A study led by Sant Joan de Déu shows the benefits of the Unified Protocol in young people at high risk of psychosis
Impact of the Unified Protocol on Attenuated Psychotic Symptoms, Cognitive Biases and Cognitive Insight in Patients at Ultra High Risk (UHR) for Psychosis: Secondary Results of a Pilot Randomized Controlled Trial, published in Journal of Clinical Psychology, reports the secondary outcomes of a pilot randomized controlled trial involving 36 individuals at clinical high risk for psychosis. One group of participants received a group intervention based on the Unified Protocol in addition to their usual treatment, while a second group received usual treatment alone.
Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders
The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP) is a cognitive-behavioural psychological intervention designed to treat different emotional disorders, such as anxiety and depression, using a single therapeutic approach. Unlike traditional treatments that focus on a specific diagnosis, the Unified Protocol adopts a transdiagnostic approach by targeting the common mechanisms underlying a range of psychological disorders, particularly emotion dysregulation. Its aim is to help individuals better understand, regulate, and cope with intense or distressing emotions.
The study was led by Dr Trinidad Peláez, researcher in the MERITT research group at Institut de Recerca Sant Joan de Déu(IRSJD) and Parc Sanitari Sant Joan de Déu (PSSJD), in collaboration with professionals from several national and international institutions, including the Universidad de Zaragoza (specifically the IPES group) and King's College London.
The findings show that participants who received the Unified Protocol intervention experienced improvements in attenuated psychotic symptoms, as well as in several cognitive biases and aspects related to cognitive insight. These findings reinforce the potential of transdiagnostic psychological interventions to address emotional difficulties associated with the risk of psychosis at an early stage.
Ultra-high risk for psychosis
The ultra-high risk (UHR) mental state for psychosis is an early clinical stage in which an individual experiences moderate and/or transient symptoms within the psychosis spectrum that are clinically relevant but do not yet reach the intensity or duration required for a diagnosis of a fully developed psychotic disorder.
Individuals at UHR may experience perceptual disturbances, such as hearing noises or voices or seeing things that others do not see; unusual thoughts or beliefs, such as feeling watched or persecuted by others; difficulties with concentration; social withdrawal; and a decline in academic, occupational, or social functioning. These difficulties are often accompanied by anxiety, depression, and significant emotional distress.
Not everyone at ultra-high risk will go on to develop psychosis. However, identifying these early signs allows psychological support and specialised follow-up to be provided before symptoms worsen. Research in this field focuses on developing preventive interventions capable of reducing emotional distress, improving daily functioning, and decreasing the risk of progression to more severe psychotic disorders.
An innovative approach to intervening during the early stages of psychosis
The research team concludes that the Unified Protocol may represent a promising tool for early intervention in individuals at clinical high risk for psychosis, particularly because of its impact on emotional symptoms and certain cognitive processes associated with the development of psychotic disorders.
The study findings show that participants who took part in the Unified Protocol group intervention experienced a greater reduction in attenuated psychotic symptoms than those who received usual treatment alone. This suggests that addressing emotion regulation and maladaptive thinking patterns at very early stages may help reduce psychological distress and clinical vulnerability.
In addition, the study identified improvements in several cognitive biases-that is, patterns of information processing that may contribute to distorted interpretations of reality. Changes were also observed in aspects related to cognitive insight, the ability to recognise and question one's own interpretations and beliefs.
According to the authors, these findings reinforce the idea that emotional and cognitive factors play a key role during the early stages of psychosis and that transdiagnostic interventions may provide broader benefits than treatments focused exclusively on specific psychotic symptoms.
However, the research team also notes that this was a pilot study with a relatively small sample size. Larger clinical trials with long-term follow-up will be required to confirm these findings and determine the true potential of the intervention for preventing psychosis.
Dr Trinidad Peláez highlights that the study findings suggest that early interventions aimed at improving emotion regulation may also have a positive impact on attenuated psychotic symptoms. This type of transdiagnostic intervention makes it possible to address, simultaneously, the different clinical presentations and needs of young people at ultra-high risk for psychosis.
This study forms part of the research promoted by Institut de Recerca Sant Joan de Déu (IRSJD) to develop new evidence-based psychological intervention strategies focused on prevention and community mental health.
Article reference
This type of transdiagnostic intervention makes it possible to address, simultaneously, the different clinical presentations and needs of young people at ultra-high risk for psychosis.
