In the United States, individuals living in rural areas experience high rates of behavioral health problems; however, there is an alarming shortage of available providers to help these individuals, particularly when compared to urban areas. For example, 81% of metropolitan counties have a psychologist compared to 53% of nonmetropolitan counties (Andrilla et al., 2018). In addition to the lack of available behavioral health clinicians, individuals living in rural areas endorse stigma-related cultural norms that may reduce their likelihood to seek treatment. There have been advancements, however, toward integrating mental health services into primary care, given that a substantial proportion of patients in rural settings present to primary care settings for mental health care, including efforts to adapt evidence-based psychological treatments for specific behavioral health disorders. At this time, there is a need to enhance the training of clinicians in rural areas in evidence-based psychological treatments. The purpose of this article is to discuss a candidate treatment to implement in primary care settings: The unified protocol for transdiagnostic treatment of emotional disorders (UP; Barlow et al., 2018). Strong evidence supports the ability of the UP to target problems that commonly present in primary care (e.g., depression, anxiety), and it has been adapted in a variety of ways for a range of settings and populations (Cassiello-Robbins et al., 2020). This article provides an overview of the UP and a review of its efficacy, a discussion of its applicability in rural primary care settings, and suggests future directions for research and implementation.
Public Health Significance StatementThis article discusses the urgent need to improve access to quality behavioral health care in rural areas and introduces a promising evidence-based psychological treatment that has the potential to meet this need. Furthermore, it outlines specific next steps for the research-informed implementation of this treatment in rural primary care settings.