(PS8-C63) A Socially-distanced Case Study: The Telehealth Administration of the Unified Protocol for Adolescents (UP-A) for a Gender-nonconforming Adolescent with Generalized Anxiety and Depression

The onset of mood and anxiety disorders can disrupt typical developmental trajectories and burden the already complicated early adolescent years.  Anxiety and depression are two of the most common mental health diagnoses in adolescents, with higher prevalence rates for gender-nonconforming youth relative to an age-equivalent population of cisgender youth (Veale et al., 2017).  Treating comorbid mental health concerns in nonbinary can be difficult, as the clinician and client must first rank order anxiety/depression symptom severity to focus treatment on the most severe diagnosis regardless of how arbitrary the distinction may seem. This arduous task is particularly challenging, as depression and anxiety are closely linked to underlying mechanisms and etiological factors (Garber & Weersing, 2010).  The Unified Protocol-Adolescent (UP-A) was developed to address anxiety and depression symptoms both simultaneously and trans-diagnostically (Ehrenreich, Goldstein, Wright, & Barlow, 2009).  Based on Barlow’s transdiagnostic approach to treating anxiety/depressive symptoms in adults (2014), the UP-A focuses on the common underlying mechanisms associated with emotional disorders (i.e., anxiety and depression) using a cognitive-behavioral framework.

In the current case study, the clinician implemented the UP-A to a gender-nonconforming 13-year-old diagnosed with both Generalized Anxiety and Mild Depression based on a semi-structured clinical interview and measures of emotional/behavioral functioning.  All identifying information was either not included or altered in a way that did not change the dynamics of the case.  Treatment consisted of 22, 50-minute telehealth psychotherapy sessions.  The treatment addressed diagnoses concurrently amidst the additional stress of the ongoing COVID19 pandemic.  Treatment consisted of emotion identification and psychoeducation, present-moment awareness, cognitive restructuring, problem-solving, and additional behavioral techniques applicable to the client’s presenting concerns (i.e., anxiety and depression symptoms impairing academic and social functioning).  Outcome data demonstrated significant reductions in both anxiety and depression symptoms.  Specifically, the client exhibited a qualitative change on all three Revised Children’s Anxiety and Depression Scale scales (RCADS), moving from clinical to non-clinical score ranges.  Additionally, the client completed the RCADS-25 weekly, providing new data for the clinician to analyze specific clinical progress through each section of the UP-A.  Moreover, the findings demonstrate the potential efficacy of the UP-A via a telehealth platform.  This finding is particularly important and timely, as clinicians are faced with unique challenges due to the COVID-19 pandemic.  Clinical and research implications regarding the utility of implementing a flexible, transdiagnostic approach to treating diverse adolescents’ emotional disorders will be discussed.