Effect of Unified Protocol on neuroticism, emotion regulation skills, and symptom severity—A case series

Background: There has been a shift from single disease protocols to interventions that address shared vulnerabilities across disorders with high comorbidity. Unified Protocol (UP) is an emotion-focused transdiagnostic intervention that addresses neuroticism, a shared mechanism identified in emotional disorders by enhancing emotion regulation skills. In this study, we attempted to understand the effect of the (UP) on symptom severity, emotion regulation, and neuroticism. Methods: A non-concurrent multiple baseline design was adopted. Six clients with a primary diagnosis of an anxiety disorder were randomly assigned to a 2, 3, or 4-week baseline period, following medication stabilization for 4 weeks. Following the baseline period, UP was delivered over 15–18 sessions. Neuroticism and emotion regulation were assessed at baseline, post, and follow-up. Anxiety severity was measured weekly by both an independent rater and on self-report. Results: Of the 6 clients randomized, 3 completed the intervention. Visual analysis was used to examine changes in symptom severity and Reliable Change Index (RCI) was used to examine changes in scores on neuroticism and emotion regulation across time points for the 3 completers. Reliable change was observed in 1 out of 3 clients for neuroticism and in 2 out of 3 clients for emotion regulation skills. Change in slope, and level of symptom severity was observed across participants. Conclusions: UP is a parsimonious approach to addressing co-morbidities. Our findings support the role of emotion regulation skills in the management of anxiety. A larger sample is required to establish these findings more robustly and support generalization of findings.