Results of a brief online group application of the unified protocol for the preventionof emotional disorders in university students: a pilot study with multiple baseline experimental design
Abstract
Emotional disorders (EDs) are the most common disorders among the young population. The development of preventive programs for EDs is essential to avoid their possible appearance. Transdiagnostic prevention programs could present an advantage over existing ones to improve emotional regulation strategies. Thus, the objective of this study has been to determine the preliminary feasibility and effectiveness of a brief program based on the Unified Protocol (UP). The project consisted of a pilot study using a multiple baseline experimental design. Nine university students received a 5-session program based on the UP in online-group format. Significant differences were found after the intervention for emotion regulation, perceived social support and avoidance, with moderate-large effect sizes (Cohen's r = .49 - .59). These improvements showed increases at 1-month and 3-month follow-ups. Those results are in line with those showing that brief transdiagnostic preventive programs could be useful for the prevention of EDs in the university population.
Downloads
References
Andreu, Y., Galdón, M. J., Dura, E., Ferrando, M., Murgui, S., García, A., Ibáñez, E., & Valencia, U. De. (2008). Psicothema, 20(4), 844-850.
Arrigoni, F., Marchena-Consejero, E., & Navarro-Guzmán, J. (2021). Aplicación y evaluación de la eficacia del Protocolo Unificado transdiagnóstico con estudiantes universitarios españoles [Application and evaluation of the effectiveness of the Unified Transdiagnostic Protocol with Spanish university students]. Revista Costarricense de Psicología, 40(2), 149-169. https://doi.org/10.22544/rcps.v40i02.05
Auerbach, R. P., Alonso, J., Axinn, W. G., Cuijpers, P., Ebert, D. D., Green, J. G., Hwang, I., Kessler, R. C., Liu, H., y Mortier, P. (2016). Mental disorders among college students in the World Health Organization world mental health surveys. Psychological Medicine, 46(14), 2955-2970. https://doi.org/10.1017/S0033291716001665.
Auerbach, R., Mortier, P., Bruffaerts, R., Alonso, J., Benjet, C., Cuijpers, P., Demyttenaere, K., Ebert, D., Green, J., Murray, E., Nock, M., Pinder-amaker, S., Sampson, N., Stein, D., Vilagut, G., Zaslavsky, A., & Kessler, R. (2019). Student Project : Prevalence and Distribution of Mental Disorders. Journal of Abnormal Psychology, 127(7), 623-638. https://doi.org/10.1037/abn0000362.
Badia Llach, X., Monserrat, S., Roset, M., & Herdman, M. (1999). Feasibility, validity and test-retest reliability of scaling methods for health states: The visual analogue scale and the time trade-off. Quality of Life Research, 8(4), 303-310. https://doi.org/10.1023/A:1008952423122
Barlow, D. H., Ellard, K. K., Sauer-Zavala, S., Bullis, J. R., & Carl, J. R. (2014). The Origins of Neuroticism. Perspectives on Psychological Science, 9(5), 481-496. https://doi.org/10.1177/1745691614544528
Barlow, D.H., Farchione, T. J., Sauer-Zavala, S., Murray-Latin, H., Ellard, K. K., Bullis, J. R., ... Cassiello-Robbins, C. (2018). Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide (2nd ed.). Oxford University Press.
Bayram, N., & Bilgel, N. (2008). The prevalence and socio-demographic correlations of depression, anxiety and stress among a group of university students. Social Psychiatry and Psychiatric Epidemiology, 43(8), 667-672. https://doi.org/10.1007/s00127-008-0345-x
Bentley, K. H., Boettcher, H., Bullis, J. R., Carl, J. R., Conklin, L. R., Sauer-Zavala, S., Pierre-Louis, C., Farchione, T. J., & Barlow, D. H. (2018). Development of a Single-Session, Transdiagnostic Preventive Intervention for Young Adults at Risk for Emotional Disorders. Behavior Modification, 42(5), 781-805. https://doi.org/10.1177/0145445517734354
Bentley, K. H., Gallagher, M. W., Carl, J. R., & Barlow, D. H. (2014). Development and validation of the Overall Depression Severity and Impairment Scale. Psychological Assessment, 26(3), 815-830. https://doi.org/10.1037/a0036216
Brent, D. A., Brunwasser, S. M., Hollon, S. D., Weersing, V. R., Clarke, G. N., Dickerson, J. F., Garber, J. (2015). Effects of cognitive-behavioral prevention program on depression 6 years after implementation among at-risk adolescents: A randomized clinical trial. JAMA Psychiatry, 72(11), 1110-1118. https://doi.org/10.1001/jamapsychiatry. 2015.1559
Brown, T. A., Campbell, L. A., Lehman, C. L., Grisham, J. R., & Mancill, R. B. (2001). Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. Journal of Abnormal Psychology, 110(4), 585-599. https://doi. org/10.1037//0021-843X.110.4.585.
Bullis, J. R., Boettcher, H., Sauer-Zavala, S., Farchione, T. J., & Barlow, D. H. (2019). What is an emotional disorder? A transdiagnostic mechanistic definition with implications for assessment, treatment, and prevention. Clinical Psychology: Science and Practice, 26(2), 1-19. https://doi.org/10.1111/cpsp.12278
Bienvenu, O. J., & Ginsburg, G. S. (2007). Prevention of anxiety disorders. International Review of Psychiatry, 19(6), 647-654. https://doi.org/10.1080/09540260701797837
Brooks, R. (1996). EuroQol: the current state of play. Health Policy, 37(1), 53-72. https://doi.org/10.1016/0168-8510(96)00822-6
Cabello, R., Salguero, J. M., Fernández-Berrocal, P., & Gross, J. J. (2013). A Spanish adaptation of the emotion regulation questionnaire. European Journal of Psychological Assessment, 29(4), 234. https://doi.org/10.1027/1015-5759/a000150
Castro-Camacho, L., Díaz, M.M., & Barbosa, S. (2021). Effect of a group prevention program based on the unified protocol for college students in Colombia: A quasi-experimental study. Journal of Behavioral and Cognitive Therapy, 32(2), 111-123. https://doi.org/10.1016/j.jbct.2021.04.001
Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences (2nd ed.). Lawrence Erlbaum Associates, Publishers.
Craske, M. G., & Zucker, B. G. (2002). Prevention of anxiety disorders: A model for intervention. Applied and Preventive Psychology, 10(3), 155-175. https://doi.org/10.1016/S0962-1849(01)80012-3
Derogatis, L.R. (2001). Brief Symptom Inventory (BSI)-18. Administration, scoring and procedures manual. NCS Pearson, Inc.
De Sousa, C. R., & da Costa Padovani, R. (2021). Assertive skills: A comparison of two group interventions with brazilian university students. Psicologia: Reflexao e Critica, 34, 27. https://doi.org/10.1186/s41155-021-00188-7
Ferreres-Galán,, V., Quilez-Orden, A., & Osma, J. (2022). Application of the unified protocol for transdiagnostic treatment of emotional disorders in post-bariatric surgery patients: an effectiveness and feasibility study in group format. Annals of Psychology/Anales de Psicología, 38(2), 219- 231. https://doi.org/10.6018/analesps.482301
Gál, Z., Kasik, L., Jámbori, S., Fejes, J. B., & Nagy, K. (2022). Social problem-solving, life satisfaction and well-being among high school and university students. International Journal of School and Educational Psychology, 10(1), 170-180. https://doi.org/10.1080/21683603.2020.1856249
Gratz, K. L., & Roemer, L. (2008). 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, 30(4), 315. https://doi.org/10.1007/s10862-008-9102-4
Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. Journal of Personality and Social Psychology, 85(2), 348-362. https://doi.org/10.1037/0022-3514.85.2.348
Hervás, G., & Jódar, R. (2008). Adaptación al castellano de la Escala de Dificultades en la Regulación Emocional [Spanish adaptation of the Difficulties in Emotional Regulation Scale]. Clínica y Salud, 19(2), 139-156.
IBM Corp. Released (2012). IBM SPSS Statistics for Windows (Version 21.0) [software computer]. Armonk, NY: IBM Corp.
Labrador, F.J., Bernaldo-de-Quirós, M., García-Fernández, G., Estupiñá, F., Fernández-Arias, I., Labrador-Méndez, M. (2016). Characteristics of demand and psychological treatments in a university clinic. Clínica y Salud, 27(1), 7-14. https://doi.org/ 10.1016/j.clysa.2016.01.002
Landeta, O., & Zumalde, E. C. (2002). Adaptación y validación de la escala multidimensional de apoyo social percibido [Adaptation and validation of the multidimensional scale of perceived social support]. Ansiedad y estrés, 8(2), 173-182. https://doi.org/10.4321/S0211-57352017000200006
Larsen, D. L., Atkinson, C. C., Hargreaves, W. A., y Nguyen, T. D. (1979). Assessment of client/patient satisfaction: Development of a general scale. Evaluation and Program Planning, 2(3), 197-207. https://doi.org/10.1016/0149-7189(79)90094-6
Martínez-Borba, V., Osma, J., Crespo-Delgado, E., Andreu-Pejo, L., & Monferrer-Serrano, A. (2022). Prevention of Emotional Disorders and Symptoms Under Health Conditions: a Pilot Study using the Unified Protocol in a Fertility Unit. Annals of Psychology/Anales de Psicología, 38(1), 25-35. https://doi.org/10.6018/analesps.462331
Miranda-Mendizabal, A., Castellví, P., Parés-Badell, O., Alayo, I., Almenara, J., Alonso, I., Blasco, M. J., Cebrià, A., Gabilondo, A., Gili, M., Lagares, C., Piqueras, J. A., Rodríguez-Jiménez, T., Rodríguez-Marín, J., Roca, M., Soto-Sanz, V., Vilagut, G., & Alonso, J. (2019). Gender differences in suicidal behavior in adolescents and young adults: systematic review and meta-analysis of longitudinal studies. International Journal of Public Health, 64(2), 265-283. https://doi.org/10.1007/s00038-018-1196-1
Norman, S. B., Hami Cissell, S., Means-Christensen, A. J., & Stein, M. B. (2006). Development and validation of an Overall Anxiety Severity and Impairment Scale (OASIS). Depression and Anxiety, 23(4), 245-249. https://doi.org/10. 1002/da.20182
Osma, J., Quilez-Orden, A., Suso-Ribera, C., Peris-Baquero, O., Norman, S. B., Bentley, K. H., & Sauer-Zavala, S. (2019). Psychometric properties and validation of the Spanish versions of the overall anxiety and depression severity and impairment scales. Journal of Affective Disorders, 252, 9-18. https://doi.org/10.1016/j.jad.2019.03.063
Osma, J., Martínez-Loredo, V., Quilez-Orden, A., Peris-Baquero, Ó., & Suso-Ribera, C. (2021). Validity evidence of the multidimensional emotional disorders inventory among non-clinical spanish university students. International Journal of Environmental Research and Public Health, 18(16). https://doi.org/10.3390/ijerph18168251
Ribeiro, I., Pereira, R., Freire, I., de Oliveira, B., Casotti, C., Boery, E. (2018). Stress and Quality of Life Among University Students: A Systematic Literature Review. Health Professions Education, 4(2), 70-77. https://doi.org/10.1016/j.hpe.2017.03.002.
Rosellini, A. J., & Brown, T. A. (2019). The Multidimensional Emotional Disorder Inventory (MEDI): Assessing transdiagnostic dimensions to validate a profile approach to emotional disorder classification. Psychological Assessment, 31(1), 59-72. https://doi.org/10.1037/pas0000649
Saha, S., Lim, C. C. W., Cannon, D. L., Burton, L., Bremner, M., Cosgrove, P., Huo, Y., & J. McGrath, J. (2021). Co-morbidity between mood and anxiety disorders: A systematic review and meta-analysis. Depression and Anxiety, 38(3), 286-306. https://doi.org/10.1002/da.23113
Sauer-Zavala, S., Cassiello-Robbins, C., Conklin, L. R., Bullis, J. R., Thompson-Hollands, J., & Kennedy, K. A. (2017a). Isolating the Unique Effects of the Unified Protocol Treatment Modules Using Single Case Experimental Design. Behavior Modification, 41(2), 286-307. https://doi.org/10.1177/0145445516673827
Sauer-Zavala, S., Gutner, C. A., Farchione, T. J., Boettcher, H. T., Bullis, J. R., & Barlow, D. H. (2017b). Current Definitions of “Transdiagnostic” in Treatment Development: A Search for Consensus. Behavior Therapy, 48(1), 128-138. https://doi.org/10.1016/j.beth.2016.09.004
Sauer-Zavala, S., Tirpak, J. W., Eustis, E. H., Woods, B. K., & Russell, K. (2021). Unified Protocol for the Transdiagnostic Prevention of Emotional Disorders: Evaluation of a Brief, Online Course for College Freshmen. Behavior Therapy, 52(1), 64-76. https://doi.org/10.1016/j.beth.2020.01.010
Sauer-Zavala, S., Fournier, J. C., Jarvi Steele, S., Woods, B. K., Wang, M., Farchione, T. J., & Barlow, D. H. (2020). Does the unified protocol really change neuroticism? Results from a randomized trial. Psychological Medicine, 51(14), 2378-2387. https://doi.org/10.1017/S0033291720000975
Suso-Ribera, C., Castilla, D., Zaragozá, I., Ribera-Canudas, M. V., Botella, C., & García-Palacios, A. (2018). Validity, reliability, feasibility, and usefulness of pain monitor. The Clinical Journal of Pain, 34(10), 900-908. https://doi.org/ 10.1097/AJP.0000000000000618
Stockings, E. A., Degenhardt, L., Dobbins, T., Lee, Y. Y., Erskine, H. E., Whiteford, H. A., y Patton, G. (2016). Preventing depression and anxiety in young people: a review of the joint efficacy of universal, selective and indicated prevention. Psychological Medicine, 46(1), 11-26. https://doi.org/10.1017/S0033291715001725.
Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment, 52(1), 30-41. https://doi.org/10.1207/s15327752jpa5201_2
Copyright (c) 2024 Servicio de Publicaciones, University of Murcia (Spain)
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
The works published in this journal are subject to the following terms:
1. The Publications Service of the University of Murcia (the publisher) retains the property rights (copyright) of published works, and encourages and enables the reuse of the same under the license specified in paragraph 2.
© Servicio de Publicaciones, Universidad de Murcia, 2022
2. The works are published in the online edition of the journal under a Creative Commons Reconocimiento-CompartirIgual 4.0 (legal text). You can copy, use, distribute, transmit and publicly display, provided that: i) you cite the author and the original source of publication (journal, editorial and URL of the work), ii) are not used for commercial purposes, iii ) mentions the existence and specifications of this license.
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
3. Conditions of self-archiving. Is allowed and encouraged the authors to disseminate electronically pre-print versions (version before being evaluated and sent to the journal) and / or post-print (version reviewed and accepted for publication) of their works before publication, as it encourages its earliest circulation and diffusion and thus a possible increase in its citation and scope between the academic community. RoMEO Color: Green.