Unified Protocol: Group treatment for children and adolescents with anxiety and depression

The aim of the project is to investigate group treatment using the Unified Protocol for children and adolescents with anxiety and/or depression within Child and Adolescent Psychiatry (CAP) in Karlstad. The study examines both the feasibility of delivering the treatment in routine clinical practice and whether participation is associated with changes in anxiety, depression, functioning, and quality of life.
The Unified Protocol (UP) is a transdiagnostic form of cognitive behavioral therapy (CBT). This means that the treatment does not focus on a single diagnosis, but rather on common processes that may contribute to different forms of emotional difficulties. During treatment, participants practice, among other things, understanding and attending to emotions, increasing flexibility in how they think and act, reducing avoidance, and gradually approaching emotions and situations that are experienced as difficult.

The following research questions are central to the study:

Is group treatment with the Unified Protocol associated with reduced symptoms of anxiety and depression and improved quality of life and functioning in children and adolescents?
Is the treatment associated with a reduced impact of the child’s anxiety symptoms on caregivers’ daily lives and functioning?
Is the group treatment feasible within Child and Adolescent Psychiatry in terms of recruitment, participation, adherence, and acceptability?
How do children, adolescents, and caregivers experience the treatment content, group format, relevance, and usefulness?

Participants are followed throughout treatment and until approximately three months after treatment has ended. They complete questionnaires assessing, among other things, anxiety, depression, quality of life, and functional impairment. Information about attendance and treatment completion is also collected. In addition, a sample of children, adolescents, and caregivers will be interviewed about their experiences of the treatment.

From a broader perspective, the study may contribute knowledge about how a transdiagnostic group treatment can be used within Child and Adolescent Psychiatry. If the treatment proves feasible and is associated with improved well-being, the findings may contribute to the development of accessible treatment options for children and adolescents with anxiety and depression.

Participants

Participants are recruited through Child and Adolescent Psychiatry in Karlstad. The study includes two age groups: children aged 9–11 years and adolescents aged 15–17 years. To be eligible for participation, the child or adolescent must:

be a patient at Child and Adolescent Psychiatry in Karlstad,
be aged 9–11 years or 15–17 years, and
meet the criteria for an anxiety disorder and/or depression.

Children and adolescents with severe self-harming behavior, suicidality, or severe social difficulties that make group treatment unsuitable are not included in the study. Suitability is assessed by clinicians within Child and Adolescent Psychiatry prior to the start of the group. Participation in the research study is voluntary. A decision not to participate in the research will not affect the opportunity to take part in the group treatment or to receive continued care within Child and Adolescent Psychiatry. A total of up to 46 children and adolescents are planned to participate in the study.

The intervention

The Unified Protocol is available in different versions adapted for children and adolescents. The project uses the Unified Protocol for Children (UP-C) for children aged 9–11 years and the Unified Protocol for Adolescents (UP-A) for adolescents aged 15–17 years. The treatment is delivered in a group format and consists of 15 group sessions.

The treatment is organized around different modules focusing on, among other things, motivation, understanding and awareness of emotions, flexible thinking, emotion-driven behaviors and avoidance, and gradually approaching emotions, bodily sensations, and situations that have previously been avoided. A central principle of the treatment is that participants develop new ways of relating to strong and unpleasant emotions. The goal is not to avoid or eliminate all difficult emotions, but to increase the ability to manage them and to act in ways that are consistent with what is important in the longer term.

Caregivers are also involved in the treatment. During the parent sessions, they receive information about the skills the children and adolescents are working on and, among other things, practice strategies for supporting the child’s independence, emotion regulation, and helpful behaviors.

Project organization and implementation

The project is conducted in collaboration between Child and Adolescent Psychiatry in Region Värmland and Karlstad University. The study is a clinical within-group study. Participants complete questionnaires before treatment, during treatment, after treatment has ended, and at a follow-up approximately three months later. The assessments measure symptoms of anxiety, symptoms of depression, quality of life, and functional impairment.

The study also examines the feasibility of the treatment, including information about participants’ attendance, treatment completion, and the need for additional treatment sessions. After treatment has ended, individual interviews are also conducted with a sample of children, adolescents, and caregivers in order to gain a more in-depth understanding of how the group treatment is experienced.

Five treatment groups are planned within the project. Data collection will take place during the project period 2026–2029.

The principal investigator is Siri Jakobsson Störe. The research team also includes licensed psychologist Rebecka Hektor, licensed psychologist Andrea Stjerngren, and Associate Professor Maria Unenge Hallerbäck.