Screening and Promoting Recovery after Injury by Treating Early

INTERVENTION: This study involves two elements: Screening and Intervention. In order to identify participants who are experiencing emotional disorders and who will benefit from the treatment, a two stage screening process will be carried out. Injury survivors will first be screened face to face 1 week post injury using the Posttrauma Adjustment Scale in order to identify those who are at risk of developing emotional disorders. This will be carried out during their admission to the trauma service. Participants identified as 'at risk' will then be screened again over the telephone at 4 weeks post injury using the MINI Neuropsychiatric Inteview 6.0 to determine whether they meet criteria for one or more emotional disorders. Those who meet this criteria will then proceed to the intervention phase of the study. The active treatment in the intervention phase is 'The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders' (UP). The UP is a psychological intervention which targets the shared underlying processes of emotional disorders, such as cognitive distortions, emotional avoidance, maladaptive emotion driven behaviours and emotional dysregulation. It is a face to face therapy delivered by a trained clinician over 10‐14 weekly 60 minute sessions. The number of weeks of face to face therapy is dependent on the clinician's assessment of the patient's needs and how many aspects of the protocol are relevant to their clinical presentation. The treatment has 8 modules and the protocol allows for flexibility in the number of sessions taken to complete each module to accommodate differences in patient presentation. CONDITION: Anxiety Depression Injuries Posttraumatic Stress Disorder PRIMARY OUTCOME: Presence of major depression, an anxiety disorder or posttraumatic stress disorder as assessed using the MINI international neuropsychiatric interview. A dichotomous variable indicating the presence or absence of any emotional disorder will be created and serve as the primary outcome measure. Severity of emotional disorder as measured by the Posttraumatic Stress Disorder Checklist, the Beck Anxiety Inventory, and the Beck Depression Inventory SECONDARY OUTCOME: Disability as assessed by the World Health Organisation Disability Assessment Scale. Perceived control over emotional experiences will be assessed using the Anxiety Control Questionnaire ‐Revised. Quality of life as assessed using the Assessment of Quality of Life Questionnaire ‐ 6D. Use of strategies to avoid unpleasant emotions (experiential avoidance) as measured by the Brief Multi‐dimensional Experiential Avoidance Questionnaire. INCLUSION CRITERIA: SCREENING a) A patient with traumatic physical injury that requires an admission of at least 24 hours to the trauma service. b) No brain injury or only mild Traumatic Brain Injury c) Age between 18 and 70 years. d) A reasonable comprehension of English (defined by proficiency to read and understand the participant information sheet and consent form) TREATMENT a) All inclusion criteria as stated overall in the study, plus: b) Depression, Anxiety or PTSD MINI scores that exceed the symptom threshold. c) Participant accepts invitation for therapy