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Cognitive and Behavioral Practice 28 (2021) 393–409

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A Single-Session Workshop to Enhance Emotional Awareness

and Emotion Regulation for Graduate Students: A Pilot Study
Emily E. Bernstein, Harvard University
Nicole J. LeBlanc and Kate H. Bentley, Massachusetts General Hospital
Paul J. Barreira, Harvard University Health Services
Richard J. McNally, Harvard University

Emerging adults are at substantial risk for developing or worsening psychopathology and university students appear to be
particularly vulnerable. Interventions targeted at these young adults that can mitigate transdiagnostic causal risk factors
or burgeoning mental health problems have the potential to make a large impact. We aimed to develop and pilot test an
accessible, single-session, transdiagnostic group intervention with the goals of enhancing emotion regulation skills and
reducing risk for mental health problems in graduate students. The intervention included psychoeducation, skills instruc-
tion (e.g., mindful emotion awareness, cognitive flexibility, countering emotion-driven behaviors), group discussion, and
supervised practice based on content from the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders. The
pilot program demonstrated strong feasibility and acceptability. Baseline, 1-month, and 3-month follow-up surveys also
suggested benefits for reducing emotional avoidance and suppression, increasing use of cognitive reappraisal, and reduc-
ing symptoms of depression and neuroticism. Graduate students have seldom been the beneficiaries of university-based
intervention and prevention research. Furthermore, most college and university mental health centers do not have the
capacity to provide psychoeducation, preventative, or early intervention services to the many students who need or could
benefit from them. Results suggest that future iterations of this intervention could address such barriers to meaningfully
supporting emerging adults in graduate school.

Mental Health in Emerging Adulthood disorders and substance use (Hankin & Abramson,

E MERGING adulthood (broadly defined as ages

18–30 in high-income countries) is a period of
profound change (Arnett, 2000). During this time,
young people experience neurodevelopmental
changes that support emotion regulation abilities, as
well as increased facility with adaptive emotion regula-
tion strategies (Taber-Thomas & Perez-Edgar, 2015;
Zimmermann & Iwanski, 2014). These changes enable
emerging adults to cope with an increasingly complex
and fluctuating social environment, as well as educa-
tional and occupational challenges. Emerging adults
who struggle to navigate this developmental stage, how-
ever, appear to be at substantial risk for developing or
worsening psychopathology, particularly emotional
Keywords: unified protocol; emotion regulation; transdiagnostic;
cognitive-behavioral therapy; graduate students
1077-7229/20/Ó 2021 Association for Behavioral and Cognitive
Therapies. Published by Elsevier Ltd. All rights reserved.
2001; Leebens & Williamson, 2017; Masten et al.,
2008). This risk appears to be increasing in younger
cohorts, who are experiencing severe anxiety, depres-
sion, and psychological distress at substantially higher
rates than older generations (Twenge, 2000; Twenge
et al., 2019). Further, college and university students
are particularly vulnerable to increases in psy-
chopathology (Booth et al., 2016).
Emerging adults enrolled in graduate school experi-
ence major life transitions, stress, and uncertainty
(Gewin, 2012). Popular press and academic reports
alike highlight the widespread, but relatively under-
studied, mental health problems in graduate schools.
Common sources of distress include issues of negative
social comparison, self-consciousness and fears of judg-
ment, perseveration on setbacks and struggles, fear of
failure, and general anxiety (Di Pierro, 2017; Troop,
2011). Graduate students across fields of study are
more likely to experience anxiety and depression
compared to the general public (Di Pierro, 2017;
394 Bernstein et al.
Garcia-Williams et al., 2014; Levecque et al., 2017). Fur-
thermore, graduate students appear at elevated risk for
suicide thoughts and behaviors; an estimated 15% of
graduate students report lifetime, serious suicidal idea-
tion or self-harm, 7.3% within the past 2 weeks, and 5–
10% have a history of suicide attempts (Drum et al.,
2009; Garcia-Williams et al., 2014). In comparison,
4.3% of the general population over the age of 18
(4.7% of those ages 26–49) reports serious thoughts
of suicide, and just 0.5% a history of attempts
(Substance Abuse and Mental Health Services
Administration, 2019). Reports of mental health prob-
lems among graduate students have been associated
with feelings of loneliness and lack of social support,
competitiveness of academic program, poor work–life
balance, lack of support from advisors, number of
semesters spent in school, financial concerns, identify-
ing as female, transgender, or nonbinary, and being a
sexual minority or international student (Di Pierro,
2017; Garcia-Williams et al., 2014; Hyun et al., 2006;
Rummell, 2015).
Mental Health Services on College/
University Campuses
These statistics make it clear that emerging adults
enrolled in graduate school are at elevated risk for psy-
chopathology. Importantly, however, this phase also
seems ideal for engaging empirically supported preven-
tion and early intervention efforts for emotional disor-
ders (Tyssen et al., 2001). Interventions targeted at
these young adults that can mitigate transdiagnostic,
modifiable risk factors or burgeoning mental health
problems have the potential to make a large impact
and shift mental health trajectories across the life span.
However, graduate students have seldom been the ben-
eficiaries of university-based intervention and preven-
tion research. Furthermore, most college and
university mental health centers do not have the capac-
ity to provide psychoeducation, preventative, or early
intervention services to the many students (graduate
and undergraduate) who need or could benefit from
them. This is especially true among graduate popula-
tions as on-campus mental health resources are fre-
quently targeted for undergraduates. According to
the most recent Association for University and College
Counseling Center Directors (AUCCCD) annual sur-
vey, of the 621 centers involved, 64.7% reported need-
ing more service hours to meet student needs, almost
half implement session limits, and approximately one
third had wait-lists (LeViness et al., 2017). Additionally,
centers reported increases in time spent providing
direct services at the expense of indirect services, such
as training, supervision, and consultation. This pattern
parallels the larger trend of a shortage of mental health
care providers across the country (Thomas et al.,
2009).
Students experience numerous barriers to treat-
ment—for example, most interventions used at health
centers and in the community require multiple ses-
sions, making them impractical or unappealing for
many busy students. Young people also identify stigma,
perceived lack of need for treatment, and faculty’s atti-
tudes about treatment as additional barriers to even
seeking treatment (Dearing et al., 2005; Eisenberg
et al., 2007; Gaddis et al., 2018; Thomas et al., 2014).
Although an estimated half of students experience
mental health concerns in a given year, a minority
report ever using mental health services, with estimates
ranging from 30% to less than 20% (Hyun et al., 2006;
Rummell, 2015). Treatment-seeking behavior is fur-
ther reduced among students of color, relative to
White peers, and is particularly low among Asian and
Asian American students (Lipson et al., 2018). With
so many students in the United States meeting criteria
for a mental disorder in the past year and many more
at risk or experiencing subthreshold symptoms, the
current paradigm of individual-based, long-term treat-
ment is unlikely to be feasible for addressing these
problems. Thus, there is an urgent need for brief and
scalable prevention and early intervention programs
on college and university campuses that can better
reach students (Kazdin & Rabbitt, 2013; Schleider &
Weisz, 2017).
Promise of Brief Preventive Group
Interventions
Given the rising rates of psychopathology in emerg-
ing adults and college/university campuses’ difficulties
meeting these needs, we aimed to develop and pilot
test an accessible, transdiagnostic group intervention
with the goals of enhancing emotion regulation skills
and reducing risk for mental health problems in grad-
uate students. The intervention included psychoeduca-
tion, skills instruction, group discussion, and
supervised practice based on content from the Unified
Protocol for Transdiagnostic Treatment of Emotional
Disorders (UP; Barlow, Ellard, et al., 2017; Barlow,
Farchione, et al., 2017; Barlow et al., 2011). The UP
is an evidence-based cognitive-behavioral treatment
developed by Barlow and colleagues to apply across
the full range of anxiety, depressive, and related disor-
ders (including subthreshold symptoms; Barlow,
Ellard, et al., 2017; Barlow, Farchione, et al., 2017;
Barlow et al., 2004). Through core skills modules
(e.g., mindful emotion awareness, cognitive flexibility,
countering emotion-driven behaviors), the UP teaches
adaptive, nonavoidant strategies for responding to
intense emotions (Ellard et al., 2010; Sauer-Zavala
 Transdiagnostic CBT Workshop for Graduate Students
et al., 2012). Randomized trials have indicated high
rates of treatment response (e.g., significant improve-
ments in symptom [anxiety, depression] severity, levels
of negative affect, and daily functioning) to the UP that
were maintained at 6-month and 12-month follow-ups
(Barlow & Farchione, 2018; Bullis et al., 2014;
Farchione et al., 2012).
To date, the UP has been successfully adapted to
treat a variety of target populations. The vast majority
of empirical support has been demonstrated for
patients with anxiety and obsessive–compulsive disor-
ders (for which it appears to be as effective as gold-
standard diagnosis-specific interventions; e.g., Barlow,
Ellard, et al., 2017; Barlow, Farchione, et al., 2017),
and comorbid unipolar and bipolar depressive disor-
ders (Boswell et al., 2014; Ellard et al., 2017). The UP
has shown preliminary empirical support in case series,
small open trials, or single-case experimental design
studies for posttraumatic stress disorder, alcohol use
disorder (comorbid with anxiety), eating disorders,
insomnia, and suicidal and nonsuicidal self-injurious
thoughts and behaviors (see Barlow & Farchione,
2018). The UP has also been successfully implemented
in group format (Bullis et al., 2015; De Ornelas Maia
et al., 2015; Osma et al., 2018; Reinholt et al., 2017).
Recently, the UP was adapted and piloted as a single-
session, 2-hour prevention-focused group intervention
for first-year university students (Bentley et al., 2018).
The in-person intervention received moderate to high
acceptability and satisfaction ratings and participants
(n = 45) reported declines in neuroticism and emo-
tional avoidance and improvements in quality of life
from baseline to the 1-month follow-up. A subsequent
online, single-session intervention (1–2 hours) simi-
larly received good satisfaction ratings and participants
reported lower stress and negative affect at 1-month
and 6-month follow-ups relative to those in the control
condition (Sauer-Zavala et al., 2020).
Parallel meta-analytic data suggest that cognitive-,
behavioral-, and mindfulness-based interventions,
social support, and psychoeducation are particularly
helpful for student populations (Regehr et al., 2013;
Yusufov et al., 2018). There is evidence that skills-
oriented group interventions and the inclusion of
supervised practice are particularly strong predictors
of positive outcomes for students, including preven-
tion, reducing symptoms, and enhancing well-being
(Conley et al., 2013, 2015, 2017). Excitingly, group
treatments delivered in a class setting have yielded sim-
ilar prevention outcomes to those delivered in clinical
ones, suggesting that quality interventions can be suc-
cessfully delivered in nontraditional contexts (Conley
et al., 2013). Most of these interventions, however,
involve multiple sessions, with averages around 10
395
hours. And, only a small number have been designed
for graduate students (Conley et al., 2013, 2015,
2017). Within this subgroup, most focus on general
stress management or mindfulness and meditation
techniques and have specifically targeted students in
medical or other clinical fields (Jones & Johnston,
2000; Kao et al., 2014; McGrady et al., 2012; Shapiro
et al., 2007). For these reasons, there have been calls
for more innovation in reaching graduate students
(Conley et al., 2017; Garcia-Williams et al., 2014)
We built on these earlier works to adapt the UP for
graduate students and sought to address some
reported barriers to treatment seeking in a few ways.
First, the intervention was a single session and utilized
a group format, limiting the investment required of
participants. This design builds on promising evidence
that brief and even single-session interventions can be
as, and in some cases more, effective than traditional
long-term programs for a host of outcomes, including
anxiety, depression, self-esteem, and substance use in
adolescents and adults (Cooper & Archer, 1999;
Ghafoori et al., 2016; Kenney et al., 2014; Mio &
Matsumuto, 2018; Schleider & Weisz, 2016, 2017).
And in addition to reaching more people, group for-
mats have the added benefits of providing a sense of
community and social support, which can be particu-
larly helpful for graduate students reporting feeling
isolated. Furthermore, in the context of a single-
session intervention, group formats can be advanta-
geous as participants offer multiple examples of nega-
tive emotions, stressful experiences, and applications
of the intervention skills for one another. Second, to
further increase accessibility and minimize stigma,
the intervention was framed as a workshop intended
to teach evidence-based skills for managing stress,
rather than treatment or group therapy. It was offered
for individuals struggling with a host of negative emo-
tions or stressors, as well as for individuals who were
simply curious about the topics. Workshops were held
in on-campus classroom buildings, rather than in the
college counseling center. The intervention was deliv-
ered by upper-level graduate student clinicians (i.e.,
peers), held in the evening and within individual
departments, and was advertised by students and
administrators within given departments.
This pilot program was meant to be a primary and
secondary (preventing current subclinical stress symp-
toms from converting to outright disorders) preven-
tion program to enhance students’ emotional well-
being via teaching them emotion regulation skills. Par-
ticipants were not selected for specific levels of emo-
tional symptoms or psychopathology. Specific aims
were to use evidence-based methods to (a) educate stu-
dents about emotions; (b) equip students with adaptive
396 Bernstein et al.
cognitive-behavioral skills to cope with different types
of stress and prevent the development or worsening
of emotional symptoms; and (c) collect preliminary
feasibility, acceptability, and outcomes data.
Methods
Procedure
The workshop was adapted under the supervision of
UP author, Dr. Kate Bentley, to ensure that the gradu-
ate student workshop remained consistent with the
aims and targets of the original UP. Departments were
selected through a larger initiative by Harvard Univer-
sity Health Services to collect data on the mental health
and needs of graduate students. Departments offered
this pilot program were the first to request and com-
plete the Health Services survey. Consistent across sur-
veys were students’ requests for additional resources.
The pilot program ultimately included six workshops
conducted across four departments. Workshop leaders
met with two to four student representatives from each
of the initial departments to (a) provide a brief over-
view of the workshop, including its format and four
components; (b) gauge interest; (c) gather informa-
tion regarding the structure and common stressors of
their programs; (d) solicit feedback regarding the tone
of the materials (e.g., Did the psychoeducation appear
too basic?); and (e) solicit feedback on how best to
advertise, where and when the workshop should be
held, and whether it should be intra- or inter-
departmental. No representatives declined the offer
to host a workshop and all representatives expressed
a preference for workshops to be for their department
alone, believing that it would be more comfortable and
helpful to learn the skills alongside peers undergoing
similar pressures and that it could support ongoing
conversations among students afterward.
Workshops were then advertised by administrators
and the student representatives within individual
departments via e-mail, flyers, and word of mouth.
Interested students were able to sign up and opt into
the research arm, a decision that had no bearing on
their participation in the workshop. Participants who
consented to participate in the research arm com-
pleted online questionnaires at baseline (up to 3 days
before the workshop), immediately after the workshop,
and follow-up (1- and 3 months after the workshop),
and were compensated $10 for each completed survey.
Participants who completed all surveys received an
additional $10 for a possible total of $50. To mitigate
confidentiality concerns, we prohibited faculty, staff,
or others who were not current graduate students in
a given department from joining or observing work-
shops. Names of participants were not shared with
departments. It was also made clear that data would
not be shared with faculty and that deidentified results
would be reported in aggregate across departments.
Finally, participants completed surveys on their per-
sonal devices and were therefore able to fill them out
in private.
Sample
Eligible participants were current graduate students.
Participants were over 18 years of age (M = 26.1,
SD = 2.6) and represented first- through eighth-year
students. Among attendees who consented to provide
demographic information (n = 53, 67.1%), the major-
ity identified as female (n = 32, 60.4%), White
(n = 36, 67.9%), and not Hispanic or Latino (n = 43,
81.1%). Participants reported on average mild depres-
sive symptoms (Patient Health Questionnaire [PHQ-9]
M = 7.2, SD = 4.8) and moderate anxiety symptoms
(Generalized Anxiety Disorder 7-Item [GAD-7]
M = 6.8, SD = 5.1). Twelve participants’ (22.7%)
PHQ-9 scores exceeded the threshold for a probable
depression diagnosis (10) and 13 participants’
(24.5%) GAD-7 scores exceeded the threshold for a
probable anxiety disorder diagnosis (10). A summary
of demographic and clinical characteristics of the sam-
ple are included in Table 1. There were no differences
in demographics, histories of service use, or responses
to clinical measures among departments.
Twenty-two participants (41.5%) reported having
received a mental health diagnosis in the past. Half
of participants reported past or current use of psy-
chotherapy services and close to a third past or current
psychiatric medication use. Among participants who
never accessed services, the most common barriers
reported included lack of time (n = 9, 47.4%) and con-
cerns waning before an appointment (n = 10, 52.6%).
Other barriers included financial cost, embarrassment,
worries about side effects, and not believing services
would be helpful.
Materials
Intervention
Format. The workshop lasted 2 hours and was led by
two advanced doctoral students in clinical psychology
and supervised by a licensed clinical psychologist.
The workshop included PowerPoint slides to present
and summarize key concepts, didactic presentation of
material, experiential exercises, and group discussion.
Participants were provided with blank worksheets to
use throughout the workshop to record group exam-
ples and practice skills independently. Students
 Transdiagnostic CBT Workshop for Graduate Students 397

Table 1
Demographic Characteristics and Service Use

Measure Whole sample Group differences

n (%)
Gender v2 = 3.59, p = .73
Male 20 (37.7)
Female 32 (60.4)
Other 1 (1.9)
Race v2 = 6.82, p = .87
White 36 (67.9)
Black 3 (5.7)
Asian 9 (17.0)
Multiracial 3 (5.7)
Other 2 (3.8)
Ethnicity v2 = 2.38, p = .50
Hispanic/Latino 10 (18.9)
Not Hispanic/Latino 43 (81.1)
Graduate year v2 = 9.54, p = .95
1 14 (26.4)
2 9 (17.0)
3 7 (13.2)
4 10 (18.9)
5 8 (15.1)
6 4 (7.6)
7 0 (0.0)
8 1 (1.9)
Current use of services v2 = 3.36, p = .34
Yes 23 (43.4)
Medication 12 (22.6)
Psychotherapy 18 (34.0)
No 30 (56.6)
Past use of services v2 = 2.98, p = .40
Yes 31 (58.5)
Medication 16 (30.2)
Psychotherapy 27 (50.9)
Other 4 (7.6)
No 22 (41.5)
Measure M (SD) Group differences
Age 26.1 (2.6) F(3, 49) = 0.23, p = .88
BEAQ 46.1 (7.5) F(3, 48) = 1.96, p = .13
ERQ Reappraisal 4.2 (1.0) F(3 ,49) = 0.38, p = .77
ERQ Suppression 3.3 (1.5) F(3, 49) = 2.61, p = .06
BFI Extraversion 25.0 (7.2) F(3, 48) = 0.57, p = .64
BFI Neuroticism 26.9 (5.1) F(3, 48) = 0.84, p = .48
PHQ-9 7.2 (4.8) F(3, 49) = 1.73, p = .17
GAD-7 6.8 (5.1) F(3, 49) = 2.08, p = .12
Q-LES-Q-SF 62.9 (13.6) F(3, 47) = 0.98, p = .41
Note. Characteristics of the sample are described in terms of counts and proportions (categorical variables) or means (M) and standard
deviations (SD; continuous variables). Group differences refer to the separate departmental workshops. BEAQ = Brief Experiential
Avoidance Questionnaire; ERQ = Emotion Regulation Questionnaire; BFI = Big Five Inventory; PHQ-9 = Patient Health Questionnaire 9-
Item; GAD-7 = Generalized Anxiety Disorder 7-Item; Q-LES-Q-SF = Quality of Life Enjoyment and Satisfaction Questionnaire—Short
Form.
398 Bernstein et al.
received one 10-minute break midway through the
workshop.
Content. The sessions were broken down to cover
the four core components of the UP and followed
the structure of Bentley et al. (2018): function of emo-
tions (psychoeducation), mindful emotion awareness
(present-focused, nonjudgmental awareness of
thoughts, feelings, and behaviors), cognitive flexibility
(identifying negative automatic interpretations and gen-
erating alternative appraisals), and countering emotion-
driven behaviors (interrupting cycles of negative
emotion and choosing actions in line with one’s goals).
The first section covered the functional, adaptive
nature of emotions. Leaders asked students to rethink
the idea that some emotions are good and some are
bad, and explored the important functions different
emotions serve. To do so, the groups generated exam-
ples of when different basic emotions (i.e., sadness,
happiness, anger, fear, anxiety, and guilt) are typically
felt and why humans evolved to feel them. Leaders
would then poll the group and ask who would com-
pletely turn off one of their emotions if given the
opportunity. Through the ensuing discussion, groups
would discuss the dangers of not having each emotion
(e.g., without fear, a person would be in physical dan-
ger; without anxiety, a person would not prepare for
an exam or presentation). Leaders challenged students
to consider that negative emotions are not inherently
problematic, but instead that certain habits of reacting
to strong emotions can be. As a first step in helping stu-
dents understand their emotional experiences, leaders
concluded this module by introducing the three-
component model, or the interactions among cogni-
tive, behavioral, and physiological components of emo-
tions. Students practiced filling out a three-component
model as a group and, time allowing, as individuals. To
do so, leaders would solicit an example of a common
stressor from a group member and then ask that stu-
dent to walk through his or her reactions. Other stu-
dents were also invited to add additional examples of
cognitive, behavioral, and physiological responses they
might have in the same situation.
The second section introduced the concept of
mindful emotional awareness to promote adaptive
responses to emotional experiences. Mindfulness in
this context was defined as practicing being aware of
one’s emotional experience as it unfolds, and trying
to observe the moment without judging it. Leaders
would emphasize that the goal is to strengthen one’s
ability to observe and refocus one’s attention when it
has drifted, rather than to necessarily feel relaxed or
to prevent one’s mind from wandering. Participants
were led through two experiential exercises. First, they
were guided through a mindful breathing practice.
Second, they repeated the mindful breathing exercise
followed by prompts to observe physical sensations,
thoughts, and actions (or action urges). Group discus-
sion about the experience followed each practice.
The third section focused on how thoughts influ-
ence emotional experiences, recognizing negative
automatic thoughts, and strategies for generating alter-
native appraisals. This module began with an ambigu-
ous picture, which was briefly used to illustrate how
although most situations can be interpreted in more
than one way, our brains instinctively come up with
an initial interpretation very quickly, which can make
it hard to see alternatives. This was followed with a dis-
cussion of an ambiguous social interaction (e.g., receiv-
ing an e-mail from one’s advisor asking to meet). With
both stimuli, leaders asked participants to generate
examples of possible interpretations and how each
interpretation would impact their feelings and behav-
iors. Participants were then introduced to thinking
traps, specifically jumping to conclusions and catastro-
phizing, provided with graduate school-related exam-
ples, and practiced generating personal examples for
each. Last, using an example of each type of thinking
trap from the group, leaders walked participants
through challenging questions (e.g., “What evidence
do I have for and against this belief?”; “Could there
be any other explanations?”; “How bad would it really
be?”; “How could I cope with it?”) to come up with
more balanced and flexible interpretations. Partici-
pants were allowed time to practice challenging one
of their own thoughts independently.
The fourth section highlighted common, problem-
atic emotion-driven behaviors (e.g., avoidance).
Emotion-driven behaviors were defined as anything a
person does to avoid feeling an emotion, escape an
uncomfortable emotion, or prevent it from getting
too intense. Groups would share examples of common,
unhelpful behaviors (e.g., procrastination, oversleep-
ing, yelling, avoiding networking, substance use) and
discuss the short-term benefits of these behaviors
(i.e., relief), as well as long-term consequences (i.e.,
perpetuating problematic cycles). Leaders then
reviewed ways to counter such tendencies. Students
practiced identifying emotion-driven behaviors and
potential specific, concrete alternative actions first as
a group and then as individuals. Leaders would make
sure to review at least one single-step example, such
as choosing to text a friend when noticing one’s habit
of withdrawing during stressful periods, and at least
one multistep or graded example, such as progressively
working up to talking to professors at departmental
social hours. Participants were asked to identify at least
one alternative action they could commit to trying
 Transdiagnostic CBT Workshop for Graduate Students
within the next 24 hours. Leaders emphasized the
importance of specificity and repeated practice.
Leaders concluded with a review of all skills and
strategies for continued practice. Active practice
(group and individual work) was integral to each sec-
tion. A summary of key points and copies of worksheets
were provided to participants as well.
Considerations and Modifications for Current
Study. First, leaders presented the workshop as an
introduction to evidence-based skills for managing
stress or other negative emotions common to graduate
school. Leaders intentionally avoided clinical lan-
guage, such as “depressed,” “disorder,” “therapy,” or
“treatment,” throughout the workshop and empha-
sized that the skills can be helpful for everyone, includ-
ing themselves. To illustrate, leaders would begin with
a slide titled “Does this apply to me?” and say:
Let’s talk a little bit about who these skills are for. The
short answer is anyone. We use these ourselves all the
time! Have you ever looked back and wished you han-
dled a situation differently? We all respond to our emo-
tions in ways that are unhelpful sometimes. For instance,
who here has felt anxious about a project and procrasti-
nated starting it? Said something mean in the heat of the
moment? Sacrificed sleep when stressed? Isolated your-
self or stopped doing things when you’re feeling low?
These are common responses to strong emotions that
a lot of us can relate to. The reason these reactions feel
bad is because they conflict with your values or goals—
they ultimately get in the way of what you really want
to do, whether that’s succeeding in your research, being
healthy, or enjoying other people or hobbies.
This introduction is the first example of how feed-
back from student representatives was used. Procrasti-
nation, lashing out when upset, sacrificing sleep, and
withdrawing from others were common experiences
reported during these meetings. They were therefore
selected with the hope that graduate students would
quickly feel that the workshop was highly relevant to
them. Another key addition was made to the psychoed-
ucation portion at the start of the workshop. Consistent
with the UP, the take-home message was that all emo-
tions communicate important information, and that
it is how we respond to emotions that can get in our
way. In this context, leaders would also explicitly say:
“Graduate school is really stressful. And we can’t
change that. But, we can try to change how we respond
to or navigate it.” Conversations with students before
and after workshops highlighted that this direct, clear
validation of the unique, emotional experience of
graduate school was important for communicating
understanding, increasing buy-in, and reducing shame.
399
Second, examples leaders used to illustrate new con-
tent or skills were intentionally relevant to graduate
students (e.g., research presentations, relationships
with advisors, writing a dissertation)—for example, to
introduce the bidirectional relationship between
thoughts and emotions, leaders would say:
The way we think about or interpret situations can
really color how we feel about them. For example,
imagine your advisor e-mails and asks to meet with
you ASAP. If you read it to mean that she didn’t like
the paper you just sent, how would you feel? If you
think it’s because she has a big project she wants to
involve you in, how would you feel? If you think maybe
she just wants to check in briefly in person, how would
you feel? Based on your thought, how would you act
leading up to or even during the meeting? Also, do
you think the way you were already feeling that day
(let’s say, grumpy, excited, or anxious) might influence
the way you think about the situation? If you were run-
ning late for lab and had skipped breakfast, would you
be more or less likely to think something was wrong? If
you were having a relaxing morning and had just
received good news from a different professor, would
you be more or less likely to think something was
wrong?
In this same module, slides included intentional
examples of thinking traps, such as “when talking to
other graduate students, think ‘everyone is smarter
than me’; before the qualifying examination, think
‘I’m going to fail. I’ll have to leave the program.’” Sim-
ilarly, examples of emotion-driven behaviors included
avoiding meetings with one’s advisor or dissertation
committee, perfectionism, spending excessive amounts
of time in the lab or doing other work at the expense of
health behaviors.
Third, as each workshop was held within an individ-
ual department, leaders were careful to tailor the con-
versations to the particular group in two primary ways.
For one, leaders would use language consistent with
the norms of the department. Through prior meetings
with student representatives, leaders would know what
milestones (e.g., a first-year paper, a second-year quali-
fying exam, annual committee meetings) or experi-
ences (e.g., working independently without regular
attention from faculty, working in lab groups with con-
stant oversight from faculty, heavy teaching loads, diffi-
culty obtaining teaching positions) were good
examples of stressors that participants could all relate
to or how to describe various players in a department
(e.g., advisor, principal investigator, committee, lab
group). This knowledge was also used to provide exam-
ple thinking traps and emotion-driven behaviors that
were most likely to resonate with a given group.
400 Bernstein et al.
Second, leaders would ask for examples from the
group to be used for all skills practices. In this way,
leaders would collaborate with participants to articu-
late their emotional challenges and experiences and
use cognitive-behavioral skills to address them.
Finally, we adapted the presentation of material to
suit these young adults. We updated visual aids (e.g.,
modern fonts and slide themes, familiar graphics inter-
change formats [GIFs] and movie or television clips) to
render them current for this age group. Additionally,
leaders referenced the literature supporting the skills
being taught given that the population was empirically
minded. We also aimed to use language throughout the
workshop that communicated the basics of cognitive-
behvaioral therapy (CBT) in a digestible and actionable
way, while not oversimplifying it—for example, below is
an excerpt from the behavioral module:
The tricky thing about emotion-driven behaviors is that
they can feel like they happen automatically. You might
not feel like you are making a conscious choice to avoid
starting an assignment or talking to a new professor,
because avoiding these things can become a habit. This
happens because, in the moment, avoidance usually
feels better, or at least safer, than approaching the
problem. The issue is that even though avoiding the
emotions that make you feel uncomfortable (or the sit-
uations that might lead to those emotions) causes relief
in the short-term, it can cause problems down the line.
Sometimes, the negative consequences of avoiding are
obvious. If you spend all semester watching TV mara-
thons instead of preparing for your qualifying exam,
it’s pretty clear that you’ll do poorly. But what about
waiting again and again for the “right time” to bring
up something that’s bothering you with your advisor?
Editing a paper for months to make it perfect? Re-
reading emails 20 times before sending them? Spend-
ing all of your free time in the lab to avoid feeling
unproductive? Ultimately, avoidance makes things actu-
ally feel even harder to do and makes you feel less able
to cope. So again, if we know that all of these emotion-
driven behaviors we’ve brainstormed together are
going to come back to bite us, why do we keep doing
them? Because it feels better in the short-term, even
though it’s painful later on!
In this discussion, leaders have defined emotion-
driven behaviors, with an emphasis on avoidance, and
then go on to introduce alternative or opposite actions.
They do not, however, delve into the differences
between types of emotion-driven behaviors or avoid-
ance (e.g., overt, safety behaviors, cognitive), let alone
behavioral activation and scheduling, hierarchies, or
exposures. At the same time, leaders acknowledge the
complexity of these ideas, such as noting examples of
behaviors that are more subtle and may not necessarily
be problematic for a given individual. This lens could
be particularly important for individuals without clini-
cal levels of avoidance or impairment. Speaking to a
group of students trained in critical thinking, we
attempted to present this nuance in terms of critically
thinking about the function of one’s behaviors. For
example, leaders would add the following ideas:
There are some times where you can’t do it all and it’s
okay to prioritize parts of your life over others. And
sometimes it’s okay to watch TV and it’s human to pro-
crastinate. This is about the big picture and keeping
your long-term goals in mind by using mindfulness
and cognitive flexibility. It’s about you making decisions
about what to do (choosing to leave lab to go on a run
to let off steam or choosing to stay late in your office
and write) rather than choices being driven by emo-
tions like anxiety or habit.
Baseline Measures. Before the workshop, research par-
ticipants completed validated self-report question-
naires of demographic characteristics, past use of
treatment services, emotional distress, emotion regula-
tion, and quality of life. Participants who reported
never using mental health services were asked follow-
up questions about this decision, thereby enabling us
to identify barriers to access.
The nine-item PHQ-9 was used to assess for depres-
sive symptoms. The PHQ-9 is a commonly used, reliable,
and valid measure of depression severity (Kroenke et al.,
2001). The PHQ-9 asks respondents to rate each of the
nine Diagnostic and Statistical Manual of Mental Disorders
(DSM-IV; American Psychiatric Association, 2000) diag-
nostic criteria for a major depressive episode on a scale
from 0 (not at all) to 3 (nearly every day). Higher sum
scores indicate more severe symptoms.
The GAD-7 measures anxiety symptoms. This seven-
item scale is a brief, but reliable and valid measure of
general anxiety severity (Spitzer et al., 2006). Respon-
dents indicate on a scale from 0 (not at all) to 3 (nearly
every day) how frequently they experience various symp-
toms (e.g., feeling nervous, anxious, or on edge). Total
scores can range from 0 to 21; higher scores reflect
more severe anxiety.
We also administered the eight-item Neuroticism
and eight-item Extraversion subscales of the Big Five
Inventory (BFI) to capture general emotional distress
and different aspects of temperament (John et al.,
1991, 2008). Respondents indicated how much they
identify with various temperamental descriptors on a
scale from 1 (disagree strongly) to 5 (agree strongly).
Scores could therefore range from 8 to 40, with higher
scores reflecting greater extraversion and neuroticism.
 Transdiagnostic CBT Workshop for Graduate Students
Emotion regulation measures included the Brief
Experiential Avoidance Questionnaire (BEAQ) and
Emotion Regulation Questionnaire (ERQ). The 10-
item ERQ (Gross & John, 2003) assesses the use of
two emotion regulation strategies: cognitive reap-
praisal and emotional suppression. Both subscales have
strong internal and test–retest reliability. Higher scores
indicate greater use of the strategy. The BEAQ (Gámez
et al., 2011, 2014) is a 15-item self-report measure that
assesses several types of experiential and emotional
avoidance strategies. Example items include “I’m quick
to leave any situation that makes me feel uneasy,” “I
work hard to keep out upsetting feelings,” “I try to
put off unpleasant tasks for as long as possible,” and
“The key to a good life is never feeling any pain.”
The measure has good internal consistency and con-
struct validity. Scores can range from 15 to 90, with
higher scores indicating greater use of avoidance
strategies.
Finally, the Quality of Life Enjoyment and Satisfac-
tion Questionnaire—Short Form (Q-LES-Q-SF) was
administered. The Q-LES-Q-SF captures an individual’s
enjoyment of and satisfaction with various domains of
daily life and functioning (e.g., physical health, social
relationships; Endicott et al., 1993). The first 14 items
are rated on a scale from 1 to 5 and scored as a percent-
age maximum possible score:
(total raw score minimum possible score)/
(maximum possible score minimum possible
score)
Higher percentage scores correspond to greater
quality of life. The final item asks participants to rate
their overall life satisfaction and contentment during
the past week and is scored alone.
Postworkshop Measures. Immediately after the work-
shop, participants completed anonymous question-
naires to assess satisfaction and learning. Specifically,
participants were asked (a) Overall, how acceptable
was the workshop to you? In other words, did you think
that the workshop approach and activities made sense
and were reasonable? (b) Overall, how satisfied were
you with the workshop? Answers could range from 1
(not at all acceptable/satisfactory) to 5 (extremely accept-
able/satisfactory). Open, qualitative feedback on the
workshop was also solicited. Finally, participants were
given 10 true or false questions about content from
the workshop to gauge understanding and skills acqui-
sition (e.g., “Starting to approach uncomfortable situa-
tions as opposed to avoiding them, is one strategy for
changing problematic cycles of emotion”).
401
Follow-up Measures. At 1-month and 3-months post-
workshop, participants repeated baseline measures of
emotionality, temperament, emotion regulation, and
quality of life (PHQ-9, GAD-7, BFI, BEAQ, ERQ, and
Q-LES-Q-SF). They also reported on their use of speci-
fic skills from the workshop over the past month using
a 1–7 scale (1 = never, 3 = some of the time, 5 = most of the
time, 7 = all of the time). The three-component model
skill was described as “When experiencing a strong
emotion, I have taken time to notice my thoughts,
physical feelings, and behaviors, and considered how
these three parts interact.” Mindful emotion awareness
was described as “When feeling stressed, anxious, or
down, I have guided my attention to the present
moment rather than focusing on what happened in
the past or might happen in the future.” Cognitive flex-
ibility was described as “I have been aware of my nega-
tive automatic thoughts and made an effort to
reevaluate them in order to come up with alternative
interpretations.” Finally, alternative (or opposite)
action was described as “I have made an effort to do
something different, or act opposite, when I feel like
avoiding an uncomfortable situation or emotion.”
Data Analysis
Feasibility. We assessed feasibility in terms of workshop
attendance, skills acquisition, and self-reported skills
use at 1-month and 3-month follow-up. It was estab-
lished a priori that the program would be deemed fea-
sible if 75% of students registered for the workshop
attended, participants answered 75% of learning
checks correctly immediately after the workshop, and
if participants reported using skills at least some of
the time (3) at follow-up. We used independent sam-
ple t tests for continuous measures and chi-square tests
for categorical measures to test whether demographics,
baseline use of emotion regulation strategies, symp-
toms, temperament, or quality of life differed between
enrolled individuals who did and did not attend a
workshop (i.e., consented to participate in the research
arm via online questionnaire [up to 3 days before the
workshop], but did not ultimately attend the in-
person workshop).
Acceptability and Preliminary Outcomes. The program
would be defined as acceptable if, on a scale from 1
(not at all acceptable) to 5 (extremely acceptable), average
satisfaction ratings 4. This criterion was also deter-
mined a priori. Preliminary outcomes were evaluated
with measures of emotion regulation (BEAQ, ERQ)
and emotional symptoms (PHQ-9, GAD-7, neuroti-
cism) over the follow-up period. Secondary measures
402 Bernstein et al.
included quality of life (Q-LES-Q-SF) and tempera-
ment (extraversion). One-way analyses of variance
(ANOVA) were used to examine whether skills acquisi-
tion differed between departments. Skills use and
other outcome measures were assessed using linear
mixed models, in which time (baseline, 1 month,
3 months) was a fixed predictor and participant was a
random effect. This also allowed us to examine individ-
ual departmental workshops as potentially moderating
factors. Finally, given the small sample and within-
condition nature of these analyses, we also computed
Reliable Change Indices (RCIs) for each case and
report the percentage of cases surpassing the mini-
mum threshold of reliable change (z > 1.96) for each
outcome measure (Jacobson & Truax, 1991).
Results
Feasibility
Across the six pilot workshops, 92 students signed
up and 79 attended (85.87% overall attendance rate;
minimum attendance rate for a given workshop was
75.0%). The mean number of students per workshop
was 13.2; attendance ranged from 4 to 20. Sixty-four
students consented to the research component of the
pilot program during the sign-up process and com-
pleted baseline (preworkshop) surveys. Fifty-three of
those students ultimately attended a workshop and
therefore had, at minimum, data for the baseline and
postworkshop surveys (67.1% of workshop attendees).
There were no significant differences in any demo-
graphic or clinical measure between individuals who
did (n = 53) and did not (n = 11) attend a workshop,
ps > 0.05. Fifty-two individuals (98.1%) completed the
1-month follow-up survey and 50 (94.3%) completed
the 3-month follow-up survey.
Participants performed well on the learning checks
of skills acquisition immediately after the workshop,
with an average score of 9.5 out of 10 (SD = 0.9). There
were no differences in performance by department, F
(3, 49) = 0.13, p = .94. Additionally, average reports
of skills use exceeded 3 (some of the time) for the
three-component model, mindfulness, cognitive flexi-
bility, and opposite action at both 1-month and 3-
month follow-ups (see Table 2). Use of the three-
component model increased from 1 month to
3 months, F(1, 29) = 11.86, p = .001. Use of other skills
did not differ between the two time points, ps > 0.05.
Acceptability
Average acceptability scores were 4.7 (out of 5;
SD = 0.5) and average satisfaction scores were 4.2
(out of 5; SD = 0.7). Ratings are visualized in Fig. 1.
Table 2
Skills Use
Measure 1 month 3 months Difference
M (SD) M (SD)
Three- 3.4 (1.3) 4.0 (1.3) p = .001
component
model
Mindfulness 3.5 (1.2) 3.9 (1.3) p = .10
Cognitive 4.1 (1.4) 4.4 (1.6) p = .20
flexibility
Opposite action 3.9 (1.4) 3.9 (1.4) p = .66
Note. Higher score indicates more frequent use of skill (1–7): 1
(never); 3 (some of the time); 5 (most of the time); 7 (all of the time).
M = mean; SD = standard deviation.
There were no differences in ratings by department
for acceptability, F(3, 48) = 1.63, p = .19, or satisfaction,
F(3, 48) = 2.72, p = .06. Forty-two (79.3%) participants
indicated that they would want to attend a future
review or booster session. An additional 5 (9.5%) stu-
dents indicated maybe, 1 (1.9%) indicated no, and 5
(9.5%) did not answer the question. Responses did
not differ by department, v2 = 9.96, p = .53. Thirty-
one (58.5%) participants provided qualitative evalua-
tions, of which 27 were positive (e.g., “It gave us con-
crete and achievable ways to manage emotions,”
“Very useful and encouraged us to be comfortable talk-
ing about emotions”) and 4 were mixed (e.g., “I think
if the information were new to me it would have been
more helpful,” “I . . . feel guilty about taking time to do
this instead of working”).
Outcomes
Means and standard deviations for each outcome
measure at baseline, 1 month, and 3 months are
included in Table 3. Participants reported positive
changes in emotion regulation following the work-
shop, including less emotional avoidance (BEAQ), F
(2, 97.48) = 11.25, p < .001, less emotional suppression
(ERQ Suppression), F(2, 98.15) = 4.74, p = .01, and
more reappraisal (ERQ Reappraisal), F(2,
98.83) = 10.23, p < .001. Relative to baseline, BEAQ
scores were significantly lower at both 1 month and
3 months, ps < 0.05. Correspondingly, relative to base-
line, 14.6% of participants experienced reliable, posi-
tive change in BEAQ scores (RCI; z > 1.96) at
1 month and 25.0% at 3 months. ERQ Reappraisal
scores were significantly higher at 3 months than at
baseline and at 1 month, ps < 0.05. And ERQ Suppres-
sion scores declined significantly from baseline to
3 months, p = .007. Similarly, 25.0% of participants
had significant, positive RCIs for ERQ Reappraisal
 Transdiagnostic CBT Workshop for Graduate Students 403

Fig. 1. Acceptability and satisfaction ratings

and 12.0% for ERQ Suppression at 3 months. Notably,
RCI calculations revealed no reliable worsening of
reports for BEAQ or ERQ Suppression at 3 months
and only 4.0% for ERQ Reappraisal.
Additionally, participants experienced declines in
depressive symptoms (PHQ-9), F(2, 99.01) = 3.14,
p = .048, and neuroticism (BFI Neuroticism), F(2,
95.69) = 5.30, p = .007, after the workshop. Specifically,
PHQ-9 scores at 3 months were significantly lower than
at baseline, p = .04, and BFI Neuroticism scores at
3 months were significantly lower than at baseline
and 1 month, ps < 0.05. Relative to baseline, 28.0% of
participants reported reliable improvements in PHQ-
9 scores and 44.9% in BFI Neuroticism scores at
404 Bernstein et al.

Table 3
Clinical Measures

Measure Baseline 1 month 3 months Effect of time

M (SD) M (SD) M (SD)
BEAQ 46.1 (7.5) 41.9 (9.0) 41.33 (9.6) p < .001
ERQ Reappraisal 4.2 (1.0) 4.4 (0.8) 4.80 (0.7) p < .001
ERQ Suppression 3.3 (1.5) 3.1 (1.4) 2.94 (1.3) p = .01
BFI Extraversion 25.0 (7.2) 24.7 (7.3) 25.86 (7.6) p = .03
BFI Neuroticism 26.9 (5.1) 26.3 (5.0) 25.68 (5.2) p = .007
PHQ-9 7.2 (4.8) 6.1 (3.4) 5.68 (3.7) p = .048
GAD-7 6.8 (5.1) 6.8 (4.3) 5.98 (4.3) p = .25
Q-LES-Q-SF 49.2 (7.6) 62.8 (13.7) 65.71 (13.8) p = .29
Note. M = mean; SD = standard deviation; BEAQ = Brief Experiential Avoidance Questionnaire (high scores = more avoidance);
ERQ = Emotion Regulation Questionnaire (high scores = more reappraisal and suppression); BFI = Big Five Inventory (high scores = high
extraversion and neuroticism); PHQ-9 = Patient Health Questionnaire 9-Item (high scores = worse depression); GAD-7 = Generalized
Anxiety Disorder 7-Item (high scores = worse anxiety); Q-LES-Q-SF = Quality of Life Enjoyment and Satisfaction Questionnaire—Short
Form (high scores = better quality of life).

3 months, relative to the 10.0% of participants who
experienced reliable worsening of depressive symp-
toms and 28.6% who reported reliable increases in
neuroticism. Finally, there was a main effect of time
on BFI Extraversion, F(2, 95.60) = 3.63, p = .03, such
that scores increased from 1 month to 3 months,
p = .048. At 3-months postworkshop, 44.9% of partici-
pants reported reliable increases in extraversion,
whereas 30.6% reported reliable worsening. Although
anxiety symptoms (GAD-7) numerically declined with
time and reports of quality of life (Q-LES-Q-SF)
increased, changes were not statistically significant,
ps > 0.05. At 3 months, 22.0% of participants reported
reliable improvements in GAD-7 scores and 27.1% in
Q-LES-Q-SF scores. Only 10.0% of students reported
reliable increases in GAD-7 scores and 14.6% reported
reliable decreases in Q-LES-Q-SF scores. Changes for
all outcome measures are visualized in Fig. 2. Individ-
ual departments did not emerge as a significant moder-
ator for any of the above outcomes, ps > 0.05.
Discussion
This study aimed to adapt the UP for use as a single-
session, transdiagnostic group intervention for gradu-
ate students. The intervention educated students about
emotions and equipped them with specific skills to
cope with stress. Results demonstrated that the inter-
vention was feasible, with high rates of attendance
and comprehension and reports of continued skills
use throughout the follow-up period. Coupled with
high acceptability and satisfaction ratings, these find-
ings suggest that participants understood and res-
onated with the rationale for UP skills and were able
to implement them independently. Moreover, students
reported increased use of cognitive flexibility and
decreased use of emotional avoidance and suppres-
sion—positive changes in emotion regulation strate-
gies in line with the intervention. Students also
tended to report declines in depressive symptoms
and neuroticism over 3 months following the interven-
tion. Furthermore, it was encouraging to see a minority
of students report worsening symptoms, virtually no
increase in use of experiential avoidance or emotional
suppression, and no decline in use of cognitive reap-
praisal following the workshop.
Though these data suggest preliminary evidence for
positive outcomes, without a control condition (e.g.,
one-on-one CBT, wait-list, other workshop), it is prema-
ture to conclude that this intervention is efficacious.
Furthermore, we were unable to examine outcomes
beyond three months. Given the fluctuations in exter-
nally and internally imposed stress inherent in gradu-
ate school (e.g., exam periods, holiday vacations),
future work would ideally examine outcomes over
longer periods and within these varying contexts. In
the present study, workshops were conducted in
November, February, and March. Consequently, base-
line and follow-up surveys were administered during a
range of academic periods for students, including
exams, ends of semesters, and winter and summer vaca-
tions, as well as typical weeks. Results did not vary by
department, suggesting that at least in a small pilot
sample, workshop effects were not significantly
impacted by time of year.
Additionally, in this pilot study, we were unable to
parse out the effects of past or concurrent mental
health services on individuals’ decisions to attend work-
shops or their responses to the intervention, or to com-
pare effects based on whether or not participants met
diagnostic criteria or were at high risk for a mental dis-
order. Responses to the surveys could also be skewed by
 Transdiagnostic CBT Workshop for Graduate Students 405

Fig. 2. Changes in clinical measures. Note. Time: 1 = baseline; 2 = 1-month follow-up; 3 = 3-month follow-up. (A) BEAQ = Brief
Experiential Avoidance Questionnaire; declines indicate reduced use of avoidance. (B) ERQ = Emotion Regulation
Questionnaire; increases indicate greater use of reappraisal. (C) ERQ; declines indicate reduced use of suppression. (D) PHQ-
9 = Patient Health Questionnaire 9-Item; declines indicate reduced depressive symptoms. (E) GAD-7 = Generalized Anxiety
Disorder 7-Item; declines indicate reduced anxious symptoms. (F) BFI = Big Five Inventory; declines indicate reduced
neuroticism. (G) BFI; increases indicate heightened extraversion. (H) Q-LES-Q-SF = Quality of Life Enjoyment and Satisfaction
Questionnaire—Short Form; increases indicate improved quality of life

students’ desires to perform well. Although researchers
emphasized that responses would be helpful in evaluat-
ing and improving the program, and explicitly asked
for critical feedback, it is difficult to confirm whether
data accurately reflect participants’ experiences, partic-
ularly without a control group.
Still, findings are promising and merit future study.
Encouragingly, results were consistent with and built
on those from the single-session UP intervention for
first-year undergraduates. Acceptability data were
comparable and rates of attendance higher in this
population compared to the undergraduate program.
Additionally, the undergraduate program found
within-condition statistically significant improvements
for neuroticism, quality of life, and experiential avoid-
ance, and only numerical trends for the remaining out-
come measures (Bentley et al., 2018). Future programs
with graduate students would benefit from not only
including comparison groups and longer assessment
periods but also recruiting larger, more diverse sam-
ples and assessing use of skills and emotional experi-
ences in real time and with more ecologically valid
measures (e.g., daily diary, ecological momentary
assessment). Future work may also expand this pro-
gram to include post-workshop supports, such as addi-
tional supervised practice of skills, online resources,
reminders to use skills, and booster sessions.
The two-hour intervention appeared acceptable
and beneficial. However, changes may be more robust
or persist longer term with a higher dose of the
406 Bernstein et al.
intervention (e.g., a longer workshop) or repeated
engagement (e.g., booster sessions). Importantly, the
intervention comprised the core messages from the
UP, but could not include the entire nuance and
guided work from the longer, multisession, original
protocol. In support of such modifications, a majority
of participants indicated interest in future booster or
review sessions and a large number of participants
described wanting extended time for discussion and
practice in their qualitative feedback. Additionally,
although the workshop was intended to be transdiag-
nostic, much of the discussion centered on experi-
ences of anxiety, fear, and sadness; future iterations
of the study could incorporate discussion of other com-
mon issues, such as substance use or health behaviors
for bolstering resilience (e.g., exercise, sleep).
Consistent with prior study of graduate student
mental health, students in this study largely endorsed
at least mild symptoms of depression and anxiety and
about half had actively sought clinical support. Equally
concerning, many non-treatment-seeking students
reported notable barriers to accessing care, including
time constraints, financial cost, stigma, doubts that ser-
vices would be helpful, or feelings that their problems
were insufficiently severe to warrant an appointment.
These observations underscore the urgent need to
develop more time- and cost-efficient interventions,
particularly for emerging adults. Universities every-
where are grappling with the high, and rising, rates
of stress, anxiety, and depression among students and
are unable to feasibly reach all at-risk students.
Conclusions
Scalable, early interventions that target subclinical
or mild symptoms may be particularly useful in mitigat-
ing mental health burdens on campuses, reducing wait-
lists for treatment, and conserving university resources
for higher acuity cases. The UP holds particular pro-
mise given its focus on transdiagnostic emotion regula-
tion skills that are broadly applicable to the emotional
challenges of emerging adulthood and graduate
school. In this way, the program can support students
experiencing nonspecific distress, evidenced in reduc-
tions in neuroticism at follow-up, as well as disorder-
specific symptoms. The present format also provides
notable advantages for reaching students—for exam-
ple, workshops were scheduled at times, locations,
and points in the academic year selected by students
to be most accessible and useful. Moreover, partici-
pants within a workshop came from the same academic
field, enabling us to tailor material to stressors espe-
cially characteristic of specific disciplines. Additionally,
we aimed to increase accessibility and reduce stigma by
eliminating a requisite clinical threshold for enrolling,
presenting the intervention as a workshop rather than
group treatment, and conducting workshops within
individual departments to increase social support and
normalize mental health problems. Overall, study
results are heartening that a brief, group intervention
could benefit emerging adults in managing the stress
of graduate school and reducing or preventing symp-
toms of emotional disorders. Findings support more
research that could evaluate the program in more rig-
orous, diverse ways.
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 Transdiagnostic CBT Workshop for Graduate Students 409

The authors have no competing interests to disclose.
This work was supported by the Pershing Square Fund for
Research on the Foundations of Human Behavior (E.E.B.). The
sponsor had no involvement in study design, data collection,
analysis, or interpretation, writing, or decision to submit this
article for publication. The authors would like to thank the
following individuals for their feedback and support during the
development of this project: David H. Barlow, Jocelyn J. Fuentes,
Samantha R. Giffen, Jonathan Haefner, Ian T. Hill, Cate Leonard,
Barbara S. Lewis, David Martin, Maureen Rezendes, Hannah
Shaffer, Aleyda M. Trevino, Alyson R. Warr, S. Rue Wilson, and
Ziyan Zhu.
Address correspondence to Emily E. Bernstein, Department of
Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA
02138. e-mail: ebernstein@g.harvard.edu.
Received: October 11, 2019
Accepted: September 22, 2020
Available online 10 November 2020