The Effectiveness of Adjunctive Mindfulness Therapy with a Unified Protocol on the Emotional Disorders and Sleep Problems of Adolescents
,
Abstract
Background and Objective: The results of different studies have indicated the comorbidity between emotional disor-ders and sleep problems. However, no study has compared the outcome of mindfulness and unified protocol on the emotional problems and the sleep quality of the adolescents with emotional disorders.
Materials and Methods: The current investigation was a quasi-experimental study with a control group, which was conducted in 2019. The participants included adolescents with emotional disorders in control (n = 15) and experimental (n = 16) groups. Both groups received 14 sessions of therapy. The assessments were performed in three stages: pre-test, post-test, and follow-up. The measurements included the Pittsburgh Sleep Quality Index (PSQI) and the Screen for Child Anxiety Related Disorders (SCARED).
Results: The mean age of the participants in the experimental and control groups was 13.06 and 13.05 years, respec-tively. Given the results, both treatments alleviated the sleep and emotional problems of the adolescents diagnosed with emotional disorders. However, the combined treatment of mindfulness and the unified protocol led to more improve-ments. The calculated effect size of this treatment was 0.21 for sleep quality and 0.24 for the SCARED questionnaire.
Conclusion: Based on the findings, utilizing mindfulness as a supplementary therapeutic method can enhance the chances of reductions in the emotional problems and the improvements of sleep quality in the adolescents with emo-tional disorders.
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10. Ehrenreich-May J, Rosenfield D, Queen AH, et al. An initial waitlist-controlled trial of the unified protocol for the treatment of emotional disorders in adolescents. J Anxiety Disord 2017; 46: 46-55.
11. Ginsburg GS, Becker EM, Keeton CP, et al. Naturalistic follow-up of youths treated for pediatric anxiety disorders. JAMA Psychiatry 2014; 71: 310-8.
12. Barlow DH, Farchione TJ, Bullis JR, et al. The unified protocol for transdiagnostic treatment of emotional disorders compared with diagnosis-specific protocols for anxiety disorders: A randomized clinical trial. JAMA Psychiatry 2017; 74: 875-84.
13. Farchione TJ, Fairholme CP, Ellard KK, et al. Unified protocol for transdiagnostic treatment of emotional disorders: A randomized controlled trial. Be hav Ther 2012; 43: 666-78.
14. Barlow DH, Allen LB, Choate ML. Unified protocol for the treatment of emotional disorders. Boston, MA: Boston University; 2003. [Unpublished].
15. Kabat-Zinn J, Hanh TN. Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. New York, NY: Delta Book; 2009.
16. Saltzman A, Santorelli S. A Still Quiet Place: A Mindfulness Program for Teaching Children and Adolescents to Ease Stress and Difficult Emotions. Oakland, CA: New Harbinger Publications; 2014.
17. Napoli M, Krech PR, Holley LC. Mindfulness training for elementary school students. J Appl Psychol 2005; 21: 99-125.
18. Ehrenreich-May J, Bilek E, Buzzella B, Kennedy SM, Mash JA, Bennett S. Unified protocols for the treatment of anxiety disorders in adolescents and children. New York, NY: Oxford University Press; 2016.
19. Snel E. Sitting Still Like a Frog: Mindfulness Exercises for Kids (and Their Parents). Boulder, CO: Shambhala; 2013.
20. Ehrenreich JT, Goldstein CM, Wright LR, et al. Development of a unified protocol for the treatment of emotional disorders in youth. Child Fam Behav Ther 2009; 31: 20-37.
21. Buysse DJ, Reynolds CF 3rd, Monk TH, et al. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res 1989; 28: 193-213.
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25. Birmaher B, Brent DA, Chiappetta L, et al. Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED): A replication study. J Am Acad Child Adolesc Psychiatry 1999; 38: 1230-6.
26. Birmaher B, Khetarpal S, Brent D, et al. The Screen for Child Anxiety Related Emotional Disorders (SCARED): Scale construction and psychometric characteristics. J Am Acad Child Adolesc Psychiatry 1997; 36: 545-53.
27. Mohammadi A, Soleimani M, Mohammadi MR, et al. Unified Protocol for Transdiagnostic Prevention of Depression and Anxiety in Iranian Adolescents: Protocol development and initial outcome data. Iran J Psychiatry 2019; 14: 171-8.
28. Sherman JA, Tonarely NA, Ehrenreich-May J. Targeting comorbid anxiety and depression using the unified protocol for transdiagnostic treatment of emotional disorders in adolescents. Clin Case Stud 2018; 17: 59-76.
29. Essau CA, Sasagawa S, Jones G, et al. Evaluating the real-world effectiveness of a cognitive behavior therapy-based transdiagnostic program for emotional problems in children in a regular school set-ting. J Affect Disord 2019; 253: 357-65.
30. Kennedy SM, Bilek EL, Ehrenreich-May J. A randomized controlled pilot trial of the unified protocol for transdiagnostic treatment of emotional dis-orders in children. Behav Modif 2019; 43: 330-60.
31. Sloan T, Telch MJ. The effects of safety-seeking behavior and guided threat reappraisal on fear re-duction during exposure: an experimental investigation. Behav Res Ther 2002; 40: 235-51.
32. Roemer L, Litz BT, Orsillo SM, et al. A preliminary investigation of the role of strategic withholding of emotions in PTSD. J Trauma Stress 2001; 14: 149-56.
33. Girio-Herrera E, Ehrenreich-May J. Using flexible clinical processes in the unified protocol for the treatment of emotional disorders in adolescence. Psychotherapy (Chic) 2014; 51: 117-22.
34. Holzel BK, Lazar SW, Gard T, et al. How does mindfulness meditation work? proposing mechanisms of action from a conceptual and neural perspective. Perspect Psychol Sci 2011; 6: 537-59.
35. Hayes AM, Feldman G. Clarifying the construct of mindfulness in the context of emotion regulation and the process of change in therapy. Clin Psychol (New York) 2004; 11: 255-62.
36. Bridges LJ, Denham SA, Ganiban JM. Definitional issues in emotion regulation research. Child Dev 2004; 75: 340-5.
37. Trungpa C. Cutting through spiritual materialism. Berkeley, CA: Shambhala; 1973.
38. Young S. Purpose and method of Vipassana meditation. Humanist Psychol 1994; 22: 53-61.
39. Belleville G, Cousineau H, Levrier K, St-Pierre-Delorme ME, Marchand A. The impact of cognitive-behavior therapy for anxiety disorders on con-comitant sleep disturbances: A meta-analysis. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 2010.
40. Heidenreich T, Tuin I, Pflug B, et al. Mindfulness-based cognitive therapy for persistent insomnia: A pilot study. Psychother Psychosom 2006; 75: 188-9.
41. Ong JC, Shapiro SL, Manber R. Combining mind-fulness meditation with cognitive-behavior therapy for insomnia: A treatment-development study. Be hav Ther 2008; 39: 171-82.
42. Mohammadpour M, Bavafa A, Foroughi A, et al. Generalized anxiety disorder and comorbid symptoms of sleep: The Unified protocol for transdiagnostic treatment of emotional disorders. J Sleep Sci 2019; 3: 80-9.
43. Pouyanfard S, Mohammadpour M, Parvizifard A, et al. The effectiveness of mindfulness-integrated cognitive-behavioral therapy on sleep quality, anxiety, and fatigue in patients with multiple sclerosis: A randomized clinical trial. J Sleep Sci. 2019; 4(1-2): 1-8.
44. Gross CR, Kreitzer MJ, Reilly-Spong M, et al. Mindfulness-based stress reduction versus pharmacotherapy for chronic primary insomnia: A randomized controlled clinical trial. Explore (NY) 2011; 7: 76-87.
2. Kroes M, Kalff AC, Kessels AG, et al. Child psychiatric diagnoses in a population of Dutch school-children aged 6 to 8 years. J Am Acad Child Adolesc Psychiatry 2001; 40: 1401-9.
3. Brady EU, Kendall PC. Comorbidity of anxiety and depression in children and adolescents. Psychol Bull 1992; 111: 244-55.
4. Kessler R, Greenberg P. The economic burden of anxiety and stress disorders. Neuropsychopharmacology: The Fifth Generation of Progress 2002; 67: 981-92.
5. Seager I, Rowley AM, Ehrenreich-May J. Targeting common factors across anxiety and depression using the unified protocol for the treatment of emotional disorders in adolescents. J Ration-Emot Cogn-Behav Ther 2014; 32: 67-83.
6. Aldao A, Nolen-Hoeksema S, Schweizer S. Emotion-regulation strategies across psychopathology: A meta-analytic review. Clin Psychol Rev 2010; 30: 217-37.
7. Chorpita BF, Brown TA, Barlow DH. Diagnostic reliability of the dsm-iii-r anxiety disorders: Mediating effects of patient and diagnostician characteristics. Behav Modif 1998; 22: 307-20.
8. Brozina K, Abela JR. Symptoms of depression and anxiety in children: Specificity of the hopelessness theory. J Clin Child Adolesc Psychol 2006; 35: 515-27.
9. Snyder J, Bullard L, Wagener A, et al. Childhood anxiety and depressive symptoms: trajectories, relationship, and association with subsequent depression. J Clin Child Adolesc Psychol 2009; 38: 837-49.
10. Ehrenreich-May J, Rosenfield D, Queen AH, et al. An initial waitlist-controlled trial of the unified protocol for the treatment of emotional disorders in adolescents. J Anxiety Disord 2017; 46: 46-55.
11. Ginsburg GS, Becker EM, Keeton CP, et al. Naturalistic follow-up of youths treated for pediatric anxiety disorders. JAMA Psychiatry 2014; 71: 310-8.
12. Barlow DH, Farchione TJ, Bullis JR, et al. The unified protocol for transdiagnostic treatment of emotional disorders compared with diagnosis-specific protocols for anxiety disorders: A randomized clinical trial. JAMA Psychiatry 2017; 74: 875-84.
13. Farchione TJ, Fairholme CP, Ellard KK, et al. Unified protocol for transdiagnostic treatment of emotional disorders: A randomized controlled trial. Be hav Ther 2012; 43: 666-78.
14. Barlow DH, Allen LB, Choate ML. Unified protocol for the treatment of emotional disorders. Boston, MA: Boston University; 2003. [Unpublished].
15. Kabat-Zinn J, Hanh TN. Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. New York, NY: Delta Book; 2009.
16. Saltzman A, Santorelli S. A Still Quiet Place: A Mindfulness Program for Teaching Children and Adolescents to Ease Stress and Difficult Emotions. Oakland, CA: New Harbinger Publications; 2014.
17. Napoli M, Krech PR, Holley LC. Mindfulness training for elementary school students. J Appl Psychol 2005; 21: 99-125.
18. Ehrenreich-May J, Bilek E, Buzzella B, Kennedy SM, Mash JA, Bennett S. Unified protocols for the treatment of anxiety disorders in adolescents and children. New York, NY: Oxford University Press; 2016.
19. Snel E. Sitting Still Like a Frog: Mindfulness Exercises for Kids (and Their Parents). Boulder, CO: Shambhala; 2013.
20. Ehrenreich JT, Goldstein CM, Wright LR, et al. Development of a unified protocol for the treatment of emotional disorders in youth. Child Fam Behav Ther 2009; 31: 20-37.
21. Buysse DJ, Reynolds CF 3rd, Monk TH, et al. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res 1989; 28: 193-213.
22. Farrahi MJ, Nakhaee N, Sheibani V, et al. Reliability and validity of the Persian version of the Pitts-burgh Sleep Quality Index (PSQI-P). Sleep Breath 2012; 16: 79-82.
23. Sadock BJ, Sadock VA, Ruiz P. Kaplan and Sadock's synopsis of psychiatry: Behavioral sciences/clinical psychiatry. Philadelphia, PA: Lippincott Williams and Wilkins; 2011.
24. Jastrowski Mano KE, Evans JR, Tran ST, et al. The psychometric properties of the screen for child anxiety related emotional disorders in pediatric chronic pain. J Pediatr Psychol 2012; 37: 999-1011.
25. Birmaher B, Brent DA, Chiappetta L, et al. Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED): A replication study. J Am Acad Child Adolesc Psychiatry 1999; 38: 1230-6.
26. Birmaher B, Khetarpal S, Brent D, et al. The Screen for Child Anxiety Related Emotional Disorders (SCARED): Scale construction and psychometric characteristics. J Am Acad Child Adolesc Psychiatry 1997; 36: 545-53.
27. Mohammadi A, Soleimani M, Mohammadi MR, et al. Unified Protocol for Transdiagnostic Prevention of Depression and Anxiety in Iranian Adolescents: Protocol development and initial outcome data. Iran J Psychiatry 2019; 14: 171-8.
28. Sherman JA, Tonarely NA, Ehrenreich-May J. Targeting comorbid anxiety and depression using the unified protocol for transdiagnostic treatment of emotional disorders in adolescents. Clin Case Stud 2018; 17: 59-76.
29. Essau CA, Sasagawa S, Jones G, et al. Evaluating the real-world effectiveness of a cognitive behavior therapy-based transdiagnostic program for emotional problems in children in a regular school set-ting. J Affect Disord 2019; 253: 357-65.
30. Kennedy SM, Bilek EL, Ehrenreich-May J. A randomized controlled pilot trial of the unified protocol for transdiagnostic treatment of emotional dis-orders in children. Behav Modif 2019; 43: 330-60.
31. Sloan T, Telch MJ. The effects of safety-seeking behavior and guided threat reappraisal on fear re-duction during exposure: an experimental investigation. Behav Res Ther 2002; 40: 235-51.
32. Roemer L, Litz BT, Orsillo SM, et al. A preliminary investigation of the role of strategic withholding of emotions in PTSD. J Trauma Stress 2001; 14: 149-56.
33. Girio-Herrera E, Ehrenreich-May J. Using flexible clinical processes in the unified protocol for the treatment of emotional disorders in adolescence. Psychotherapy (Chic) 2014; 51: 117-22.
34. Holzel BK, Lazar SW, Gard T, et al. How does mindfulness meditation work? proposing mechanisms of action from a conceptual and neural perspective. Perspect Psychol Sci 2011; 6: 537-59.
35. Hayes AM, Feldman G. Clarifying the construct of mindfulness in the context of emotion regulation and the process of change in therapy. Clin Psychol (New York) 2004; 11: 255-62.
36. Bridges LJ, Denham SA, Ganiban JM. Definitional issues in emotion regulation research. Child Dev 2004; 75: 340-5.
37. Trungpa C. Cutting through spiritual materialism. Berkeley, CA: Shambhala; 1973.
38. Young S. Purpose and method of Vipassana meditation. Humanist Psychol 1994; 22: 53-61.
39. Belleville G, Cousineau H, Levrier K, St-Pierre-Delorme ME, Marchand A. The impact of cognitive-behavior therapy for anxiety disorders on con-comitant sleep disturbances: A meta-analysis. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 2010.
40. Heidenreich T, Tuin I, Pflug B, et al. Mindfulness-based cognitive therapy for persistent insomnia: A pilot study. Psychother Psychosom 2006; 75: 188-9.
41. Ong JC, Shapiro SL, Manber R. Combining mind-fulness meditation with cognitive-behavior therapy for insomnia: A treatment-development study. Be hav Ther 2008; 39: 171-82.
42. Mohammadpour M, Bavafa A, Foroughi A, et al. Generalized anxiety disorder and comorbid symptoms of sleep: The Unified protocol for transdiagnostic treatment of emotional disorders. J Sleep Sci 2019; 3: 80-9.
43. Pouyanfard S, Mohammadpour M, Parvizifard A, et al. The effectiveness of mindfulness-integrated cognitive-behavioral therapy on sleep quality, anxiety, and fatigue in patients with multiple sclerosis: A randomized clinical trial. J Sleep Sci. 2019; 4(1-2): 1-8.
44. Gross CR, Kreitzer MJ, Reilly-Spong M, et al. Mindfulness-based stress reduction versus pharmacotherapy for chronic primary insomnia: A randomized controlled clinical trial. Explore (NY) 2011; 7: 76-87.
| Files | ||
| Issue | Vol 5 No 4 (2020): Autumn | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jss.v5i4.7805 | |
| Keywords | ||
| Unified protocol Emotional disorders Sleep Mindfulness | ||
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How to Cite
1.
Sarallahi M, Ahmadi R, Soltanabadi S, Farnoodimehr R, Foroughi A. The Effectiveness of Adjunctive Mindfulness Therapy with a Unified Protocol on the Emotional Disorders and Sleep Problems of Adolescents. J Sleep Sci. 2021;5(4):132-139.
