2 - (IOP 9) Brief Group Adaptation of the Unified Protocol for Integrated Primary Care: Mixed Methods Evaluation of Whether Targeted Constructs Change During Treatment

Group psychotherapy delivered in primary care settings can help to bridge the mental health treatment divide by increasing access to evidence-based treatment for patients who may not have the time, money, or willingness to seek specialty care. The Unified Protocol (UP) for Transdiagnostic Treatment of Emotional Disorders, which can treat multiple different disorders simultaneously by targeting underlying mechanisms of emotion dysregulation, is an efficient way to accommodate the needs of patients with a variety of presenting concerns in a group format. We developed a brief group adaptation of the UP specifically for integrated primary care settings called Managing Stress and Emotions (MSE), which at five 60-minute classes is the lowest UP dose tested in group format according to a recent review of the group UP literature. MSE covers psychoeducation and tracking of emotions, mindful emotion awareness, cognitive appraisal and reappraisal, emotional behaviors, and relapse prevention. In a pilot open trial (N=18) we found significant pre- to post-treatment decreases in mental health symptoms and functional impairment. The purpose of this mixed methods evaluation was to examine whether the constructs targeted in MSE (potential mechanisms) changed pre- to post-treatment as evidenced by scores on validated measures and/or qualitative reports. Participants were 18 adult Veterans (33% female, 28% racial/ethnic minority, mean age=47 [15] years) recruited from 2 VA healthcare systems who screened positive for symptoms of anxiety, depression, or adjustment; completed validated measures at pre- and post-treatment (n=12); and provided qualitative feedback on what (if any) coping skills they learned and any changes in behavior or functioning at post. Participants showed significant pre- to post-treatment improvements in non-acceptance of emotional reactions (p=.005, d=1.0) and use of cognitive restructuring (p=.04, d=-.67) with medium to large effect sizes. Decreases in experiential avoidance (p=.13, d=.47), lack of emotional clarity (p=.06, d=.61), and lack of emotional awareness (p=.56, d=.17) were not statistically significant but had small to medium effect sizes. Rapid analysis of interview data found that most participants reported increased self-awareness and use of mindfulness, cognitive flexibility, and alternative behaviors to improve psychosocial functioning after MSE. Overall, the quantitative pattern of improvements in emotional clarity/acceptance and use of adaptive cognitive-behavioral and emotion regulation strategies was reinforced by qualitative reports of good understanding of the primary skills taught in MSE with successful application of those skills to regulate emotional intensity and manage life stressors. Despite the small sample size and open trial design, our results are promising given the low dose of group UP treatment delivered to a sample of primary care patients and the consistency with prior research showing that emotional regulation skills mediate the impact of the UP on mental health outcomes. Future research is needed to corroborate our findings in larger samples and formally examine mechanisms of brief group UP treatment using longitudinal designs.