By Rachel Bernstein and Darby Saxbe
Things have felt harder than usual for you lately. You’re on the hunt for a new job and each rejection is knocking your confidence to new lows. The dark days of winter got you down and you’ve been finding it hard to leave home. You’ve been turning down plans with friends more than usual and now the FOMO is setting in. It’s felt more difficult than ever to keep your emotions in check. Before you know it, you’ve got four different problems you want to work on, and you don’t know where to start. Let’s face it, it’s time to get some help.
After a quick Google search of “therapist near me,” the search results make you feel like you might as well be swimming in a bowl of alphabet soup. There are a number of different treatment options on the page in front of you: CBT (Cognitive Behavioral Therapy), ACT (Acceptance & Commitment Therapy), IPT (Interpersonal Therapy), DBT (Dialectical Behavior Therapy), EMDR (Eye Movement Desensitization and Reprocessing), and the list goes on and on. How do you choose which ones are the best fit for your problems?
You’re not alone. More than half of people with an anxiety disorder diagnosis also have a depressive disorder, or an additional anxiety disorder, like social anxiety. This may be because these problems have more in common than we originally thought. While psychology's main diagnostic manual, the DSM-5, categorizes various mood disorders into distinct diagnoses, researchers have discovered shared underlying genetic, neurological, and psychosocial traits related to how individuals with these problems process emotions (Barlow, 2014). Around the time these ideas came to light, a group of psychologists at Boston University, led by Dr. David Barlow, extended this work to develop a treatment called the Unified Protocol for people who suffer from multiple emotional disorders at once. So, while the thought of treating these different problems at the same time may sound daunting and difficult, there may be a solution that works.
The Unified Protocol is a type of psychotherapy that targets emotion understanding, processing, and responses regardless of the diagnoses you might have. The Unified Protocol was developed as a form of another effective psychotherapy, Cognitive Behavioral Therapy (CBT). CBT and the Unified Protocol both work on breaking the cycle between our negative thoughts, feelings, and behaviors to improve how we feel in our everyday life. What makes the Unified Protocol unique is that it is a transdiagnostic approach to treatment; it can be applied to over 35 different mental health diagnoses that fall under the category of emotional disorders.
In the Unified Protocol, therapists teach their clients strategies across five modules that ultimately aim to target emotion dysregulation, a common underlying factor of these diagnoses. The five modules, briefly, are:
By better identifying when your emotions feel out of your control, you may be able to learn how to regulate your responses and manage them more effectively. In fact, an early key element to the Unified Protocol is identifying your “ARC”:
A – Antecedents: Events that occur before your emotional reaction
R – Responses: Your emotional reaction to the event
C – Consequences: Things that happen directly or indirectly because of your emotional reaction
By learning more about how you experience and respond to emotions, you can work to catch these situations as they’re happening and try to change how you respond to them in real time. The Unified Protocol, like some other kinds of therapy, will involve practicing strategies like this both in session with your therapist and out of session in your everyday life.
Several studies have been conducted to determine if the Unified Protocol is effective in reducing symptoms of anxiety and depression. There have also been studies to determine how the Unified Protocol compares to other well-established treatments.
First and foremost, the Unified Protocol works. In a review by researchers Nathan Sakiris and David Berle (2019), the Unified Protocol was found to reduce symptoms of generalized anxiety disorder, social anxiety disorder, panic disorder, obsessive compulsive disorder, post-traumatic stress disorder, and borderline personality disorder across 15 different studies and more than 1200 patients. These effects lasted for at least six months after treatment.
Research also shows that the Unified Protocol was just as effective as other therapies that focus on treating a single disorder, and people who were receiving the Unified Protocol tended to drop out of treatment less (Eustis et al., 2020). This means the Unified Protocol is a promising option for those who are experiencing emotional difficulties in different categories.
There is certainly more work to be done to understand exactly how the Unified Protocol achieves its effects, and who it is most effective for. Also, despite being a promising treatment option, it can be difficult to find a trained provider in the community. Research teams are hard at work trying to get the Unified Protocol into the hands of people who may benefit from it, but there is still a ways to go. That being said, if managing big emotions is something that is difficult for you, and there is a provider in your local area, the Unified Protocol might help.
So, next time you feel like you’re sifting through a bowl of alphabet soup to find the best care for you or a loved one, keep the Unified Protocol in mind.
Look at the therapist directory on Psychology Today or visit https://www.unifiedprotocol.com/therapists to find a Unified Protocol therapist in your area and to learn about other ways you might access this treatment.
Rachel Bernstein is a graduate student in the USC Clinical Psychology Ph.D. program.
References
Barlow, D. H., Ellard, K. K., & Fairholme, C. P. (2010). Unified protocol for transdiagnostic treatment of emotional disorders: Workbook. Oxford University Press.
Barlow, D. H. (Ed.). (2014). Clinical handbook of psychological disorders: A step-by-step treatment manual. Guilford publications.
Brown, T. A., Campbell, L. A., Lehman, C. L., Grisham, J. R., & Mancill, R. B. (2001). Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. Journal of abnormal psychology, 110(4), 585.
Eustis, E. H., Gallagher, M. W., Tirpak, J. W., Nauphal, M., Farchione, T. J., & Barlow, D. H. (2020). The Unified Protocol compared with diagnosis-specific protocols for anxiety disorders: 12-month follow-up from a randomized clinical trial. General hospital psychiatry, 67, 58-61.
Sakiris, N., & Berle, D. (2019). A systematic review and meta-analysis of the Unified Protocol as a transdiagnostic emotion regulation based intervention. Clinical psychology review, 72, 101751.
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