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BABCP spring meeting: David Barlow's unified protocol for the treatment of emotional disorders - introduction (first post)

Just off the sleeper.  Slept like a baby - well maybe better, knowing some babies.  Now it's two days of the British Association for Behavioural and Cognitive Psychotherapies (BABCP) Spring Workshops and Conference.  Today it's workshops and we have a choice of half a dozen or so.  I've plumped for David Barlow's "Unified protocol for the treatment of emotional disorders".  The publicity reads:

This workshop will review recent evidence supporting and discuss applications of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP), an emotion-focused, cognitive-behavioural treatment designed to be applicable across the anxiety, mood, and related disorders. 

Learning objectives:
In this workshop, you will learn: a) Evidence supporting a unified conceptualization of emotional disorders; b) Case conceptualization from a unified perspective; c) Application of core components of the Unified Treatment protocol; d) Challenges of applying treatment concepts to diagnostically diverse populations; e) Strategies for preventing emotional avoidance and altering action tendencies; and f) How to create effective emotion exposures.

Implications for the science and practice of CBT:
Increased parsimony (and possibly efficacy) in the treatment of emotional disorders by focusing on 5 core modules applicable to all disorders and comorbidities.

David H. Barlow is Professor of Psychology and Psychiatry and Founder and Director Emeritus of the Center for Anxiety and Related Disorders at Boston University. He received his Ph.D. from the University of Vermont in 1969 and has published over 500 articles and chapters and over 60 books mostly in the area of the nature and treatment of emotional disorders. He is the recipient of numerous awards, and his research has been continuously funded by the National Institutes of Health for 40 years.

Barlow, D.H., Ellard, K.K., Fairholme, C.P., Farchione, T.J., Boisseau, C.L. Allen, L.B. & Ehrenreich-May, J. (2011). The unified protocol for transdiagnostic treatment of emotional disorders: Client workbook. New York, NY: Oxford University Press.
Barlow, D.H., Farchione, T.J., Fairholme, C.P., Ellard, K.K., Boisseau, C.L. Allen, L.B. & Ehrenreich-May, J. (2011). The unified protocol for transdiagnostic treatment of emotional disorders: Therapist guide. New York, NY: Oxford University Press.
Fairholme, C. P., Boisseau, C. L., Ellard, K. K., Ehrenreich, J. T., & Barlow, D. H. (2010). Emotions, emotion regulation, and psychological treatment: A unified perspective. In A. M. Kring & D. M. Sloan (Eds.), Emotion regulation and psychopathology: A transdiagnostic approach to etiology and treatment. (pp. 283-309). New York, NY US: Guilford Press.
Wilamowska, Z.A., Thompson-Hollands, J., Fairholme, C.P., Ellard, K.K., Farchione, T.J., & Barlow, D.H. (2010). Conceptual background, development, and preliminary data from the unified protocol for transdiagnostic treatment of emotional disorders. Depression and Anxiety, 27, 882-890.

So David Barlow is something of a psychotherapy/CBT star.  Deservedly so by the sound of it.  I've known of his work for many years - the first time I heard him talk was back at the BABCP Canterbury conference in '97.  I wasn't immediately attracted to his style, but a full day workshop with him should clarify this more.  He certainly should know what he's talking about.  The publicity description for his slim and rather expensive "The unified protocol ... Therapist guide", which was just published in January, reads "Emerging conceptualizations of major emotional disorders emphasize their commonalities rather than their differences ... Current research lends support for a unified transdiagnostic approach to treatment of these disorders that considers these commonalities and is applicable to a range of emotional disorders. Unified Protocol for Transdiagnostic Treatment of Emotional Disorders, part of the TreatmentsThatWork series of therapist manuals and patient workbooks, is a radical departure from disorder-specific treatments of various emotional disorders, and is designed to be applicable to all anxiety and unipolar mood disorders, as well as other disorders with strong emotional components, such as many somatoform and dissociative disorders. The Unified Protocol (UP) capitalizes on the contributions made by cognitive-behavioral theorists by distilling and incorporating the common principles of CBT present in all evidenced based protocols for specific emotional disorders, as well as drawing on the field of emotion science for insights into deficits in emotion regulation. The UP contains seven (actually eight it turns out in the workshop) modules and focuses on four core strategies: becoming mindfully aware of emotional experience; reappraising rigid emotion laden attributions; identifying and preventing behavioral and emotional avoidance; and facilatating exposure to both interoceptive and situational cues associated with emotional experiences."  

Mm ... looks interesting.  I'm not so sure about the "radical departure" bit any more.  When David Barlow published "Toward a unified treatment for emotional disorders." in Behavior Therapy back in 2004, it felt pretty cutting edge.  Now, seven years later, lots of people are on this bandwagon.  Acceptance and Commitment Therapy (ACT) is a huge example of this, but so is the work of many other researchers.  My current understanding of the field is 1.) It looks like these more unified transdiagnostic approaches can often be as effective as more disorder-specific methods.  2.) This clearly has encouraging implications for therapist training and the breadth of knowledge/technique that therapists are expected to stay current with.  3.)  There is little evidence at the moment that transdiagnostic approaches are more effective than earlier disorder-specific methods.  4.)  There is still debate and considerably more research needed to be more certain about what particular treatment areas it's best to focus on in these transdiagnostic approaches.

We'll see.  Maybe I'm out of date on my understanding.  Today should certainly update me on the state of this field.

See tomorrow's post for a description of how the workshop went


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