Unified Psychodynamic Protocol for anxiety disorders

Domain I · Psychodynamic & depth psychology · Leichsenring, Salzer · 2014

What it is

UPP-ANXIETY is a transdiagnostic, modular, short-term psychodynamic therapy for GAD, panic disorder (with or without agoraphobia) and social anxiety disorder. It is also proposed, with less evidence, for specific phobia, avoidant personality disorder and other anxiety presentations. OCD and PTSD…

Format

• Format. Individual, face-to-face therapy of up to 25 sessions. The last three are booster sessions spaced two weeks apart. The therapist must already be trained in psychodynamic therapy.. Weekly frequency is the usual SE short-term default but the 2014 paper does not state it. The authors'…
• Practical phase map. The paper gives no per-module session counts. The map below borrows the phase lengths from the authors' SET manuals and is approximate.

Who practises it, and how they are trained or regulated

• Hinted module list mapped to the 2014 version: "setting treatment goals" sits in Module 2. "Function of anxiety" is spread across Module 1 (signal anxiety) and Module 7 (the defensive function of anxiety, worry and avoidance). "Deficits in ego functions" corresponds to the authors' transdiagnostic rationale (affect regulation, mentalisation, object relations) and to the rule of being more supportive when structural…

Evidence status, as the guide reports it

• UPP-ANXIETY is a transdiagnostic, modular, short-term psychodynamic therapy for GAD, panic disorder (with or without agoraphobia) and social anxiety disorder. It is also proposed, with less evidence, for specific phobia, avoidant personality disorder and other anxiety presentations. OCD and PTSD…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Feeling shamed by the interruption. Keep a warm tone.
• Fragmentation or dissociation under affect focus. Stabilise first.
• Disconfirming evidence being dismissed as luck. Keep collecting it.
• Repeated demands for reassurance. Take these as material for the CCRT.
• Ambivalence showing up as uncertainty about scheduling. Take it to Module 2.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.