Could we devise one mental health treatment for many counseling problems? Given that so many problems have similar symptoms (anxiety, mood dysregulation, vigilance, intrusive and unwanted thoughts, etc.) and appear to involve common neurobiological processes (limbic systems), might we be able to find a single treatment for multiple expressions of problems?
David Barlow and others say yes.
The Renfrew Center (an eating disorder clinic) publishes Perspectives: A Professional Journal of the Renfrew Center Foundation, a free journal. In their Winter 2011 issue they have a brief article by David Barlow and Christina Boisseau about a new “transdiagnostic unified treatment protocol” (UP) that can be applied to all anxiety and depressive (and eating) disorders. Let me summarize a few points from the article:
- 70 to 80% of clients with eating disorders also have anxiety disorders, 50% meet criteria for depression
- A number of anxiety and depressive disorders have emotional dysregulation as a central theme
- Etiology of these diagnoses may be best accounted for by “triple vulnerability theory”: biological vulnerability to negative mood…early negative childhood experiences due to attachment issues or unpredictable environment leading to an elevated sympathetic nervous system…and psychological learning from an event focusing on a particular issue (anxiety, panic, observation of parent’s panic, etc.)
- The Unified Protocol (UP) focuses on “the way that individuals with emotional disorders experience and respond to their emotions” (p. 3). UP consists of 5 core modules
- emotional awareness training (focus on “nonjudgmental present-focused awareness”)
- cognitive reappraisal (“identifying and subsequently challenging core cognitive themes”)
- emotion driven behaviors (EDB) and emotional avoidance (identifying maladaptive EDBs, learn new responses and avoid avoiding emotions)
- awareness and tolerance of physical sensations (self-explanatory…as they relate to emotions)
- emotion exposure (“…goal is to help patients experience emotions fully and reduce the avoidance that has served to maintain their disorders(s)”)
- These modules are flexible and shaped to the individual needs of the client
Obviously, there is much work to be done to validate this protocol but it makes sense. You can see the CBT foundation but also a greater focus on emotion rather than cognition.
Those interested in the full text and references can find it here!