Recently I have been familiarizing myself with various psychotherapy treatment protocols and manuals. Manualized psychotherapy is great! A treatment manual tells practitioners what to do, when to do it, and how they should conceptualize their client’s problem. In scientific jargon, treatment models and their accompanying manualized treatment protocol inform an idiosyncratic case formulation.

But what do practitioners do when their clients present with more than one problem?

One solution to such cases where clients are dealing with more than one psychological disorder at the same time has been the development of transdiagnostic treatment protocols such as the Unified Protocol for transdiagnostic treatment of emotional disorders (Barlow et al., 2017). This has multiple advantages, most notable of which is that it is easier to both learn and teach one protocol (learn as an aspiring therapist and teach from the perspective of supervisors) sufficiently well to foster expertise in its delivery.

Other advantages relate to the fact that people show up for therapy with multiple problems, not just one problem that nicely fits into a predefined manualized treatment.

So what are the implications of transdiagnostic treatments for clients?

First of all, transdiagnostic treatments like the Unified Protocol aim to foster general cognitive and behavioral skills. These include, but are not limited to:

1. increased understanding of how our thoughts, emotions, and behavior interact;
2. increased ability to view thoughts as opinions, not facts;
3. increased tolerance of the body’s emotional responses (sometimes called “interoceptive feedback”); and
4. increased cognitive flexibility, meaning that people undergoing treatment become increasingly aware of their propensity to think the worst (or catastrophize) and jump to conclusions (collectively known as thinking traps).

These skills are sometimes referred to as common factors in cognitive behavioral therapy (Sighvatsson et al., 2020), which essentially means that they are likely going to benefit you regardless of what problem you have.

But this sounds simple enough, why have I not been taught this before?

Let’s begin by making one thing clear: Even if you feel like you don’t have the skills listed above, it does NOT mean that you necessarily have a problem! The thing is that psychological problems are defined by them being experienced as a problem. So, even if you feel like you jump to conclusions or think the worst sometimes… that does not necessarily mean that you have a problem. On the contrary, it simply means that you are human!

That’s what’s so so interesting about psychology, one man’s heaven is another man’s hell – and rest assured, we all have our problems. However, if you do feel like you are struggling with life and it affects your ability to function in important areas of your life, please do seek help from a mental health professional!

Concluding remarks

I started this post on some reflections on transdiagnostic therapy and treatment interventions for psychological problems in an attempt to unpack them, at least to some degree, in easy to grasp language. My goal with doing so is quite simple: Increase awareness of these types of treatments!

The Unified Protocol treatment has been successfully adopted e-platforms. For instance, pioneering work led by Professor Per Carlbring has revolutionized modern treatment opportunities, bringing high-quality psychotherapy to your PC or smartphone (for example, see Rozental et al., 2024).

However, in Iceland, access to psychotherapy is poor, financially burdensome, and the government barely chips in for those whom need it the most.

If treatment for many different psychological problems can be delivered via the internet and that treatment proves time and time again to be effective, one must ask why access to it is not fostered?

The financial burden of untreated psychological problems far outweighs the start-up cost associated with creating an e-therapy platform available for everyone. One is forced to draw the conclusion that mental health is not prioritized by our elected officials… at least that’s how it looks, and actions speak louder than words.

Do better!

References

Barlow, D. H., Farchione, T. J., Sauer-Zavala, S., Murray Latin, H., Ellard, K. K., Bullis, J. R., Bentley, K. H., Boettcher, H. T., & Cassiello-Robbins, C. (2017). Unified Protocol for transdiagnostic treatment of emotional disorders: Therapist guide (2nd ed.). Oxford University Press. https://doi.org/10.1093/med-psych/9780190685973.001.0001

Rozental, A., Shafran, R., Johansson, F., Forsström, D., Jovicic, F., Gelberg, O., Molin, K., Carlbring, P., Andersson, G., & Buhrman, M. (2024). Treating perfectionism via the internet: A randomized controlled trial comparing cognitive behavior therapy to unified protocol. Cognitive Behaviour Therapy, 53(3), 324-350. https://doi.org/10.1080/16506073.2024.2327339

Sighvatsson, M. B., Salkovskis, P. M., Sigurdsson, E., Valdimarsdottir, H. B., Thorsdottir, F., & Sigurdsson, J. F. (2020). ‘You should always look at the washing machine without actually being in it!’ Thematic framework analysis of patients’ understanding of transdiagnostic cognitive behaviour therapy and its mechanisms. Psychology and Psychotherapy: Theory, Research and Practice, 93(2), 258–275. https://doi.org/10.1111/papt.12220

Image generated with OpenAI’s DALL-E using the following prompt: “Generate a picture of e-therapy that helps many people in Iceland with smartphones and PC”