Aims and Hypotheses

The current study investigated change in TPA severity ratings across the course of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C/A; Ehrenreich-May et al., 2018). There is initial evidence to suggest that the TPA can capture early-treatment response, defined broadly as a significant improvement in client symptom severity occurring early in treatment, to the UP-C/A (Milgram et al., 2021); however, no study has looked to see if the TPA can capture symptom improvement and treatment efficacy across the UP-C/A. The current study aims to address this gap in the literature by examining change in TPA severity ratings between the first and last sessions of the UP-C/A in youth with emotional disorders from a research clinic-based evaluation of this intervention. Given past work indicating the effectiveness of the UP-C/A in reducing anxiety and depression symptom ratings, we hypothesized that TPA ratings would significantly decrease over the course of treatment indicating treatment effectiveness across the UP-C/A (Queen et al., 2014).

Our second aim is to assess the clinical significance of the TPA. The reliable change index (RCI; Jacobson & Truax, 1991) can be used to assess whether changes in a psychometric measure are representative of clinically reliable change produced by an intervention or are due to measurement error. The RCI is one additional method to assess significant changes associated with psychotherapy since it can provide an evidence-based analysis of change (Del Prette & Del Prette, 2008). We hypothesize that the RCI ratings from the TPA will indicate clinically significant reductions in personalized measures of treatment outcome in youth.

We also investigated what clinical and demographic variables were associated with change in top problem ratings. Studies have varied in consistency as to the specific demographic predictors that influence treatment outcomes. For instance, some studies have found that older age, lower socio-economic status, and minority status are associated with poorer treatment outcomes (Ginsburg et al., 2011; Jakubovski & Bloch, 2016). However, other studies have found no significant relationship between age, ethnicity, and income regarding treatment outcomes (Treadwell et al., 1995; Bennet et al., 2013; Southam-Gerow et al., 2001). Prior work investigating the UP-C/A has shown that depression, symptom severity, parent psychopathology, and child age were not significant predictors of anxiety and depression symptom and diagnosis-level treatment outcomes (Kennedy et al., 2018). As such, we hypothesize that demographic variables, such as age, ethnicity, and gender will also not significantly predict change in top problems for both the child and parent. We also aim to see if any clinical variables such as early- or mid- treatment response, baseline anxiety and depression symptoms, and number of sessions attended significantly predicts change in top problem ratings.