Unified protocol for the treatment of children and adolescents with anxiety syndromes

Anxiety is common among children and adolescents and often occurs with other illnesses such as depression. Unified protocol is a therapeutic treatment approach that has been developed to treat the underlying factors that are common in several mental illnesses. The protocol has been developed to be used both with co-morbidity and with single diagnoses.

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SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

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Published: Report no: ut202209 Registration no: SBU 2021/571

Question

What scientific studies are there on the effects of treatment with the Unified Protocol on children and adolescents with anxiety disorders?

Identified literature

No relevant systematic review was identified but 3 primary studies were identified [1-3]. The primary studies were not assessed for risk of bias.

References

  1. Ehrenreich-May J, Rosenfield D, Queen AH, Kennedy SM, Remmes CS, Barlow DH. An initial waitlist-controlled trial of the unified protocol for the treatment of emotional disorders in adolescents. J Anxiety Disord. 2017;46:46-55. Available from: https://doi.org/10.1016/j.janxdis.2016.10.006.
  2. Kennedy SM, Bilek EL, Ehrenreich-May J. A Randomized Controlled Pilot Trial of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children. Behav Modif. 2019;43(3):330-60. Available from: https://doi.org/10.1177/0145445517753940.
  3. Maleki M, Khorramnia S, Foroughi A, Amiri S, Amiri S. Comparing the effectiveness of the unified protocol in combination with an additional mindfulness treatment to the unified protocol alone as treatment for adolescents diagnosed with emotional disorders. Trends Psychiatry Psychother. 2021;43(1):57-64.

Literature search

PsycINFO/Psychology and Behavioral Sciences Collection via EBSCO 17 December 2021

Title: Unified protocol for the treatment of anxiety in children and adolescents
The final search result, usually found at the end of the documentation, forms the list of abstracts.

AB = Abstract; AU = Author; DE = Term from the thesaurus; MH = Exact Subject Heading from CINAHL Subject Headings; MM = Major Concept; TI = Title; TX = All Text. Performs a keyword search of all the database's searchable fields; ZC = Methodology Index; * = Truncation; " " = Citation Marks; searches for an exact phrase; N = Near Operator (N) finds the words if they are a maximum of x words apart from one another, regardless of the order in which they appear.; W = Within Operator (W) finds the words if they are within x words of one another, in the order in which you entered them
Search termsItems found
Population: Children and adolescents with anxiety
1. DE "Anxiety Disorders" OR DE "Generalized Anxiety Disorder" OR DE "Obsessive Compulsive Disorder" OR DE "Panic Attack" OR DE "Panic Disorder" OR DE "PANIC disorders" OR DE "Phobias" OR DE "Separation Anxiety Disorder" OR TI (Anxiet* OR Obsessive Compulsive Disorder* OR "OCD" OR "GAD" OR Panic Attack* OR Panic Disorder* OR Neurotic Disorder* OR Phobi*) OR AB (Anxiet* OR Obsessive Compulsive Disorder* OR "OCD" OR "GAD" OR Panic Attack* OR Panic Disorder* OR Neurotic Disorder* OR Phobi*) OR SU (Anxiet* OR Obsessive Compulsive Disorder* OR "OCD" OR "GAD" OR Panic Attack* OR Panic Disorder* OR Neurotic Disorder* OR Phobi*) 314,244
2. DE "CHILDREN" OR DE "CHILD patients" OR DE "SCHOOL children" OR ZG "adolescence (13-17 yrs)" OR ZG "school age (6-12 yrs)" OR TI (Child* OR kids OR girl OR girls OR boy OR boys OR teen* OR adolescen* OR youth* OR p#ediatric* OR youngster* OR school* OR ((first or second or third or fourth or fifth or sixth or seventh) N2 grader*) OR highschool* OR secondary school* OR secondary education* OR high school* OR juvenile* OR minor*) OR AB (Child* OR kids OR girl OR girls OR boy OR boys OR teen* OR adolescen* OR youth* OR p#ediatric* OR youngster* OR school* OR ((first or second or third or fourth or fifth or sixth or seventh) N2 grader*) OR highschool* OR secondary school* OR secondary education* OR high school* OR juvenile* OR minor*) OR SU (Child* OR kids OR girl OR girls OR boy OR boys OR teen* OR adolescen* OR youth* OR p#ediatric* OR youngster* OR school* OR ((first or second or third or fourth or fifth or sixth or seventh) N2 grader*) OR highschool* OR secondary school* OR secondary education* OR high school* OR juvenile* OR minor*) 1,848,600
3. S1 AND S2 105,862
Intervention: Unified protocol
4 DE "Transdiagnostic Treatment" OR TX ("UP-C" OR (emotion* N3 detective*) OR "UP-Y") OR TI Transdiagnostic* OR AB Transdiagnostic* OR SU Transdiagnostic* 4,546
5. TX "unified protocol" 423
Study types: systematic reviews
6. DE "Meta Analysis" OR ZC "systematic review" OR ZC "meta analysis" OR DE "Systematic Review" OR TX (systematic* N3 review*) OR TX (metaanaly* OR meta-analy* OR meta analy*) 224,602
Study types: randomised controlled trials and other trials
7. ZC "treatment outcome/clinical trial" OR DE "Clinical Trials" OR DE "Placebo" OR TI (((singl* OR doubl* OR tripl* OR trebl*)) N2 (blind* OR dumm* OR mask*)) OR ((randomi?ed OR controlled) N2 (study OR trial* OR design OR method* OR test* OR assessment OR experiment OR comparison)) OR ((random*) N3 (assign* OR alloca*)) OR (clinical W2 trial*) OR placebo* OR “wait* list*” OR “comparison group*” OR (control* W1 (group* or condition*)) OR (control* W1 (group* or condition*)) OR ((treatment* OR service* OR care) N2 (usual OR standard OR traditional OR ordinary)) OR (randomi?ed N6 n=) OR (compared N2 control*)) OR AB (((singl* OR doubl* OR tripl* OR trebl*)) N2 (blind* OR dumm* OR mask*)) OR ((randomi?ed OR controlled) N2 (study OR trial* OR design OR method* OR test* OR assessment OR experiment OR comparison)) OR ((random*) N3 (assign* OR alloca*)) OR (clinical W2 trial*) OR placebo* OR “wait* list*” OR “comparison group*” OR (control* W1 (group* or condition*)) OR (control* W1 (group* or condition*)) OR ((treatment* OR service* OR care) N2 (usual OR standard OR traditional OR ordinary)) OR (randomi?ed N6 n=) OR (compared N2 control*)) OR SU (((singl* OR doubl* OR tripl* OR trebl*)) N2 (blind* OR dumm* OR mask*)) OR ((randomi?ed OR controlled) N2 (study OR trial* OR design OR method* OR test* OR assessment OR experiment OR comparison)) OR ((random*) N3 (assign* OR alloca*)) OR (clinical W2 trial*) OR placebo* OR “wait* list*” OR “comparison group*” OR (control* W1 (group* or condition*)) OR (control* W1 (group* or condition*)) OR ((treatment* OR service* OR care) N2 (usual OR standard OR traditional OR ordinary)) OR (randomi?ed N6 n=) OR (compared N2 control*)) 426,078
Combined sets:
8. S3 AND S4 639
9. S8 OR S5 1,015
10. S9 AND S6 235
11. S9 AND S7 248
Final result
  10 [Systematic reviews]  
  11 [controlled trials] 248

Cochrane Library via Wiley 17 December 2021 (CDSR, Cochrane Protocols & CENTRAL)

Title: Unified protocol for the treatment of anxiety in children and adolescents
The final search result, usually found at the end of the documentation, forms the list of abstracts.

:au = Author; MeSH = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; this term only = Does not include terms found below this term in the MeSH hierarchy; :ti = Title; :ab = Abstract; :kw = Keyword; * = Truncation; " " = Citation Marks; searches for an exact phrase; CDSR = Cochrane Database of Systematic Review; Cochrane Protocols = Protocols of systematic reviews registered in Cochrane Library; CENTRAL = Cochrane Central Register of Controlled Trials, “trials”
Search termsItems found
Population: children and adolescents with anxiety
1. MeSH descriptor: [Anxiety Disorders] explode all trees 7,472
2. (Anxiety OR Anxieties OR "Obsessive Compulsive Disorder*" OR OCD OR GAD OR "Panic Attack" OR "Panic Disorder*" OR "Neurotic Disorder*" OR "Phobia*" OR phobic):ti,ab,kw 61,965
3. MeSH descriptor: [Child] explode all trees 59,662
4. MeSH descriptor: [Adolescent] explode all trees 108,631
5. (child* OR kids OR girl OR  girls OR boy OR boys OR teen* OR adolescen* OR youth* OR p?ediatric* OR youngster* OR school* OR highschool* OR secondary school* OR secondary education* OR high school* OR juvenile* OR minor*):ti,ab,kw 314,192
6. ((first or second or third or fourth or fifth or sixth or seventh) W grader*):ti,ab,kw 2
7. #3 OR #4 OR #5 OR #6 314193
8. #1 OR #2 62,206
9. #7 AND #8 16,467
Intervention: Unified protocol
10. ("Unified protocol") 167
11. ("UP-C" OR "UP-Y" OR "emotion* detective*" OR transdiagnostic*):ti,ab,kw 912
Combined sets
12. #9 AND #11 203
13. #12 OR #10 338
Final result
  #13 CDSR/1
Cochrane Protocols/1
CENTRAL/336

Embase via Elsevier 17 December 2021

Title: Unified protocol for the treatment of anxiety in children and adolescents
The final search result, usually found at the end of the documentation, forms the list of abstracts.

/de = Term from the EMTREE controlled vocabulary; /exp = Includes terms found below this term in the EMTREE hierarchy; /mj = Major Topic; :ab = Abstract; :au = Author; :ti = Article Title; :ti,ab = Title or abstract; * = Truncation; ' ' = Citation Marks; searches for an exact phrase; NEAR/n = Requests terms that are within 'n' words of each other in either direction; NEXT/n = Requests terms that are within 'n' words of each other in the order specified
Search termsItems found
Population: Children and adolescents with anxiety
1. 'anxiety disorder'/exp OR "Anxiety":ti,ab,kw OR "Anxieties":ti,ab,kw OR "Obsessive Compulsive Disorder":ti,ab,kw OR "Obsessive Compulsive Disorders":ti,ab,kw OR "OCD":ti,ab,kw OR "GAD":ti,ab,kw OR "Panic Attack":ti,ab,kw OR "Panic Disorder":ti,ab,kw OR "Neurotic Disorders":ti,ab,kw OR "Panic Disorders":ti,ab,kw OR "Neurotic Disorder":ti,ab,kw OR "Phobia":ti,ab,kw OR "phobias":ti,ab,kw OR "phobic":ti,ab,kw 516,165
2. 'child'/exp OR 'adolescent'/exp OR child*:ti,ab,kw OR 'kids':ti,ab,kw OR girl:ti,ab,kw OR girls:ti,ab,kw OR boy:ti,ab,kw OR boys:ti,ab,kw OR teen*:ti,ab,kw OR adolescen*:ti,ab,kw OR youth*:ti,ab,kw OR pediatric*:ti,ab,kw OR paediatric*:ti,ab,kw OR youngster*:ti,ab,kw OR school*:ti,ab,kw OR 'first grader*':ti,ab,kw OR 'second grader*':ti,ab,kw OR 'third grader*':ti,ab,kw OR 'fourth grader*':ti,ab,kw OR 'fifth grader*':ti,ab,kw OR 'sixth grader*':ti,ab,kw OR 'seventh grader*':ti,ab,kw OR highschool*:ti,ab,kw OR ((secondary:ti,ab,kw OR high*:ti,ab,kw) AND adj2:ti,ab,kw AND (school*:ti,ab,kw OR education:ti,ab,kw)) OR juvenile*:ti,ab,kw OR minor*:ti,ab,kw 5,225,380
3. 1 AND 2 131,769
Intervention: Unified protocol
4. 'up-c':ti,ab,kw OR 'emotion* detective*':ti,ab,kw OR 'up-y':ti,ab,kw OR 'transdiagnostic':ti,ab,kw OR 'transdiagnostical':ti,ab,kw OR 'transdiagnostic approach'/exp  
5. 'unified protocol'/exp OR 'unified protocol'  
Study types: randomised controlled trials and other controlled trials
6. 'controlled clinical trial'/exp 863,978
7. ((‘singl*’ OR ‘doubl*’ OR ‘tripl*’ OR ‘trebl*’) NEXT/3 (‘blind*’ OR ‘dumm*’ OR ‘mask*’)):ti,ab,kw 262,218
8. ('controlled' NEXT/2 (trial OR comparison OR experiment OR study OR test)):ti,ab,kw 320,958
9. (clinical NEAR/3 trial):ti,ab,kw 267,056
10. ('control*' NEXT/1 (group* OR condition*)):ti,ab,kw 773,552
11. 'comparison group*':ti,ab,kw 25,991
12. 'wait* list*':ti,ab,kw 24,190
13. ((treatment OR intervention OR experimental) NEXT/1 group*):ti,ab,kw 286,289
14. (matched NEXT/1 (control* OR group* OR comparison*)):ti,ab,kw 130,959
15. ((treatment* OR service* OR care) NEAR/2 (usual OR standard OR traditional OR ordinary)):ti,ab,kw 217,862
16. (compared NEAR/3 control*):ti,ab,kw 607,279
17. #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14 OR #15 OR #16 2,609,887
Study types: systematic reviews
18. 'systematic review'/de OR 'meta analysis'/exp OR 'cochrane database syst rev':ta OR ((systematic NEAR/3 review):ti,ab) OR 'meta analys*':ti,ab OR metaanalys*:ti,ab 548,508
Combined sets
19. #3 AND #4 629
20. #19 OR #5 995
21. #20 AND #18 [systematic reviews] 62
22. #20 AND #17 [controlled trials] 201
Final result
  #21[systematic reviews] 62
  #22 [controlled trials] 201

Medline via OvidSP 17 December 2021

Title: Unified protocol for the treatment of anxiety in children and adolescents
The final search result, usually found at the end of the documentation, forms the list of abstracts.

.ab. = Abstract; .ab,ti. = Abstract or title; .af. = All fields; Exp = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; .sh. = Term from the Medline controlled vocabulary; .ti. = Title; / = Term from the Medline controlled vocabulary, but does not include terms found below this term in the MeSH hierarchy; * = Focus (if found in front of a MeSH-term); * or $ = Truncation (if found at the end of a free text term); .mp = Text, heading word, subject area node, title; " " = Citation Marks; searches for an exact phrase; ADJn = Positional operator that lets you retrieve records that contain your terms (in any order) within a specified number (n) of words of each other
Search termsItems found
Population: Children and adolescents with anxiety
1. exp Child/ or exp adolescent/ 3,199,838
2. (child* or kids or girl or girls or boy or boys or teen* or adolescen* or youth* or p?ediatric* or youngster* or school* or highschool* or secondary school* or secondary education* or high school* or juvenile* or minor*).tw,kw. 2,503,177
3. ((first or second or third or fourth or fifth or sixth or seventh) adj grader*).tw,kw 2,744
4. exp Anxiety Disorders/ 84,490
5. (Obsessive Compulsive Disorder* or OCD or GAD or Panic Attack or Panic Disorder* or Neurotic Disorder* or phobi*).kw,tw. 46,354
6. 1 or 2 or 3 [population age] 4,245,693
7. 4 or 5 [population diagnosis] 104,919
8. 6 and 7 [population] 33,045
Intervention: Unified protocol
9. (Unified protocol or UP-C or UP-Y or emotion* detective*).mp. 450
10. transdiagnostic*.tw,kw. 3,002
11. 9 or 10 3,328
Study types: randomised controlled trials and other controlled trials
12. exp Controlled Clinical Trial/ or random allocation/ 727,611
13. ((singl* or doubl* or tripl* or trebl*) adj3 (blind* or dumm* or mask*)).tw,kw. 186,415
14. (clinical adj3 trial).tw,kw. 169,406
15. clinical trial.pt. 532,426
16. random*.tw,kw. 1,272,900
17. (control* adj (group* or condition*)).tw,kw. 542,714
18. comparison group*.tw,kw. 20,151
19. wait* list*.tw,kw. 14,953
20. ((treatment or intervention or experimental) adj group*).tw,kw. 200,587
21. (matched adj (control* or group* or comparison*)).tw,kw. 95,073
22. ((treatment* or service* or care) adj2 (usual or standard or traditional or ordinary)).tw,kw. 131,615
23. (compared adj3 control*).tw,kw. 412,036
24. 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23 2,670,881
Study types: Systematic reviews
25. (Systematic Review or Meta-Analysis).pt. or Cochrane Database Syst Rev.ja. or ((systematic adj3 review) or "meta analys*" or metaanalys*).ti,ab 372,242
Combined sets
26. 8 and 11 [population and intervention] 274
27. 26 and 24 [controlled trials] 85
28. 26 and 25 [systematic reviews] 26
Final result
  27 [controlled trials] 85
  28 [systematic reviews] 26
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