OBJECTIVE Although the Unified Protocol contains multiple distinct skills to target anxiety, depression, and related conditions, researchers have yet to establish if patients' use of these skills contributes to symptom change. Using data from the first-stage randomization of a sequential multiple assignment randomized trial, we tested whether general skillfulness, defined by skill knowledge, frequency, quality, and effectiveness, predicted within- or between-person changes in anxiety and depression. We further tested whether use of particular UP skills (e.g., mindfulness and behavior change) predicted changes in these outcomes. METHOD Participants (N = 70; Mage = 33.74, 67% female, 74% white) completed six sessions of core UP modules and reported on their skillfulness and specific skill use using two novel measures, along with their symptoms of anxiety (Overall Anxiety Severity and Impairment Scale) and depression (Overall Depression Severity and Impairment Scale) before each session, and their alliance (Working Alliance Inventory) after each session. We disaggregated between- from within-person effects to test the effects of skillfulness, skill use, and the alliance on session-to-session symptom change. RESULTS Greater within-person skillfulness predicted decreases in anxiety and depression. More frequent within-person use of all UP skills predicted decreases in anxiety, whereas more frequent within-person use of alternative actions specifically predicted decreases in depression. CONCLUSIONS This pattern of results provides guidance on the specific aspects of skill training to prioritize in transdiagnostic treatments depending on whether therapists are targeting anxiety or depression. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

中文翻译：

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统一协议中技能使用的维度：探索对焦虑和抑郁的独特影响。

目标尽管统一协议包含针对焦虑、抑郁和相关疾病的多种不同技能，但研究人员尚未确定患者对这些技能的使用是否有助于症状改变。使用来自顺序多重分配随机试验的第一阶段随机化的数据，我们测试了由技能知识、频率、质量和有效性定义的一般技能是否可以预测焦虑和抑郁的个体内部或个体之间的变化。我们进一步测试了使用特定的 UP 技能（例如，正念和行为改变）是否可以预测这些结果的变化。方法 参与者（N = 70；法师 = 33.74，67% 女性，74% 白人）完成了 6 节核心 UP 模块，并使用两项新措施报告了他们的技能和具体技能使用情况，以及每次会议前他们的焦虑症状（总体焦虑严重程度和损害量表）和抑郁症（总体抑郁严重程度和损害量表），以及每次会议后他们的联盟（工作联盟清单）。我们分解了个体之间的影响，以测试技能、技能使用和联盟对会话间症状变化的影响。结果 更高的人际技能预示着焦虑和抑郁的减少。更频繁地使用所有 UP 技能可以预测焦虑的减少，而更频繁地使用替代动作可以预测抑郁症的减少。结论 这种结果模式为技能培训的特定方面提供了指导，根据治疗师是针对焦虑症还是抑郁症，在跨诊断治疗中优先考虑这些方面。（PsycInfo 数据库记录 (c) 2022 APA，保留所有权利）。