patients with heterogeneous emotional disorders (Woods et al, 2020). Any patient who meets the diagnostic criteria of one or multiple emotional disorders can be viewed as experiencing the same underlying psychopathology, and this is the focus of transdiagnostic treatments (Pearl & Norton, 2017).…”

Section: Discussionmentioning

confidence: 99%

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

Zemestani

Ommati

Rezaei

et al. 2022

Personality Disorders: Theory, Research, and Treatment

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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.

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Isolating the Effects of Mindfulness Training Across Anxiety Disorder Diagnoses in the Unified Protocol

Cited by 15 publications

References 24 publications

Dimensions of Skill Use in the Unified Protocol: Exploring Unique Effects on Anxiety and Depression

Dimensions of Skill Use in the Unified Protocol: Exploring Unique Effects on Anxiety and Depression

Transdiagnostic Processes as Mediators of Change in an Internet-delivered Intervention based on the Unified Protocol

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

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