1. Robert D. Friedberg, Ph.D., ABPP, ACT rfriedberg@paloaltou.edu
Beyond alphabet soup: The need for transdiagnostic and unified CBT protocols for youth
Robert D. Friedberg, Ph.D., ABPP, ACT

2. Agenda
No alphabet soup for you: Why we need transdiagnostic unified approach
Unified approaches
Modular CBT
MATCH-ADTC
Unified Protocol for Youth

3. Alphabet Soup CBT for Dep CBT for OCD CBT for GAD CBT for PTSD
CBT for SAD
CBT for SOP

4. Why we need Transdiagnostic CBT for youth
Co-morbidity
Caseloads of practitioners typically reflect severe co-morbidity and consequently they do not invest in single disorder protocols
Complicated family circumstances (Chu, 2012)
Targeting core mechanisms and common pathways increase possibility of generalization (Chu, 2012, Chu & Ehrenreich- May, 2013).
Increased clinical flexibility (Chu & Ehrenreich-May, 2013)

5. Transdiagnostic approach
A transdiagnostic approach offers a comprehensive treatment package
Integrated interventions target multiple problems; solves the multiple manual problem
Transdiagnostic and unified protocols may better serve dissemination and training

6. Transdiagnostic approach
Based on (chu, 2012)
Shared etiology
Common pathways
Similar maintaining processes

7. Common pathways to disorders (Chu & Ehrenreich-May, 2013
Cognitive
Attention
Memory
Intolerance of uncertainty (Dugas & Ladouceur, 2000)
Perception of control
Thought suppression
Rumination
Perfectionism

8. Common pathways Emotional Interpersonal Community/Sociocultural
Hi Negative affect, low positive affect
Experiential avoidance
Interpersonal
Family conflict
Peers
Community/Sociocultural
Neighborhood influences
Broader societal forces

9. Attentional pathways Diagnostic group Attentional pathway Panic
Catastrophic misinterpretation of normal bodily sensations
Social anxiety
Fear of negative evaluation, embarassment, scrutiny
OCD
Intrusive thoughts regarding responsibility for harm
PTSD
Hypervigilance to threat cues and reaction to past trauma
GAD
Vigilance to range of dangers, consequences of worrying
Eating Dis
Overconcern with body weight and shape
Depression
Overconcern with worth and acceptability

10. Memory Intrusive memories common to PTSD Social Phobia Agoraphobia
Body Dysmorphic Disorder
Bipolar Disorder
Major Depressive Disorder

11. A potential useful algorithm
Dudley, Kuyken, & Padesky, 2011
Transdiagnostic UP’s are useful when
Single Disorder that is Not otherwise specified (NOS) or does not match protocol’s parameters
Two or more co-morbid conditions

12. Modules and manuals Chorpita, Daleiden, & Weisz, 2005 Manuals
Specifies therapy content
Operationalizes therapeutic procedure
Specify a sequence to the operations
Supports adherence checks
Proliferation of many manuals with a select few disorders

13. Modules Modules Distill discrete techniques from manuals
Combine different techniques into conceptual categories based on shared common elements
Creates meaningful units that have relationship between them

14. Modules Modules allow practitioners to make better use of outcome data
Can be responsive to individual variations
Diagnosis
Age
Ethnicity
Gender

15. MATCH-ADTC Weisz & Chorpita (2012)
Modular Approach to Therapy with Children and Adolescents with Anxiety, Depression, Trauma, and Conduct Problems
Like a library of procedures
Complete with flow charts, clinician guidance systems, scripts, materials, dashboard monitoring systems

16. MATCH-ADTC: Some components
Brief description of procedure
Recommendation for individual/family
Goals of procedure
Materials needed
Prompts for therapists
Scripts
Prompt to end session on positive note (“Leave em laughing”)

17. Examples of core procedures by problem area
Fear ladder
Anx, Trauma
Active ignoring
Conduct
Exposure
Problem solving
Depression
Trauma narrative
Trauma
Psychoeducation
Anx, Dep, Trauma, Conduct
Pleasant activity scheduling
Correcting cognitive errors

18. MATCH-ADTC: Clinical Information System
Yields Brief Problem Checklist which reports on “top” problems identified by parents (Chorpita et al., 2010)
May also use broader measures such as the CBCL and/or the Stengths and Difficulties Questionnaires
Records which modules were used and their effectiveness

19. Unified protocol for youth
Components of the UP (Ehrenreich-May & Bilek, 2012)
Three common principles
Altering antecedent cognitive reappraisals
Handling threat perceptions
Modifying negative attributional biases
Preventing emotional avoidance
Focusing on helping patients focus on uncomfortable emotions without avoidance
Modifying action tendencies
Encountering avoided behaviors, increasing approach
Decreased distraction rumination, inhibition

20. Summary Transdiagnostic approaches serve Parsimony Training
More ecological valid patient care

21. THANK YOU!!!!!!!!!!!!!!!!!!!!!