At Crownview Psychiatric Institute, we employ a variety of evidence-based, research-supported therapeutic services to ensure that we are best prepared to address the full scope of each client’s mental health needs.

For many of our clients, the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders is a particularly beneficial element of their care. Commonly referred to as the Unified Protocol or the UP, this approach can be a source of both symptom relief and essential skills development for adults with complex mental health conditions.

What Is the Unified Protocol?

The Unified Protocol was established by Dr. David Barlow and his team in the early 2000s. They developed this approach in response to the following realizations:

  • Certain symptoms are common to several types of mental health disorders. For example, excessive fear or worry is a characteristic of every type of anxiety disorder.
  • It is common for people who have one type of mental health disorder (such as generalized anxiety disorder) to also have another condition (such as persistent depressive disorder).

Although many people have multiple mental health disorders that share common symptoms, standard treatment protocols often address each disorder as distinct and separate. The Unified Protocol represents a concerted effort to find a more efficient and effective way of treating people who living with these complex mental health concerns.

In the therapist’s guide to the UP that Dr. Barlow and his associates wrote, they identified the following three goals for this treatment approach:

  • To help patients learn to better understand and tolerate their emotional experiences
  • To ground them within the current context in which they are occurring
  • To counter maladaptive strategies for managing uncomfortable emotional experiences

In addition to establishing these goals, Dr. Barlow and his team emphasized that the Unified Protocol is not designed to eliminate difficult or challenging emotions.

Instead, therapists who employ the principles of the Unified Protocol help their clients understand how their maladaptive responses to distressing emotions may contribute to the symptoms they experience. The therapists can then help their clients adopt healthier ways of managing difficult emotions when they arise.

Who Can Benefit from the Unified Protocol?

When the Unified Protocol was developed, it was initially designed to help people who had co-occurring anxiety and depression. Through the years, it has proved to be an effective way to help those who have a variety of mental health disorders, including the following:

  • Anxiety disorders
  • Depressive disorders
  • Obsessive-compulsive disorder (OCD)
  • Posttraumatic stress disorder (PTSD)
  • Bipolar disorder
  • Borderline personality disorder
  • Hypochondriasis

The Unified Protocol has also demonstrated benefits for people whose struggles with mental illnesses are accompanied by co-occurring substance use disorders.

Overcoming Core Vulnerabilities

The Unified Protocol is based on the understanding that many people whose lives have been impacted by one or more emotional disorders often exhibit the following three characteristics:

  • High levels of negative affect: People who have these disorders are inclined to experience frequent, intense emotions such as anger, fear, sadness, jealousy, and resentment. These and similar feelings are referred to by clinicians as negative emotions.
  • Negative view of emotions: When people who have these disorders experience negative emotions, they often think that they represent personal flaws or other undesirable traits. They may believe, for example, that experiencing fear simply means they are weak.
  • Aversive reactions to emotions: Due to their negative view of distressing emotions, people who have certain mental health disorders will engage in unhealthy, self-defeating, or otherwise maladaptive behaviors in an attempt to repress or hide from these feelings.

The founders of the Universal Protocol refer to the characteristics listed above as the “three core vulnerabilities.” The UP is designed to help clients develop specific skills that can empower them to overcome these vulnerabilities.

Developing Core Skills

To address the vulnerabilities listed in the previous section, the Unified Protocol focuses on helping clients develop five core skills:

  • Mindful emotion awareness: This skill involves remaining present and viewing one’s emotions without judgment. As clients develop the ability to observe their emotions without self-criticism or reflexive reaction, they will be less likely to employ maladaptive responses.
  • Challenging automatic thoughts and increasing cognitive flexibility: Among people who have certain mental health concerns, perceived threats can trigger automatic thoughts of worst-case scenarios, which can lead to inappropriate responses. As clients learn to recognize the relationship between thoughts and emotions, they will be better able to avoid negative thought patterns and view potential challenges from a more flexible, open-minded perspective.
  • Identifying and modifying emotional behaviors: The UP defines emotional behaviors as ways that people attempt to manage strong emotions. This skill involves evaluating the short- and long-term effects of certain emotional behaviors, identifying self-defeating reactions, and developing healthier and more productive ways of responding in particularly emotional moments.
  • Increasing awareness and tolerance of physical sensations: As clients develop this skill, they will gain a greater understanding of the ways that physical sensations such as an elevated heart rate or momentary lightheadedness can trigger negative emotions and maladaptive behaviors. They can use this knowledge to adopt healthier ways of responding to these sensations.
  • Engaging in emotion exposures: As a culmination of the work clients have done to develop the previous four skills, emotion exposures place clients in circumstances or situations that would have previously prompted a maladaptive response. With each opportunity to put their newly developed skills into action, clients take greater control of their behaviors and demonstrate an expanded capacity for healthy independent living.

Following a Structured Approach

To help clients develop essential skills and overcome core vulnerabilities, the Unified Protocol is organized into eight modules:

  1. Setting Goals and Maintaining Motivation
  2. Understanding Emotions
  3. Mindful Emotion Awareness
  4. Cognitive Flexibility
  5. Countering Emotional Behaviors
  6. Understanding and Confronting Physical Sensations
  7. Emotion Exposures
  8. Recognizing Accomplishments and Looking to the Future

Modules three through seven are considered the “core modules,” as they align most closely with the five core skills. Modules one and two introduce clients to concepts and procedures that are integral to the UP, while the final module is focused on how clients can apply their newfound abilities as they move forward in their treatment and recovery.

Benefits of the Unified Protocol

The specific benefits a client receives from the Unified Protocol will depend on their unique needs and treatment goals. In general, though, the UP can help people in the following ways:

  • Developing valuable skills: The five core skills that clients develop through UP sessions can lead to significant improvements in many parts of their life, including their ability to form and maintain healthy relationships and function more effectively within their community.
  • Overcoming problematic vulnerabilities: Therapy sessions that incorporate the Unified Protocol can help clients identify and address maladaptive thought and behavior patterns that have previously undermined their ability to live a more satisfying life.
  • Gaining greater self-awareness: The Unified Protocol provides clients with the structure and guidance they need to explore the motivations behind their decisions and behaviors, so that they can act in a more purposeful manner as they progress in their recovery.
  • Experiencing relief from the symptoms of multiple mental health disorders: Breaking the cycle of automatic thoughts and emotional response can be a source of considerable relief to people who have been living with complex mental health concerns.
  • Exerting greater control over their thoughts and actions: The modules and activities that comprise the Unified Protocol empower clients to act with intention and assume greater responsibility for how they conduct themselves.

Evidence-Based Results

Several studies document the effectiveness of the Unified Protocol among various client and patient populations. For example, a 2017 study in the journal JAMA Psychiatry found that the UP produced better treatment outcomes than a diagnosis-specific treatment approach did for individuals who had several anxiety disorders.

The 2017 study assessed 223 patients diagnosed with panic disorder. Some of the study’s subjects did not have a co-occurring disorder, while others also had one or more of the following: social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder (OCD), and agoraphobia. These individuals participated in either 16 UP sessions or 16 sessions of single-disorder protocols (SDPs).

The researchers found that the people whose care involved the Unified Protocol were more likely to complete treatment. They also found that the UP led to more sustained progress among all subjects as well as considerable improvement among those who had co-occurring disorders:

Results indicated that emotional disorder symptoms improved similarly for UP and SDPs, with both groups demonstrating significant reductions in the severity of the principal diagnosis posttreatment, with the UP evidencing significantly less attrition than the SDPs.

With regard to comorbid conditions, 62% of patients treated with the UP no longer met diagnostic criteria for any emotional disorder, and these improvements were largely maintained one year later.

“The UP produces symptom reduction equivalent to criterion standard evidence-based psychological treatments for anxiety disorders with less attrition,” the researchers concluded. “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.”

Learn More Today

To determine if you or someone that you care about can benefit from the Unified Protocol and other elements of care at Crownview Psychiatric Institute, contact us today. A member of our admissions team will be happy to answer all your questions and help you make the most informed treatment-related decisions for yourself or on behalf of your loved one.