The efficacy of the unified protocol for emotional disorders in children and adolescents: A systematic review and meta-analysis

Schäpermeier, Malte; Jesussek, Anna-Lena; Kirchherr, Jasmin; Monninger Maximilian; Feneberg, Anja C.; Hechler, Tanja

Abstract

Transdiagnostic treatments such as the Unified Protocol for Emotional Disorders in Children and Adolescents (UP-C/A; Ehrenreich-May, J., Kennedy, S.M., Sherman, J.A., Bilek, E.L., Buzzella, B.A., Bennett, S.M., Barlow, D.H., 2017a) aim to target shared mechanisms across mental disorders and to achieve positive treatment outcomes. Several studies investigated the UP-C/A with promising results regarding the improvement of internalizing symptoms. However, there is currently no meta-analysis investigating the efficacy across the existing studies. In this preregistered systematic review and meta-analysis (PROSPERO CRD 42023474832), we analyzed whether the UP-C/A is effective in reducing internalizing symptoms (primary outcome) and secondary outcomes such as emotion regulation in comparison to control treatments where applicable, and from pre- to post-treatment and follow-up. We also examined whether moderators (i.e., sample and treatment characteristics) predicted the effects of the UP-C/A. We included 21 studies (9 RCTs, 11 uncontrolled studies, 1 single-case experimental study) with a total of N = 994 participants. For internalizing symptoms, we found moderate to large controlled effects post-treatment (g = 0.58, p = .014) and at follow-up (g = 0.79, p = .003). Uncontrolled effects were large in both cases. We also found moderate to large effects for secondary outcomes (i.e., emotion regulation, global severity of psychopathology, global functioning). Treatment format did not impact the efficacy. Overall, our findings suggest that the UP-C/A is effective in treating internalizing symptoms in children and adolescents that can be offered in different formats. However, more research is needed to draw robust conclusions regarding specific treatment mechanisms underlying these effects.