Learning About Therapeutic Modalities: What Is the Unified Protocol (UP)?

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Psychotherapy is a rich and vibrant field that is continually evolving. This means there is a great variety of therapeutic approaches practiced by mental health professionals. Some, such as Cognitive Behavioral Therapy, are well-known and widely researched. Today we’d like to introduce you to a promising, newer modality that you may be less familiar with: the Unified Protocol (UP). The UP draws upon ideas and concepts from other traditions, particularly Cognitive Behavioral Therapy (CBT). It was developed by David Barlow and his team of researchers at the Center for Anxiety and Related Disorders (CARD) at Boston University. Research has demonstrated that clients who engage in the UP not only show marked improvement during treatment, but also continue to maintain and even further improve upon their progress after they transition out of therapy. This is thought to be because the UP goes beyond helping you in the moment to also teach you how to internalize these skills to serve you throughout life.

The UP is unique in that it is a transdiagnostic treatment, meaning that it can be applied to a wide variety of presenting concerns, including anxiety, OCD, depression, eating disorders, and more. Rather than focusing on diagnoses and symptoms, the UP focuses on emotional, cognitive and behavioral patterns that tend to be present across a wide range of problems. These include:

  • Frequently and intensely experiencing strong, distressing emotions
  • Viewing emotional experiences negatively
  • Avoiding and suppressing emotions

What does this mean for you in therapy?

It is always good to remember that, no matter the modality, therapy is not simply about feeling good but rather about getting good at managing how you are coping with what you are feeling. By becoming better able to tolerate stressors and emotions as they arise, a byproduct tends to be that overall you do feel better. However, coming to therapy with the goal of never having to feel bad just isn’t realistic. With that in mind, the UP works on learning to respond to uncomfortable emotions more flexibly and effectively. In doing so, you will likely find that other stressors and symptoms present in your life are improved as well when you are better able to tolerate distress.

How exactly will your therapist help you accomplish this?

Given that the UP is a manualized treatment, there quite literally is a manual with a step-by-step process to follow for evidence-based practice. What is important to consider is that manuals and research evidence don’t always reflect your lived experience, so it is essential for both you and your therapist to remain flexible within any approach. Your therapist will help you do this by centering your needs during treatment as well as employing their clinical expertise to determine when/whether certain interventions are useful or not. With that in mind, it is possible that you and your therapist may not follow the UP to a tee, and that is okay! Some interventions that you may or may not see depending on what your therapist recommends and what fits best for you include:

  • Fostering mindful emotion awareness through:
    • Increasing your understanding of emotions with exploration around why they occur and how they are adaptive
    • Exploring the interaction between your thoughts, physical sensations, and behaviors in generating your internal experience of emotions
    • Tracking emotional experiences to gain awareness, identify triggers, and develop an objective view of emotions
    • Cultivating a nonjudgmental and sense of present-moment awareness toward emotional experiences
  • Increasing flexibility in your thinking patterns through:
    • Challenging negative automatic thoughts
    • Recognizing and decreasing thoughts in which you may overestimate the likelihood of negative event happening and/or exaggerate the consequences of that negative event if it did happen
    • Developing confidence in your ability to deal with distress
    • Not eliminating or replacing negative thoughts but rather increasing flexibility in your thinking patterns to help regulate your emotions
    • Learning how to find a new outlook on situations to consider new perspectives
    • Revisiting and deepening exploration of interaction between thoughts, physical sensations, and behaviors
  • Changing patterns of action and behavior that do not serve you through:
    • “Acting” your way into new way of feelings – think “fake it until you make it”
    • Identifying where you tend to avoid emotions, at times out of feeling a need for safety against perceived versus real threats
    • Eliminating avoidance by creating new learning and memories to decrease tendency to avoid or suppress emotions with replacement of actions that better serve you
  • Recognizing and confronting physical sensations and increasing your ability to tolerate emotions through:
    • Eliciting of and exposure to emotions
    • Increasing awareness and tolerance of physical sensations through exposures in which you first experience the physical sensation separate from the emotion in a safe, intentional way to reduce the contribution of physical sensations to emotion aversion and avoidance
    • Identifying how physical sensations influence thoughts and behaviors and vice versa
    • Challenging expectations about ability to cope through exposures
    • Confronting the distressing situation if possible

The UP focuses on eliminating avoidance of difficult emotions and increasing your ability to tolerate and effectively cope with distress knowing that, at the end of the day, life will inevitably put you in uncomfortable situations that you simply cannot avoid. While avoidance may work for you in some situations, there will be other times where it is likely going to do more harm than good. By aiming to empower you to confront life head on, no matter what it throws at you, the UP sets you up to get better at coping with whatever arises for you, reducing emotional distress in the process.

To learn more about the UP, visit Unified Protocol Institute.


Barlow, D. H., Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L., Allen, L. B., & May, J. T. E. (2018). Unified protocol for transdiagnostic treatment of emotional disorders: Therapist guide. Oxford University Press.

Thompson-Brenner, H., Singh, S., Gardner, T., Brooks, G.E., Smith, M.T., Lowe, M.R., & Boswel, J.F. (5 Mar. 2021). “The Renfrew Unified Treatment for Eating Disorders and Comorbidity: Long-Term Effects of an Evidenced-Based Practice Implementation in Residential Treatment.” Frontiers in Psychiatry.