Abstract
Anxiety, depression, and related emotional disorders are prevalent and impairing (Merikangas et al., 2010). They not only have high levels of symptom overlap but also share underlying temperament factors such as high neuroticism (Barlow, Sauer-Zavala, Carl, Bullis, & Ellard, 2014; Tonarely, Sherman, Grossman, Shaw, & Ehrenreich-May, under review) and low extroversion (Barlow et al., 2014; Tonarely, Sherman, & Ehrenreich-May, 2017). The Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C and UP-A, respectively; Ehrenreich-May et al., 2018) and similar core dysfunction-focused transdiagnostic therapy approaches may lead to successful treatment by targeting higher-order factors that cut across an array of emotional disorders (Marchette & Weisz, 2017). This study aimed to assess how changes in modifiable risk factors associated with the construct of neuroticism and common to emotional disorders (i.e., poor distress tolerance, heightened avoidance, impaired cognitive flexibility) as well as symptoms of emotional disorders (i.e., anxiety and depressive symptoms, severity of presenting problems) occur in concordance with the administration of different treatment components of the UP-A. One key question that this study explored was whether changes in the identified modifiable risk factors displayed by individuals with emotional disorders and emotional disorder symptoms occur directly following the presentation of treatment components, or whether changes might instead be staggered throughout treatment. Within this study, single-case analytic strategies were employed, including the application of a multiple-baseline design and novel modeling techniques (Barlow & Nock, 2009; Jarrett & Ollendick, 2012; Manolov, Gast, Perdices, & Evans, 2014; Parker & Hagan-Burke, 2007), to characterize changes in facets of neuroticism and emotional disorder symptoms during the implementation of the UP-A. Treatment-based change was demonstrated by within treatment improvements, at both group and individual levels, in regard to symptoms of anxiety and depression, presenting problems, and facets of neuroticism, along with clinician-rated severity and impairment in relation to emotional disorders. While various patterns of change emerged throughout treatment on an individual level, the most robust findings involved changes in anxiety, experiential avoidance, and distress tolerance and, for specific subjects, changes in depression. Interestingly, while anxiety changed primarily linearly throughout treatment, experiential avoidance tended to change more pointedly following the introduction of relevant treatment components, and results were subject-dependent with regard to trajectories of change in depression and distress tolerance. Overall, change in experiential avoidance and distress tolerance tended to occur simultaneously to reductions in emotional disorder symptoms. This study helps to clarify the course of expected change in adolescent-reported variables believed to be common among a range of emotional disorders during a transdiagnostic treatment, as well as provides preliminary information regarding how to tailor the UP-A for individuals with different clinical profiles (e.g., high experiential avoidance, low distress tolerance, primary anxiety, significant depression).