Group treatment using the Unified Protocol or other transdiagnostic CBT for the treatment of children and adolescents with depression or anxiety

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SBU Enquiry Service

Responds to queries received from Swedish healthcare and social service providers, or governmental organisations. Queries have a limited scope and the process is designed to enable a more rapid response, typically within two to three months. Reports are based on systematic reviews, that are identified through structured searches and critically appraised for risk of bias.

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Published: Report no: ut202606 Registration no: SBU 2026/184

Question

What effect does group treatment using the Unified Protocol or other transdiagnostic cognitive behavioral therapy have on the treatment of children and adolescents with depression or anxiety?

PICO

  • Population: Children or adolescents aged 0-18, diagnosed with depression or anxiety
  • Intervention: Unified Protocol or other group based transdiagnostic CBT
  • Comparison: No treatment or other treatment
  • Outcome: Symptoms of depression or anxiety

Method

A systematic literature search was performed using the following databases: Medline, Scopus and PsycInfo.
Two authors independently assessed the abstracts of all identified studies.
Risk of bias in relevant systematic reviews was assessed using an assessment tool based on AMSTAR.

Identified literature

One relevant systematic review with moderate risk of bias were identified [1]. The results and conclusions are presented in Table 1. In one relevant systematic review, the risk of bias was considered to be high, therefore the results and conclusions are not reported [2].

Table 1 Systematic reviews with moderate risk of bias.
OCD = Obsessive-Compulsive Disorder; RCT = Randomized controlled trial
Included studies Population, Intervention, Control Outcome and Results
Bähr et al, 2025 [1]
Together and beyond: A systematic review on characteristics and efficacy of transdiagnostic psychotherapeutic group-based interventions for children and adolescents
80 studies
42 RCT
7 controlled trials
31 uncontrolled studies 

Relevant studies:
4 RCT
3 uncontrolled studies 

Setting:
USA: 4 studies
Iran: 1 study
Japan: 1 study
Kina: 1 study
Portugal: 1 study		 Population (in relevant
studies):
Children and adolescents
(n=348), 0–17 years, with
anxiety, depression and OCD
Sample size: 16–77 

Intervention (in relevant studies):
Unified Protocol (UP) 

Control (in relevant studies):
Wait-list control
ABC Emotion
Cool Kids		 Narrative synthesis of seven
relevant primary studies

4 studies (one active-control
RCT, two waitlist-control RCT,
one un-controlled study):
Significant improvements in
both depression and anxiety
symptoms

2 studies (un-controlled
studies): mixed results

1 study (one active-control
RCT): Clinical improvements
in both intervention and
control group, with no
significant differences
between groups.
Authors' conclusion:”Despite predominantly positive mental health outcomes and few reported adverse effects, the significant number of studies with substantial risk of bias highlights the need for higher-quality research..”

References

  1. Bahr C, Phan D, Murawska N, Gerber J, Jordan A, Hoffmann K, et al. Together and beyond: A systematic review on characteristics and efficacy of transdiagnostic psychotherapeutic group-based interventions for children and adolescents. Clin Psychol Rev. 2025;121:102642. Available from: https://doi.org/10.1016/j.cpr.2025.102642
  2. Ewing DL, Monsen JJ, Thompson EJ, Cartwright-Hatton S, Field A. A Meta-Analysis of Transdiagnostic Cognitive Behavioural Therapy in the Treatment of Child and Young Person Anxiety Disorders. Behav Cogn Psychother. 2015;43(5):562–77. Available from: https://doi.org/10.1017/S1352465813001094

Search strategies

Medline via OvidSP 17 March 2026

Title: Unified protocol children or adolescents
/ = Term from the MeSH controlled vocabulary; .sh = Term from the MeSH controlled vocabulary; exp = Term from MeSH including terms found below this term in the MeSH hierarchy; .ti,ab = Title or abstract; .tw = Title or abstract; .kf = Keywords; .kw = Keywords, exact; .bt = Book title. NLM Bookshelf; .pt = Publication type; .ja = Journal abbreviation; .af = All fields; adjn = Adjacent. Proximity operator retrieving adjacent words, adj3 retrieves records with search terms within two terms from each other; * or $ = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population: barn och unga
1. exp Child/ or exp adolescent/ 3 626 453
2. (child* or kid* or girl* or boy* or teen* or adolescen* or youth*).ab,bt,kf,ti. 2 984 930
Intervention: transdiagnostisk kbt
3. (transdiagnostic* or Unified protocol or tCBT or emotion* detective*).ti.ab.bt.kf. 7341
Study types: systematic reviews and meta-analysis
4. (Systematic Review/ or Meta-Analysis/ or Cochrane Database Syst Rev.ja. or (((systematic or realist or integrative or mixed method* or umbrella) adj4 (review)) or "meta analys*" or metaanalys*).ti,bt,ab.) not (editorial/ or letter/ or case reports/) 604 484
Combined sets:
5. 1 or 2 4 983 629
6. 5 and 3 2606
Final result
7. 6 and 4 161

Scopus via scopus.com 17 March 2026

Title: Unified protocol children or adolescents
Search terms Items found
TITLE-ABS-KEY = Title, abstract or keywords (including indexed keywords and author keywords); ALL = All fields; W/n = Within. Proximity operator retrieving terms within n words from each other; PRE/n = Precedes by. Proximity operator, the first term in the search must precede the second by n words; LIMIT-TO (X) = Includes only results of specified type, e.g., publication type or time range; DOCTYPE = Publication type; “re” = review; “le” = letter; “ed” = editorial; “ch” = book chapter; “cp” = conference proceedings; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Population: barn och unga
1. TITLE-ABS-KEY (child* OR kid* OR girl* OR boy* OR ;teen* OR adolescen* OR youth*) 7 452 487
Intervention: transdiagnostisk kbt
2. TITLE-ABS-KEY(transdiagnostic* or (Unified protocol) or tCBT) 18 761
3. TITLE-ABS-KEY ( emotion* AND detective* ) 174
Study types: systematic reviews and meta-analysis
4. TITLE-ABS-KEY ( ( (systematic OR realist OR integrative OR “mixed method*” or umbrella) W/3 review ) OR "meta analy*" OR metaanaly* ) AND (EXCLUDE (DOCTYPE, “le”) OR EXCLUDE (DOCTYPE, “ed”) OR EXCLUDE (DOCTYPE, “ch”) OR EXCLUDE (DOCTYPE, “cp”)) 911 873
Combined sets:
5. 2 or 3 18 931
6. 5 and 6 3613
Final result
7. 6 and 4 259

PSYCINFO via EBSCO 17 March 2026

Title: Unified protocol children or adolescents
Search terms Items found
TI = Title; AB = Abstract; SU = Keyword, exact or part (including all other fields for indexed and author keywords); DE = Exact keyword; TX = All text; MR = Methodology; Nn = Near. Proximity operator retrieving terms within n words from each other; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Population: barn och unga
1. TI(child* OR kid* OR girl* OR boy* OR teen* OR adolescen* OR youth*) OR
AB(child* OR kid* OR girl* OR boy* OR teen* OR adolescen* OR youth*) OR
SU(child* OR kid* OR girl* OR boy* OR teen* OR adolescen* OR youth*)		 1 356 864
Intervention: transdiagnostisk kbt
2. TI (transdiagnostic* or Unified protocol or tCBT or emotion* detective*) OR AB (transdiagnostic* or Unified protocol or tCBT or emotion* detective*) OR SU (transdiagnostic* or Unified protocol or tCBT or emotion* detective*) 7147
Study types: systematic reviews and meta-analysis / randomized controlled trials
3. (TI(((systematic OR realist OR integrative OR “mixed method*” OR umbrella) N3 review) OR "meta analys*" OR metaanalys*) OR AB(((systematic OR realist OR integrative OR “mixed method*” OR umbrella) N3 review) OR "meta analys*" OR metaanalys*) OR SU(((systematic OR realist OR integrative OR “mixed method*” OR umbrella) N3 review) OR "meta analys*" OR metaanalys*)) OR (MR "Systematic Review" OR MR "meta analysis") 124 726
Combined sets:
4. 1 and 2 2123
Final result
5. 4 and 3 140
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