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Current classification systems for mental disorders emphasize categorical assessment. In the domain of emotional disorders, this is inconsistent with a growing consensus that anxiety, depressive, and related disorders are best conceptualized as variations on shared underlying processes, chiefly heightened negative affect, and aversion to unwanted emotional experiences. Dimensional assessment of transdiagnostic emotional disorder constructs offers advantages for clinical and research applications, including increased parsimony and improved validity, yet there are drawbacks to many dimensional assessment systems for emotional disorders. The case presented in this paper illustrates the potential clinical utility of a new self-report instrument—the Multidimensional Emotional Disorders Inventory (MEDI)—which assesses nine dimensions characteristic of emotional disorders. MEDI scores for a highly comorbid patient are examined over the course of transdiagnostic emotion-focused cognitive-behavioral treatment. At baseline, midtreatment, and posttreatment, the MEDI offered information above and beyond DSM categorical assessment, including detection of subclinical symptoms and symptom change, while remaining parsimonious. Implications for possible use as a treatment planning instrument, integration with categorical assessment, and future research directions are discussed.

Interoceptive exposure (IE; exposure focused on anxiety about somatic sensations) is a well-established component of treatments for panic disorder (PD), but little is known about the specificity of its effects or individual response patterns resulting from this intervention. This study investigated the utility of IE in the treatment of PD with claustrophobia, examining its mechanisms in isolation and in combination with situational exposure. Ten adults with PD and claustrophobia were treated with a flexible single-case approach. Participants received up to 6 sessions of IE; nonresponders received up to 6 additional sessions of IE combined with situational exposure. Hypotheses were: 1) Reductions in anxiety sensitivity (AS) and fearful expectancies would coincide with the introduction of IE and reach clinical significance by the end of the IE phase; 2) Reductions in claustrophobic avoidance would coincide with the introduction of situational exposure; 3) Fear extinction and distress habituation would occur in both intervention phases. Hypothesis 1 was not supported: Five participants experienced a reduction in AS and six participants experienced reduced expectancies of feared outcomes, but this did not reliably coincide with introduction of IE. Hypothesis 2 was supported: Claustrophobic avoidance improved more after the addition of situational exposure. Hypothesis 3 was supported: Habituation and fear extinction, whereby distress and expectancies of feared outcomes decreased and fear tolerance increased, were observed in response to IE delivered alone and in combination with situational exposure. IE appeared more helpful to participants who were fearful of the physical consequences of somatic sensations (e.g., heart attack) vs. other consequences (e.g., embarrassment). The observed variability in response to IE suggests a need for individualized implementation of this intervention.

Quality of life is lower among individuals with anxiety disorders; however, this construct is rarely a focus in treatment research. This study explores changes in quality of life in a randomized, controlled trial of several cognitive-behavioral treatments (CBTs) for anxiety disorders. Adults with heterogeneous anxiety disorders ( N = 223) were randomly assigned to (a) unified protocol for transdiagnostic treatment of emotional disorders, (c) a single-disorder protocol targeting their principal diagnosis, or (c) a waitlist control condition, and assessed at baseline, posttreatment, and 6-month follow-up. At baseline, the sample evidenced deficits in quality of life, with no significant differences in quality of life across diagnoses or condition. Results suggest improved quality of life among participants in treatment, at similar rates across treatment condition and diagnostic category, and at levels significantly higher than the waitlist. Improvements were maintained through 6-month follow-up. This study supports CBT as effective in promoting quality of life.

Recent years have seen increased interest in transdiagnostic interventions, which seek to alleviate psychopathology by targeting mechanisms responsible for its etiology and maintenance across diagnostic categories. These interventions are promising due to being cost and time efficient and applicable to diverse clinical presentations. There is a growing parallel appreciation for the dimensional nature of emotional disorders, including anxiety, depressive, and related disorders in which emotion dysregulation is central. Positive affect and well-being are important, yet often overlooked, in the development and maintenance of psychopathology. This chapter explores transdiagnostic treatments to enhance positive affect and well-being in emotional disorders. One intervention is profiled, the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP), a transdiagnostic cognitive behavioral treatment targeting neuroticism with a mounting body of evidence for anxiety and related disorders. This chapter highlights ways the UP and other transdiagnostic interventions may enhance positive functioning in emotional disorders. Also explored are the ways in which positive functioning can be enhanced from a multidisciplinary perspective, drawing on research in the areas of spirituality, religion, and positive psychology. The central thesis proposed in this chapter is that a transdiagnostic approach targeting not only intense negative affect but also positive affect may be particularly helpful in improving quality of life for individuals with deficits across dimensions of well-being. Future directions in this line of research are proposed.

Patients with multiple mental disorders often experience sexual dysfunction and reduced quality of life. The unified protocol (UP) is a transdiagnostic treatment for emotional disorders that has the potential to improve quality of life and sexual functioning via improved emotion management. The present study evaluates changes in quality of life and sexual functioning in a highly comorbid sample treated with the UP in a group format. Forty-eight patients were randomly assigned to either a UP active-treatment group or a medication-only control group. Treatment was delivered in 14 sessions over the course of 4 months. Symptoms of anxiety and depression were assessed using the Beck Anxiety Inventory and Beck Depression Inventory. Sexual functioning was assessed by the Arizona Sexual Experience Scale (ASEX), and quality of life was assessed by the World Health Organization Quality of Life-BREF scale (WHOQOL-BREF). Quality of life, anxiety and depression all significantly improved among participants treated with the UP. Some improvement in sexual functioning was also noted. The results support the efficacy of the UP in improving quality of life and sexual functioning in comorbid patients.

Research in psychopathology has identified psychological processes that are relevant across a range of Diagnostic and Statistical Manual (DSM) mental disorders, and these efforts have begun to produce treatment principles and protocols that can be applied transdiagnostically. However, review of recent work suggests that there has been great variability in conceptions of the term "transdiagnostic" in the treatment development literature. We believe that there is value in arriving at a common understanding of the term "transdiagnostic." The purpose of the current paper is to outline three principal ways in which the term "transdiagnostic" is currently used, to delineate treatment approaches that fall into these three categories, and to consider potential advantages and disadvantages of each approach.

Background and objectives Interoceptive exposure (IE) is a behavioral intervention that reduces anxiety sensitivity and distress associated with somatic sensations. In this discussion, we describe the history, current applications and additional clinical potential of IE. Method We review the origins of IE and its historical application to panic disorder, as well as the accumulating evidence for transdiagnostic application to other disorders including post-traumatic stress disorder, social anxiety disorder, specific phobias and physical disorders. Then, we discuss ways in which IE could contribute to the treatment of additional disorders. Results IE is well-established in the treatment of panic disorder and increasingly used to target anxiety-provoking physical sensations in other disorders. Research and clinical evidence suggests that anxiety sensitivity is present across a range of disorders, and may actually be one variation on a broader phenomenon of interoceptive sensitivity, or anxiety focused on physical sensations that have been conditioned to unpleasant emotional states. Moreover, somatic symptoms are central to the experience of most emotions and may contribute to avoidant coping, a maintenance factor for disorders of emotion. IE has potential as a transdiagnostic intervention targeting interoceptive sensitivity in disorders such as depression and eating disorders. Nevertheless, IE is underutilized by clinicians in practice. Recent research in inhibitory learning and extinction suggests strategies for maximizing the effectiveness of IE. Limitations This review is not exhaustive in nature, and systematic research on transdiagnostic applications of IE remains scarce. Conclusions IE is a potentially powerful yet understudied transdiagnostic intervention.

Although the emotional disorders (EDs) have achieved favorable reliability in the Diagnostic and Statistical Manual of Mental Disorders (DSM), accumulating evidence continues to underscore limitations in ED diagnostic validity. In particular, taxometric, comorbidity, and other descriptive psychopathology studies of transdiagnostic phenotypes suggest that the EDs may be best conceptualized as dimensional entities that are more similar than different. Despite optimism that the fifth edition of the DSM (DSM-5) would constitute a meaningful shift toward dimensional ED assessment and diagnosis, most changes contribute little movement in that direction. In the present report, we summarize past and anticipate persisting (i.e., in DSM-5) limitations of a purely categorical approach to ED diagnosis. We then review our alternative dimensional-categorical profile approach to ED assessment and classification, including preliminary evidence in support of its validity and presentation of two ED profile case examples using our newly developed Multidimensional Emotional Disorder Inventory. We end by discussing the transdiagnostic treatment implications of our profile approach to ED classification and directions for future research.

Background: In the past decade, a great deal of research has examined the efficacy and mechanisms of attentional bias modification (ABM), a computerized cognitive training intervention for anxiety and other disorders. However, little research has examined how anxious patients perceive ABM, and it is unclear to what extent perceptions of ABM influence outcome. Aims: To examine patient perceptions of ABM across two studies, using a mixed methods approach. Method: In the first study, participants completed a traditional ABM program and received a hand-out with minimal information about the purpose of the task. In the second study, participants completed an adaptive ABM program and were provided with more extensive rationale and instructions for changing attentional biases. Results: A number of themes emerged from qualitative data related to perceived symptom changes and mechanisms of action, acceptability, early perceptions of the program, barriers/facilitators to engagement, and responses to adaptive features. Moreover, quantitative data suggested that patients’ perceptions of the program predicted symptom reduction as well as change in attentional bias. Conclusions: Our quantitative data suggest that it may be possible to quickly and inexpensively identify some patients who may benefit from current ABM programs, although our qualitative data suggest that ABM needs major modifications before it will be an acceptable and credible treatment more broadly. Although the current study was limited by sample size and design features of the parent trials from which these data originated, our findings may be useful for guiding hypotheses in future studies examining patient perceptions towards ABM.

Chapter 8 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook looks at one part of our emotional experiences—our thoughts—and describes how thoughts are very important for influencing how we feel. The chapter describes our tendency to get stuck in automatic patterns of thinking, which we refer to as thinking traps. This treatment describes two specific types of thinking traps: jumping to conclusions and thinking the worst. Next, readers are encouraged to identify their own patterns of negative thinking to generate alternative interpretations. The overall goal is to be more flexible in our thinking, referred to as cognitive flexibility.

Chapter 9 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook looks at another part of our emotional experiences—emotional behaviors, which refer to the things we do to manage our emotions. This chapter presents skills to help us identify and evaluate our emotional behaviors by examining both the short term and long term consequences of these actions. In general, unhelpful emotional behaviors provide short term relief from strong emotions but set us up to experience even more strong emotions in the future. Lastly, we learn to counter unhelpful emotional behaviors by replacing current emotional behaviors with new, alternative behaviors, a skill called choosing an Alternative Action.

Chapter 5 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide is designed to provide a review of the patient’s presenting problems and diagnoses within the context of the emotional disorder framework. This is an opportunity for the therapist to start identifying how the patient’s experience fits into a transdiagnostic model emphasizing frequent strong emotions and aversive, avoidant responses to these emotions. This first session also emphasizes the importance of cultural factors and then provides patients with an introduction to the treatment protocol.

Chapter 1 of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide introduces the treatment program, which is applicable to all anxiety and unipolar depressive disorders, and potentially other disorders with strong emotional components (e.g., eating disorders, borderline personality disorder). This introductory chapter lays out the advantages of a unified, transdiagnostic approach as well as the efficacy of the Unified Protocol (UP). The chapter concludes with an explanation of the purpose of the therapist guide, which gives mental health providers guidance on administration of the UP.

Chapter 4 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook focuses on identifying ways that your emotional responding is interfering with your lives—the top problems you would like to change and how determine the specific steps needed to address these problems. The importance of maintaining motivation for making these difficult changes is also discussed. The topics covered in this chapter form the necessary foundation for building a healthier relationship with our emotions. The rest of the skills in this book build upon this groundwork. This chapter also explores the costs and benefits of changing and remaining the same.

Chapter 7 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide provides psychoeducation on the functional, adaptive nature of emotions and assists patients in developing greater awareness of patterns of emotional responding, including potential maintaining factors (e.g., common triggers, environmental contingencies, and/or the maintaining role of avoidance). Patients also learn how to monitor and track their emotions by focusing on three core components of their emotional experiences (thoughts, physical feelings, and behaviors).

The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook was developed to help people who are struggling with intense emotions like anxiety, sadness, anger, and guilt. A person may have an emotional disorder when his or her emotions are so overwhelming that they get in the way of moving forward in life. Although emotions affect our lives in different ways, there are three features that often occur across emotional disorders. These are (a) frequent, strong emotions; (b) negative reactions to emotions; and (c) avoidance of emotions. The goal of this workbook is to change the way that people with emotional disorders respond to their emotions when they occur. This treatment program is applicable to all anxiety and unipolar depressive disorders and potentially other disorders with strong emotional components. The strategies included in this treatment are largely based on common principles found in existing empirically supported psychological treatments.

Chapter 3 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide covers assessment, monitoring, and medication. The chapter also clarifies who will benefit from the UP program as well as the benefits for patients of using the corresponding workbook. This chapter addresses what to do if other emotional problems are present and who should administer the program.

Chapter 11 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide focuses on interoceptive exposure, or exposure to physical sensations that are associated with (and can sometimes trigger) intense emotions. The exercises described in the UP workbook are designed to assist patients in gaining further awareness of physical sensations that are part of an emotional reaction. Further, these exercises, and continued exposures focused on physical sensations, are expected to help patients learn to tolerate and think differently about the sensations and provide an opportunity to break the conditioned association between the sensations and strong emotions such as fear, anxiety, and sadness.

Chapter 9 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide focuses on one very important component of emotional experiences: thoughts. Specifically, therapists will teach their patients to develop a greater awareness of how patient thoughts (or interpretations) influence their emotions, to learn to identify their negative thinking patterns, and to increase flexibility in interpreting different situations. The concepts introduced in this chapter are aimed to facilitate patients’ ability to approach emotion-provoking situations and respond to their emotions in more helpful, adaptive ways.

Chapter 13 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide provides information for the therapist and does not correspond to a particular therapy session. There is tremendous variability in the extent to which individuals use medication, psychological treatment, or some combination of the two. If a particular patient is using medication, discontinuation may be addressed toward the end of therapy when patients are beginning to feel better and more confident in their ability to manage their symptoms without medication. This chapter addresses some reasons for medication use and how medication use might affect treatment. It also provides information on how medications can be discontinued.

Chapter 2 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide notes that the Unified Protocol (UP) is based on traditional cognitive-behavioral principles, but the particular emphasis on the way individuals experience and respond to their emotions is unique in that it brings emotional processes to the forefront, making them available to fundamental psychological mechanisms of change. Core skills of the UP are introduced. These include mindful emotion awareness, which involves the practice of nonjudgmental, present-focused attention toward emotional experiences; challenging automatic thoughts related to external threats and internal threats and increasing cognitive flexibility; identifying and modifying problematic action tendencies, or emotional behaviors; increasing awareness and tolerance of physical sensations through interoceptive exposures; and engagement in emotion exercises. The chapter concludes with a description of the treatment modules.

Chapter 12 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook describes medications that are commonly prescribed for emotional disorders. These include anti-anxiety medications such as benzodiazepines and beta blockers, as well as antidepressant medications like selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. In addition, individuals with emotional disorders are sometimes prescribed mood stabilizers or antipsychotic medications. The chapter answers frequently asked questions about medications. It also provides recommendations for how to discontinue medications under the supervision of the prescribing physician. This treatment program can be completed in combination with the use of medication and considerations for this practice are described in this chapter.

Chapter 13 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook reviews the treatment program. (1) All emotions, even the ones that feel negative or uncomfortable, provide important information that can motivate us to take action in helpful ways. (2) Staying present in the moment and taking a nonjudgmental view of emotions can help to prevent emotions from increasing in intensity. The way we think about a situation influences how we feel, and how we feel affects the way we interpret a situation. (3) Although avoiding uncomfortable emotional experiences can work well in the short-term, it isn’t an effective long-term coping strategy. The chapter helps us to evaluate our progress and revisit our treatment goals. The most effective way to maintain progress and to keep improving is to continue to practice the skills learned in this program, and therefore a practice plan is developed in this last chapter.

Chapter 8 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide introduces patients to cultivating a nonjudgmental, present-focused stance toward their emotional experiences. The previous module asked patients to monitor to how their emotions unfold over time. This module builds on that work by encouraging patients to incorporate mindful awareness that moves beyond simply paying attention to these experiences. The principles of mindfulness are very consistent with the overall goal of the UP—to develop a more open, approach-oriented relationship with emotions.

Chapter 10 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook looks at the third part of an emotional experience—the physical sensations associated with our emotions. Physical sensations refer to any physical symptoms that we might experience during strong emotions (e.g., racing heart, sweating, or nausea). We learn to identify these physical sensations and how they impact our experience of emotions. We then learn to confront uncomfortable physical sensations through physical exercises designed to bring on the sensations that come up when we have strong emotions. We do this because facing physical sensations over and over makes them easier to tolerate.

Chapter 12 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide focuses on Emotion Exposures. These are exercises designed specifically to provoke strong emotional responses so that patients can put into practice the skills they have developed thus far in therapy. Following a brief introduction to the concept of Emotion Exposures and the rationale for engaging in these exercises, therapists assist patients to gradually confront internal and external stimuli that produce intense emotional reactions while helping them modify their responses to those emotions. Therapists will help patients incorporate the skills learned in therapy (present-focused awareness, nonjudgment, cognitive reappraisal) into their exposure practice and address any emotion avoidance (or other behaviors) that may impede treatment progress.

Chapter 15 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide looks at providing the UP treatment in a group format. Benefits of group therapy (such as efficiency, patients supporting one another) are discussed. Although the authors always intended for the UP to be a treatment that could be used in either an individual or group format, most of the studies to date have looked at how the UP works in an individual format. Therefore, the authors are still learning the best way to teach the strategies in a group format. Some recommendations for how to adapt the UP for a group format are provided. These look at structure, treatment rationale, flexible application of the UP model, and conducting emotion exposures in a group format.

Chapter 14 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide evaluates the patient’s progress and to plan for the future. Therapists will also reinforce the skills learned in treatment, review key treatment concepts, and help patients develop strategies for preventing “relapse.” Additionally, this chapter is used to address symptom recurrence and how patients can maintain treatment gains in the long term.

Chapter 6 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide was designed to help patients clarify the top problem areas in which emotions interfere with their ability to function and to begin to identify concrete steps to take in order to achieve the desired change. This module provides two exercises for enhancing the motivation necessary in initiating this type of treatment program and can be reviewed as needed throughout the course of treatment. The purpose of this module is to maximize the patient’s readiness for change and increase motivation to engage in treatment. Troubleshooting problems with filling out the forms is also covered.

Chapter 1 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook describes the types of problems the Unified Protocol (UP) program was designed to address. The chapter begins by defining emotional disorders, which are characterized by the frequent experience of strong emotions, negative reactions to these emotional experiences, and efforts to escape or avoid them. Next, the types of disorders that that fit within the larger class of emotional disorders, and are addressed by the is treatment, are described. Finally, this chapter helps readers determine whether this treatment is a good fit for the types of problems they are experiencing.

Chapter 7 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook presents the benefits of applying mindful awareness, a nonjudgmental present-focused stance, to emotional experiences. Mindful awareness is first practiced through a formal meditation exercise that introduces readers to applying this quality of attention to their emotions. Next, readers are encouraged to continue practicing mindful emotion awareness though the use of a Mindful Mood Induction exercise. Finally, the chapter continues by focusing on the Anchoring in the Present skill, which allows us to apply the concept of mindful emotion awareness to emotional experiences as they are coming up in daily life.

Chapter 5 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook teaches that emotions are necessary and helpful in our day-to-day lives and explains why we wouldn’t actually want to get rid of all “bad” feelings. Instead of getting rid of negative emotions, the goal of this treatment is to help people respond differently when these emotions come up. The chapter looks at how emotions (such as fear, sadness, anxiety, and anger, as well as positive emotions, like happiness, excitement, and pride) can go from providing useful input to feeling totally overwhelming. Emotional experiences are made less overwhelming by breaking them down into more manageable parts—thoughts, physical sensations, and behaviors.

Chapter 10 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide focuses on the behavioral component of the emotional response and begins by reviewing the role of emotional behaviors (i.e., behaviors that are used to control strong emotions) in the development and maintenance of maladaptive emotional responding. In this module, therapists help patients to identify relevant emotional behaviors and then work with them to develop and engage in Alternative Actions. Over time, it is expected that these Alternative Actions will help remediate cognitive and behavioral patterns contributing to the frequent occurrence of strong negative affect and maintaining patient distress in response to experience of strong emotions.

Chapter 11 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook explains what emotion exposures are and why they are so important. Facing strong emotions give us the opportunity to learn that (a) any uncomfortable emotions we feel are temporary—even without engaging in any avoidance, our negative emotions will eventually subside; (b) we can cope with negative emotions better than we thought; and (c) we can perform tasks and activities that are important to us even when experiencing strong emotions. The chapter teaches how to design effective emotion exposure exercises as well as to develop an emotion exposure hierarchy. We then repeatedly practice confronting strong emotions through emotion exposure exercises.

Chapter 6 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook teaches us to put our emotional experience in context by examining what happens before and after we feel a strong emotion. First, we look for patterns in the situations or events that trigger emotions. Next, we continue to break-down our emotional response into thoughts, physical sensations, and behaviors. Finally, we look at the consequences for how we respond to our emotions, both in the short term and in the long term. The way we respond in the midst of an emotional response can have consequences for the emotions we feel in the future, and this understanding may help motivate us to make changes in the way we’re currently coping.

Chapter 4 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide outlines the overall session structure and clarifies the therapist’s role within treatment. The chapter explains the importance of homework (and homework review) and out-of-session practice. The chapter also emphasizes the importance of patient commitment and how best to deal with patient ambivalence and resistance.

Chapter 2 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook provides an overview of the skills that will be learned in this treatment and discusses the importance of practicing these skills. Specifically, this treatment includes the following skills: Setting Goals and Maintaining Motivation , Understanding Emotions, Mindful Emotion Awareness, Cognitive Flexibility, Countering Emotional Behaviors, Understanding and Confronting Physical Sensations, and Emotion Exposures. The chapter describes how this treatment can be used in combination with other treatments like medication and other types of therapy, and it helps readers determine if now is the right time for them to begin the UP program.

Chapter 3 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook teaches the importance of monitoring emotions and experiences, as well as about record-keeping. Keeping ongoing records of experiences helps us understand how changing our relationship with our emotions corresponds to the gains made in treatment. The chapter introduces questionnaires to be used throughout treatment to monitor emotions and teaches how to track progress throughout treatment.

Cognitive-behavioral prevention programs have demonstrated efficacy in reducing subclinical symptoms of anxiety and depression, and there is some evidence to suggest that they can lower the risk of future disorder onset. However, existing interventions tend to be relatively lengthy and target specific disorders or problem areas, both of which limit their potential for widespread dissemination. To address these limitations, we aimed to develop a single-session, transdiagnostic preventive intervention based on the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders for young adults at risk for developing anxiety and/or depressive disorders within a college setting. Results from this proof-of-concept study indicated that the intervention was viewed as highly satisfactory and acceptable. The intervention also was successful at delivering adaptive emotion management skills in its 2-hr workshop format. Future studies evaluating the efficacy of this novel transdiagnostic, emotion-focused prevention program are warranted.

Anxiety disorders are a common class of disorders, and comorbidity among anxiety disorders is frequently observed. Cognitive-behavioral and behavioral psychotherapies for anxiety disorders are effective, though most evidence-based treatment protocols focus on the treatment of one principal anxiety disorder. In the last decade, treatments that aim to treat underlying vulnerabilities shared across anxiety disorders have been developed to more efficiently help patients that present with one or more anxiety and related disorders. We discuss two of these transdiagnostic treatments, the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders, developed by David Barlow and colleagues, and Transdiagnostic Group Cognitive-Behavioral Therapy, developed by Peter Norton and colleagues. Background, similarities and differences, as well as evidence for each treatment are discussed. To date, the evidence from initial trials demonstrates efficacy for unified transdiagnostic treatments that is comparable to single-diagnosis protocols, providing promise for reducing therapist burden in acquiring and using evidence-based psychotherapies.

Social anxiety disorder is characterized by fear and avoidance of social situations in which one may be evaluated by others. The disorder results from a complex interplay among genetic factors (e.g., family history of the disorder); temperamental factors (e.g., behavioral inhibition and anxiety sensitivity); biological contributors; parenting style and other environmental considerations; and cognitive factors, such as interpretation biases and heightened self-focused attention. In this article, we discuss the contribution of these factors for the etiology and maintenance of the disorder throughout the lifespan.

Importance Transdiagnostic interventions have been developed to address barriers to the dissemination of evidence-based psychological treatments, but only a few preliminary studies have compared these approaches with existing evidence-based psychological treatments. Objective To determine whether the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) is at least as efficacious as single-disorder protocols (SDPs) in the treatment of anxiety disorders. Design, Setting, and Participants From June 23, 2011, to March 5, 2015, a total of 223 patients at an outpatient treatment center with a principal diagnosis of panic disorder with or without agoraphobia, generalized anxiety disorder, obsessive-compulsive disorder, or social anxiety disorder were randomly assigned by principal diagnosis to the UP, an SDP, or a waitlist control condition. Patients received up to 16 sessions of the UP or an SDP for 16 to 21 weeks. Outcomes were assessed at baseline, after treatment, and at 6-month follow-up. Analysis in this equivalence trial was based on intention to treat. Interventions The UP or SDPs. Main Outcomes and Measures Blinded evaluations of principal diagnosis clinical severity rating were used to evaluate an a priori hypothesis of equivalence between the UP and SDPs. Results Among the 223 patients (124 women and 99 men; mean [SD] age, 31.1 [11.0] years), 88 were randomized to receive the UP, 91 to receive an SDP, and 44 to the waitlist control condition. Patients were more likely to complete treatment with the UP than with SDPs (odds ratio, 3.11; 95% CI, 1.44-6.74). Both the UP (Cohen d , −0.93; 95% CI, −1.29 to −0.57) and SDPs (Cohen d , −1.08; 95% CI, −1.43 to −0.73) were superior to the waitlist control condition at acute outcome. Reductions in clinical severity rating from baseline to the end of treatment (β, 0.25; 95% CI, −0.26 to 0.75) and from baseline to the 6-month follow-up (β, 0.16; 95% CI, −0.39 to 0.70) indicated statistical equivalence between the UP and SDPs. Conclusions and Relevance The UP produces symptom reduction equivalent to criterion standard evidence-based psychological treatments for anxiety disorders with less attrition. Thus, it may be possible to use 1 protocol instead of multiple SDPs to more efficiently treat the most commonly occurring anxiety and depressive disorders. Trial Registration clinicaltrials.gov Identifier:NCT01243606

The goal of this review is to examine the clinical studies on d-cycloserine, a partial glutamatergic N-methyl-D-aspartate agonist, as an augmentation strategy for exposure procedures during cognitive behavioral therapy for anxiety disorders. Although cognitive behavioral therapy and anxiolytic medications are more effective than placebo for treating anxiety disorders, there is still considerable room for further improvement. Traditional combination strategies typically yield disappointing results. However, recent studies based on translational research have shown promise to augment the neural circuitry underlying fear extinction with pharmacological means. We discuss the current state of the literature, including inconsistencies of findings and issues concerning the drug mechanism, dosing, and dose timing. D-cycloserine is a promising combination strategy for cognitive behavioral therapy of anxiety disorders by augmenting extinction learning. However, there is also evidence to suggest that d-cycloserine can facilitate reconsolidation of fear memory when exposure procedures are unsuccessful.