Effectiveness of Emotion-Focused Cognitive Behavioral Therapy for Treating Adolescents With Emotional Disorders

Anxiety and depression are among the most prevalent psychiatric disorders in youth.
Adolescents with anxiety or depression experience persistent emotional distress that can
cause problems with school, family, and friends. In addition, anxiety and depressive
disorders commonly co-exist, causing further distress for those affected. If left untreated,
the difficulties associated with these disorders can persist into adulthood. Fortunately,
anxiety and depression are highly treatable using a combination of medications and forms of
psychotherapy, but many youth in community settings are unlikely to receive these
treatments. An emotion-focused, cognitive behavioral treatment, specifically designed to
meet a broad range of treatment needs of adolescents, may provide one way of translating
effective treatment components to community settings. This study will evaluate the
effectiveness of a transdiagnostic, emotion-focused, cognitive behavioral treatment program,
called the Unified Protocol for the Treatment of Emotional Disorders in Youth (UP-Y), for
adolescents with anxiety or unipolar depressive disorders.

Participants in this study will be assigned to receive either immediate or delayed UP-Y
program sessions. Study participation will last up to 12 months after beginning treatment.
Upon initiation of treatment, parent and child participants will undergo initial assessments
that will include questionnaires about anxiety, worry, depression and emotion regulation;
and an interview pertaining to the adolescent's anxiety and depression. Both parent and
adolescent participants will then attend up to 21 weekly treatment sessions, lasting 60
minutes each. During sessions, participants will learn skills regarding acceptance of
intense emotional states, how to actively cope with emotions, and act in healthy ways during
anxiety- and depression-provoking situations. Throughout the course of treatment, parent and
adolescent participants will be asked to keep records about the adolescent's emotions and
functioning. Participants will also be given at-home assignments to practice skills learned
in treatment sessions. During and after treatment, participants will complete questionnaires
about their thoughts on the treatment sessions. Participants will repeat the initial
assessment either following the waitlist delayed treatment condition or 8 weeks into
treatment, immediately after the last treatment session as well as at months 3 and 6 of
follow-up.

Inclusion Criteria:

- Principal diagnosis of major depressive disorder, social anxiety disorder, social
phobia, panic disorder with or without agoraphobia, generalized anxiety disorder,
obsessive compulsive disorder, agoraphobia, post-traumatic stress disorder, dysthymic
disorder, anxiety disorder not-otherwise-specified, or depressive disorder
not-otherwise-specified

- At least one parent (or caregiver with whom the adolescent is living) available to
accompany the adolescent to all assessment sessions and attend parent sessions as
prescribed

- For adolescents on medication, there must be a 1-month stabilization period (for
benzodiazepines) or 3-month stabilization period (for selective serotonin reuptake
inhibitors, serotonin-norepinephrine reuptake inhibitors, or tricyclics) before study
entry

- Able to maintain current medication regimen (or remain off psychopharmacologic
treatment if not currently taking such medications) throughout the study, unless
changes are medically necessary

Exclusion Criteria:

- Co-occurring conditions, including positive diagnosis of schizophrenia, bipolar I or
II disorder, pervasive developmental disorder, organic brain syndrome, mental
retardation , or current suicidal/homicidal ideation

- A prior course of cognitive behavioral treatment

- Inability to speak, read, or understand English sufficiently well to complete study
procedures