Anxiety Disorders Clinical Trial
Official title:
Cost-efficacy and Acceptability of the Unified Protocol for the Treatment of Emotional Disorders in the Spanish Public Mental Health System Using a Group Format
The present randomized, controlled trial will compare the cost-efficacy and acceptability of the Unified Protocol in group format against traditional individual Cognitive Behavioral Treatment in a sample of patients with emotional disorders. Ultimately, the goal of the current study is to explore whether the Unified Protocol in group format can be a cost-effective psychological intervention for emotional disorders in the Spanish National Health System, that is, one that generates long-lasting changes in symptoms, while reducing both direct and indirect economic costs associated with the treatment of emotional disorders.
Emotional disorders (EDs; i.e., depressive and anxiety disorders) have become the most
prevalent psychiatric disorders globally. The 12-month prevalence of anxiety and depressive
disorders affect 14% and 7.8% (6.9% by major depression) of the population, respectively, and
comordibity may be as high as 50%. Lifetime prevalence rates in primary care settings in
Spain reveal that mood and anxiety disorders, as defined in the DSM-IV-TR, are the most
prevalent psychiatric problems as well, with 35.8% and 25.6%, respectively.
As a result of their high prevalence in the population, emotional disorders have become a
global health problem due to their associated costs.For instance, a study conducted in 36
countries estimated that the annual cost of treatment for depressive disorders and anxiety
problems amounted to $91 billion and $56 billion, respectively. If both direct and indirect
costs of these emotional disorders were accounted for, expenses increased to $925,000
million. In Spain, when both direct and indirect costs are included, mood and anxiety
disorders are estimated to cost €10,763 million and €10,365 million, respectively.
Pharmacological treatment and individual cognitive behavioral therapy (CBT) are the most
frequent interventions for emotional disorders in the Spanish National Health System.
Therefore, increasing the efficiency of these treatments may be a way of reducing the current
public health costs of emotional disorders. A recently developed form of CBT, the Unified
Protocol for the Treatment of Emotional Disorders (UP), might serve the aforementioned
purpose, as it can be applied to a variety of disorders simultaneously and it can be easily
performed in a group format. The UP was created on the basis of the identification of common
psychopathological vulnerability factors in emotional disorders, together with elements and
techniques shared by disorder-specific cognitive-behavioral treatments. In the UP,
traditional CBT techniques (i.e., cognitive restructuring) and contemporary practices (i.e.,
mindfulness) are combined to treat emotion regulation deficits, which are argued to be the
underlying common factor in all emotional disorders. The UP is a structured, manual-based
treatment, so it can be easily applied in a group format. This, together with the fact that
the UP can be applied simultaneously to individuals with different emotional disorders, might
help reduce existent waiting lists and current costs of individual treatment.
So far, studies exploring the effectiveness of the UP in a group format have led to promising
findings. Overall, results suggest that the UP has between moderate and strong effect sizes
on numerous outcomes, including depression, anxiety, positive and negative affect, quality of
life, overall adjustment, and avoidance of negative sensations, for both anxiety and mood
disorders. These studies have also revealed that between half and two thirds of patients
ceased to meet diagnostic criteria after the treatment and one investigation, conducted by
the investigators participating in the present study, revealed that changes remained stable
12 months after treatment completion. Despite the previous results are encouraging,
conclusions should be interpreted with caution as sample sizes have been small (11
participants in two studies and 47 patients in one investigation) and cost-effectiveness of
the UP in group format compared with traditional individual CBT remains unclear.
Methodologically-sound, randomized, controlled trials are needed in order to replicate the
aforementioned findings and to elucidate whether the UP in group format is an effective and
efficient treatment option for emotional disorders in public settings.
It is expected that both interventions (CBT and UP) will be comparable in terms of
effectiveness and acceptability, but treatment costs will be lower in the UP condition. To
ensure the generalizability of results, the hypotheses will be tested in various public
mental health centers in Spain.
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