Basic Principles Underlying Treatment and Outline of the Treatment Procedures

Chapter 2 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide notes that the Unified Protocol (UP) is based on traditional cognitive-behavioral principles, but the particular emphasis on the way individuals experience and respond to their emotions is unique in that it brings emotional processes to the forefront, making them available to fundamental psychological mechanisms of change. Core skills of the UP are introduced. These include mindful emotion awareness, which involves the practice of nonjudgmental, present-focused attention toward emotional experiences; challenging automatic thoughts related to external threats and internal threats and increasing cognitive flexibility; identifying and modifying problematic action tendencies, or emotional behaviors; increasing awareness and tolerance of physical sensations through interoceptive exposures; and engagement in emotion exercises. The chapter concludes with a description of the treatment modules.

Module 8: Recognizing Accomplishments and Looking to the Future

Chapter 14 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide evaluates the patient’s progress and to plan for the future. Therapists will also reinforce the skills learned in treatment, review key treatment concepts, and help patients develop strategies for preventing “relapse.” Additionally, this chapter is used to address symptom recurrence and how patients can maintain treatment gains in the long term.

Module 5: Countering Emotional Behaviors

Chapter 10 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide focuses on the behavioral component of the emotional response and begins by reviewing the role of emotional behaviors (i.e., behaviors that are used to control strong emotions) in the development and maintenance of maladaptive emotional responding. In this module, therapists help patients to identify relevant emotional behaviors and then work with them to develop and engage in Alternative Actions. Over time, it is expected that these Alternative Actions will help remediate cognitive and behavioral patterns contributing to the frequent occurrence of strong negative affect and maintaining patient distress in response to experience of strong emotions.

Introduction to the Unified Protocol

Chapter 1 of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide introduces the treatment program, which is applicable to all anxiety and unipolar depressive disorders, and potentially other disorders with strong emotional components (e.g., eating disorders, borderline personality disorder). This introductory chapter lays out the advantages of a unified, transdiagnostic approach as well as the efficacy of the Unified Protocol (UP). The chapter concludes with an explanation of the purpose of the therapist guide, which gives mental health providers guidance on administration of the UP.

Module 7: Emotion Exposures

Chapter 12 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide focuses on Emotion Exposures. These are exercises designed specifically to provoke strong emotional responses so that patients can put into practice the skills they have developed thus far in therapy. Following a brief introduction to the concept of Emotion Exposures and the rationale for engaging in these exercises, therapists assist patients to gradually confront internal and external stimuli that produce intense emotional reactions while helping them modify their responses to those emotions. Therapists will help patients incorporate the skills learned in therapy (present-focused awareness, nonjudgment, cognitive reappraisal) into their exposure practice and address any emotion avoidance (or other behaviors) that may impede treatment progress.

Module 3: Mindful Emotion Awareness

Chapter 8 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide introduces patients to cultivating a nonjudgmental, present-focused stance toward their emotional experiences. The previous module asked patients to monitor to how their emotions unfold over time. This module builds on that work by encouraging patients to incorporate mindful awareness that moves beyond simply paying attention to these experiences. The principles of mindfulness are very consistent with the overall goal of the UP—to develop a more open, approach-oriented relationship with emotions.

Module 1: Setting Goals and Maintaining Motivation

Chapter 6 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide was designed to help patients clarify the top problem areas in which emotions interfere with their ability to function and to begin to identify concrete steps to take in order to achieve the desired change. This module provides two exercises for enhancing the motivation necessary in initiating this type of treatment program and can be reviewed as needed throughout the course of treatment. The purpose of this module is to maximize the patient’s readiness for change and increase motivation to engage in treatment. Troubleshooting problems with filling out the forms is also covered.

Additional Information for Therapists

Chapter 3 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide covers assessment, monitoring, and medication. The chapter also clarifies who will benefit from the UP program as well as the benefits for patients of using the corresponding workbook. This chapter addresses what to do if other emotional problems are present and who should administer the program.

Module 4: Cognitive Flexibility

Chapter 9 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide focuses on one very important component of emotional experiences: thoughts. Specifically, therapists will teach their patients to develop a greater awareness of how patient thoughts (or interpretations) influence their emotions, to learn to identify their negative thinking patterns, and to increase flexibility in interpreting different situations. The concepts introduced in this chapter are aimed to facilitate patients’ ability to approach emotion-provoking situations and respond to their emotions in more helpful, adaptive ways.

Module 2: Understanding Emotions

Chapter 7 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide provides psychoeducation on the functional, adaptive nature of emotions and assists patients in developing greater awareness of patterns of emotional responding, including potential maintaining factors (e.g., common triggers, environmental contingencies, and/or the maintaining role of avoidance). Patients also learn how to monitor and track their emotions by focusing on three core components of their emotional experiences (thoughts, physical feelings, and behaviors).