Hostname: page-component-848d4c4894-mwx4w Total loading time: 0 Render date: 2024-07-01T17:53:34.032Z Has data issue: false hasContentIssue false
  • English
  • Français

Effectiveness of the unified protocol for treating co-morbid health anxiety and depression: an empirical case study

Published online by Cambridge University Press:  24 May 2021

Chris Gaskell ,
Ben Hague  and
Stephen Kellett Open the ORCID record for Stephen Kellett [Opens in a new window]
Chris Gaskell
Affiliation:
University of Sheffield, Sheffield, UK
Ben Hague
Affiliation:
South West Yorkshire NHS Foundation Trust, UK
Stephen Kellett*
Affiliation:
University of Sheffield, Sheffield, UK and Sheffield Health and Social Care NHS Foundation Trust, UK
*
*Corresponding author. Email: s.kellett@sheffield.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Aims:

The unified protocol (UP) is indicated when patients present with co-morbidity, but no studies have previously investigated the effectiveness of the UP with co-morbid health anxiety and depression.

Method:

An A/B single case design evaluated outcomes for a 27-year-old male presenting with health anxiety and co-morbid depression. Following a 21-day assessment-baseline period containing three sessions, the manualised UP was delivered across a 42-day period containing seven intervention sessions. Four idiographic measures (occurrence and duration of health checking, sleep duration and food intake satisfaction) were collected daily throughout, and two nomothetic measures were collected at four time points.

Results:

All sessions were attended. Number of health checking episodes reduced from four per day to two per day. A 59 minute per day reduction in time spent health checking occurred, and sleep increased by 100 minutes per night. There was little apparent change in terms of food intake satisfaction. There was a reliable and clinically significant reduction in depression.

Discussion:

Further testing of the effectiveness of the UP with co-morbid health anxiety and depression in true single case experimental designs is now indicated.

Keywords

depressionhealth anxietysingle case experimental designtherapy outcome
Type
Main
Information
Behavioural and Cognitive Psychotherapy , Volume 49 , Issue 6 , November 2021 , pp. 673 - 683
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the British Association for Behavioural and Cognitive Psychotherapies

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Andersen, P., Toner, P., Bland, M., & McMillan, D. (2016). Effectiveness of transdiagnostic cognitive behaviour therapy for anxiety and depression in adults: a systematic review and meta-analysis. Behavioural and Cognitive Psychotherapy, 44, 673–690. https://doi.org/10.1017/S1352465816000229 CrossRefGoogle ScholarPubMed
Arco, L. (2015). A case study in treating chronic comorbid obsessive-compulsive disorder and depression with behavioral activation and pharmacotherapy. Psychotherapy, 52, 278–286. https://doi.org/10.1037/pst0000018 CrossRefGoogle ScholarPubMed
Barkham, M., Bewick, B., Mullin, T., Gilbody, S., Connell, J., Cahill, J., Mello-Clark, J., Richards, D., Unsworth, G., & Evans, C. (2013). The CORE-10: a short measure of psychological distress for routine use in the psychological therapies. Counselling and Psychotherapy Research, 13, 3–13. https://doi.org/10.1080/14733145.2012.729069.CrossRefGoogle Scholar
Barlow, D. H., Allen, L. B., & Choates, M. L. (2004). Toward a unified treatment for emotional disorders: history of development. Behavior Therapy, 35, 205–230. doi: 10.1016/j.beth.2016.11.005. https://doi.org/10.1016/S0005-7894(04)80036-4 CrossRefGoogle Scholar
Barlow, D. H., Farchione, T. J., Bullis, J. R., Gallagher, M. W., Murray-Latin, H., Sauer-Zavala, S., Bentley, K. H., Thompson-Hollands, J., Conklin, L. R., Boswell, J. F., Ametaj, A., Carl, J. R., Boettcher, H. T., & Classiello-Robbins, C. (2017). The unified protocol for transdiagnostic treatment of emotional disorders compared with diagnosis-specific protocols for anxiety disorders: a randomized clinical trial. JAMA Psychiatry, 74, 875–874. https://doi.org/10.1001/jamapsychiatry.2017.2164 CrossRefGoogle ScholarPubMed
Barlow, D. H., Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L., Allen, L. B., & Ehrenreich-May, J. (2010). Unified Protocol for Transdiagnostic Treatment of Emotional Disorders. Oxford Unversity Press.Google Scholar
Boswell, J. F., Anderson, L. M., & Barlow, D., H. (2014). An idiographic analysis of change processes in the unified transdiagnostic treatment of depression. Journal of Consulting and Clinical Psychology, 82, 1060–1071. http://dx.doi.org/10.1037/a0037403 CrossRefGoogle ScholarPubMed
Chen, M., Hyppa-Martin, J. K., Reichle, J. E., & Symons, F. J. (2016). Comparing single case design overlap-based effect size metrics from studies examining speech generating device interventions. American Journal on Intellectual and Developmental Disability, 121, 169–193. https://doi.org/10.1352/1944-7558-121.3.169 CrossRefGoogle ScholarPubMed
Connell, J., & Barkham, M. (2007). CORE-10 User Manual, version 1.1. CORE System Trust and CORE Information Management Systems Ltd.Google Scholar
Deacon, B. J., & Abramowitz, J. Z. (2005). The Yale-Brown Obsessive Compulsive Scale: factor analysis, construct validity, and suggestions for refinement. Journal of Anxiety Disorders, 19, 573–585. https://doi.org/10.1016/j.janxdis.2004.04.009 CrossRefGoogle ScholarPubMed
Di Nardo, P. A., Brown, T. A., & Barlow, D. H. (1994). Anxiety Disorders Interview Schedule for DSM-IV: Lifetime version (ADIS-IV-L). Psychological Corporation.Google Scholar
Dugas, M. J., Gagnon, F., Ladouceur, R., Freeston, M. H. (1998). Generalized anxiety disorder: a preliminary test of a conceptual model. Behaviour Research and Therapy, 36, 215–226. https://doi.org/10.1016/S0005-7967(97)00070-3 CrossRefGoogle ScholarPubMed
Farchione, T. J, Fairholme, C. P., Ellard, K. K., Boisseau, C. L, Thompson-Hollands, J., Carl, J. R., Gallagher, M. W., & Barlow, D. H. (2012). Unified protocol for transdiagnostic treatment of emotional disorders: a randomized controlled trial. Behavior Therapy, 43, 666–678. https://doi.org/10.1016/j.beth.2012.01.001 CrossRefGoogle Scholar
Frost, R. O., Steketee, G., Krause, M. S., & Trepanier, K. L. (1995). The relationship of the Yale-Brown obsessive compulsive scale (YBOCS) to other measures of obsessive compulsive symptoms in a nonclinical population. Journal of Personality Assessment, 65, 158–168. https://doi.org/10.1207/s15327752jpa6501_12 CrossRefGoogle Scholar
Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. L., Heninger, G. R., & Charney, D. S. (1989). The Yale-Brown Obsessive Compulsive Scale: i. Development, use and reliability. Archives of General Psychiatry, 46, 1006–1011. https://doi.org/10.1001/archpsyc.1989.01810110048007 CrossRefGoogle ScholarPubMed
Hague, B., Scott, S., & Kellett, S. (2015). Transdiagnostic CBT treatment of co-morbid anxiety and depression in an older adult: single case experimental design. Behavioural and Cognitive Psyhotherapy, 43, 119–124. https://doi.org/10.1017/S1352465814000411 CrossRefGoogle Scholar
Hirschfeld, R, M. (2001). The comorbidity of major depression and anxiety disorders: recognition and management in primary care. Journal of Clinical Psychiatry, 3, 244–254. https://doi.org/10.4088/pcc.v03n0609 Google ScholarPubMed
Jacobson, N., & Truax, P. (1991). Clinical significance: a statistical approach to defining change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19. http://doi.org/10.1037/0022-006X.59.1.12 CrossRefGoogle ScholarPubMed
Kellett, S., Oxborough, P., & Gaskell, C. (2020). Treatment of compulsive buying disorder: comparing the effectiveness of cognitive behavioural therapy with person-centred experiential counselling. Behavioural and Cognitive Psychotherapy. http://doi.org/10.1017/S1352465820000521 CrossRefGoogle Scholar
McEvoy, P. M., Nathan, P., & Norton, P. J. (2009). Efficacy of transdiagnostic treatments: a review of published outcome studies and future research directions. Journal of Cognitive Psychotherapy, 23, 20–33. http://doi.org/10.1891/0889-8391.23.1.20 CrossRefGoogle Scholar
McManus, F., Shafran, R., & Cooper, Z. (2010). What does a ‘transdiagnostic’ approach have to offer the treatment of anxiety disorders? British Journal of Clinical Psychology, 49, 491–505. https://doi.org/10.1348/014466509X476567 CrossRefGoogle ScholarPubMed
McMillan, D., & Morley, S. (2010). Single case quantitative methods for practice based evidence. In Barkham, M., Hardy, G. E., & Mellor-Clark, J. (eds.), Developing and Delivering Practice Based Evidence: A Guide for the Psychological Therapies (pp. 109–138). Wiley-Blackwell.CrossRefGoogle Scholar
Mohammadpour, M., Sadeghi, K., Foroughi, A., Amiri, S., Parvizifard, A., & Khoramniya, S. (2018). The unified protocol for transdiagnostic treatment of emotional disorders: treatment of comorbid psychopathology accompanying a generalized anxiety disorder. International Journal of Behavioral Science, 12, 125–131.Google Scholar
Morley, S. (2017). Single-Case Methods in Clinical Psychology: A Practical Guide. Routledge.CrossRefGoogle Scholar
Olatunji, B. O., Kauffman, B. Y., Meltzer, S., Davis, M. L., Smits, J. A., & Powers, M. B. (2014). Cognitive-behavioral therapy for hypochondriasis/health anxiety: a meta-analysis of treatment outcome and moderators. Behaviour Research and Therapy, 58, 65–74. https://doi.org/10.1016/j.brat.2014.05.002 CrossRefGoogle ScholarPubMed
Parker, R. I., & Vannest, K. J. (2009). An improved effect size for single-case research: nonoverlap of all pairs. Behavior Therapy, 40, 357–367. http://doi.org/10.1016/j.beth.2008.10.006 CrossRefGoogle ScholarPubMed
Parker, R. I., Vannest, K. J., & Davis, J. L. (2011). Effect size in single-case research: a review of nine nonoverlap techniques. Behavior Modification, 35, 303–322. https://doi.org10.1177/0145445511399147 CrossRefGoogle ScholarPubMed
Salkovskis, P. M., & Kirk, J. (1989). Obsessional disorders. In Hawton, K., Salkovskis, P. M., Kirk, J., & Clark, D. M. (eds), Cognitive Behavioural Therapy for Psychiatric Problems: A Practical Guide (pp. 129–168). Oxford University Press.10.1093/med:psych/9780192615879.003.0005CrossRefGoogle Scholar
Sauer-Zavala, S., Bentley, K. H., & Wilner, J. G. (2016). Transdiagnostic treatment of borderline personality disorder: a clinical replication series. Journal of Personality Disorders, 30, 35–51. https://doi.org/10.1521/pedi_2015_29_179 CrossRefGoogle ScholarPubMed
Sauer-Zavala, S., Cassiello-Robbins, C., Conklin, L. R., Bullis, J. R., Thompson-Hollands, J., & Kennedy, K. A. (2017). Isolating the unique effects of the unified protocol treatment modules using single case experimental design. Behavior Modification, 41, 286–307. https://doi.org/10.1177/0145445516673827 CrossRefGoogle ScholarPubMed
Scruggs, T. E., & Mastropiere, M. A. (1998). Summarizing single-subject research: Issues and applications. Behavior Modification, 22, 221–242. https://doi.org/10.1177/01454455980223001 CrossRefGoogle ScholarPubMed
Shadish, W. R., & Sullivan, K. J. (2011). Characteristics of single-case designs used to assess intervention effects in 2008. Behaviour Research Methods, 43, 971–980. https://doi.org/10.3758/s13428-011-0111-y CrossRefGoogle Scholar
Wilamowska, Z. A., Thompson-Hollands, J., Fairholme, C. P., Ellard, K. K., Farchione, T. J., & Barlow, D. (2010). Conceptual background, development, and preliminary data from the unified protocol for transdiagnostic treatment of emotional disorders. Depression and Anxiety, 27, 882–890. https://doi.org/10.1002/da.20735 CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.