Volume 32, Issue 1 (3-2025)
RJMS 2025, 32(1): 1-13 |
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Research code: IRCT20230627058601N1
Ethics code: IR.IAU.SEMNAN.REC.1402.005
Clinical trials code: 12852825298208994018162750635
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Amiri A, Izadi Mazidi M, Eshrati S, Jafari Mehdiabad A. Effectiveness of Unified Transdiagnostic Treatment on Emotional Distress, and Difficulty in Emotion Regulation in Patients with History of Suicide Attempt. RJMS 2025; 32 (1) :1-13
URL: http://rjms.iums.ac.ir/article-1-8562-en.html
URL: http://rjms.iums.ac.ir/article-1-8562-en.html
1- MSc. of Clinical Psychology, Semnan Branch, Islamic Azad University, Semnan, Iran
2- Assistant Professor, Department of Psychology, Faculty of Literature and Humanities, Yasoug University, Yasoug, Iran ,maryam.izadi.psy@gmail.com
3- Assistant Professor, Department of Addiction, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences,Tehran, Iran
4- Assistant Professor of Psychiatry, Tehran University of Medical, Sciences, Tehran, Iran
2- Assistant Professor, Department of Psychology, Faculty of Literature and Humanities, Yasoug University, Yasoug, Iran ,
3- Assistant Professor, Department of Addiction, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences,Tehran, Iran
4- Assistant Professor of Psychiatry, Tehran University of Medical, Sciences, Tehran, Iran
Abstract: (1865 Views)
Background & Aims: Suicide and suicide-related behaviors constitute major psychiatric emergencies and represent a significant public health concern worldwide. Suicide attempts are associated with substantial psychological, social, and economic burdens for individuals, families, and healthcare systems. Research has consistently demonstrated that emotional distress and deficits in emotion regulation are among the most important psychological factors associated with suicidal thoughts and behaviors. Individuals with a history of suicide attempts often experience intense negative emotions, including anxiety, depression, stress, fear, and hopelessness, and frequently struggle to regulate these emotional experiences effectively. Difficulties in emotion regulation may increase vulnerability to emotional distress and contribute to maladaptive coping strategies such as avoidance, suppression, rumination, and self-harming behaviors. The Unified Transdiagnostic Treatment (UTT), developed within the cognitive-behavioral framework, focuses on common emotional processes underlying a wide range of emotional disorders rather than targeting disorder-specific symptoms. This treatment emphasizes emotional awareness, cognitive flexibility, reduction of emotional avoidance, and adaptive emotion regulation strategies. Given the central role of emotional dysregulation in suicidal behavior, the present study aimed to investigate the effectiveness of the Unified Transdiagnostic Treatment in reducing emotional distress and improving emotion regulation among patients with a history of suicide attempts attending psychiatric hospitals in Tehran, Iran.
Methods: This study employed a quasi-experimental design with a pretest-posttest control group. The statistical population consisted of patients aged between 18 and 40 years who attended psychiatric hospitals in Tehran during 2023 and had a documented history of at least one suicide attempt as well as at least one diagnosis within the spectrum of emotional disorders. Participants were recruited through purposive sampling. Initially, 50 eligible individuals were enrolled in the study; however, six participants withdrew during the intervention period, resulting in a final sample of 44 participants. The remaining participants were randomly assigned to either an experimental group (n = 22) or a control group (n = 22).
Data were collected using two standardized instruments: the Difficulties in Emotion Regulation Scale (DERS) developed by Gratz and Roemer and the Depression, Anxiety, and Stress Scale-21 (DASS-21), which was used as a measure of emotional distress. After obtaining ethical approval, informed consent was secured from all participants. Baseline assessments were administered before the intervention. Participants in the experimental group received the Unified Transdiagnostic Treatment protocol in addition to routine psychiatric care. The intervention consisted of eight weekly individual sessions, each lasting approximately 90 minutes, based on the treatment protocol developed by Barlow and colleagues. The sessions focused on psychoeducation about emotions, increasing emotional awareness, identifying emotional triggers and maladaptive behavioral responses, enhancing cognitive flexibility, modifying automatic maladaptive appraisals, reducing emotional avoidance, and developing adaptive emotion regulation skills. Participants in the control group received only the usual psychiatric and psychological services provided by the hospitals. Following completion of the intervention, both groups completed the posttest assessments. Data were analyzed using descriptive statistics and multivariate analysis of covariance (MANCOVA) through SPSS version 26. Assumptions of normality, homogeneity of variances, and homogeneity of covariance matrices were examined and confirmed prior to conducting the main analyses.
Results: The mean age of participants was 27.20 years (SD = 7.88), and approximately 65.9% of the sample were female. Descriptive findings indicated a noticeable reduction in emotional distress and difficulties in emotion regulation among participants in the experimental group at posttest, whereas changes in the control group were minimal. The results of multivariate analysis of covariance revealed a statistically significant overall difference between the experimental and control groups on the combined dependent variables following the intervention (F = 139.06, p < .001). The effect size was substantial, with the intervention accounting for approximately 87% of the variance in the combined outcome variables.
Follow-up univariate analyses demonstrated significant differences between groups on both emotional distress and difficulties in emotion regulation. Specifically, participants who received the Unified Transdiagnostic Treatment showed significantly lower levels of emotional distress compared with those in the control group (F = 207.199, p < .001). Likewise, significant improvements were observed in emotion regulation, with participants in the treatment group reporting markedly fewer difficulties in emotion regulation than those in the control group (F = 188.912, p < .001). Effect size estimates indicated that approximately 82% of the variance in emotional distress scores and 83% of the variance in emotion regulation difficulties were attributable to the intervention. These findings suggest that the Unified Transdiagnostic Treatment produced robust and clinically meaningful improvements in emotional functioning among individuals with a history of suicide attempts.
Conclusion: The findings of the present study provide strong evidence for the effectiveness of the Unified Transdiagnostic Treatment in reducing emotional distress and improving emotion regulation among patients with a history of suicide attempts. The intervention appears to achieve these outcomes through several interrelated mechanisms, including enhancing emotional awareness, facilitating nonjudgmental observation of emotional experiences, increasing recognition and understanding of emotions, identifying patterns of emotional avoidance, promoting cognitive reappraisal, and fostering greater psychological flexibility. By helping individuals modify maladaptive emotional and cognitive responses and adopt more adaptive coping strategies, the treatment reduces vulnerability to intense emotional suffering and emotional dysregulation, both of which are recognized risk factors for suicidal behavior. Given its transdiagnostic nature and emphasis on core emotional processes shared across various emotional disorders, the Unified Transdiagnostic Treatment may serve as an effective therapeutic option for patients with a history of suicide attempts and co-occurring emotional difficulties. Mental health professionals are encouraged to consider this intervention as part of comprehensive treatment programs aimed at reducing psychological distress and improving emotional functioning in this high-risk population. Future research should examine the long-term effectiveness of this treatment, its impact on suicidal ideation and recurrent suicide attempts, and its applicability across diverse age groups and clinical settings.
Methods: This study employed a quasi-experimental design with a pretest-posttest control group. The statistical population consisted of patients aged between 18 and 40 years who attended psychiatric hospitals in Tehran during 2023 and had a documented history of at least one suicide attempt as well as at least one diagnosis within the spectrum of emotional disorders. Participants were recruited through purposive sampling. Initially, 50 eligible individuals were enrolled in the study; however, six participants withdrew during the intervention period, resulting in a final sample of 44 participants. The remaining participants were randomly assigned to either an experimental group (n = 22) or a control group (n = 22).
Data were collected using two standardized instruments: the Difficulties in Emotion Regulation Scale (DERS) developed by Gratz and Roemer and the Depression, Anxiety, and Stress Scale-21 (DASS-21), which was used as a measure of emotional distress. After obtaining ethical approval, informed consent was secured from all participants. Baseline assessments were administered before the intervention. Participants in the experimental group received the Unified Transdiagnostic Treatment protocol in addition to routine psychiatric care. The intervention consisted of eight weekly individual sessions, each lasting approximately 90 minutes, based on the treatment protocol developed by Barlow and colleagues. The sessions focused on psychoeducation about emotions, increasing emotional awareness, identifying emotional triggers and maladaptive behavioral responses, enhancing cognitive flexibility, modifying automatic maladaptive appraisals, reducing emotional avoidance, and developing adaptive emotion regulation skills. Participants in the control group received only the usual psychiatric and psychological services provided by the hospitals. Following completion of the intervention, both groups completed the posttest assessments. Data were analyzed using descriptive statistics and multivariate analysis of covariance (MANCOVA) through SPSS version 26. Assumptions of normality, homogeneity of variances, and homogeneity of covariance matrices were examined and confirmed prior to conducting the main analyses.
Results: The mean age of participants was 27.20 years (SD = 7.88), and approximately 65.9% of the sample were female. Descriptive findings indicated a noticeable reduction in emotional distress and difficulties in emotion regulation among participants in the experimental group at posttest, whereas changes in the control group were minimal. The results of multivariate analysis of covariance revealed a statistically significant overall difference between the experimental and control groups on the combined dependent variables following the intervention (F = 139.06, p < .001). The effect size was substantial, with the intervention accounting for approximately 87% of the variance in the combined outcome variables.
Follow-up univariate analyses demonstrated significant differences between groups on both emotional distress and difficulties in emotion regulation. Specifically, participants who received the Unified Transdiagnostic Treatment showed significantly lower levels of emotional distress compared with those in the control group (F = 207.199, p < .001). Likewise, significant improvements were observed in emotion regulation, with participants in the treatment group reporting markedly fewer difficulties in emotion regulation than those in the control group (F = 188.912, p < .001). Effect size estimates indicated that approximately 82% of the variance in emotional distress scores and 83% of the variance in emotion regulation difficulties were attributable to the intervention. These findings suggest that the Unified Transdiagnostic Treatment produced robust and clinically meaningful improvements in emotional functioning among individuals with a history of suicide attempts.
Conclusion: The findings of the present study provide strong evidence for the effectiveness of the Unified Transdiagnostic Treatment in reducing emotional distress and improving emotion regulation among patients with a history of suicide attempts. The intervention appears to achieve these outcomes through several interrelated mechanisms, including enhancing emotional awareness, facilitating nonjudgmental observation of emotional experiences, increasing recognition and understanding of emotions, identifying patterns of emotional avoidance, promoting cognitive reappraisal, and fostering greater psychological flexibility. By helping individuals modify maladaptive emotional and cognitive responses and adopt more adaptive coping strategies, the treatment reduces vulnerability to intense emotional suffering and emotional dysregulation, both of which are recognized risk factors for suicidal behavior. Given its transdiagnostic nature and emphasis on core emotional processes shared across various emotional disorders, the Unified Transdiagnostic Treatment may serve as an effective therapeutic option for patients with a history of suicide attempts and co-occurring emotional difficulties. Mental health professionals are encouraged to consider this intervention as part of comprehensive treatment programs aimed at reducing psychological distress and improving emotional functioning in this high-risk population. Future research should examine the long-term effectiveness of this treatment, its impact on suicidal ideation and recurrent suicide attempts, and its applicability across diverse age groups and clinical settings.
Type of Study: Research |
Subject:
Clinical Psychiatry
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