Practically Speaking: Behind the Episode - Group UP! Transdiagnostic Group Treatment Using Unified Protocol
The COVID-19 pandemic brought about significant challenges for healthcare systems worldwide, with behavioral health services being particularly overwhelmed by the increased demand for mental health support. Even before the pandemic, many behavioral health clinics throughout the Military Healthcare System (MHS) and in the civilian sector were contending with increased demand for services beyond the capacity of the system to provide them. Traditional models of therapy rooted in 45- or 50-min individual therapy sessions, while appropriate in many situations and presentations, are not what everyone needs.
Additionally, clinical presentations, at least within the MHS behavioral health clinics are becoming more diverse and perhaps less focused on the “signature [behavioral health] wounds” of the conflicts in Iraq and Afghanistan, such as post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI).
Recently the Practical for Your Practice (P4P) team sat down for a fantastic discussion with Drs. William Isler and Adam Hodge to discuss an innovative approach to addressing some of these issues which utilizes a transdiagnostic group therapy based on the Unified Protocol for emotional disorders, developed by David Barlow and colleagues.
The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) is a therapeutic approach developed to address a wide range of emotional disorders within a single, unified framework. This treatment protocol was developed to simplify and streamline the therapeutic process by targeting the common underlying factors and processes that contribute to various emotional disorders, such as anxiety disorders, depression, and related conditions.
Dr. Isler explained that behavioral health experts in the US Air Force focused on distilling the core principles and skills of the standard Unified Protocol, normally 12-16 individual sessions, into a group therapy protocol “...with five sessions, and these are the core tenets that Barlow set out to say, these are the five most important things that we want to include in our class. And in a military setting we thought this would probably work for us. Again, those individual sessions were sometimes up to 90 minutes and we're trying to get them down into 50 minutes, just for our population.”
Dr. Hodge described the five sessions of the protocol in this way. “So the Unified Protocol that we use in the military setting focuses first on emotion identification, and then we move into a mindfulness module that looks at just being aware of the present moment, being nonjudgmental about our emotional experiences, and then it moves into a cognitive restructuring or cognitive flexibility component which teaches about the automatic thoughts… Then the last two sessions are more focused on exposure and how our behavior is impacted by the emotional disorder, how we typically try to avoid whatever emotional experience it is and paying specific attention to those behaviors. And the final session, we actually design motion exposure experiments and a plan for patients to then take that, use that on their own and then be able to move forward.”
So does it work? Take a listen to the podcast episode for a compelling discussion about Group UP effectiveness, research outcomes, and even an “EBP Confessional” from Dr. Hodge about some of his early experiences facilitating a group.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Kevin Holloway, Ph.D., is a licensed clinical psychologist working as Director of Online Training, Technology and Telehealth at the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.
The COVID-19 pandemic brought about significant challenges for healthcare systems worldwide, with behavioral health services being particularly overwhelmed by the increased demand for mental health support. Even before the pandemic, many behavioral health clinics throughout the Military Healthcare System (MHS) and in the civilian sector were contending with increased demand for services beyond the capacity of the system to provide them. Traditional models of therapy rooted in 45- or 50-min individual therapy sessions, while appropriate in many situations and presentations, are not what everyone needs.
Additionally, clinical presentations, at least within the MHS behavioral health clinics are becoming more diverse and perhaps less focused on the “signature [behavioral health] wounds” of the conflicts in Iraq and Afghanistan, such as post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI).
Recently the Practical for Your Practice (P4P) team sat down for a fantastic discussion with Drs. William Isler and Adam Hodge to discuss an innovative approach to addressing some of these issues which utilizes a transdiagnostic group therapy based on the Unified Protocol for emotional disorders, developed by David Barlow and colleagues.
The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) is a therapeutic approach developed to address a wide range of emotional disorders within a single, unified framework. This treatment protocol was developed to simplify and streamline the therapeutic process by targeting the common underlying factors and processes that contribute to various emotional disorders, such as anxiety disorders, depression, and related conditions.
Dr. Isler explained that behavioral health experts in the US Air Force focused on distilling the core principles and skills of the standard Unified Protocol, normally 12-16 individual sessions, into a group therapy protocol “...with five sessions, and these are the core tenets that Barlow set out to say, these are the five most important things that we want to include in our class. And in a military setting we thought this would probably work for us. Again, those individual sessions were sometimes up to 90 minutes and we're trying to get them down into 50 minutes, just for our population.”
Dr. Hodge described the five sessions of the protocol in this way. “So the Unified Protocol that we use in the military setting focuses first on emotion identification, and then we move into a mindfulness module that looks at just being aware of the present moment, being nonjudgmental about our emotional experiences, and then it moves into a cognitive restructuring or cognitive flexibility component which teaches about the automatic thoughts… Then the last two sessions are more focused on exposure and how our behavior is impacted by the emotional disorder, how we typically try to avoid whatever emotional experience it is and paying specific attention to those behaviors. And the final session, we actually design motion exposure experiments and a plan for patients to then take that, use that on their own and then be able to move forward.”
So does it work? Take a listen to the podcast episode for a compelling discussion about Group UP effectiveness, research outcomes, and even an “EBP Confessional” from Dr. Hodge about some of his early experiences facilitating a group.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Kevin Holloway, Ph.D., is a licensed clinical psychologist working as Director of Online Training, Technology and Telehealth at the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.