Accelerated Unified Protocol for Transdiagnostic Treatment of Anxiety Disorders in a VHA System

Veterans often present with multiple co-occurring mental health disorders, such as anxiety and depression, posing significant treatment challenges. Veterans are at increased risk for suicide, and anxiety and mood disorders are associated with increased suicide attempts and death by suicide. The Unified Protocol (UP) is a transdiagnostic cognitive behavioral therapy (CBT) intervention that addresses underlying emotional experiences (ie, negative affect and emotional distress) present in anxiety, depressive, and emotional disorders. UP uses interventions that can also be found in other CBT protocols, including motivational enhancement, mindful awareness, cognitive reframing, and exposure strategies. As a transdiagnostic intervention, UP can address anxiety, mood, emotional disorders, and other co-occurring disorders within the same treatment. Few veterans who could benefit from high-quality CBT interventions, such as UP, can access them.

The Veterans Affairs Pacific Islands Health Care System (VAPIHCS) created the Intensive Virtual Evidence-Based Psychotherapy Team for Anxiety With or Without Co- Occurring Depression program to deliver transdiagnostic UP with an accelerated model of service delivery (≥ 3 therapy sessions weekly). The program increased access to and completion of CBT for patients at VAPIHCS. By delivering UP in a massed or accelerated format (≥ 4 sessions weekly), the program provided an empirical solution that increased access to UP. It consists of 3 main components: (1) individual massed UP therapy (4 sessions weekly); (2) whole health and wellness classes (4 group sessions weekly); and (3) individual health coaching (1 session weekly). A total of 87.5% of participants completed all 16 UP therapy sessions the first year. Patients reported reduced anxiety, depression, suicidal ideation, and substance use risk with improvements in psychological flexibility and quality of life.

Virtual massed UP was found to be feasible, acceptable, effective, and to have high retention rates and patient satisfaction in a diverse veteran population with anxiety and other emotional disorders.