Cognitive Reappraisal as a Potential Mechanism of Unified Protocol for Emotional Disorders

Abstract

This study aimed to investigate changes in cognitive reappraisal as a mechanism of the unified protocol (UP) for emotional disorders. Data were collected as part of a larger randomized clinical equivalence trial that assessed the efficacy of the UP, a transdiagnostic cognitive-behavioral therapy (CBT), relative to well-established single-disorder protocols and a wait-list control. The present sample included 132 individuals with primary diagnoses of panic disorder, generalized anxiety disorder, social anxiety disorder, or obsessive-compulsive disorder who were randomized to either the UP or the control group. They were assessed at five major time points during treatment, as well as a 6- and 12-month follow-up. Measures included the Overall Anxiety Severity and Impairment Scale for anxiety symptoms, the Overall Depression Severity and Impairment Scale for depression symptoms, and the Emotion Regulation Questionnaire to assess cognitive reappraisal. Multilevel mixed-effects models showed that cognitive reappraisal skills improved significantly over time in the UP group compared to a wait-list control group. Within the UP group, increases in cognitive reappraisal predicted subsequent reductions in anxiety and depression scores at the following time point. The greatest degree of improvement in cognitive reappraisal was observed at the last two time points during treatment, and these gains were sustained across the follow-up period. These findings underscore the importance of cognitive reappraisal, suggesting that it functions as a key transdiagnostic mechanism contributing to the UP’s efficacy in treating emotional disorders. This research highlights the necessity for targeted interventions to enhance reappraisal skills, informing the optimization of the UP for individuals with emotional disorders.