A pilot randomized effectiveness trial of the unified protocol in trauma‐exposed veterans

Background The unified protocol (UP) is a promising transdisgnostic treatment for emotional disorders; limited data exists with trauma‐exposed populations. This study compared effectiveness of the UP, presented centered therapy (PCT), and treatment as usual (TAU) in trauma‐exposed veterans presenting to routine care. Method Trauma‐exposed veterans with one or more emotional disorder diagnoses participated in a pilot hybrid‐1 effectiveness/preimplementation study. Thirty‐seven male and female veterans were randomized to one of three conditions. Results Multilevel growth curve modeling demonstrated improvement over time across conditions with large effect sizes (range: −2.15 to −3.32), with the UP demonstrating the greatest change. The between group effect sizes for reductions in number of comorbid diagnoses were medium to small and statistically significant (TAU and UP, d = 0.49, p = .056; TAU and PCT d = 0.18, p = .166, UP and PCT d = 0.31, p = .229). Only the UP led to a decrease in the number of comorbid diagnoses (d = −0.71). Psychosocial functioning varied by group, with slight increases in impairment in PCT and TAU, and medium effect size reduction in the UP. Only the UP exhibited significant decreases in self‐reported anxiety and depression. Between group differences for UP and PCT were medium to large and statistically significant for depression across two measures (d = −0.72 to d = −1.40). Conclusions This represents the first trial examining effectiveness of the UP, PCT, and TAU in trauma‐exposed veterans. Despite a small sample, large effect size differences demonstrated promising advantages for the UP. Trial Registration Number: NCT02944994.