The Effectiveness of the Unified Protocol on Emotional Dysregulation and Cognitive Emotion Regulation Strategies in Patients with Psychosomatic Disorders
Background: The unified treatment approach (UP) is an emotion-focused cognitive-behavioral therapy in which the main object of treatment is emotional processes. The aim of the present research was to examine the effectiveness of The Unified Protocol (UP) on emotional dysregulation and cognitive emotion regulation strategies in patients with psychosomatic disorders.
Methods: Emotion-focused cognitive behavioral therapy (ECBT), a unified treatment, with 12 weekly group sessions of 2 hours, was presented to 14 patients with psychosomatic complaints at the Subspecialty Center of Psychiatry in Isfahan in 2013. Pre- and post-intervention assessments were done by means of the self-report tests of Difficulties in Emotion Regulation Scale (DERS) and Cognitive Emotion Regulation Questionnaire (CERQ).
Results: Significant reductions in post-test scores of total emotional dysregulation (P < 0.01) as well as the factors of non-acceptance (P < 0.05) and strategy (P < 0.01) were seen, while the other factors (goal, impulse, awareness, and clarity) did not change. Moreover, a significant reduction was observed in the catastrophizing strategy score (P < 0.05), in comparison with other cognitive strategies.
Conclusion: This pilot study including 14 patients with psychosomatic disorders indicates that the Unified treatment approach is an effective treatment in improvement of emotional dysregulation and in reduction of utilizing maladaptive cognitive strategies.
- The unified protocol
- Emotional dysregulation
- Cognitive emotion regulation strategies
- Psychosomatic disorders
Abdi, R. (2012). The evaluation of efficacy of transdiagnostic treatment in women with generalized anxiety disorder [PhD Thesis]. Tabriz, Iran: University of Tabriz.
Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clin Psychol Rev, 30(2), 217-237. doi:S0272-7358(09)00159-7 [pii];10.1016/j.cpr.2009.11.004 [doi]. Retrieved from PM:20015584
Allen, L. B., Tsao, J. C. I., Seidman, L. C., Ehrenreich-May, J., & Zeltzer, L. K. (2012). A unified, transdiagnostic treatment for adolescents with chronic pain and comorbid anxiety and depression. Cognitive and Behavioral Practice, 19(1), 56-67.
Allen, L.B., McHugh, R. K., & Barlow, D. H. (2007). Emotional disorders. In Barlow DH (Ed.), Clinical handbook of psychological disorders (4th ed.,). New York, NY: The Guilford Press.
Berking, M., Poppe, C., Luhmann, M., Wupperman, P., Jaggi, V., & Seifritz, E. (2012). Is the association between various emotion-regulation skills and mental health mediated by the ability to modify emotions? Results from two cross-sectional studies. J Behav Ther Exp Psychiatry, 43(3), 931-937. doi:S0005-7916(11)00096-6 [pii];10.1016/j.jbtep.2011.09.009 [doi]. Retrieved from PM:22406495
Boisseau, C. L., Farchione, T. J., Fairholme, C. P., Ellard, K. K., & Barlow, D. H. (2010). The development of the unified protocol for the transdiagnostic treatment of emotional disorders: a case study. Cogn Behav Pract., 17(1), 102-113. doi:10.1016/j.cbpra.2009.09.003 [doi]. Retrieved from PM:23997572
Campbell-Sills L, & Barlow DH. (2009). Incorporating emotion regulation into conceptualizations and treatments of anxiety and mood disorders. In Gross JJ (Ed.), Handbook of emotion regulation (1st ed., pp. 542-559). New York, NY: The Guilford Press.
Campbell-Sills, L., Barlow, D. H., Brown, T. A., & Hofmann, S. G. (2006). Acceptability and suppression of negative emotion in anxiety and mood disorders. Emotion., 6(4), 587-595. doi:2006-21788-005 [pii];10.1037/1528-3522.214.171.1247 [doi]. Retrieved from PM:17144750
Ehrenreich, J. T., Goldstein, C. M., Wright, L. R., & Barlow, D. H. (2009). Development of a Unified Protocol for the Treatment of Emotional Disorders in Youth. Child Fam Behav Ther, 31(1), 20-37. doi:10.1080/07317100802701228 [doi]. Retrieved from PM:19617930
Ellard, K. K., Fairholme, C. P., Boisseau, C. L., Farchione, T. J., & Barlow, D. H. (2010). Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders: Protocol Development and Initial Outcome Data. Cognitive and Behavioral Practice, 17(1), 88-101.
Erismana, S.M., Salters-Pedneaultb, K.,& Roemer, L. Emotion regulation and mindfulness. Available from: http://www.medvetenpsykologi.se/mediafiler/Emotion-regulation and mindfulness. pdf. Accessed 2013.
Esmaeili, L., Aghaei, A., Abedi, M. R., Esmaeili, M., & Aghaei, M. (2012). The efficacy of emotional regulation on the aggression of epileptic girls (14-18) in Isfahan. Procedia - Social and Behavioral Sciences, 46, 2183-2187.
Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L., Thompson-Hollands, J., Carl, J. R. et al. (2012). Unified protocol for transdiagnostic treatment of emotional disorders: a randomized controlled trial. Behav Ther, 43(3), 666-678. doi:S0005-7894(12)00002-0 [pii];10.1016/j.beth.2012.01.001 [doi]. Retrieved from PM:22697453
Garnefski, N., Kraaij, V., & Spinhoven, P. (2001). Negative life events, cognitive emotion regulation, and emotional problems. Personality and Individual Differences, 30(8), 1311–1327. doi:10.1016/S0191-8869(00)00113-6.
Garnefski, N., Kraaij, V., & Spinhoven, P. (2002). Manual for the use of the Cognitive Emotion Regulation Questionnaire: A questionnaire measuring cognitive coping strategies. Leiderdorp, The Netherlands: DATEC.
Garnefski, N., Rieffe, C., Jellesma, F., Terwogt, M. M., & Kraaij, V. (2007). Cognitive emotion regulation strategies and emotional problems in 9 - 11-year-old children: the development of an instrument. Eur Child Adolesc.Psychiatry, 16(1), 1-9. doi:10.1007/s00787-006-0562-3 [doi]. Retrieved from PM:16791542
Garnefski, N., & Kraaij, V. (2006a). Relationships between cognitive emotion regulation strategies and depressive symptoms: A comparative study of five specific samples. Personality and Individual Differences, 40(8), 1659-1669.
Garnefski, N., Teerds, J., Kraaij, V., Legerstee, J., & van den Kommer, T. (2004). Cognitive emotion regulation strategies and depressive symptoms: differences between males and females. Personality and Individual Differences, 36(2), 267-276.
Greenberg, L.S. (2002). Emotion-focused therapy: coaching clients to work through their feelings. Washington, DC: American Psychological Association.
Garnefski, N.,& Kraaij, V. (2006b). Cognitive emotion regulation questionnaire–development of a short 18-item version (CERQ-short). Personality and Individual Differences, 41, 1045-1053. doi:10.1016/j.paid.2006.04.010.
Gratz, K., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41-54.
Grat, K., & Tull, M.T. (2013). Emotion regulation as a mechanism of change in acceptance-and mindfulness-based treatments. In Baer, R.A, (Ed.), Assessing mindfulness and acceptance: Illuminating the processes of change. Oakland, CA: New Harbinger Publications. [In press].
Gross, J.J. (2008). Emotion regulation. In Lewis, M., Haviland-Jones, J.M & Feldman Barrett, L (Ed.). Handbook of emotion, (4th ed. pp.497-512). New York, NY: The Guilford Press.
Gross, J.J. (1998). The emerging field of emotion regulation: An integrative review. Review of General Psychology, 2(3), 271-299. doi:10.1037/1089-26126.96.36.1991.
Hassani, J., Azadfallah, P., & Rasoulzade-Tabatabaei, S.K. (2009). Impact of reappraisal and suppression of emotional experiences on frontal EEG asymmetries based on Neuroticism and Extraversion dimensions. The Journal of Psychology of Tabriz University, 4(13), 71-37.
Hassani, J. (2011).The evaluation of validity and reliability cognitive emotion regulation questionnaire short form. Journal of behavioral Sciences, 9(4), 229-40.
Heiy, J.E. (2010). Emotion regulation flexibility: an exploration of the effect of flexibility in emotion regulation on mood [MSc Thesis]. Columbus, OH: Graduate School of the Ohio State University.
Khanzadeh, M., Saidiyan, M., Hosseinchary, M., & Edrissi, F. (2012). Factor structure and psychometric properties of difficulties of emotional regulation scale. Journal of Behavioral Sciences, 6(1), 96-87.
Linehan, M.M. (1993). Cognitive–behavioral treatment of borderline personality disorder. New York: The Guilford Press.
Mauss, I. B., Levenson, R. W., McCarter, L., Wilhelm, F. H., & Gross, J. J. (2005). The tie that binds? Coherence among emotion experience, behavior, and physiology. Emotion., 5(2), 175-190. doi:2005-06671-005 [pii];10.1037/1528-35188.8.131.52 [doi]. Retrieved from PM:15982083
Mohammadi, A., Birashk, B., & Gharaie, B. (2013). Comparison of the effect of group transdiagnostic therapy and group cognitive therapy on anxiety and depressive symptoms. Iran J Public Health, 42(1), 48-55. Retrieved from PM:23514901
Orgeta, V. (2011). Emotion dysregulation and anxiety in late adulthood. J Anxiety Disord, 25(8), 1019-1023. doi:S0887-6185(11)00116-2 [pii];10.1016/j.janxdis.2011.06.010 [doi]. Retrieved from PM:21813262
Ochsner, K. N., & Gross, J. J. (2005). The cognitive control of emotion. Trends Cogn Sci, 9(5), 242-249. doi:S1364-6613(05)00090-2 [pii];10.1016/j.tics.2005.03.010 [doi]. Retrieved from PM:15866151
Parkinson, B., & Totterdell, P. (1999). Classifying affect-regulationstrategies. Cognition and Emotion, 13 (3), 277–303. doi: 10.1080/026999399379285.
Payne, F.E. (2013). A definition of emotions. JBEM Index, 3(4). Available from: http://www.bmei.org/jbem/volume/num4/payne_a_definition_of_emotions.php.
Rezwan,S., Bahrami,F.,&Abedi,M. (2006). Impact of emotion regulation on students' happiness and thought rumination. Iran J Psychiatry Clin Psychol, 12(3), 257-251.Persian.
Roemer, L., Lee, J. K., Salters-Pedneault, K., Erisman, S. M., Orsillo, S. M., & Mennin, D. S. (2009). Mindfulness and emotion regulation difficulties in generalized anxiety disorder: preliminary evidence for independent and overlapping contributions. Behav Ther, 40(2), 142-154. doi:S0005-7894(08)00065-8 [pii];10.1016/j.beth.2008.04.001 [doi]. Retrieved from PM:19433145
Salehi, A., Baghban,A.,Bahrami, F.,&Ahmadi, A. (2011). The relationship between cognitive emotion regulations strategies and emotional problems according to individual and family factors. Journal of Counseling and Family Therapy, 1(1), 1-18. [In Persian].
Salters-Pedneault, K. Emotion Regulation. Available from: http://ptsd.about.com/ od/glossary/g/emotionreg.htm. Accessed 2013.
Thompson RA. (1994). Emotion regulation: A theme in search of definition. Monographs of the Society for Research in Child Development, 59 (2-3), 25–52.
Troy, A.S., & Mauss, I.B. (2011). Resilience in the face of stress: emotion regulation as a protective factor. In Southwick, S.M., Litz, B.T., Charney, D., & Friedman, M.J. Resilience and mental health: Challenges across the lifespan (pp.30-44). Cambridge, UK: Cambridge University Press.
Tull, M. T., & Gratz, K. L. (2008). Further examination of the relationship between anxiety sensitivity and depression: the mediating role of experiential avoidance and difficulties engaging in goal-directed behavior when distressed. J Anxiety Disord, 22(2), 199-210. doi:S0887-6185(07)00079-5 [pii];10.1016/j.janxdis.2007.03.005 [doi]. Retrieved from PM:17419002
Taylor, G. J. (1984). Alexithymia: concept, measurement, and implications for treatment. Am J Psychiatry, 141(6), 725-732. Retrieved from PM:6375397
Taylor, G.J. (1987). Psychosomatic medicine and contemporary psychoanalysis. Madison, CT: International Universities Press.
Wicksell, R. K., Olsson, G. L., & Hayes, S. C. (2010). Psychological flexibility as a mediator of improvement in Acceptance and Commitment Therapy for patients with chronic pain following whiplash. Eur J Pain, 14(10), 1059. doi:S1090-3801(10)00102-3 [pii];10.1016/j.ejpain.2010.05.001 [doi]. Retrieved from PM:20538493
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. Depress.Anxiety, 27(10), 882-890. doi:10.1002/da.20735 [doi]. Retrieved from PM:20886609