Swedish Agency for Health Technology Assessment and Assessment of Social Services
Unified protocol for the treatment of children and adolescents with anxiety syndromes
Anxiety is common among children and adolescents and often occurs with other illnesses such as depression. Unified protocol is a therapeutic treatment approach that has been developed to treat the underlying factors that are common in several mental illnesses. The protocol has been developed to be used both with co-morbidity and with single diagnoses.
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Question
What scientific studies are there on the effects of treatment with the Unified Protocol on children and adolescents with anxiety disorders?
Identified literature
No relevant systematic review was identified but 3 primary studies were identified [1-3]. The primary studies were not assessed for risk of bias.
References
- Ehrenreich-May J, Rosenfield D, Queen AH, Kennedy SM, Remmes CS, Barlow DH. An initial waitlist-controlled trial of the unified protocol for the treatment of emotional disorders in adolescents. J Anxiety Disord. 2017;46:46-55. Available from: https://doi.org/10.1016/j.janxdis.2016.10.006.
- Kennedy SM, Bilek EL, Ehrenreich-May J. A Randomized Controlled Pilot Trial of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children. Behav Modif. 2019;43(3):330-60. Available from: https://doi.org/10.1177/0145445517753940.
- Maleki M, Khorramnia S, Foroughi A, Amiri S, Amiri S. Comparing the effectiveness of the unified protocol in combination with an additional mindfulness treatment to the unified protocol alone as treatment for adolescents diagnosed with emotional disorders. Trends Psychiatry Psychother. 2021;43(1):57-64.
Literature search
PsycINFO/Psychology and Behavioral Sciences Collection via EBSCO 17 December 2021
| The final search result, usually found at the end of the documentation, forms the list of abstracts. AB = Abstract; AU = Author; DE = Term from the thesaurus; MH = Exact Subject Heading from CINAHL Subject Headings; MM = Major Concept; TI = Title; TX = All Text. Performs a keyword search of all the database's searchable fields; ZC = Methodology Index; * = Truncation; " " = Citation Marks; searches for an exact phrase; N = Near Operator (N) finds the words if they are a maximum of x words apart from one another, regardless of the order in which they appear.; W = Within Operator (W) finds the words if they are within x words of one another, in the order in which you entered them |
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| Search terms | Items found | |
|---|---|---|
| Population: Children and adolescents with anxiety | ||
| 1. | DE "Anxiety Disorders" OR DE "Generalized Anxiety Disorder" OR DE "Obsessive Compulsive Disorder" OR DE "Panic Attack" OR DE "Panic Disorder" OR DE "PANIC disorders" OR DE "Phobias" OR DE "Separation Anxiety Disorder" OR TI (Anxiet* OR Obsessive Compulsive Disorder* OR "OCD" OR "GAD" OR Panic Attack* OR Panic Disorder* OR Neurotic Disorder* OR Phobi*) OR AB (Anxiet* OR Obsessive Compulsive Disorder* OR "OCD" OR "GAD" OR Panic Attack* OR Panic Disorder* OR Neurotic Disorder* OR Phobi*) OR SU (Anxiet* OR Obsessive Compulsive Disorder* OR "OCD" OR "GAD" OR Panic Attack* OR Panic Disorder* OR Neurotic Disorder* OR Phobi*) | 314,244 |
| 2. | DE "CHILDREN" OR DE "CHILD patients" OR DE "SCHOOL children" OR ZG "adolescence (13-17 yrs)" OR ZG "school age (6-12 yrs)" OR TI (Child* OR kids OR girl OR girls OR boy OR boys OR teen* OR adolescen* OR youth* OR p#ediatric* OR youngster* OR school* OR ((first or second or third or fourth or fifth or sixth or seventh) N2 grader*) OR highschool* OR secondary school* OR secondary education* OR high school* OR juvenile* OR minor*) OR AB (Child* OR kids OR girl OR girls OR boy OR boys OR teen* OR adolescen* OR youth* OR p#ediatric* OR youngster* OR school* OR ((first or second or third or fourth or fifth or sixth or seventh) N2 grader*) OR highschool* OR secondary school* OR secondary education* OR high school* OR juvenile* OR minor*) OR SU (Child* OR kids OR girl OR girls OR boy OR boys OR teen* OR adolescen* OR youth* OR p#ediatric* OR youngster* OR school* OR ((first or second or third or fourth or fifth or sixth or seventh) N2 grader*) OR highschool* OR secondary school* OR secondary education* OR high school* OR juvenile* OR minor*) | 1,848,600 |
| 3. | S1 AND S2 | 105,862 |
| Intervention: Unified protocol | ||
| 4 | DE "Transdiagnostic Treatment" OR TX ("UP-C" OR (emotion* N3 detective*) OR "UP-Y") OR TI Transdiagnostic* OR AB Transdiagnostic* OR SU Transdiagnostic* | 4,546 |
| 5. | TX "unified protocol" | 423 |
| Study types: systematic reviews | ||
| 6. | DE "Meta Analysis" OR ZC "systematic review" OR ZC "meta analysis" OR DE "Systematic Review" OR TX (systematic* N3 review*) OR TX (metaanaly* OR meta-analy* OR meta analy*) | 224,602 |
| Study types: randomised controlled trials and other trials | ||
| 7. | ZC "treatment outcome/clinical trial" OR DE "Clinical Trials" OR DE "Placebo" OR TI (((singl* OR doubl* OR tripl* OR trebl*)) N2 (blind* OR dumm* OR mask*)) OR ((randomi?ed OR controlled) N2 (study OR trial* OR design OR method* OR test* OR assessment OR experiment OR comparison)) OR ((random*) N3 (assign* OR alloca*)) OR (clinical W2 trial*) OR placebo* OR “wait* list*” OR “comparison group*” OR (control* W1 (group* or condition*)) OR (control* W1 (group* or condition*)) OR ((treatment* OR service* OR care) N2 (usual OR standard OR traditional OR ordinary)) OR (randomi?ed N6 n=) OR (compared N2 control*)) OR AB (((singl* OR doubl* OR tripl* OR trebl*)) N2 (blind* OR dumm* OR mask*)) OR ((randomi?ed OR controlled) N2 (study OR trial* OR design OR method* OR test* OR assessment OR experiment OR comparison)) OR ((random*) N3 (assign* OR alloca*)) OR (clinical W2 trial*) OR placebo* OR “wait* list*” OR “comparison group*” OR (control* W1 (group* or condition*)) OR (control* W1 (group* or condition*)) OR ((treatment* OR service* OR care) N2 (usual OR standard OR traditional OR ordinary)) OR (randomi?ed N6 n=) OR (compared N2 control*)) OR SU (((singl* OR doubl* OR tripl* OR trebl*)) N2 (blind* OR dumm* OR mask*)) OR ((randomi?ed OR controlled) N2 (study OR trial* OR design OR method* OR test* OR assessment OR experiment OR comparison)) OR ((random*) N3 (assign* OR alloca*)) OR (clinical W2 trial*) OR placebo* OR “wait* list*” OR “comparison group*” OR (control* W1 (group* or condition*)) OR (control* W1 (group* or condition*)) OR ((treatment* OR service* OR care) N2 (usual OR standard OR traditional OR ordinary)) OR (randomi?ed N6 n=) OR (compared N2 control*)) | 426,078 |
| Combined sets: | ||
| 8. | S3 AND S4 | 639 |
| 9. | S8 OR S5 | 1,015 |
| 10. | S9 AND S6 | 235 |
| 11. | S9 AND S7 | 248 |
| Final result | ||
| 10 [Systematic reviews] | ||
| 11 [controlled trials] | 248 | |
Cochrane Library via Wiley 17 December 2021 (CDSR, Cochrane Protocols & CENTRAL)
| The final search result, usually found at the end of the documentation, forms the list of abstracts. :au = Author; MeSH = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; this term only = Does not include terms found below this term in the MeSH hierarchy; :ti = Title; :ab = Abstract; :kw = Keyword; * = Truncation; " " = Citation Marks; searches for an exact phrase; CDSR = Cochrane Database of Systematic Review; Cochrane Protocols = Protocols of systematic reviews registered in Cochrane Library; CENTRAL = Cochrane Central Register of Controlled Trials, “trials” |
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| Search terms | Items found | |
|---|---|---|
| Population: children and adolescents with anxiety | ||
| 1. | MeSH descriptor: [Anxiety Disorders] explode all trees | 7,472 |
| 2. | (Anxiety OR Anxieties OR "Obsessive Compulsive Disorder*" OR OCD OR GAD OR "Panic Attack" OR "Panic Disorder*" OR "Neurotic Disorder*" OR "Phobia*" OR phobic):ti,ab,kw | 61,965 |
| 3. | MeSH descriptor: [Child] explode all trees | 59,662 |
| 4. | MeSH descriptor: [Adolescent] explode all trees | 108,631 |
| 5. | (child* OR kids OR girl OR girls OR boy OR boys OR teen* OR adolescen* OR youth* OR p?ediatric* OR youngster* OR school* OR highschool* OR secondary school* OR secondary education* OR high school* OR juvenile* OR minor*):ti,ab,kw | 314,192 |
| 6. | ((first or second or third or fourth or fifth or sixth or seventh) W grader*):ti,ab,kw | 2 |
| 7. | #3 OR #4 OR #5 OR #6 | 314193 |
| 8. | #1 OR #2 | 62,206 |
| 9. | #7 AND #8 | 16,467 |
| Intervention: Unified protocol | ||
| 10. | ("Unified protocol") | 167 |
| 11. | ("UP-C" OR "UP-Y" OR "emotion* detective*" OR transdiagnostic*):ti,ab,kw | 912 |
| Combined sets | ||
| 12. | #9 AND #11 | 203 |
| 13. | #12 OR #10 | 338 |
| Final result | ||
| #13 | CDSR/1 Cochrane Protocols/1 CENTRAL/336 |
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Embase via Elsevier 17 December 2021
| The final search result, usually found at the end of the documentation, forms the list of abstracts. /de = Term from the EMTREE controlled vocabulary; /exp = Includes terms found below this term in the EMTREE hierarchy; /mj = Major Topic; :ab = Abstract; :au = Author; :ti = Article Title; :ti,ab = Title or abstract; * = Truncation; ' ' = Citation Marks; searches for an exact phrase; NEAR/n = Requests terms that are within 'n' words of each other in either direction; NEXT/n = Requests terms that are within 'n' words of each other in the order specified |
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| Search terms | Items found | |
|---|---|---|
| Population: Children and adolescents with anxiety | ||
| 1. | 'anxiety disorder'/exp OR "Anxiety":ti,ab,kw OR "Anxieties":ti,ab,kw OR "Obsessive Compulsive Disorder":ti,ab,kw OR "Obsessive Compulsive Disorders":ti,ab,kw OR "OCD":ti,ab,kw OR "GAD":ti,ab,kw OR "Panic Attack":ti,ab,kw OR "Panic Disorder":ti,ab,kw OR "Neurotic Disorders":ti,ab,kw OR "Panic Disorders":ti,ab,kw OR "Neurotic Disorder":ti,ab,kw OR "Phobia":ti,ab,kw OR "phobias":ti,ab,kw OR "phobic":ti,ab,kw | 516,165 |
| 2. | 'child'/exp OR 'adolescent'/exp OR child*:ti,ab,kw OR 'kids':ti,ab,kw OR girl:ti,ab,kw OR girls:ti,ab,kw OR boy:ti,ab,kw OR boys:ti,ab,kw OR teen*:ti,ab,kw OR adolescen*:ti,ab,kw OR youth*:ti,ab,kw OR pediatric*:ti,ab,kw OR paediatric*:ti,ab,kw OR youngster*:ti,ab,kw OR school*:ti,ab,kw OR 'first grader*':ti,ab,kw OR 'second grader*':ti,ab,kw OR 'third grader*':ti,ab,kw OR 'fourth grader*':ti,ab,kw OR 'fifth grader*':ti,ab,kw OR 'sixth grader*':ti,ab,kw OR 'seventh grader*':ti,ab,kw OR highschool*:ti,ab,kw OR ((secondary:ti,ab,kw OR high*:ti,ab,kw) AND adj2:ti,ab,kw AND (school*:ti,ab,kw OR education:ti,ab,kw)) OR juvenile*:ti,ab,kw OR minor*:ti,ab,kw | 5,225,380 |
| 3. | 1 AND 2 | 131,769 |
| Intervention: Unified protocol | ||
| 4. | 'up-c':ti,ab,kw OR 'emotion* detective*':ti,ab,kw OR 'up-y':ti,ab,kw OR 'transdiagnostic':ti,ab,kw OR 'transdiagnostical':ti,ab,kw OR 'transdiagnostic approach'/exp | |
| 5. | 'unified protocol'/exp OR 'unified protocol' | |
| Study types: randomised controlled trials and other controlled trials | ||
| 6. | 'controlled clinical trial'/exp | 863,978 |
| 7. | ((‘singl*’ OR ‘doubl*’ OR ‘tripl*’ OR ‘trebl*’) NEXT/3 (‘blind*’ OR ‘dumm*’ OR ‘mask*’)):ti,ab,kw | 262,218 |
| 8. | ('controlled' NEXT/2 (trial OR comparison OR experiment OR study OR test)):ti,ab,kw | 320,958 |
| 9. | (clinical NEAR/3 trial):ti,ab,kw | 267,056 |
| 10. | ('control*' NEXT/1 (group* OR condition*)):ti,ab,kw | 773,552 |
| 11. | 'comparison group*':ti,ab,kw | 25,991 |
| 12. | 'wait* list*':ti,ab,kw | 24,190 |
| 13. | ((treatment OR intervention OR experimental) NEXT/1 group*):ti,ab,kw | 286,289 |
| 14. | (matched NEXT/1 (control* OR group* OR comparison*)):ti,ab,kw | 130,959 |
| 15. | ((treatment* OR service* OR care) NEAR/2 (usual OR standard OR traditional OR ordinary)):ti,ab,kw | 217,862 |
| 16. | (compared NEAR/3 control*):ti,ab,kw | 607,279 |
| 17. | #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14 OR #15 OR #16 | 2,609,887 |
| Study types: systematic reviews | ||
| 18. | 'systematic review'/de OR 'meta analysis'/exp OR 'cochrane database syst rev':ta OR ((systematic NEAR/3 review):ti,ab) OR 'meta analys*':ti,ab OR metaanalys*:ti,ab | 548,508 |
| Combined sets | ||
| 19. | #3 AND #4 | 629 |
| 20. | #19 OR #5 | 995 |
| 21. | #20 AND #18 [systematic reviews] | 62 |
| 22. | #20 AND #17 [controlled trials] | 201 |
| Final result | ||
| #21[systematic reviews] | 62 | |
| #22 [controlled trials] | 201 | |
Medline via OvidSP 17 December 2021
| The final search result, usually found at the end of the documentation, forms the list of abstracts. .ab. = Abstract; .ab,ti. = Abstract or title; .af. = All fields; Exp = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; .sh. = Term from the Medline controlled vocabulary; .ti. = Title; / = Term from the Medline controlled vocabulary, but does not include terms found below this term in the MeSH hierarchy; * = Focus (if found in front of a MeSH-term); * or $ = Truncation (if found at the end of a free text term); .mp = Text, heading word, subject area node, title; " " = Citation Marks; searches for an exact phrase; ADJn = Positional operator that lets you retrieve records that contain your terms (in any order) within a specified number (n) of words of each other |
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| Search terms | Items found | |
|---|---|---|
| Population: Children and adolescents with anxiety | ||
| 1. | exp Child/ or exp adolescent/ | 3,199,838 |
| 2. | (child* or kids or girl or girls or boy or boys or teen* or adolescen* or youth* or p?ediatric* or youngster* or school* or highschool* or secondary school* or secondary education* or high school* or juvenile* or minor*).tw,kw. | 2,503,177 |
| 3. | ((first or second or third or fourth or fifth or sixth or seventh) adj grader*).tw,kw | 2,744 |
| 4. | exp Anxiety Disorders/ | 84,490 |
| 5. | (Obsessive Compulsive Disorder* or OCD or GAD or Panic Attack or Panic Disorder* or Neurotic Disorder* or phobi*).kw,tw. | 46,354 |
| 6. | 1 or 2 or 3 [population age] | 4,245,693 |
| 7. | 4 or 5 [population diagnosis] | 104,919 |
| 8. | 6 and 7 [population] | 33,045 |
| Intervention: Unified protocol | ||
| 9. | (Unified protocol or UP-C or UP-Y or emotion* detective*).mp. | 450 |
| 10. | transdiagnostic*.tw,kw. | 3,002 |
| 11. | 9 or 10 | 3,328 |
| Study types: randomised controlled trials and other controlled trials | ||
| 12. | exp Controlled Clinical Trial/ or random allocation/ | 727,611 |
| 13. | ((singl* or doubl* or tripl* or trebl*) adj3 (blind* or dumm* or mask*)).tw,kw. | 186,415 |
| 14. | (clinical adj3 trial).tw,kw. | 169,406 |
| 15. | clinical trial.pt. | 532,426 |
| 16. | random*.tw,kw. | 1,272,900 |
| 17. | (control* adj (group* or condition*)).tw,kw. | 542,714 |
| 18. | comparison group*.tw,kw. | 20,151 |
| 19. | wait* list*.tw,kw. | 14,953 |
| 20. | ((treatment or intervention or experimental) adj group*).tw,kw. | 200,587 |
| 21. | (matched adj (control* or group* or comparison*)).tw,kw. | 95,073 |
| 22. | ((treatment* or service* or care) adj2 (usual or standard or traditional or ordinary)).tw,kw. | 131,615 |
| 23. | (compared adj3 control*).tw,kw. | 412,036 |
| 24. | 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23 | 2,670,881 |
| Study types: Systematic reviews | ||
| 25. | (Systematic Review or Meta-Analysis).pt. or Cochrane Database Syst Rev.ja. or ((systematic adj3 review) or "meta analys*" or metaanalys*).ti,ab | 372,242 |
| Combined sets | ||
| 26. | 8 and 11 [population and intervention] | 274 |
| 27. | 26 and 24 [controlled trials] | 85 |
| 28. | 26 and 25 [systematic reviews] | 26 |
| Final result | ||
| 27 [controlled trials] | 85 | |
| 28 [systematic reviews] | 26 | |
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