Targeting Comorbid Anxiety and Depression Using the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents

Abstract

This article presents the use of an emotion-focused, transdiagnostic therapy approach designed for adolescents with a range of anxiety, obsessive-compulsive, depressive, and related disorders, referred to here as emotional disorders. Preliminary work suggests that emotional disorders share underlying temperament factors, such as high neuroticism and low extroversion in adults and adolescents, possibly influencing the development and maintenance of emotional disorders across the life span. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) and similar core dysfunction-focused, transdiagnostic therapy approaches may lead to successful treatment by targeting higher order factors that cut across an array of emotional disorders The utility of UP-A for adolescents experiencing a variety of emotional disorder symptoms is demonstrated here through the case illustration of Tony, a 15-year-old adolescent male with severe social and generalized anxiety and mild levels of depression. After 16 individual treatment sessions, Tony demonstrated significant reductions in anxiety and depressive symptoms, as well as an ability to respond more adaptively to a range of emotional experiences. This case study illustrates how short-term, transdiagnostic treatment using the UP-A can effectively ameliorate a wide range of emotional disorder symptoms in adolescents and may also lead to changes in core features of neuroticism, potentially preventing development of further emotional difficulties over time.

Keywords

transdiagnostic treatment adolescent anxiety depression cognitive-behavioral therapy (CBT)

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References

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Angold

Costello

E. J.

Erkanli

(1999). Comorbidity. Journal of Child Psychology and Psychiatry, 40, 57-87.

Barlow

D. H.

Ellard

K. K.

Fairholme

C. P.

Farchione

T. J.

Boisseau

C. L.

May

J. T. E.

Allen

L. B.

(2010). Unified protocol for transdiagnostic treatment of emotional disorders: Workbook. Oxford, UK: Oxford University Press.

Barlow

D. H.

Farchione

T. J.

Bullis

J. R.

Gallagher

M. W.

Murray-Latin

Sauer-Zavala

. . . Cassiello-Robbins

(2017). The unified protocol for transdiagnostic treatment of emotional disorders compared with diagnosis-specific protocols for anxiety disorders: A randomized clinical trial. JAMA Psychiatry, 74, 875-884.

Barlow

D. H.

Sauer-Zavala

Carl

J. R.

Bullis

J. R.

Ellard

K. K.

(2014). The nature, diagnosis, and treatment of neuroticism: Back to the future. Clinical Psychological Science, 2, 344-365.

Beck

A. T.

(1979). Cognitive therapy of depression. New York, NY: Guilford Press.

Bilek

E. L.

Ehrenreich-May

(2012). An open trial investigation of a transdiagnostic group treatment for children with anxiety and depressive symptoms. Behavior Therapy, 43, 887-897.

Boomsma

D. I.

van Beijsterveldt

C. E.

Hudziak

J. J.

(2005). Genetic and environmental influences on anxious/depression during childhood: A study from the Netherlands twin register. Genes, Brain and Behavior, 4, 466-481.

10.

Brady

E. U.

Kendall

P. C.

(1992). Comorbidity of anxiety and depression in children and adolescents. Psychological Bulletin, 111, 244-255.

11.

Brown

T. A.

Barlow

D. H.

(2014). Anxiety and related disorders interview schedule for DSM-5 (ADIS-5)–Adult version. New York, NY: Oxford University Press.

12.

Bullis

J. R.

Fortune

M. R.

Farchione

T. J.

Barlow

D. H.

(2014). A preliminary investigation of the long-term outcome of the unified protocol for transdiagnostic treatment of emotional disorders. Comprehensive Psychiatry, 55, 1920-1927.

13.

Butler

A. C.

Chapman

J. E.

Forman

E. M.

Beck

A. T.

(2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26, 17-31.

14.

Cayoun

B. A.

(2011). Mindfulness-integrated CBT: Principles and practice. Hoboken, NJ: John Wiley.

15.

Chorpita

B. F.

Yim

Moffitt

Umemoto

L. A.

Francis

S. E.

(2000). Assessment of symptoms of DSM-IV anxiety and depression in children: a revised child anxiety and depression scale. Behaviour Research and Therapy, 38(8), 835-855. doi:10.1016/S0005-7967(99)00130-8

16.

Cummings

C. M.

Caporino

N. E.

Kendall

P. C.

(2014). Comorbidity of anxiety and depression in children and adolescents: 20 years after. Psychological Bulletin, 140, 816-845.

17.

Ehrenreich

J. T.

Goldstein

C. M.

Wright

L. R.

Barlow

D. H.

(2009). Development of a unified protocol for the treatment of emotional disorders in youth. Child & Family Behavior Therapy, 31, 20-37.

18.

Ehrenreich-May

Kennedy

S. M.

Sherman

J. A.

Bilek

E. L.

Buzzella

B. A.

Bennett

S. M.

Barlow

D. H.

(2017). Unified protocols for the transdiagnostic treatment of emotional disorders in children and adolescents: Therapist guide. New York: Oxford University Press.

19.

Ehrenreich-May

Queen

A. H.

Bilek

E. L.

Remmes

C. S.

Marciel

K. K.

(2014). The unified protocols for the treatment of emotional disorders in children and adolescents. In Ehrenreich-May

Chu

B. C.

(Eds.), Transdiagnostic treatments for children and adolescents principles and practice (pp. 267-293). New York, NY: Guilford Press.

20.

Ehrenreich-May

Rosenfield

Queen

A. H.

Kennedy

S. M.

Remmes

C. S.

Barlow

D. H.

(2017). An initial waitlist-controlled trial of the unified protocol for the treatment of emotional disorders in adolescents. Journal of Anxiety Disorders, 46, 46-55.

21.

Eley

T. C.

Bolton

O’Connor

T. G.

Perrin

Smith

Plomin

(2003). A twin study of anxiety-related behaviours in pre-school children. Journal of Child Psychology and Psychiatry, 44, 945-960.

22.

Farchione

T. J.

Fairholme

C. P.

Ellard

K. K.

Boisseau

C. L.

Thompson-Hollands

Carl

J. R.

. . . Barlow

D. H.

(2012). Unified protocol for transdiagnostic treatment of emotional disorders: A randomized controlled trial. Behavior Therapy, 43, 666-678.

23.

Guy

(ED.) (1976). ECDEU assessment manual for psychopharmacology (pp. 218-222). Rockville, MD: US Department of Health, Education, and Welfare Public Health Service Alcohol, Drug Abuse, and Mental Health Administration.

24.

Huebner

S. E.

Dew

(1995). Preliminary Validation of the Positive and Negative Affect Schedule with Adolescents. Journal of Psychoeducational Assessment, 13(3), 286-293. doi:10.1177/073428299501300307

25.

Ishikawa

Okajima

Matsuoka

Sakano

(2007). Cognitive behavioural therapy for anxiety disorders in children and adolescents: A meta-analysis. Child and Adolescent Mental Health, 12, 164-172.

26.

Keenan

Hipwell

A. E.

(2005). Preadolescent clues to understanding depression in girls. Clinical Child and Family Psychology Review, 8, 89-105.

27.

Kendall

P. C.

(2011). Child and adolescent therapy: Cognitive-behavioral procedures. New York, NY: Guilford Press.

28.

Kennedy

S. M.

Bilek

E. L.

Ehrenreich-May

(under review). A randomized controlled pilot trial of the Unified Protocol for the Treatment of Emotional Disorders in Children (UP-C). Journal of Psychopathology and Behavioral Assessment.

29.

Kendall

P. C.

Furr

J. M.

Podell

J. L.

(2010). Child-focused treatment of anxiety. In Weisz

J. R.

Kazdin

A. E.

(Eds.), Evidence-based psychotherapies for children and adolescents (2nd ed., pp. 45-59). New York, NY: Guilford Press.

30.

Kennedy

S. M.

Ehrenreich-May

(2016). Assessment of emotional avoidance in adolescents: Psychometric properties of a new multidimensional measure. Journal of Psychopathology and Behavioral Assessment, 39, 279-290.

31.

Leyro

T. M.

Bernstein

Vujanovic

A. A.

McLeish

A. C.

Zvolensky

M. J.

(2011). Distress Tolerance Scale: A confirmatory factor analysis among daily cigarette smokers. Journal of Psychopathology and Behavioral Assessment, 33(1), 47-57.

32.

Linehan

M. M.

(2015). DBT skills training manual (2nd ed.). New York, NY: Guilford Press.

33.

Lyneham

H. J.

Abbott

M. J.

Rapee

R. M.

(2007). Interrater reliability of the anxiety disorders interview schedule for DSM-IV: Child and parent version. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 731-736.

34.

Marchette

L. K.

Weisz

J. R.

(2017). Practitioner review: Empirical evolution of youth psychotherapy toward transdiagnostic approaches. Journal of Child Psychology and Psychiatry, 58, 970-984.

35.

Middeldorp

C. M.

Cath

D. C.

Van Dyck

Boomsma

D. I.

(2005). The co-morbidity of anxiety and depression in the perspective of genetic epidemiology: A review of twin and family studies. Psychological Medicine, 35, 611-624.

36.

Miller

W. R.

Rollnick

(2002). Motivational interviewing: Preparing people for change (2nd ed.). New York, NY: Guilford Press.

37.

Pass

Whitney

Reynolds

(2016). Brief behavioral activation for adolescent depression: Working with complexity and risk. Clinical Case Studies, 15, 360-375.

38.

Queen

A. H.

Barlow

D. H.

Ehrenreich-May

(2014). The trajectories of adolescent anxiety and depressive symptoms over the course of a transdiagnostic treatment. Journal of Anxiety Disorders, 28, 511-521.

39.

Silverman

W. K.

Saavedra

L. M.

Pina

A. A.

(2001). Test-retest reliability of anxiety symptoms and diagnoses with the anxiety disorders interview schedule for DSM-IV: Child and parent versions. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 937-944.

40.

Silverman & Albano (nnd.). Child and Parent Versions (ADIS-5 C/P). Manuscript in preparation.

41.

Simons

J. S.

Gaher

R. M.

(2005). The Distress Tolerance Scale: Development and validation of a self-report measure. Motivation and Emotion, 29, 83-102.

42.

Sobell

L. C.

Sobell

M. B.

(2003). Using motivational interviewing techniques to talk with clients about their alcohol use. Cognitive and Behavioral Practice, 10, 214-221.

43.

Tonarely

N. A.

Kennedy

S. M.

Ehrenreich-May

(2016). Psychometric properties of the Distress Tolerance Scale in Clinically Anxious Youth. New York, NY: In Poster session presented at the Annual meeting of the Asssociation for Behavioral and Cognitive Therapies (ABCT).

44.

Tonarely

N. A.

Sherman

J. A.

Ehrenreich-May

(2017). The factor structure of neuroticism in youth. San Diego, CA: In Poster session presented at the Annual meeting of the Association for Behavioral and Cognitive Therapies (ABCT).

45.

UCLA Department of Psychology. Child F.I.R.S.T. program. http://www.childfirst.ucla.edu/Resources.html.

46.

Watson

Clark

L. A.

Tellegen

(1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54(6), 1063-1070.

47.

Weiss

D. C.

Chorpita

B. F.

(2011). Revised Children’s Anxiety and Depression Scale: User’s guide. Unpublished Manuscript. Retrieved from http://www.childfirst.ucla.edu/resources.html

48.

Weisz

J. R.

Chorpita

B. F.

Frye

M. Y.

Lau

Bearman

S. K.

. . . Hoagwood

K. E.

(2011). Youth top problems: Using idiographic, consumer-guided assessment to identify treatment needs and to track change during psychotherapy. Journal of Consulting and Clinical Psychology, 79, 369-380.

49.

Weisz

J. R.

Moore

P. S.

Southam-Gerow

M. A.

Weersing

V. R.

Valeri

S. M.

McCarty

C. A.

(2005). Therapist’s manual PASCET: Primary and secondary control enhancement training program (3rd ed.). Los Angeles: University of California.

50.

Wilamowska

Z. A.

Thompson- Hollands

Fairholme

C. P.

Ellard

K. K.

Farchione

T. J.

Barlow

D. H.

(2010). Conceptual background, development, and preliminary data from the unified protocol for transdiagnostic treatment of emotional disorders. Depression and Anxiety, 27, 882-890.

51.

Wood

J. J.

Piacentini

J. C.

Bergman

R. L.

McCracken

Barrios

(2002). Concurrent validity of the anxiety disorders section of the anxiety disorders interview schedule for DSM-IV: Child and parent versions. Journal of Clinical Child and Adolescent Psychology, 31, 335-342.

52.

Zigarelli

J. C.

Jones

J. M.

Palomino

C. I.

Kawamura

(2016). Culturally responsive cognitive behavioral therapy: Making the case for integrating cultural factors in evidence-based treatment. Clinical Case Studies, 15, 427-442.