(PS5-21) Implementation of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Japanese Clinical Settings: Examining the Role of Implementation Leadership

Abstract Text:

Introduction: The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) is a transdiagnostic cognitive-behavioral therapy (CBT) focused on emotion regulation. Despite the demonstrated efficacy for emotional disorders (e.g., anxiety and depressive disorders), UP remains underutilized in Japan. Literature on implementation science suggests that implementation leadership plays a key role in the use of evidence-based practices (Williams et al., 2020). However, its role in implementing evidence-based psychotherapy in Japanese clinical settings remains unexplored. This study examined the influence of implementation leadership on the sustained use of the UP among Japanese clinicians.

Methods: We asked clinicians who attended the UP training workshops to participate in the cross-sectional study and complete an online survey. Participants provided informed consent before completing measures on demographics, the Implementation Leadership Scale (ILS, Range = 0–48), the Intervention Appropriateness Measure (IAM, Range = 4–20), and the Provider Report of Sustainment Scale in organizational and individual contexts (PRESS-org/ind, Range = 0–12). This study was approved by the National Center of Neurology and Psychiatry (A2023-089).

Results: Two hundred seventy-eight participants completed the survey. The most common age group was 40–49 years (n = 101), and the most frequent length of clinical experience was 10–20 years (n = 103). The most prevalent profession was psychologist (n = 166), followed by physician (n = 79) and other professions (n = 33). After screening for eligibility—such as excluding those not actively providing psychotherapy—188 respondents were deemed eligible. The median scores were as follows: ILS (Mdn = 12.00), IAM (Mdn = 13.00), PRESS-org (Mdn = 0.00), and PRESS-ind (Mdn = 3.00). Hierarchical multiple regression indicated that the ILS significantly predicted the PRESS-org/ind after controlling for clinical experience, profession, workplace domains, and gender. The final model explained 13% and 23% of the variance (R² = .13 and .23). Adding the IAM (ΔR² = .02 and.11) and ILS (ΔR² = .07 and.08) significantly improved both models (p < .001). The ILS (β = .30, p < .001) significantly predicted the PRESS-org, while the IAM (β = .08, p = .27) did not. Both the ILS (β = .31, p < .001) and IAM (β = .27, p < .001) significantly predicted the PRESS-ind.

Discussion: Findings highlighted the role of implementation leadership in sustaining the use of the UP in Japanese clinical settings. The ILS significantly predicted sustainment at both individual and organizational levels, with a stronger effect observed at the individual level. On the other hand, the IAM predicted individual but not organizational sustainment, indicating clinicians' perception of administering UP to their patients influences personal use but not organizational-level use.

Conclusion: This study underscores the importance of implementation leadership in sustaining the UP in Japan. Leadership training and targeted dissemination efforts could support the implementation of the UP. Further research should examine leadership's influence on implementation outcomes and additional factors contributing to sustainable practice change.