BABCP spring meeting: David Barlow's unified protocol for the treatment of emotional disorders - description (second post)
Last updated on 4th March 2016
So yesterday was the first (workshop) day of the two day British Association for Behavioural and Cognitive Psychotherapies (BABCP) Spring Workshops and Conference. Between arriving from Edinburgh on the sleeper and starting the day, I hunkered down in a cafe for breakfast and wrote some introductory thoughts about the workshop I was due to go to. The publicity material said we would "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." I wrote pre-workshop "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 Maybe I'm out of date on my understanding.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."
So how was it? I think my four part "current understanding of the field" was OK ... maybe a bit gungho, but OK. Currently there's only rather modest evidence to show that transdiagnostic interventions are as effective as disorder-specific interventions. Barlow apparently has a big trial in the pipeline to test this (for GAD, social anxiety, OCD and panic disorder), but ... as with all big, time-consuming research trials ... don't hold your breath while waiting for the final results to eventually emerge. Recent research papers by Barlow and his colleagues set the scene well though and give plenty of reasons to be encouraged that effective, more easily teachable/disseminatable transdiagnostic interventions are well worth exploring more fully. See, for example: "Balancing fidelity and adaptation in the dissemination of empirically-supported treatments: The promise of transdiagnostic interventions"; "A proposal for a dimensional classification system based on the shared features of the DSM-IV anxiety and mood disorders: Implications for assessment and treatment"; "Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders: Protocol Development and Initial Outcome Data" and "Conceptual background, development, and preliminary data from the unified protocol for transdiagnostic treatment of emotional disorders."
And the nitty-gritty of the workshop itself? Well I'm very glad that I went to it. David Barlow is one of the older statesmen of CBT. He's been around watching (and contributing importantly) to the development of the field for decades. Respect. Some wisdom. Helpful to hear his take on some of the big overview issues - the blossoming of underpinning scientific research on the value of psychological interventions; the widely accepted current state of play that - for the majority of psychological disorders - psychological therapies are at least as effective as pharmacological therapies and additionally the psychological approaches tend to produce more durable results; the increasing organizational level acceptance of CBT in the US and how dissemination is now often limited less by red tape and more by the sheer difficulty of training enough therapists; the way that the UK in many senses leads the world in acceptance and availability of CBT; and the viewpoint that different schools of therapy belong to the pre-scientific era - that it should no longer be about psychodynamic, or person-centred, or CBT, etc - it should be about what types of approach have good research backing (a move from cults to science).
And the workshop itself was very worthwhile for me. I felt the room was too hot and soporific, and the workshop was too much just a series of didactic presentations with inadequate active audience involvement, but ... the content was great. Participants have been told we'll be sent a copy of the slide series that David Barlow used. For now, there's a slide sequence from a talk by Todd Farchione, one of David's colleagues, that's already available on the internet and that includes most of the slides that we saw.
We were presented with an eight module unified protocol treatment for emotional disorders such as anxiety, depression and potentially other problems too. David commented how getting the protocol into its current form had taken longer than he'd expected - three or four years rather than the initial estimate of only a year or so. When I asked him why this was, he talked about the difficulty of getting the treatment sequence to flow well in a way that's credible to participants and effective. The protocol we were presented is apparently about version 3.5! I think it's good and can already see ways that it could possibly be improved. So the current eight module sequence runs:
1.) Motivation enhancement for treatment engagement (1/2 to 1 session).
2.) Psychoeducation & treatment rationale (1 to 3 sessions).
3.) Emotional awareness training (1 to 3 sessions).
4.) Cognitive appraisal & reappraisal (1 to 2 sessions).
5.) Emotion driven behaviours & emotional avoidance (1 to 3 sessions).
6.) Awareness & tolerance of physical sensations (1 session).
7.) Interoceptive & situational emotion exposure (4 to 6 sessions).
8.) Maintenance & relapse prevention (1 session).
Apparently modules 3 to 7 are considered the core of the treatment.
I'd like to skim briefly through the protocol making a comment or two about each module. I was impressed enough by this workshop to order myself the (rather expensive) unified protocol "Client workbook" and "Therapist guide" which obviously provide a huge amount more detail on what we covered. There is now also a developing "Unified protocol" website providing helpful background for this approach. See tomorrow's post for comments on the first two modules - motivation enhancement and psychoeducation/treatment rationale .