Effectiveness of unified protocols for transdiagnostic treatment in improving the symptoms of depression, stress, anxiety, emotion regulation, and cognitive flexibility of students with subclinical symptoms of emotional disorders: A randomized clinical trial.

BACKGROUND: The current study aimed to investigate the effectiveness of unified protocol for the transdiagnostic treatment of emotional disorders (UP) on symptoms of depression, stress, anxiety, emotion regulation (ER), and cognitive flexibility (CF) of students with subclinical symptoms of depression and anxiety disorders. MATERIALS AND METHODS: In this assessor-blinded randomized clinical trial with pretest, post-test, and 6-month follow-up, 30 Farhangian University students in 2024 were selected through convenience sampling and randomly assigned to either an intervention or control group (n = 15 each). The intervention group received 14 90-minute UP sessions. Assessments included the DASS-21, Emotion Regulation Questionnaire, and Cognitive Flexibility Inventory. Data were analyzed using SPSS 26 and ANOVA. RESULTS: ANOVA analysis revealed significant reductions in symptoms of depression (F = 279.54, P = 0.001, ŋ² = 0.90), anxiety (F = 265.55, P = 0.001, ŋ² = 0.90), and stress (F = 194.05, P = 0.001, ŋ² = 0.87) in the intervention group from baseline to post-treatment, and these improvements were sustained at 6-month follow-up. Significant interaction effects (time × group) were also observed for depression (F = 79.58, P = 0.001, ŋ² = 0.85), anxiety (F = 21.06, P = 0.001, ŋ² = 0.60), and stress (F = 97.28, P = 0.001, ŋ² = 0.87), indicating greater improvements in the intervention group compared to controls. Furthermore, post-treatment improvements were significant in cognitive flexibility (between-group: F = 9.80, P = 0.001, ŋ² =0.21) and emotion regulation (interaction: F = 11.6, P = 0.001, ŋ² = 0.46). CONCLUSIONS: The results indicated the effectiveness of UP in improving ER and CF and reducing subclinical symptoms of students in the intervention group, indicating the importance of UP as the preferred treatment in emotional disorders and also the significance of preventing the complete clinical manifestation of subclinical symptoms of emotional disorders.