The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders Compared With Diagnosis-Specific Protocols for Anxiety Disorders A Randomized Clinical Trial
The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders Compared With Diagnosis-Specific Protocols for Anxiety Disorders A Randomized Clinical Trial
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DOI：
10.1001/jamapsychiatry.2017.2164
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发表时间：
2017-09-01
期刊：
影响因子：
25.8
通讯作者：
Cassiello-Robbins, Clair
中科院分区：
文献类型：
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作者：
Barlow, David H.;Farchione, Todd J.;Cassiello-Robbins, Clair
重要性跨诊断干预措施已经开发出来，以解决传播循证心理治疗的障碍，但只有少数初步研究将这些方法与现有的循证心理治疗进行了比较。目的确定情绪障碍跨诊断治疗统一方案（Unified Protocol for Transdiagnosis Treatment of Emotional Disorders，UP）是否至少与单一障碍方案（single disorder protocols，SDP）一样有效从2011年6月23日至2015年3月5日，在门诊治疗中心共有223名患者，主要诊断为惊恐障碍伴或不伴广场恐怖症、广泛性焦虑症、强迫症、或社交焦虑障碍被随机分配的主要诊断为UP，SDP，或候补控制条件。患者接受长达16个疗程的UP或SDP，持续16至21周。在基线、治疗后和6个月随访时评估结局。在这个等效性试验的分析是基于意向treat.INTERVENTIONS的UP或SDPs。主要结果和措施盲法评价主要诊断临床严重程度评级被用来评估一个先验假设的等效性UP和SDPs。结果在223名患者中（124名女性和99名男性;平均[SD]年龄，31.1 [11.0]岁），88名患者随机接受UP，91名患者接受SDP，44名患者接受等待名单对照条件。与SDP相比，UP患者更有可能完成治疗（比值比，3.11; 95%CI，1.44-6.74）。UP（Cohen d，-0.93; 95% CI，-1.29至-0.57）和SDP（Cohen d，-1.08; 95% CI，-1.43至-0.73）在急性结局方面均上级等待名单对照条件。临床严重程度评分从基线至治疗结束的降低（β，0.25; 95% CI，-0.26至0.75）和从基线至6个月随访（beta，0.16; 95%可信区间，-0.39至0.70）表明UP和SDPs之间的统计学等效性。结论和相关性UP产生的症状减轻相当于标准证据-基于心理治疗的焦虑症，减少磨损。因此，可以使用1个方案而不是多个SDP来更有效地治疗最常见的焦虑和抑郁障碍。
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 (beta, 0.25; 95% CI, -0.26 to 0.75) and from baseline to the 6-month follow-up (beta, 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.