What is the “unified protocol” for PTSD? And how can this help?

Many of us experience at least one potentially traumatic event in our lifetime. These can be accidents, natural disasters, exposure to war and combat, or physical and sexual assault.

Humans are resilient and most adapt well afterwards. However, some people can develop post-traumatic stress disorder (PTSD) when emotional difficulties persist.

The most common symptoms include reliving the trauma through nightmares and overwhelming reminders of the event; avoid reminders of the event; chronic feeling of being alert and “on guard” in the face of danger; and profound changes in beliefs about themselves, the world and the future.

The good news is that we have a number of evidence-based treatments for PTSD. And one of the promises is the “unified protocol”.

Trauma-focused treatments

All of the common first-line treatments for PTSD involve some sort of trauma “memory treatment”. We call these treatments “trauma-focused”.

By repeatedly recalling the memory of the trauma in a safe and controlled manner, the person can begin to see this event as having occurred in the past; it no longer happens in the “here and now”. The person also learns that the memory itself is not inherently dangerous or something to be avoided.

Read more: Explanator: what is post-traumatic stress disorder?

When PTSD isn’t the only problem

However, not everyone improves with “trauma-focused” treatment. Treatment appears to be effective for a third of people, partially effective for another third, and the rest may not improve significantly.

Most people with PTSD also experience depression, high levels of anger, severe anxiety, or a combination of these. Substance use is also common. And these other difficulties reduce the chances of success with standard treatment.

Thus, in recent years, we have seen the emergence of “transdiagnostic” therapies. These aim to address the common underlying processes believed to contribute to a wide range of emotional disorders. These approaches can be especially helpful for people who have more than one emotional disorder.

This is where the “unified protocol” for treating emotional disorders comes in.

A review, led by our team at the University of Technology Sydney, indicated that people with anxiety disorders and depression can expect significant improvement by taking the structured and skill-based modules that form the treatment. .

These modules include a range of emotion regulation skills to help the person accept or re-evaluate negative emotions. People don’t completely eliminate these emotions, but learn to respond to them in the most effective way possible.

Read more: There is a strong link between anxiety and depression, and problems sleeping, and it works both ways

What about the “unified protocol” for PTSD?

Earlier this year, a randomized controlled pilot trial led by our team in Phoenix Australia, University of Melbourne, gave hope that the “unified protocol” could also help people with PTSD.

The trial included 43 adults who had experienced a traumatic event and developed symptoms of post-traumatic stress disorder, many of whom were diagnosed with PTSD. Some also suffered from depression or anxiety.

People with symptoms of post-traumatic stress who attended 10 to 14 hour sessions of the “unified protocol” once a week had fewer symptoms of PTSD at the end of treatment, and six months after treatment, than people who were free to choose any psychological or pharmacological treatment.

We think the people in the “unified protocol” group did better because this treatment can treat PTSD in a different way than directly targeting trauma memory.

In other words, the “unified protocol” can help the person to better regulate their emotions and reduce them by avoiding distressing emotions. Thus, the symptoms of PTSD can improve without focusing specifically on the memory of the trauma.

Read more: What makes a good psychologist or psychiatrist and how do you find one you like?

However, we still have a lot to learn. This is why our research team at the University of Melbourne is conducting a larger randomized controlled study.

This will hopefully tell us which people might respond better to “unified protocol” and which to trauma-focused treatment.

Having a range of treatments for PTSD, which work in different ways, can potentially help many Australians with PTSD. Ideally, this will allow clinicians and their clients to make an informed decision about the best treatment.

If this article has raised any issues for you, or if you are concerned about someone you know, call Lifeline on 13 11 14. More information on PTSD and support is available from Phoenix Australia. The Australian Association of Clinical Psychology offers a free clinical psychologist search service. Or you can see your GP for other referral options.

About Margie Peters

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