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Nonsuicidal self-injury (NSSI) has been identified as one of the strongest predictors of suicide attempts. Wall/object punching is a particularly prevalent form of NSSI among male veterans that has been linked to both impulsivity and anger. The objective of the present study was to examine the indirect effect of impulsivity on wall/object punching via anger. Participants included 124 veterans (32 identified as women, 92 identified as men) with at least one psychiatric disorder. A third of the sample met criteria for NSSI disorder (33.1%) with nearly a half of the remaining sample endorsing NSSI. Almost half (41.94%) of the sample endorsed wall/object punching. Consistent with our hypothesis, impulsivity was significantly associated with anger, which was, in turn, significantly associated with wall/object punching. Impulsivity was found to be indirectly related to wall/object punching via anger. These findings underscore the significance of assessing and treating anger among veterans engaging in wall/object punching. Improving our knowledge of anger and impulsivity and their relationship with this particularly prevalent form of NSSI among veterans may lead to a better understanding of suicide risk among veterans and inform future treatments.

Dropout from psychotherapy is common and can have negative effects for patients, providers, and researchers. A better understanding of when and why patients stop treatment early, as well as actionable factors contributing to dropout, has the potential to prevent it. Here, we examined dropout from a large randomized controlled trial of transdiagnostic versus single-diagnosis cognitive-behavioral treatment (CBT) for patients with anxiety disorders (n = 179; Barlow et al., 2017). We aimed to characterize the timing of and reasons for dropout and test whether participants who dropped out had different symptom trajectories than those who completed treatment. Results indicated that overall, the greatest risk of dropout was prior to the first treatment session. In single-diagnosis CBT, dropout risk was particularly elevated before the first session and after other early sessions, whereas in transdiagnostic CBT, dropout risk was low and stable before and during treatment. Participants most often dropped out due to failure to comply with study procedures or dissatisfaction with or desiring alternative treatment. Results from multilevel models showed that trajectories of anxiety symptoms did not significantly differ between dropouts and completers. These findings suggest that there may be specific time windows for targeted and timely interventions to prevent dropout from CBT.

This mixed methods study identified positive psychological factors and life themes expressed in autobiographical narratives of predominantly Black women living with HIV (WLWH) and investigated these in relation to depressive symptoms, antiretroviral therapy (ART) adherence (≥ 95% of time), and undetectable HIV viral load (VL) (

Veterans have high rates of suicide, and nonsuicidal self-injury (NSSI) is one of the strongest predictors of suicide risk; however, there is presently little known about antecedents of NSSI that might inform intervention efforts. Accumulating research suggests that anger and hostility play an important role in NSSI, but whether these emotions precede and predict NSSI is currently unknown. The aim of the current study was to examine the temporal relationships between anger/hostility and NSSI urges and behavior among veterans diagnosed with NSSI disorder. Our hypothesis was that angry/hostile affect would predict subsequent NSSI urge and engagement, but not vice versa. Forty veterans with NSSI disorder completed a 28-day ecological momentary assessment study with three daily prompts to report on their affect and NSSI urges and engagement. Multilevel cross-lagged path modeling was used to determine the direction of effects between angry/hostile affect and NSSI urges and engagement over time. Consistent with our hypothesis, results indicated that the lagged effects of angry/hostile affect on subsequent NSSI urge and engagement were significant, whereas the lagged effects of NSSI urge and engagement on angry/hostile affect were not significant. Findings highlight the importance of assessing and treating anger among veterans who engage in NSSI.

In 2015, the U.S. Congress passed one of the largest reforms of federal healthcare payment policy since the creation of Medicare/Medicaid and the passage of the Affordable Care Act. MACRA (the Medicare Access and Children’s Health Insurance Program Reauthorization Act of 2015) was designed to reimburse healthcare providers based on the value of their service, not the volume of patients treated. Termed value-based care, this policy aligns with a population health model focused on the “health outcomes of a group of individuals including the distribution of such outcomes within the group” (Kindig & Stoddart, 2003). Clinical psychologists, especially those with training in (a) empirically supported, transdiagnostic, and process-based treatments (Hayes & Hofmann, 2018), (b) research methods, and (c) program evaluation are well-suited to lead the implementation of behavioral interventions in the new era of value-based care. We will outline the three primary goals of value-based care and discuss the role of clinical psychologists in achieving these goals. We conclude by describing how the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP; Barlow et al., 2018) is a candidate treatment to implement in settings accountable to value-based incentives.

This article represents an implementation-focused evaluation of a multicultural peer-consultation team situated within a psychiatry department in a large academic medical center in the Southern United States. The evaluation comprised anonymous self-report questionnaires ( n = 14) as well as individual ( n = 3) or group interviews ( n = 10) conducted by outside independent evaluators. Participants were current and former team members (i.e., graduate trainees, mental health care providers, clinical and research staff members) who voluntarily participated in this multimethod implementation evaluation. Results indicated that attendance on the team had several important impacts on members, and most notably an increased ability to provide multiculturally competent care, that is treatment that carefully and routinely considers the influence of culture and context on patients and therefore their clinical presentation. Further, no negative impacts from participating on the team were noted. A primary strength of the team's sustainability is that participation on the team was deemed to be relevant and useful by current and former team members. A major barrier to participation on the team is competing demands, such as high clinical loads. We conclude that this model for multicultural peer-consultation holds promise as an effective and implementable educational method for mental health care professionals. We discuss strengths, limitations, and future directions for research.

Current classification systems for mental disorders emphasize categorical assessment. In the domain of emotional disorders, this is inconsistent with a growing consensus that anxiety, depressive, and related disorders are best conceptualized as variations on shared underlying processes, chiefly heightened negative affect, and aversion to unwanted emotional experiences. Dimensional assessment of transdiagnostic emotional disorder constructs offers advantages for clinical and research applications, including increased parsimony and improved validity, yet there are drawbacks to many dimensional assessment systems for emotional disorders. The case presented in this paper illustrates the potential clinical utility of a new self-report instrument—the Multidimensional Emotional Disorders Inventory (MEDI)—which assesses nine dimensions characteristic of emotional disorders. MEDI scores for a highly comorbid patient are examined over the course of transdiagnostic emotion-focused cognitive-behavioral treatment. At baseline, midtreatment, and posttreatment, the MEDI offered information above and beyond DSM categorical assessment, including detection of subclinical symptoms and symptom change, while remaining parsimonious. Implications for possible use as a treatment planning instrument, integration with categorical assessment, and future research directions are discussed.

Dysregulated anger in the context of emotional (e.g., mood, anxiety, related) disorders is associated with treatment attrition and a lower likelihood of responding to extant treatments. Therefore, there is a need to identify the most effective skills for targeting this anger and prioritize their delivery in treatment with the hope of producing more potent interventions. The current study explored the specific effects of two treatment skills (mindfulness and countering emotional behaviors) in isolation and combination as interventions for dysregulated anger using single-case experimental design. Patients were randomized to a 2- or 4-week baseline with no intervention applied and then to the first treatment skill received. All patients subsequently completed the alternate treatment skill and 1 month of follow-up. Results suggested the first module had clinically meaningful effects for five patients and the second module produced incremental improvement for five patients. Visual inspection and effect sizes indicated mindfulness produced greater reductions in anger when delivered in isolation compared to countering emotional behaviors (d = 0.96, 0.33, for mindfulness and countering emotional behaviors, respectively). With regard to the second module, more patients (n = 4) experienced a reduction in anger in response to mindfulness than to countering emotional behaviors (n = 1); effect sizes indicated significant improvements in response to both modules (d = 0.83, 0.72, for mindfulness and countering emotional behaviors, respectively). Taken together, results suggest mindfulness may be a more efficacious intervention for anger than countering emotional behaviors. Implications of these results for addressing dysregulated anger in treatment are discussed.

The purpose of the current study was to investigate the unique effects of a commonly used skill incorporated into treatment packages for borderline personality disorder (BPD), countering emotion-driven behavioral urges. Individuals with BPD (N = 8) participated in a single-case experimental design, specifically a multiple baseline, in which they were randomly assigned to complete a baseline assessment-only phase of 2 or 4 weeks. Participants then received four sessions of the countering emotional behaviors module from the unified protocol, followed by a 4-week follow-up phase. Throughout the duration of the study, daily data capture was used to assess real-time changes in the frequency of emotionally avoidant behaviors in response to emotional experiences. Symptoms of BPD, depression, and anxiety were also assessed. By follow-up, the majority of patients demonstrated a meaningful reduction (per single-case experimental design guidelines for evaluating improvements) in their use of avoidant behaviors. There was also preliminary evidence that encouraging participants to act counter to avoidant urges is associated with decreases in BPD, depression, and anxiety symptoms, as well as negative affectivity. The countering emotional behaviors skill from the unified protocol indeed engages its putative target of emotionally avoidant behavioral coping, indicating it is an active ingredient in multicomponent treatment packages for BPD, with implications for downstream clinical endpoints such as BPD and depressive and anxiety symptoms. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

We conducted a pilot study incorporating mobile technology and social support into cognitive behavioral therapy (CBT) for anger in veterans with posttraumatic stress disorder (PTSD). N = 26 veteran...

Hope is a positive psychology construct that comprises goals, agency thinking, and pathways thinking and has been associated with psychological and physical well-being. This paper summarizes recent findings regarding the relationship between hope and depressive symptoms as well as hope and personality disorders and traits. Studies have shown that hope is inversely associated with negative affect when examined cross-sectionally, although the relationship between hope and depression is more complex longitudinally. Little is known about hope as it pertains to personality disorders, though more recent studies have examined the relationship between hope and personality traits such as neuroticism and extraversion; results from those studies are mixed, leaving a wide gap in the literature for future exploration.

This mixed methods study identified positive psychological factors and life themes expressed in autobiographical narratives of predominantly Black women living with HIV (WLWH) and investigated these in relation to depressive symptoms, antiretroviral therapy (ART) adherence (≥ 95% of time), and undetectable HIV viral load (VL) ( 80 copies/ml).Ninety-eight WLWH from the Women's Interagency HIV Study Chicago site (M age = 45.3; 91% Black) narrated three autobiographical life turning points, reliably coded for positive factors and life themes. ART adherence, VL and depressive symptoms, assessed with Center for Epidemiologic Studies Depression Scale total score (TOT) including its four factors (negative affect (NA), positive affect (PA), somatic symptoms (SS), and interpersonal problems (IP)), were collected over two time points: concurrently with narratives and 6 months later. Composite scores across the two time points were used in all analyses.Ten positive psychological factors (gratitude, insight, compassion, meaning-making, acceptance, mindfulness, generativity, optimism, self-reliance, and benevolent God beliefs) and three positive life themes (health improvements, positive relationships, and accomplishments) were identified in narratives. Higher accomplishments, overall positive factors, insight, mindfulness, self-reliance, optimism, meaning-making, and acceptance related to lower depressive symptoms (TOT, NA, SS, or IP). Positive factors and life themes did not significantly relate to PA. Higher compassion related to higher ART adherence. Higher accomplishments related to undetectable VL independent of ART adherence.Findings that positive psychological factors and life accomplishments may relate to better health, especially to lower depression, potentially contribute to developing positive psychology interventions for Black WLWH.

Objective This study evaluated changes in positive affect within cognitive-behavioral treatments (CBT) for anxiety disorders. It was hypothesized that there would be significantly greater increases in positive affect in CBT conditions compared to the waitlist, and particularly higher in the Unified Protocol (UP) than the single disorder protocols (SDP) given the UP's focus on emotions (including positive emotions) rather than symptoms. Method Patients with heterogeneous anxiety disorders (N = 223) were randomly assigned to the UP, SDP or waitlist. Linear mixed model regression (intent to treat) analyses were used to compare change in positive affect, quality of life, and savoring between patients in the treatment conditions (UP and SDP) versus waitlist conditions. Between condition effect sizes were calculated to assess the magnitude of difference within conditions at post-treatment. Results Results indicated a significant Group (treatment vs. waitlist) × Time (pre- post-treatment) interaction (F(1, 154.36) = 6.75; p = .01) for positive affect in which the treatment group showed significant improvements in positive affect pre- to post-treatment (ESsg = 0.37, SEsg = 0.09, 95% CI [0.20: 0.54]) and the waitlist condition did not. There were no differences between UP and SDP conditions in positive affect at baseline or at post-treatment. Conclusions These results suggest CBT, which typically focuses on reductions in negative affect, may also improve positive affect. The importance of future research evaluating, targeting, and improving positive affect in CBT trials is discussed. Clinicaltrials.gov Identifier: NCT01243606

The COVID-19 pandemic has necessitated an abrupt transition to remote delivery of psychology services at a time when patients and practicing clinicians are experiencing an increase in life stressors (e.g., job loss, social isolation, need to adapt to telehealth practice), which can exacerbate mental health concerns and contribute to clinician burnout. Because the COVID-19 pandemic is affecting diverse individuals in myriad ways, these circumstances can elicit a wide range of emotions and emotional responses. Thus, treatment during this time must be able to address heterogeneous presenting problems while placing minimal burden on clinicians who are adjusting to continuously changing circumstances. Transdiagnostic, emotion-focused, cognitive behavioral treatments (CBT), such as the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP), may be particularly well suited to address the challenges faced by practicing psychologists, and their patients, in the current COVID-19 pandemic. This paper discusses the applicability and adaptability of transdiagnostic treatments to telehealth, focusing primarily on the UP in the context of the COVID-19 pandemic. Further, while many CBT skills (e.g., mindfulness) can be easily translated to tele-delivery, other skills, such as exposure, can be more difficult to implement remotely, especially in the midst of a pandemic. Thus, this paper also provides practical suggestions for clinicians with regard to implementing the UP remotely.

Suboptimal retention in HIV care is a major driver of the global epidemic, including in sub-Saharan Africa. In Tanzania, the national Community-Based HIV Services program integrates volunteer community health workers (CHWs) to support patient care engagement and reduce the burden placed on HIV clinic nurses; however, few studies have assessed the value of CHWs supporting HIV care. Qualitative interviews were conducted with 48 administrators, nurses, CHWs, and patients to explore strengths and limitations of the Community-Based HIV Services program. Stakeholders believed CHWs are uniquely positioned to establish trust and provide patient support. Patients who had frequent contact with CHWs described them as valued sources of education and encouragement, but fewer than half of the patients interviewed had ever met with a CHW. Clinic nurses described feeling disconnected from CHWs, and stakeholders highlighted the need for financial, logistical, and educational support to rejuvenate the program and effectively address care engagement challenges.

Up to 14% of veterans engage in nonsuicidal self-injury (NSSI) in their lifetime and this behavior is a relatively strong predictor of suicidal behavior compared to other identified risk factors. Further, NSSI is a clinically relevant behavior in its own right; it is associated with more severe psychopathology as well as bodily harm that sometimes requires medical intervention. Therefore, a better understanding of NSSI may help inform suicide prevention efforts as well as mental healthcare strategies for veterans. Anger may be relevant to understanding NSSI in veterans. Over 60% of veterans report difficulties managing anger and this emotion is strongly associated with engagement in NSSI. However, no research has explored the extent to which anger is present prior to NSSI or whether anger is associated with specific NSSI methods or functions in veterans. The purpose of this study was to explore whether anger was associated with engagement in specific NSSI methods, and whether anger uniquely predicted any functions of NSSI while controlling for the presence of other basic negative emotions (fear and sadness). An existing dataset of 61 veterans who reported engaging in NSSI in the past year was analyzed. Results indicated anger was the most common emotional antecedent to NSSI. Further, anger was associated with several methods of NSSI including burning oneself with a cigarette, carving pictures, designs or other marks into skin, sticking sharp objects into skin, severely scratching oneself, head banging, punching oneself, and punching walls or objects. Finally, when controlling for the presence of other negative emotions, anger was associated with engaging in NSSI to relieve tension, stop feeling numb, communicate with others, feel alive, get help from others, and prove to oneself how bad things are. These results highlight the importance of assessing and treating dysregulated anger in veterans who engage in self-harming behavior.

The Unified Protocol (UP) for Transdiagnostic Treatment of Emotional Disorders is an emotion-focused, cognitive-behavioral intervention developed to address the full range of anxiety, depressive, and related disorders. The UP consists of core therapeutic skills that, though unique in focus, are each designed to promote an approach-oriented stance toward emotional experiences. The goal of the present investigation was to characterize changes in these skills for patients that received a course of treatment with the UP, as well as to examine associations between skills and symptoms changes. Patients with principal anxiety disorders, assigned to receive treatment with the UP (N = 88) as part of a randomized controlled trial, were included in this study. They completed validated self-report measures of UP skills (Understanding Emotions, Mindful Emotion Awareness, Cognitive Flexibility, Countering Emotional Behaviors, and Interoceptive Awareness and Tolerance), as well as clinician-rated measures of psychological symptoms. Skill measures improved significantly over the course of 12 to 16 UP treatment sessions and changes in these skills measures were associated with improvements in anxiety symptoms. Determining whether improvement on all the skills learned during a course of treatment with UP is associated with symptom remission is critical to establishing the most streamlined and efficient interventions that may ultimately be best suited to widespread dissemination.

Misophonia is a newly described disorder associated with significant emotional distress, functional impairment, and a wide range of mental health problems (e.g., mood, anxiety, and personality disorders). Although recent studies have begun to validate self-report measures of misophonia, no psychometrically validated interviews have been developed. To advance a scientific understanding of misophonia, rigorously developed structured interviews are needed as a complimentary measurement approach to self-report inventories. Accordingly, the aim of this study was to develop and begin preliminarily validating a semi-structured clinical interview for misophonia. We took an iterative, grassroots approach to item generation and interview development involving key stakeholders (i.e., misophonia sufferers, experts in the field). Initial psychometric analyses from the current sample (n = 30) evidenced excellent preliminary estimates for internal consistency, convergent, discriminant, and predictive validity. Results from this study provide preliminary support for the Duke Misophonia Interview, and we recommend that this interviewer-rated measure be iteratively developed and refined using larger and more diverse samples.

Dysregulated anger is often present in the emotional (i.e., anxiety, mood, and related) disorders; however, it is rarely targeted in treatment. Transdiagnostic treatments, which focus on processes that contribute to dysregulated emotions across the range of psychopathology, might represent an efficient way to treat this anger. Using a subset of data from a recently completed equivalency trial comparing the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) to single diagnosis protocols (SDPs) for specific disorders, this study began exploring whether the UP led to great reductions in anger compared with the SDPs. Results indicated that there was a small, nonsignificant, decrease in anger in the UP condition, whereas there was a moderate, nonsignificant increase in anger in the SDP condition. At posttreatment, UP patients had significantly lower anger scores than patients who received an SDP. These preliminary results suggest that transdiagnostic treatments may be well poised to target dyregulated anger in the context of emotional disorders.

The Unified Protocol (UP) for the Transdiagnostic Treatment of Emotional Disorders is a cognitive-behavioral intervention designed to treat the range of anxiety, depressive, and related disorders. Thus far, the UP treatment modules have only been studied when they are delivered in their entirety and presented in a standard sequence. To personalize the presentation of the UP modules for a given patient’s presentation (e.g., providing the modules in a varied order, dropping irrelevant modules), it is first necessary to establish that each module leads to change in the skill it is designed to promote, and that these changes can occur in the absence of the other modules. Using a multiple baseline design in accordance with the single-case reporting guidelines in behavioral interventions (SCRIBE), eight patients with heterogeneous emotional disorders were randomly assigned to a 1- or 3-week baseline assessment phase followed by four sessions of one of four UP modules (psychoeducation, emotional awareness, cognitive flexibility, and countering emotional behaviors). Results provide preliminary support for the notion that each UP module under study leads to change in its associated skill in the absence of the other modules (five of eight patients demonstrated reliable change in the module-specific skill). In addition, exploratory analyses suggest that the emotion awareness training and cognitive flexibility modules appeared to exhibit change specific to their associated skills, psychoeducation, and countering emotional behaviors demonstrated somewhat more broad-based change across skills.

Anger plays a prominent definitional role in some psychological disorders currently widely scattered across DSM-5 categories (e.g., intermittent explosive disorder, borderline personality disorder). But the presence and consequences of anger in the emotional disorders (e.g., anxiety disorders, depressive disorders) remain sparsely examined. In this review, we examine the presence of anger in the emotional disorders and find that anger is elevated across these disorders and, when it is present, is associated with negative consequences, including greater symptom severity and worse treatment response. Based on this evidence, anger appears to be an important and understudied emotion in the development, maintenance, and treatment of emotional disorders.

This study explored the relationships between the discrepancy facet of perfectionism, time spent on academic tasks, task-related and overall anxiety, and general psychological well-being in high-achieving university students (N = 83). Using a lab paradigm, we hypothesized those higher in discrepancy would 1) experience greater task-related state anxiety, 2) invest more time in study tasks, 3) report higher overall anxiety and lower psychological well-being, and that 4) these relationships would remain significant even after taking covariates into account. Results of this preliminary study suggest individuals with elevated discrepancy do not spend more time working than other high-achievers, yet experience greater task-related and overall anxiety, and poorer psychological well-being.

The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) was designed to be a flexible, evidence-based intervention that could treat a wide range of emotional disorders. The purpose of this systematic review is to summarize (1) the range of presenting problems to which the UP has been applied with adult patients, and (2) the settings in which the protocol has been used, as well as any modifications made to it. Using PRISMA guidelines, we conducted a literature search of PsychInfo, PubMed, Proquest Dissertations and Theses, and Web of Science. The 77 studies included in this review indicated the UP has been applied to a wide range of presenting problems including anxiety, depressive, bipolar, traumatic-stressor, substance use, eating, borderline personality, insomnia, and physical health disorders. Additionally, the UP has been applied to non-diagnosable problems such as non-suicidal self-injury, subclinical presentations, and sexual minority stress. The strongest base of evidence for the UP is among Caucasian females in the United States with anxiety-related or depressive disorders. Numerous adaptions of the UP were present in the literature. Overall, results suggest the UP can be flexibly applied to a range of diagnostic presentations. However, many studies reviewed were preliminary and further research is needed.

Most patients in community practice attend significantly fewer sessions than are recommended by treatment protocols that have demonstrated efficacy in addressing emotional disorders. Personalized interventions that target the core processes thought to maintain a wide range of disorders may serve to increase treatment efficiency, addressing this gap. This study sought to evaluate the feasibility and acceptability of the personalized delivery of a mechanistically transdiagnostic intervention, the Unified Protocol (UP) for Transdiagnostic Treatment of Emotional Disorders. Using an AB phase change design in accordance with the single-case reporting guideline for behavioral interventions (SCRIBE), 18 individuals with heterogeneous emotional disorders were randomly assigned to receive UP treatment modules ordered according to either their pretreatment strengths or weaknesses. Results support the feasibility of reordering the treatment modules as the majority of patients presented with marked differences in skill levels, as well as the acceptability of this approach as patients in both conditions reported satisfaction with their assigned treatment order. Furthermore, the majority of patients demonstrated symptom improvement consistent with previously reported effects of the standard-order UP. Finally, there is preliminary evidence to suggest that those in the strengths condition displayed improvements in outcomes earlier in treatment than those in the weaknesses condition. Taken together, these findings offer preliminary support for improving treatment efficiency through the utilization of a personalized, strengths-based, transdiagnostic approach.

Objective This study aimed to examine whether the Unified Protocol (UP), a transdiagnostic cognitive-behavioral therapy for emotional disorders (i.e., anxiety, mood, and related disorders), is efficacious in the treatment of co-occurring emotional disorders compared to established single disorder protocols (SDPs) that target specific disorders (e.g., panic disorder). Method Participants included 179 adults seeking outpatient psychotherapy. Participant age ranged from 18 to 66 years, with an average of 30.66 years (SD = 10.77). The sample was 55% female and mostly Caucasian (83%). Diagnostic assessments were completed with the Anxiety Disorder Interview Schedule (ADIS), and disorder-specific, clinician-rated measures for the comorbid diagnoses of interest. Results In both treatment conditions, participants' mean number of diagnoses dropped significantly from baseline to posttreatment, and baseline to 12-month follow-up. Additionally, large effects were observed for changes in comorbid generalized anxiety (ESSG: UP = −1.72; SDP = −1.98), social anxiety (ESSG: UP = −1.33, −0.86; SDP = −1.60, −1.54), and depression (ESSG: UP = −0.83; SDP = −0.84). Significant differences were not observed in between-group comparisons. Conclusions Results suggest that both the UP and SDPs are efficacious in reducing symptoms of comorbid emotional disorders. The clinical, practical, and cost-effective advantages of transdiagnostic CBT are discussed.

Both maladaptive and adaptive emotion regulation strategies have been linked with psychopathology. However, previous studies have largely examined them separately, and little research has examined the interplay of these strategies cross-sectionally or longitudinally in patients undergoing psychological treatment. This study examined the use and interplay of adaptive and maladaptive emotion regulation strategies in 81 patients receiving cognitive-behavioral interventions for comorbid alcohol use and anxiety disorders. Patients completed measures of emotion regulation strategy use and symptoms of psychopathology pre- and post-treatment. Cross-sectionally, higher use of maladaptive strategies (e.g., denial) was significantly related to higher psychopathology pre- and post-treatment, whereas higher use of adaptive strategies (e.g., acceptance) only significantly related to lower psychopathology post-treatment. Prospectively, changes in maladaptive strategies, but not changes in adaptive strategies, were significantly associated with post-treatment psychopathology. However, for patients with higher pre-treatment maladaptive strategy use, gains in adaptive strategies were significantly associated with lower post-treatment psychopathology. These findings suggest that psychological treatments may maximize efficacy by considering patient skill use at treatment outset. By better understanding a patient's initial emotion regulation skills, clinicians may be better able to optimize treatment outcomes by emphasizing maladaptive strategy use reduction predominately, or in conjunction with increasing adaptive skill use.

Background: Previous research suggests that patients with panic disorder exhibit higher levels of aggression than patients with other anxiety disorders. This aggression is associated with more severe symptomatology and interpersonal problems. However, few studies have examined whether higher levels of aggression are associated with a worse treatment response in this population. Methods: The present study sought to examine the association of aggression with panic disorder symptom severity in a sample of 379 patients who participated in a trial examining long-term strategies for the treatment of panic disorder. Results: We found that aggression was significantly associated with higher baseline levels of panic disorder symptoms, anxiety, depression, and functional impairment. Further, we found that patients higher in aggression did not achieve the same level of improvement in general anxiety symptoms during treatment compared to patients lower in aggression, even when controlling for baseline anxiety symptom severity. Conclusion: These results suggest that more research is needed concerning patients with anxiety disorders with higher aggression, as they may be a group in need of additional treatment considerations.

Existing research supports a relationship between nonsuicidal self-injury (NSSI) and the emotional disorders (i.e., anxiety, mood, and related disorders). The aim of this investigation was to conduct a meta-analysis of the associations between NSSI and the emotional disorders, and evaluate the quality of evidence supporting this relationship. A literature search was conducted from database inception through June 2014, and two reviewers independently determined the eligibility and quality of studies. A total of 56 articles providing data on engagement in NSSI among individuals with and without emotional disorders met eligibility criteria. Compared to those without an emotional disorder, individuals with an emotional disorder were more likely to report engagement in NSSI (OR=1.75, 95% CI: 1.49, 2.06). This increase of risk of NSSI was shown for each disorder subgroup, with the exceptions of bipolar disorder and social anxiety disorder. The largest associations were observed for panic and post-traumatic stress disorder; however, the risk of NSSI did not differ significantly across disorders. The quality of evidence was variable due to inconsistent methodological factors (e.g., adjustment for confounding variables, NSSI assessment). Overall, these findings provide evidence for a relationship between NSSI and the emotional disorders, and support conceptualizations of NSSI as transdiagnostic.

Despite their prevalence, depression and suicidal ideation (SI) are relatively unaddressed problems in the college student population. There are limited individual treatment studies targeting this population. Nine students (M = 19.33 years of age; SD ± .87) with depressive symptoms and/or SI were enrolled in 6-weeks of individual cognitive behavioral therapy (CBT) with a individually tailored manual-based treatment delivery. Measures were given before and after treatment. Primary results, presented as a case series, suggested decreases in depression across students and an overall downward trend in SI. As a secondary analysis, paired samples t tests showed significant decreases in both depression and SI. In summary, short-term, individually tailored manual-based CBT may be beneficial for reducing depressive symptoms and SI among college students. More research is needed to determine the best clinical interventions and targeted treatments for this vulnerable population.

Chapter 5 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook teaches that emotions are necessary and helpful in our day-to-day lives and explains why we wouldn’t actually want to get rid of all “bad” feelings. Instead of getting rid of negative emotions, the goal of this treatment is to help people respond differently when these emotions come up. The chapter looks at how emotions (such as fear, sadness, anxiety, and anger, as well as positive emotions, like happiness, excitement, and pride) can go from providing useful input to feeling totally overwhelming. Emotional experiences are made less overwhelming by breaking them down into more manageable parts—thoughts, physical sensations, and 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.

Chapter 8 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook looks at one part of our emotional experiences—our thoughts—and describes how thoughts are very important for influencing how we feel. The chapter describes our tendency to get stuck in automatic patterns of thinking, which we refer to as thinking traps. This treatment describes two specific types of thinking traps: jumping to conclusions and thinking the worst. Next, readers are encouraged to identify their own patterns of negative thinking to generate alternative interpretations. The overall goal is to be more flexible in our thinking, referred to as cognitive flexibility.

Chapter 9 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook looks at another part of our emotional experiences—emotional behaviors, which refer to the things we do to manage our emotions. This chapter presents skills to help us identify and evaluate our emotional behaviors by examining both the short term and long term consequences of these actions. In general, unhelpful emotional behaviors provide short term relief from strong emotions but set us up to experience even more strong emotions in the future. Lastly, we learn to counter unhelpful emotional behaviors by replacing current emotional behaviors with new, alternative behaviors, a skill called choosing an Alternative Action.

Chapter 5 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide is designed to provide a review of the patient’s presenting problems and diagnoses within the context of the emotional disorder framework. This is an opportunity for the therapist to start identifying how the patient’s experience fits into a transdiagnostic model emphasizing frequent strong emotions and aversive, avoidant responses to these emotions. This first session also emphasizes the importance of cultural factors and then provides patients with an introduction to the treatment 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.

Chapter 4 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook focuses on identifying ways that your emotional responding is interfering with your lives—the top problems you would like to change and how determine the specific steps needed to address these problems. The importance of maintaining motivation for making these difficult changes is also discussed. The topics covered in this chapter form the necessary foundation for building a healthier relationship with our emotions. The rest of the skills in this book build upon this groundwork. This chapter also explores the costs and benefits of changing and remaining the same.

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).

The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook was developed to help people who are struggling with intense emotions like anxiety, sadness, anger, and guilt. A person may have an emotional disorder when his or her emotions are so overwhelming that they get in the way of moving forward in life. Although emotions affect our lives in different ways, there are three features that often occur across emotional disorders. These are (a) frequent, strong emotions; (b) negative reactions to emotions; and (c) avoidance of emotions. The goal of this workbook is to change the way that people with emotional disorders respond to their emotions when they occur. This treatment program is applicable to all anxiety and unipolar depressive disorders and potentially other disorders with strong emotional components. The strategies included in this treatment are largely based on common principles found in existing empirically supported psychological treatments.