Randomized Controlled Trial
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2022; 10(24): 8599-8614
Published online Aug 26, 2022. doi: 10.12998/wjcc.v10.i24.8599
Application of unified protocol as a transdiagnostic treatment for emotional disorders during COVID-19: An internet-delivered randomized controlled trial
Kou Yan, Mohammad Hassan Yusufi, Nabi Nazari
Kou Yan, School of Humanities and Education, Xi'an Eurasia University, Xi'an 710065, Shaanxi Province, China
Mohammad Hassan Yusufi, Education Administration, Bamyan University, Bamyan 22502, Afghanistan
Nabi Nazari, Department of Psychology, Faculty of Human Sciences, Lorestan University, Khorramabad, Lorestan, Iran
Author contributions: Nazari N made significant contributions to the conceptualization and methodology of the study, and writing of the original draft; Yan K made significant contributions to the design, software, methodology, and supervision of the study; Yusufi MH made significant contributions to the preparation, data curation, writing, and revision of the draft. All authors wrote, reviewed, and edited the manuscript.
Supported by Shaanxi Province Education Science "13th Five-Year" Planning Topic: Drama Teaching Method in Application of Research of Psychological Education of Primary School students, No. SGH17H472; and Research Team Cultivation Project of Xi 'an Eurasia University: Regional Children’s Psychological Development Research, No. 2021XJTD.
Institutional review board statement: The study was carried out in accordance with the Declaration of Helsinki and was approved and registered by the ethical and Human Subjects Review. The study was reviewed and approved by the (Bamyan University) Institutional Review Board [(Approval No: BAMAFGHEDU2019070)].
Clinical trial registration statement: This study is registered at https://clinicaltrials.gov/ct2/show/NCT04498949. The registration identification number is NCT04498949.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: The datasets generated and/or analyzed during the current study are not publicly available due to (local policy considerations and limitations of ethical approval involving the patient data and anonymity) but are available from the corresponding author upon reasonable request.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nabi Nazari, PhD, Academic Fellow, Academic Research, Research Assistant, Research Assistant Professor, Senior Editor, Department of Psychology, Faculty of Human Sciences, Lorestan University, Kamalvand St., Khorramabad 6815144316, Lorestan, Iran. nazariirani@gmail.com
Received: March 11, 2022
Peer-review started: March 11, 2022
First decision: April 18, 2022
Revised: May 2, 2022
Accepted: July 25, 2022
Article in press: July 25, 2022
Published online: August 26, 2022
Processing time: 157 Days and 13.9 Hours
ARTICLE HIGHLIGHTS
Research background

Depressive and anxiety disorders represent one of the greatest burdens among human diseases worldwide. These emotionally difficult conditions often manifest as comorbidities. A growing body of evidence indicates that the trans-diagnostic approach for treating these disorders is safe, feasible, and efficient.

Research motivation

Restricted policies (e.g., physical distancing) to minimize the risk of infection have made it more difficult to seek and attend treatment. The majority of individuals with mental health problems remain untreated. Internet-based interventions can help to address existing barriers. Also, trans-diagnostic, emotion-focused cognitive-behavioral treatments, such as unified protocol (UP), may be particularly well suited to address the challenges practicing psychologists and their patients face during the current coronavirus disease 2019 (COVID-19) pandemic.

Research objectives

This study was conducted to examine the application of an internet-delivered cognitive-behavior therapy (CBT)-transdiagnostic intervention for adults with emotional disorders.

Research methods

In this internet-delivered two-armed, accessor-blinded, parallel randomized controlled trial, 102 students with an emotional disorder were randomly allocated to receive UP or treatment as the usual interventions. Following a semi-structured clinical interview, participants completed an online survey, including the Overall Anxiety Severity and Impairment Scale, Overall Depression Severity and Impairment Scale, Difficulties in Emotion Regulation Scale, Positive and Negative Affect Schedule, and Emotional Style Questionnaire.

Research results

The findings of the current trial highlight the considerable potential of internet-delivered CBT programs, such as the UP, in improving access to online psychotherapy for affected adults by the pandemic. Our findings revealed significant changes in depression, anxiety, worry, emotion regulation, and affectivity measures in the unified protocol group posttreatment relative to baseline. There were no significant changes in the dependent variables in the control group at posttreatment relative to baseline.

Research conclusions

Transdiagnostic treatments target shared mechanisms between disorders to facilitate change across diagnoses. Overall, the findings support that the unified protocol could be an additional efficient as a parsimonious, transdiagnostic treatment of emotional disorders for young adults with emotional disorders during the current pandemic.

Research perspectives

From a global mental health perspective, a unified transdiagnostic treatment can potentially serve as a promising intervention approach that would be more cost-effective and may help to increase the availability of evidence-based treatments for emotional disorders, affordability of dissemination of a single protocol vs multiple protocols, and a decreased need for clinical observations by trained health professionals. With an interdisciplinary approach to attrition incorporating a range of technological, environmental, and individual factors, future studies may be required to comprehensively explain participants’ adherence and improve retention in internet-delivered interventions.