Importance  Transdiagnostic interventions have been developed to address barriers to the dissemination of evidence-based psychological treatments, but only a few preliminary studies have compared these approaches with existing evidence-based psychological treatments.

Objective  To determine whether the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) is at least as efficacious as single-disorder protocols (SDPs) in the treatment of anxiety disorders.

Design, Setting, and Participants  From June 23, 2011, to March 5, 2015, a total of 223 patients at an outpatient treatment center with a principal diagnosis of panic disorder with or without agoraphobia, generalized anxiety disorder, obsessive-compulsive disorder, or social anxiety disorder were randomly assigned by principal diagnosis to the UP, an SDP, or a waitlist control condition. Patients received up to 16 sessions of the UP or an SDP for 16 to 21 weeks. Outcomes were assessed at baseline, after treatment, and at 6-month follow-up. Analysis in this equivalence trial was based on intention to treat.

Interventions  The UP or SDPs.

Main Outcomes and Measures  Blinded evaluations of principal diagnosis clinical severity rating were used to evaluate an a priori hypothesis of equivalence between the UP and SDPs.

Results  Among the 223 patients (124 women and 99 men; mean [SD] age, 31.1 [11.0] years), 88 were randomized to receive the UP, 91 to receive an SDP, and 44 to the waitlist control condition. Patients were more likely to complete treatment with the UP than with SDPs (odds ratio, 3.11; 95% CI, 1.44-6.74). Both the UP (Cohen d, −0.93; 95% CI, −1.29 to −0.57) and SDPs (Cohen d, −1.08; 95% CI, −1.43 to −0.73) were superior to the waitlist control condition at acute outcome. Reductions in clinical severity rating from baseline to the end of treatment (β, 0.25; 95% CI, −0.26 to 0.75) and from baseline to the 6-month follow-up (β, 0.16; 95% CI, −0.39 to 0.70) indicated statistical equivalence between the UP and SDPs.

Conclusions and Relevance  The UP produces symptom reduction equivalent to criterion standard evidence-based psychological treatments for anxiety disorders with less attrition. Thus, it may be possible to use 1 protocol instead of multiple SDPs to more efficiently treat the most commonly occurring anxiety and depressive disorders.

Trial Registration  clinicaltrials.gov Identifier: NCT01243606

重要性  跨诊断干预措施的开发是为了解决传播循证心理治疗的障碍，但只有少数初步研究将这些方法与现有的循证心理治疗进行了比较。

目的  确定情绪障碍跨诊断治疗统一方案 (UP) 在治疗焦虑症方面是否至少与单一疾病方案 (SDP) 一样有效。

设计、环境和参与者  从2011年6月23日到2015年3月5日，门诊治疗中心总共有223名患者，主要诊断为惊恐障碍，伴或不伴广场恐惧症、广泛性焦虑症、强迫症或社交焦虑障碍根据主要诊断被随机分配到 UP、SDP 或候补名单控制条件。患者接受了多达 16 次 UP 或 SDP，为期 16 至 21 周。在基线、治疗后和 6 个月随访时评估结果。该等效性试验的分析基于意向治疗。

干预措施  UP 或 SDP。

主要结果和措施  主要诊断临床严重程度评级的盲法评估用于评估 UP 和 SDP 之间等效性的先验假设。

结果  在 223 名患者（124 名女性和 99 名男性；平均 [SD] 年龄，31.1 [11.0] 岁）中，88 名随机接受 UP，91 名接受 SDP，44 名接受候补对照条件。与 SDP 相比，患者更有可能完成 UP 治疗（比值比，3.11；95% CI，1.44-6.74）。UP（Cohen d，-0.93；95% CI，-1.29至-0.57）和SDP（Cohen d，-1.08；95% CI，-1.43至-0.73）在急性结局方面均优于候补对照条件。从基线到治疗结束（β，0.25；95% CI，-0.26 至 0.75）以及从基线到 6 个月随访（β，0.16；95% CI，-0.39 至 0.70）临床严重程度评级降低）表明 UP 和 SDP 之间的统计等效性。

结论和相关性  UP 产生的症状减轻效果相当于针对焦虑症的标准循证心理治疗，且损耗较少。因此，可以使用一种方案而不是多种 SDP 来更有效地治疗最常见的焦虑症和抑郁症。

试验注册  ClinicalTrials.gov 标识符：NCT01243606