Randomized Controlled Trial
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2022; 10(24): 8599-8614
Published online Aug 26, 2022. doi: 10.12998/wjcc.v10.i24.8599
Application of unified protocol as a transdiagnostic treatment for emotional disorders during COVID-19: An internet-delivered randomized controlled trial
Kou Yan, Mohammad Hassan Yusufi, Nabi Nazari
Kou Yan, School of Humanities and Education, Xi'an Eurasia University, Xi'an 710065, Shaanxi Province, China
Mohammad Hassan Yusufi, Education Administration, Bamyan University, Bamyan 22502, Afghanistan
Nabi Nazari, Department of Psychology, Faculty of Human Sciences, Lorestan University, Khorramabad, Lorestan, Iran
Author contributions: Nazari N made significant contributions to the conceptualization and methodology of the study, and writing of the original draft; Yan K made significant contributions to the design, software, methodology, and supervision of the study; Yusufi MH made significant contributions to the preparation, data curation, writing, and revision of the draft. All authors wrote, reviewed, and edited the manuscript.
Supported by Shaanxi Province Education Science "13th Five-Year" Planning Topic: Drama Teaching Method in Application of Research of Psychological Education of Primary School students, No. SGH17H472; and Research Team Cultivation Project of Xi 'an Eurasia University: Regional Children’s Psychological Development Research, No. 2021XJTD.
Institutional review board statement: The study was carried out in accordance with the Declaration of Helsinki and was approved and registered by the ethical and Human Subjects Review. The study was reviewed and approved by the (Bamyan University) Institutional Review Board [(Approval No: BAMAFGHEDU2019070)].
Clinical trial registration statement: This study is registered at https://clinicaltrials.gov/ct2/show/NCT04498949. The registration identification number is NCT04498949.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: The datasets generated and/or analyzed during the current study are not publicly available due to (local policy considerations and limitations of ethical approval involving the patient data and anonymity) but are available from the corresponding author upon reasonable request.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nabi Nazari, PhD, Academic Fellow, Academic Research, Research Assistant, Research Assistant Professor, Senior Editor, Department of Psychology, Faculty of Human Sciences, Lorestan University, Kamalvand St., Khorramabad 6815144316, Lorestan, Iran. nazariirani@gmail.com
Received: March 11, 2022
Peer-review started: March 11, 2022
First decision: April 18, 2022
Revised: May 2, 2022
Accepted: July 25, 2022
Article in press: July 25, 2022
Published online: August 26, 2022
Processing time: 157 Days and 13.9 Hours
Abstract
BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has been an emotionally challenging time, especially for young adults. It is associated with a substantial increase in the prevalence of mental health problems, negative symptoms, and stressful experiences that compromise well-being. In low-income countries, internet-delivered psychological services could have a remarkable impact on the population’s mental health, given the lack of mental health professionals.

AIM

To investigate the efficacy of internet-delivered cognitive-behavior therapy (CBT)-transdiagnostic intervention for adults with emotional disorders.

METHODS

In this internet-delivered randomized controlled trial, 102 students with an emotional disorder (mean age = 28.20 years, standard deviation = 5.07) were randomly allocated to receive unified protocol (UP) (n = 51) or treatment as the usual intervention. Following a semi-structured clinical interview, participants completed an online survey including the Overall Anxiety Severity and Impairment Scale, Overall Depression Severity and Impairment Scale, Difficulties in Emotion Regulation Scale, Positive and Negative Affect Schedule, and Emotional Style Questionnaire.

RESULTS

The participants showed a high degree of adherence. In total, 78% (n = 40) of the experimental group participants completed the UP treatment. Considering the intention to treat procedure, the results of the analysis of covariance indicated that participants who received UP showed statistically significant changes in depression symptoms [Cohen’s d = -1.50 with 95% confidence interval (CI): -1.90 to -1.10], anxiety (Cohen’s d = -1.06 with 95%CI: -1.48 to -0.65), difficulties with emotion regulation (Cohen’s d = -0.33 with 95%CI: -0.7 to -0.06), positive affect (Cohen's d = 1.27 with 95%CI: 0.85 to 1.68), negative affect (Cohen’s d= -1.04 with 95%CI: -1.46 to -0.63), and healthy emotionality (Cohen’s d = 0.53 with 95%CI: 0.09 to 0.13) compared with the control group.

CONCLUSION

This study’s findings highlight the potential value of transdiagnostic internet-delivered programs for young adults with an emotional disorder during the COVID-19 pandemic, and expand the research examining emotional well-being improvements resulting from CBT-transdiagnostic interventions. The findings suggest that UP, which generally concentrates on reducing negative effects, can increase positive effects.

Keywords: Unified protocol, COVID-19, Internet-delivered, Emotion regulation, Transdiagnostic, Depression, Anxiety

Core Tip: Transdiagnostic treatments may optimize mental health services during the current pandemic. The findings of this study highlight the potential value of transdiagnostic internet-delivered programs for adults. The unified protocol is a promising transdiagnostic treatment for youth with emotional disorders during the coronavirus disease 2019 pandemic. The study’s findings expand the body of research examining positive affect improvements resulting from cognitive-behavior therapy-transdiagnostic interventions.