Extensively researched across disorders
The Unified Protocol (UP) is the most extensively studied transdiagnostic treatment available today. More than 70 clinical trials demonstrate its effectiveness across a broad range of problems, including anxiety, depression, OCD, eating disorders, physical health conditions, stress- and trauma-related disorders, bipolar disorder, and borderline personality disorder.
Key publications:
Farchione, T. J., Long, L. J., Spencer-Laitt, D., Moreno, J., & Barlow, D. H. (2024). State of the Science: The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders. Behavior Therapy.
Farchione, T. J., Long, L. J., Spencer-Laitt, D., Moreno, J., & Barlow, D. H. (2024). Behavior Therapy.
Longley, S. L., & Gleiser, T. S. (2023). Efficacy of the Unified Protocol: A systematic review and meta-analysis of randomized controlled trials. Clinical Psychology: Science and Practice, 30(2), 208.
As effective as diagnosis-specific CBT
Randomized controlled trials show that the UP performs as well as traditional diagnosis-specific CBT, with lower dropout rates and treatment gains maintained for up to three years. Research also suggests that the UP reduces neuroticism — a key vulnerability factor in the development and maintenance of emotional disorders.
Key publications:
Barlow, D. H., Farchione, T. J., Bullis, J. R., Gallagher, M. W., Murray-Latin, H., Sauer-Zavala, S., ... & Cassiello-Robbins, C. (2017). The Unified Protocol for transdiagnostic treatment of emotional disorders compared with diagnosis-specific protocols for anxiety disorders: A randomized clinical trial. JAMA Psychiatry, 74(9), 875-884.
Bullis, J. R., Eustis, E. H., Curreri, A. J., Cardona, N. D., Woods, B. K., Rosellini, A. J., ... & Farchione, T. J. (2023). The Unified Protocol for transdiagnostic treatment of emotional disorders compared with diagnosis-specific protocols for anxiety disorders: A three-year follow-up. Journal of Mood & Anxiety Disorders, 3, 100024.
Osma, J., Peris-Baquero, O., Suso-Ribera, C., Farchione, T. J. & Barlow, D. H. (2021). Effectiveness of the Unified Protocol for transdiagnostic treatment of emotional disorders in group format in Spain: Results from a randomized controlled trial with 6-months follow-up. Psychotherapy Research, 1–14.
Reinholt, N., Hvenegaard, M., Christensen, A.B., Eskildsen, A., Hjorthøj, C., Poulsen, S., Arendt, M.B., Rosenberg, N.K., Gryesten, J.R., Aharoni, R.N., Alrø, A.J., Christensen, C.W. & Arnfred, S.M. (2021). Transdiagnostic versus diagnosis-specific group cognitive behavioral therapy for anxiety disorders and depression: A randomized controlled trial. Psychotherapy and Psychosomatics.
Sauer-Zavala, S., Fournier, J. C., Steele, S. J., Woods, B. K., Wang, M., Farchione, T. J., & Barlow, D. H. (2021). Does the Unified Protocol really change neuroticism? Results from a randomized trial. Psychological medicine, 51(14), 2378-2387.
Building lasting emotion regulation skills
A key reason for the UP’s impact is its focus on research-supported emotion regulation skills that cut across diagnoses. These include greater mindful awareness of emotions, increased cognitive flexibility, approaching rather than avoiding difficult situations, and practicing emotional exposure in everyday life. Together, these skills support resilience and lasting change.
Key publications:
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), e12278.
Sauer-Zavala, S., Rosellini, A. J., Bentley, K. H., Ametaj, A. A., Boswell, J. F., Cassiello-Robbins, C., ... & Barlow, D. H. (2021). Skill acquisition during transdiagnostic treatment with the Unified Protocol. Behavior Therapy, 52(6), 1325-1338.
Elhusseini, S. A., Cravens, L. E., Southward, M. W., & Sauer-Zavala, S. (2022). Associations between improvements in aversive reactions to negative emotions and increased quality of life in the Unified Protocol. Journal of Behavioral and Cognitive Therapy, 32(1), 25-32.
Semcho, S. A., Southward, M. W., Stumpp, N. E., Smith, M. M., Fruhbauerova, M., & Sauer-Zavala, S. (2024). Within-person changes in aversive reactivity predict session-to-session reductions in anxiety and depression in the unified protocol. Psychotherapy Research, 34(6), 760-773.
Flexible across formats and populations
A core strength of the UP is its flexibility. It has been successfully delivered in both individual and group formats, with adults as well as children and adolescents, and has been adapted for digital delivery with promising results. This versatility makes the UP a practical approach for diverse clinical contexts.
Key publications:
Ayuso-Bartol, A., Gómez-Martínez, M. Á., Riesco-Matías, P., Yela-Bernabé, J. R., Crego, A., & Buz, J. (2024). Systematic review and meta-analysis of the efficacy and effectiveness of the Unified Protocol for emotional disorders in group format for adults. International Journal of Mental Health and Addiction, 1-27.
Caiado, B., Guiomar, R., Gomes-Pereira, B., Góis, A. C., de Sousa, B., Canavarro, M. C., ... & Moreira, H. (2025). Is the Unified Protocol for children effective for the transdiagnostic treatment of children’s emotional disorders? A randomized controlled trial. Behavior Therapy, 56(4), 689-707.
Ehrenreich-May, J., Rosenfield, D., Queen, A. H., Kennedy, S. M., Remmes, C. S., & Barlow, D. H. (2017). An initial waitlist-controlled trial of the Unified Protocol for the treatment of emotional disorders in adolescents. Journal of Anxiety Disorders, 46, 46-55.
Schaeuffele, C., Homeyer, S., Perea, L., Scharf, L., Schulz, A., Knaevelsrud, C., ... & Boettcher, J. (2022). The Unified Protocol as an internet-based intervention for emotional disorders: Randomized controlled trial. PloS one, 17(7), e0270178.
Tulbure, B. T., Rusu, A., Sava, F. A., Sălăgean, N., & Farchione, T. J. (2018). A web-based transdiagnostic intervention for affective and mood disorders: randomized controlled trial. JMIR mental health, 5(2), e8901.
Osma, J., Martinez-Garcia, L., Quilez-Orden, A., & Peris-Baquero, Ó. (2021). Unified Protocol for the transdiagnostic treatment of emotional disorders in medical conditions: A systematic review. International Journal of Environmental Research and Public Health, 18(10), 5077.
