Investigating the Effects of the Unified Protocol on Common and Specific Factors in a Comorbid Insomniac Sample: A Single-Case Experimental Design

Abstract

Background: Insomnia and emotional disorders share common factors that underlie and perpetuate these disorders. The Unified Protocol (UP) for the transdiagnostic treatment of emotional disorders is a new treatment approach designed to target core processes of emotional disorders. Objectives: The present study examined the effects of UP on behavioral inhibition/behavioral activation, anxiety sensitivity, and emotion dysregulation as transdiagnostic factors, as well as cognition and behaviors specific to insomnia, in a small sample of patients (N = 6) with comorbid insomnia and emotional disorders. Methods: A multiple-baseline across subjects single-case experimental design with a 3-month follow-up was used. Participants were allocated to 2, 4, and 6 baseline periods and then received 14 weekly individual sessions of UP. The outcome measures were Behavioral Inhibition/Behavioral Activation Scales (BIS/BAS), Anxiety Sensitivity Index-3 (ASI-3), Difficulties in Emotion Regulation Questionnaire (DERS), Dysfunctional Beliefs and Attitudes about Sleep Scale-10 (DBAS-10), and Sleep-Related Behaviors Questionnaire (SRBQ). Data were analyzed using visual inspection, mixed model analysis, and reliable change index (RCI). Results:The mixed model analysis showed significant changes in BIS/BAS, ASI-3, DERS, DBAS-10, and SRBQ from pre-treatment to post-treatment. Most participants achieved a reliable change in BIS, ASI-3, DERS, DBAS-10, and SRBQ at a 3-month follow-up. Conclusions: This preliminary study provides empirical evidence on the utility of UP for reducing common vulnerability and sleepspecific factors in chronic insomnia comorbid with emotional disorders. Further research is needed to test these findings in randomized controlled studies.

Augmenting the unified protocol with transcranial direct current stimulation: Effects on emotion regulation and executive dysfunction

“…Further, treatment with both the UP alone and UP plus tDCS resulted in improvements in indices of executive function, including decreased reaction time and improved accuracy on behavioural tasks of response inhibition and working memory. These results are consistent with previous studies demonstrating the UP's effectiveness at improving emotion regulation skills of individuals suffering from anxiety and depressive disorders (Allen et al, 2012; Bullis et al, 2015; Ellard et al, 2017) and studies showing the UP's effectiveness in improving executive functions (Alivand et al, 2018; Arshadi et al, 2018). Further, augmenting the UP with the addition of tDCS resulted in greater treatment gains relative to the UP alone, leading to significantly greater improvements in general emotion regulation skills, the use of reappraisal strategies, working memory accuracy and inhibitory response times.…”

“…Bullis et al (2015) administered UP in group format and showed significant improvement in emotion regulation skills in individuals with anxiety and co‐morbid depression relative to a wait‐list control (Bullis et al, 2015). Alivand et al (2018) administered 14 weekly individual sessions of the UP in a sample of patients with insomnia and showed reduced behavioural inhibition, or avoidance of unpleasant experiences, from pre‐ to post‐treatment (Alivand et al, 2018). Similarly, significantly decreased behavioural inhibition and avoidance was found following treatment with the UP in a study of 32 female students with social anxiety disorder (Arshadi et al, 2018).…”

The efficacy of transdiagnostic cognitive behavioural therapy on reducing negative affect, anxiety sensitivity and improving perceived control in children with emotional disorders - a randomized controlled trial

“…In this regard, the present study aimed to investigate the efficacy of the UP-C on NA, AS, and PC in children with emotional disorders. Based on prior research (Boswell et al ., 2013; Carl, Gallagher, Sauer-Zavala, Bentley, & Barlow, 2014; Doos Ali Vand, Gharraee, Asgharnejad Farid, Ghaleh Bandi, & Habibi, 2018 ; Ellard et al ., 2017 ; García- Escalera et al ., 2017; Sandín, García-Escalera, Valiente, Espinosa, & Chorot, 2020 ; Sauer-Zavala et al ., 2012 ; Sherman & Ehrenreich-May, 2020), it was hypothesized that UP-C can reduce NA and AS, and improve PC.…”