Abstract
Although cognitive-behavioral therapy (CBT) is a well established treatment for anxiety and depressive disorders in children (Chorpita et al., 2011), a significant proportion of children do not respond to existing CBT protocols, and many protocols do not adequately address high rates of comorbidity among emotional disorders. Transdiagnostic approaches may help to improve treatment response in children, particularly for clinical or sub-clinical comorbid conditions not adequately targeted by disorder-specific CBT, and to prevent the later development of commonly occurring comorbid conditions. The Unified Protocol for the Treatment of Emotional Disorders in Children (UP-C; Ehrenreich-May et al., in press) is a transdiagnostic treatment protocol for children ages 6-13 that is organized around a set of core principles addressing emotion reactivity and regulation deficits common across emotional disorders. Results of an open trial in 22 children supported the initial efficacy and feasibility of the UP-C (Bilek & Ehrenreich-May, 2012) but were limited due to the lack of a comparison condition. This study examined additional efficacy data for the UP-C, utilizing a RCT comparing UP-C to an active, anxiety-specific intervention condition (Lyneham, Abbott, Wignall, & Rapee, 2003). Participants were 47 children with a primary anxiety or depressive disorder diagnosis (55.30% female; M age = 9.31) evaluated at baseline (Pre-Tx), mid-treatment (Mid-Tx), post-treatment (Post-Tx), and six months after treatment completion (FU) using multi-informant assessments. Condition-related differences in diagnostic outcomes were evaluated using Pearson’s chi-square test, while condition-related differences in dimensional outcomes were evaluated using latent growth curve models (LGMs) with treatment condition specified as a dummy-coded covariate. As hypothesized, no condition-related differences were found with respect to diagnostic outcomes, including remission of principal diagnosis and all emotional disorder-diagnoses at Post-Tx or FU. We also did not find significant differences in the slope of child- or parent-rated anxiety symptoms, nor in the mean levels of child- or parent-rated anxiety symptoms at Post-Tx or FU. Results provide preliminary evidence that the UP-C is at least as efficacious in treating anxiety disorders and anxiety symptoms as well-supported anxiety-specific treatment protocols. However, UP-C was superior to the active treatment control on a number of variables including treatment response status at FU, the shape of change in child-rated depression symptoms, rate of decrease in parent-rated sadness and worry dysregulation, and rate of increase in cognitive reappraisal. Additionally, UP-C participants demonstrated lower levels of parent-rated depression symptoms at Post-Tx, lower levels of parent-rated sadness dysregulation at Post-Tx and FU, and higher levels of child-rated cognitive reappraisal at Post-Tx and FU. Results provide initial support for the efficacy of the UP-C, which may produce greater gains in emotion reactivity and regulation variables compared to standard domain-specific CBT protocols without sacrificing gains in the area of anxiety.