Unified Protocol For Treatment Of Depression

The patient ("Will") was referred for individual psychotherapy by his parents. Will was an 18-year-old, heterosexual, Caucasian male who was seen for 22 outpatient psychotherapy sessions in a routine mental health clinic setting. Will completed a comprehensive initial assessment that involved the Anxiety Disorders Interview Schedule for DSM-5 (ADIS-5) [1]. Selfreport measures were administered at intake, every 2 months during treatment, and at termination to evaluate treatment response in a variety of symptom domains: the Overall Depression Severity and Impairment Scale (ODSIS) [2], the Overall Anxiety Severity and Impairment Scale (OASIS) [3], the Beck Depression Inventory (BDI-II) [4], the Penn State Worry Questionnaire (PSWQ) [5], and the Social Interaction Anxiety Scale (SIAS) [6].Will reported his developmental milestones were met within normal limits, and he had a history of good physical health. He reported one previous course of psychotherapy that lasted four sessions and focused primarily on anxiety-related problems, which he reported finding helpful. A family history of depression and anxiety-related problems was noted. The patient denied any history of psychotropic medication. At the time of the initial assessment, Will was a senior in high school and graduated partway through treatment. Will reported previously being involved in high school athletics; however, he had recently stopped participating in this and other school activities. He also reported no longer being interested in playing and listening to music and spending less time engaging in recreational and social activities since the onset of his depression.Will endorsed symptoms consistent with a major depressive episode, including significant low mood, anhedonia, sleep disturbances (problems falling and staying asleep), psychomotor agitation, persistent feelings of worthlessness, shame, and guilt. He endorsed occasional, passive suicidal ideation, yet he denied ever having a specific plan to harm himself. His reality testing appeared to be intact and he denied any alcohol or substance use. He described himself as "always quiet and shy" and that this became more pronounced after switching high schools between his freshman and sophomore years. Based on the information gathered during the diagnostic assessment, Will appeared to meet criteria for a principal (i.e., most interfering and distressing) diagnosis of major depressive disorder (MDD; clinical severity rating [CSR] = 6) and a secondary diagnosis of generalized anxiety disorder (GAD; CSR = 5). Baseline scores from the self-report measures are listed in Table 12.1.