| Study summary: |
|
Emotional disorders, specifically anxiety disorders and depression, are common, chronic,
costly, and debilitating to quality of life (Barlow, 2002). Best estimates from various
epidemiological studies place the one year prevalence of any anxiety disorder for
individuals over 18 at 11.8%, and the one year prevalence of any mood disorder 5.1% (Narrow,
Rae, Robins, & Regier, 2002). Lifetime rates are higher. We understand the nature and
causes of anxiety and unipolar mood disorders (major depressive disorder and dysthymia)
somewhat better than 10 years ago, with evidence pointing to generalized biological and
psychological vulnerabilities interacting with specific learning and, sometimes, stressful
triggering life events as etiological factors (Barlow, 2002; Brown, Chorpita, & Barlow,
1998). Pharmacological and psychological treatments have been proven effective, at least in
the short term, but most studies have ignored the effects of treatment on broad-based
patterns of comorbidity that accompany these disorders. Most comorbid disorders are usually
additional emotional disorders (Brown, Campbell, Lehman, Grisham, & Mancill, 2001). More
importantly, treatment outcomes have been less than satisfactory or ineffective for up to
50% of patients, even for the principal disorder (Nathan & Gorman, 2002). A common
pharmacological treatment exists for many emotional disorders, which is selective serotonin
re-uptake inhibitors (SSRIs) and closely related compounds. Effective psychological
treatments, on the other hand, have been developed to be very specific to each DSM-IV
diagnostic category. The purpose of this proposal is to create a unified psychological
approach to the emotional disorders. To do, this we will take advantage of recent advances
in our understanding of the nature of emotional disorders, as well as emerging knowledge of
the process of regulation and change in emotional behavior, in order to distill and refine
basic principles of successful psychological treatments. It is expected that this approach
will simplify training and dissemination, possibly improve efficacy, and perhaps also shed
further light on the nature of emotional disorders. Thus, the specific aims of this
proposal are to:
1. Develop and refine a unified psychological treatment for anxiety and non-bipolar mood
disorders derived from distilling the major ingredients of current effective approaches
in light of advancing knowledge of emotion regulation and modification.
2. Revise and develop methods of evaluating adherence and outcome utilizing this new
treatment protocol, focusing not only on symptom reduction but also quality of life and
adaptive functioning.
3. Treat a small number of patients with heterogeneous DSM-IV mood and anxiety diagnoses
with this new protocol with the purpose of making appropriate modifications for a
subsequent pilot study.
4. Conduct a pilot study testing this unified treatment in comparison to a wait-list
control condition in order to determine credibility and efficacy in terms of both
symptomatic functioning and quality of life, and relating these outcomes to those from
more disorder specific treatments. |