Clinical Intervention Training 1 - CBT Made Simple: The Unified Protocol for the Transdiagnostic Treatment of Co-occurring Anxiety, Depressive, and Related Disorders
Thursday, November 17, 2022
8:30 AM – 5:00 PM EST
Location: Marquis Ballroom B, 9th Floor
Earn 7 CE Credit
Keywords: Transdiagnostic, CBT, Emotional Disorders Level of Familiarity: Basic to Moderate Recommended Readings: Barlow, D. H., Farchione, T. J., Bullis, J. R., Gallagher, M. W., Latin, H., Sauer-Zavala, S., …. Cassiello-Robbins, C. (2017). The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders compared to diagnosis-specific protocols for anxiety disorders: A randomized clinical trial. JAMA Psychiatry, 74, 875-884. Bullis, J.R., Boettcher, H., Sauer-Zavala, S., & Barlow, D.H. (2019). What is an emotional disorder? A transdiagnostic mechanistic definition and implications for assessment, treatment and prevention. Clinical Psychology: Science and Practice, 26(2), 19-x Cassiello-Robbins, C., Southward, M., Tirpak, J., & Sauer-Zavala, S. (2020). A systematic review of Unified Protocol applications with adult populations: Facilitating widespread dissemination via adaptability. Clinical Psychology Review, 78, 101852. Sauer-Zavala, S., Cassiello-Robbins, C., Conklin, L., Bullis, J.R., Thompson-Hollands, J., & Kennedy, K. (2017). Isolating the unique effects of the Unified Protocol treatment modules using single-case experimental design. Behavior Modification, 40, 286-307. Sauer-Zavala, S., Gutner, C., Farchione, T., Boettcher, H., Bullis, J.R., & Barlow, D.H. (2017). Current definitions of “transdiagnostic” in treatment development: A search for consensus. Behavior Therapy, 48, 128-138.
Assistant Professor University of Kentucky Lexington, Kentucky
A quick Amazon search turns up hundreds of workbooks for anxiety and depression. How do you select an evidence-based approach for your patients from all of the available options? Indeed, the explosion of specific treatment manuals for each DSM disorder has created unintended barriers for implementation and dissemination of evidence-based psychological treatments. It is costly to receive training in each protocol and it may not be feasible for busy clinicians to prep different interventions for the myriad problems faced by patients on their caseloads. The Unified Protocol for the Treatment of Emotional Disorders (UP; Barlow et al., 2011, 2018) was developed to address these barriers. The UP is a transdiagnostic, emotion-focused cognitive-behavioral treatment (CBT) that targets core deficits occurring across the neurotic spectrum (e.g., anxiety, depressive, and related disorders [e.g., eating disorders, borderline personality disorder]). This workshop will first briefly review evidence supporting the development of such transdiagnostic interventions. This will be followed by a description and demonstration of how to apply core UP treatment modules, along with the similarities and differences between the UP and traditional CBT. Audio and videotaped illustrations of core treatment interventions (e.g., mindful awareness, emotion exposures) will be presented, along with detailed case examples involving complex comorbidity. Attendees will be invited to participate in exercises as part of these demonstrations.
Session Outline • Rationale for Transdiagnostic CBT o History of mental health classification o Limitations of the DSM’s categorical approach o Impact on treatment development and dissemination • Conceptual Development of the Unified Protocol o Research on psychological processes shared across emotional disorders o Emotional disorders functional model o Unified Protocol treatment targets o Empirical support for the Unified Protocol • Introductory Session o Functional assessment of patient difficulties (is the UP appropriate?) o Cultivating patient buy-in o Objective monitoring of difficulties o Psychoeducation on CBT (e.g., skill building, homework) • Module 1: Motivational Enhancement o Understanding sources of client ambivalence o Decisional balance exercise o Goal setting exercise • Module 2: Understanding Emotions o Psychoeducation on the adaptive nature of emotions o Three-component model of emotions o Identifying patterns in antecedence and consequences of emotional experiences • Module 3: Mindful Emotion Awareness o Rationale for adopting a present-focused, nonjudgmental stance toward emotions o Sitting meditation exercise o Mindful Mood Induction exercise o Anchoring in the Present exercise • Module 4: Cognitive Flexibility o The reciprocal relationship between thoughts and emotions o The nature of automatic thoughts and thinking traps o Dealing with thoughts about emotions o Addressing core beliefs • Module 5: Countering Emotional Behaviors o What are emotional behaviors? o Identifying patients’ idiographic forms of emotional avoidance o How to plan alternative action exercises • Module 6: Confronting Physical Sensations o The transdiagnostic role of physical sensations within an emotional experience o What are interoceptive exposures? o Ideas for interoceptive exposure for depression, eating pathology, anger o Dos and Don’ts of Interoceptive exposure • Module 7: Emotion Exposures o Goals for emotion exposures o How to create a hierarchy of exposure tasks o Managing in-session and out-of-session exposure practice • Module 8: Relapse Prevention o How to evaluate patient progress o Planning for continued skill practice o Encouraging a nonjudgmental stance to fluctuation in symptoms
Learning Objectives:
At the end of the session, the learner will be able to:
Develop a unified, transdiagnostic case conceptualization for patients presenting with comorbid emotional disorders.
Describe the advantages and disadvantages of the current method of classifying mental disorders.
Apply emotion-focused treatment principles and strategies (e.g., objective monitoring, mindfulness training, cognitive flexibility, reduction of emotional avoidance and maladaptive emotion driven behaviors) to patients presenting with comorbid emotional disorders.
Create effective and cohesive emotion exposures for patients with complex comorbidities.
Articulate a nonjudgmental stance to fluctuating symptoms after treatment ends, while at the same time underscoring the importance of continued practice to prevent relapse.
Long-term goal: Participants will be able to implement the Unified Protocol in their clinical practice; given the broad applicability of this treatment, use of the UP may reduce therapist preparation burden.