The unified transdiagnostic protocol (UP)
David Barlow's protocol, which works not with a single diagnosis but with the mechanism common to all emotional disorders.
The problem the protocol solves
Classical CBT developed separate protocols for separate disorders: one for panic, one for social anxiety, one for depression. This works — as long as a person has one disorder.
In reality that is rare. Usually anxiety is combined with depression, one anxiety disorder with another, and some conditions do not fit diagnostic boundaries at all. Working sequentially through three protocols is slow and inefficient.
UP starts from something else: behind all emotional disorders lies a common mechanism — a negative reaction to your own emotions and the urge to avoid them. So the work can address the mechanism rather than the diagnosis.
The common mechanism
The pattern runs roughly like this: a person experiences a strong unpleasant emotion → perceives the emotion itself as unbearable or dangerous → takes action to remove it (avoidance, distraction, suppression, a ritual) → gets brief relief → sensitivity to that emotion increases.
Only the “casing” differs: for one person it is fear of a pounding heart, for another fear of being judged, for a third an inability to tolerate sadness. The mechanism is the same.
Five modules
Emotional awareness. We learn to notice an emotion and its components — thoughts, bodily sensations, the urge to act — without merging with it.
Cognitive flexibility. Work with the automatic interpretations that intensify the emotion.
Giving up emotional avoidance. We identify all the ways in which you avoid experience, including subtle ones: distraction, safety behaviours, postponement.
Changing emotion-driven behaviour. Acting opposite to the urge: not leaving when you want to leave; not checking when you want to check.
Exposure to emotions and situations. Including interoceptive exposure — work with the bodily sensations themselves that frighten you.
Who it suits
Above all people who have “everything at once”: anxiety, low mood, irritability, bodily symptoms — and no clarity about what to tackle first. UP makes it possible to work on all of it with a single logic.
How long it lasts
The standard protocol is designed for roughly 12–18 sessions.
At the centre
UP is one of the centre’s training programmes. Elements of the protocol are used in individual work with comorbid conditions.
Find a specialist
Write to us — a coordinator will clarify what you need and suggest a therapist who works in this approach.