Queen, A. H., Barlow, D. H., & Ehrenreich-May, J. (2014). The trajectories of adolescent anxiety and depressive symptoms over the course of a transdiagnostic treatment. Journal of Anxiety Disorders, 28(6), 511–521. https://doi.org/10.1016/j.janxdis.2014.05.007

Type of Study: Other quasi-experimental
Number of Participants: 59

Population:

• Age — 12–17 years (Mean=15.42 years)
• Race/Ethnicity — 44% White, Non-Hispanic, 44% Hispanic/Latino, 7% Other, 3% Black/African American, and 2% Asian American
• Gender — 58% Female
• Status — Participants were adolescents having a primary diagnosis of any DSM-IV anxiety and/or unipolar depressive disorder.

Location/Institution: Two large urban treatment sites in Northeastern and Southeastern United States

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the separate trajectories of adolescent anxiety and depressive symptoms over the course of a transdiagnostic intervention, the Unified Protocol for the Treatment of Emotional Disorders in Adolescence (UP-A) [now called Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A)]. Participants were randomly assigned to either UP-A or a waitlist condition after an open trial. Measures utilized include the Anxiety Disorders Interview Schedule for DSM-IV-Child/Parent version (ADIS-IV-C/P), the Revised Children’s Anxiety and Depression Scale (RCADS), and the Revised Children’s Anxiety and Depression Scale - Parent version (RCADS-P). Results indicate that adolescent self-rated anxiety and depressive symptoms showed similar rates of improvement during treatment, but while anxiety symptoms continued to improve during follow-up, depressive symptoms showed nonsignificant improvement after treatment. Parent-rated symptoms also showed similar rates of improvement for anxiety and depression during the UP-A to those observed for adolescent self-report, but little improvement after treatment across either anxiety or depressive symptoms. Limitations include small sample size, most subjects had a principal anxiety disorder diagnosis, and the majority of subjects came from families of middle to upper-middle class socioeconomic status.

Length of controlled postintervention follow-up: 3 and 6 months.

Ehrenreich-May, J., Rosenfield, D., 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. https://doi.org/10.1016/j.janxdis.2016.10.006

Type of Study: Randomized controlled trial
Number of Participants: 51

Population:

• Age — 12–17 years
• Race/Ethnicity — 59% Hispanic/Latino, 24% Non-Hispanic White, 8% African American, 8% Other, and 2% Asian American
• Gender — 57% Female
• Status — Participants were adolescents with a primary diagnosis of any DSM-IV anxiety disorder (including obsessive compulsive disorder) and/or depression diagnosis

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine initial outcomes of a randomized, waitlist-controlled trial of the Unified Protocol for the Treatment of Emotional Disorders in Adolescents (UP-A) [now called Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A)]. Participants were randomly assigned to UP-A or a waitlist control group. Measures utilized include the Anxiety Disorders Interview Schedule for the DSM-IV, Child and Parent Reports (ADIS-IV-C/P), the Clinical Global Impression–Severity (CCGI-S), the Clinical Global Impression–Improvement (CGI-I), the Revised Children’s Anxiety and Depression Scale, Youth and Parent Versions (RCADS/RCADS-P), and the Adolescent Life Interference Scale (ALIS). Results indicate that the UP-A group outperformed the waitlist at mid-treatment with respect to disorder severity and functional impairment, and there was a significant treatment effect in favor of the UP-A on all outcome measures at posttreatment. Within-subjects analyses collapsing across participants revealed significant improvements on outcome measures over time. Limitations include small sample size, that controlled analyses were only conducted at the mid-point of treatment and not at post-treatment, the majority of participants presented with a principal DSM-IV anxiety disorder, the use of a waitlist control rather than an active comparison condition, and lack of controlled postintervention follow-up.

Length of controlled postintervention follow-up: None.

Mohajerin, B., Lynn, S. J., & Cassiello-Robbins, C. (2023). Unified Protocol vs Trauma-Focused Cognitive Behavioral Therapy among adolescents with PTSD. Behavior Therapy, 54(5), 823–838. https://doi.org/10.1016/j.beth.2023.03.003

Type of Study: Randomized controlled trial
Number of Participants: 93

Population:

• Age — UP-A Group: Mean=14.86 years; TF-CBT Group: mean=14.78 years
• Race/Ethnicity — 100% Iranian
• Gender — UP-A Group: 52% Female and 48% Male; TF-CBT Group: 57% Female and 42% Male
• Status — Participants were adolescents with PTSD and at least one other comorbid emotional disorder (e.g., social anxiety disorder, panic disorder, major depressive disorder, OCD, generalized anxiety disorder, substance use disorder, specific phobia, or separation anxiety).

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) with Trauma-Focused Cognitive Behavioral Treatment (TF-CBT) in terms of outcomes related to PTSD symptoms. Participants were randomized to either UP-A or to TF-CBT. Measures utilized include Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID-5), Child PTSD Symptom Scale—Self-Report Version for DSM-5 (CPSS-5-SR), Youth Anxiety Measure for DSM-5 (YAM-5), Ottawa Self-Injury Inventory (OSI), State-Trait Anger Expression Inventory for Children and Adolescents (STAXI-2 C/A), and Emotion Regulation Scale (DERS). Results indicate that at the initial post-intervention assessment, there were no significant differences between UP-A and TF-CBT except for in emotion regulation and unexpressed angry feelings, in which UP-A participants reported greater reductions. However, at follow-up assessments, the UP-A evidenced significantly better outcomes than TF-CBT. Limitations include the need for a longer follow-up period; lack of clarity on which components of the UP-A intervention or their interaction contributed to the superiority of this intervention vs. TF-CBT with regard to symptoms of anxiety, anger, and self-harm; and concerns over generalizability due to the mental health comorbidities of the demographic.

Length of controlled postintervention follow-up: 3, 6, and 9 months.

Zemestani, M., Ezzati, S., Nasiri, F., Gallagher, M. W., Barlow, D. H., & Kendall, P. C. (2024). A culturally adapted Unified Protocol for Transdiagnostic Treatment of Anxiety Disorders in Adolescents (UP-A): A randomized waitlist-controlled trial. Psychological Medicine, 54(2), 385–398. https://doi.org/10.1017/s0033291723001903

Type of Study: Randomized controlled trial
Number of Participants: 60

Population:

• Age — Mean=16.10 years
• Race/Ethnicity — 100% Iranian
• Gender — 57% Male and 43% Female
• Status — Participants were Iranian adolescents with comorbid anxiety disorders.

Location/Institution: A Middle East Country

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to test the effectiveness of a culturally adapted version of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) for Iranian adolescents with anxiety disorders. Participants were randomized to either UP-A or to a waitlist control (WLC). Measures utilized include The Anxiety Disorders Interview Schedule for DSM-5, Child and Parent Version (ADIS-5-C/P), Youth Anxiety Measure for DSM-5 (YAM-5), Emotion Regulation Questionnaire-Children and Adolescents (ERQ-CA), and Intolerance of Uncertainty Scale for Children (IUSC). Results indicate that significant changes were observed over time on major DSM-5 anxiety disorder symptoms, phobia type symptoms, and overall anxiety symptoms, as well as on emotion regulation strategies of reappraisal, and suppression, and on intolerance of uncertainty dimensions including prospective, inhibitory, and total intolerance of uncertainty, in favor of UP-A. Limitations include the lack of an active treatment condition, small sample size, short follow-up period, and concerns over the program being administered by master’s level psychologists instead of PhD level psychologists.

Length of controlled postintervention follow-up: 1 month.