Efficacy of the unified protocol for adolescents (UP-A): A systematic review of randomized controlled trials

Objective: The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) is a cognitive-behavioral therapy (CBT) approach designed to address shared etiological mechanisms underlying emotional disorders. This study aimed to conduct a systematic review of randomized controlled trials (RCTs) evaluating the efficacy of the UP-A for both the treatment and prevention of emotional disorders. Method: Six electronic databases (Scopus, PsycINFO, EBSCO, Google Scholar, PubMed, and Medline) were systematically searched for RCTs examining the effectiveness of the UP-A in adolescent populations. Eligible studies were screened, and methodological characteristics and key findings were analyzed. Results: Eleven RCTs, comprising a total of 1,002 participants, were conducted between 2017 and 2025. The included studies involved adolescents with diagnosed emotional disorders or related symptoms, as well as other mental disorders. Various delivery formats (individual, group, digital, and telehealth), settings (clinical and school-based), and purpose (treatment or prevention) were represented. Both within-group and between-group improvements favored the UP-A condition, particularly when compared to waitlist control groups. Positive outcomes extended to transdiagnostic etiological factors, including negative affect, anxiety sensitivity, intolerance of uncertainty, and emotion regulation strategies. Conclusions: This systematic review provides evidence supporting the UP-A as an effective intervention for emotional disorders and related transdiagnostic mechanisms across diverse formats and settings.