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A new treatment protocol may give practitioners a comprehensive, flexible way to treat patients with a variety of disorders, including depression, anxiety and phobias, said anxiety-disorders expert David H. Barlow, PhD, at a plenary session during APA's Annual Convention.

"The protocol takes three or four basic concepts that seem to be present in all of our successful treatments for these emotional disorders and puts them together as a single, unified, transdiagnostic set of principles that clinicians could adapt to anyone sitting in front of them," said Barlow, professor of psychology and director emeritus at the Center for Anxiety and Related Disorders at Boston University.

Barlow and colleagues are finishing a four-year National Institute of Mental Health study testing the treatment's efficacy.

The protocol incorporates three strands of research, Barlow said:

  • Changes in our understanding of how exposure therapy works. Research now finds that it's more effective to "expose" people to their actual emotional experience - which helps them better accept their emotional life and develop more positive ways of regulating their emotions - than merely to subject them to externally aversive conditions that may temporarily arouse those emotions without attending to how they are processing that experience.

  • New findings that demonstrate how emotional patterns and responses affect regions of the brain. For instance, brain-imaging studies show that cognitive reappraisal and other emotion-regulation techniques modulate the response of both the amygdala and prefrontal cortices in ways that reduce negative emotions, increase positive emotions, or both, he said.

  • Further research from Barlow's lab based on findings from emotion science shows that people with any of these emotional disorders experience their emotions in similar ways. In essence, they enter a downward spiral in which they can't accept an initial negative emotion such as anger, depression or fear; they try to suppress or get rid of the emotion; and they have trouble regulating and letting go of the emotion. By contrast, healthy controls are better able to accept, let go of and move on from their negative emotions, he noted.

The new protocol is designed as seven modules that incorporate key elements of that research, as well as principles of change - mechanisms that research shows help people scale barriers to change, Barlow said. Module topics include psychoeducation; motivational enhancement to aid treatment engagement; emotional awareness training; cognitive appraisal and reappraisal; modifying emotion-driven behaviors and emotional avoidance; internal somatic and situational exposure; relapse prevention; and present-focused emotional awareness training.

The protocol is a move toward giving practitioners greater treatment flexibility than manuals allow, Barlow noted.

"Instead of studying treatments as some sort of fixed pattern, practitioners will have principles they can flexibly apply to a variety of different emotional disorders," he said.

The treatment plan also aims to simplify what practitioners have to learn, he noted.

"Instead of having to master, say, 12 different treatment manuals, you'd just have to master one," he said. "The idea is to create a protocol that's easy to disseminate and is much more user-friendly for psychologists."


Tori DeAngelis is a writer in Syracuse, N.Y.