Comparing the effectiveness of behavioral activation in group vs. self-help format for reducing depression, repetitive thoughts, and enhancing performance of patients with major depressive disorder: a randomized clinical trial.

BACKGROUND: Behavioral activation has gained increasing attention as an effective treatment for depression. However, the effectiveness of Behavioral Activation Group Therapy (BAGT) in controlled conditions compared to its self-help programs requires more investigation. The present study aimed to compare their effectiveness on depressive symptoms, repetitive negative thinking (RNT), and performance in patients with major depressive disorder (MDD). METHODS: In this randomized clinical trial, 40 patients diagnosed with Major Depressive Disorder (MDD) were recruited based on a structured clinical interview for DSM-5 (SCID-5). Participants were allocated to BAGT (n = 20) and self-help behavioral activation (SBA; n = 20) groups. BAGT received ten weekly sessions (90 min), while the SBA group followed the same protocol as the self-help intervention. Participants were evaluated at pre-treatment, post-treatment, and the 2-month follow-up using the Beck Depression Inventory-II (BDI-II), repetitive thinking questionnaire (RTQ-31), and work and social adjustment scale (WSAS). RESULTS: The results of a Mixed ANOVA analysis revealed that participants who underwent BAGT showed significant improvement in depression, rumination, work, and social functioning post-treatment and at the 2-month follow-up. However, the SBA group did not show significant changes in any outcome. The study also found that, based on clinical significance, 68% of the BAGT participants were responsive to treatment, and 31% achieved a high final performance status at the 2-month follow-up. DISCUSSION: BAGT was more effective than SBA in MDD patients. Participants' engagement with self-help treatment is discussed. TRIAL REGISTRATION: The present trial has been registered in the Iranian Registry of Clinical Trials Center (IRCT ID: IRCT20181128041782N1|| http://www.irct.ir/ ) (Registration Date: 04/03/2019).

The effect of educational intervention on the quality of life of women suffering from pregnancy-related nausea and vomiting: a systematic review.

OBJECTIVE: The present study aimed to determine the influence of educational interventions on improving the quality of life (QOL) of women suffering from pregnancy-related nausea and vomiting (NVP) as a systematic review. METHODS: The current systematic review followed the standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist guideline. The English electronic databases were used to identify relevant studies published 2000 until 14 August 2023. The search strategies employed were based on Mesh browser keywords and free-text words. The study risk of bias was evaluated using the Cochrane Collaboration's tool for assessing the risk of bias tools and publication bias was evaluated using a funnel plot and Begg and Egger tests. The heterogeneity of the studies was evaluated using I2 and tau-squared tests. Data were analyzed using the RevMan 5 software. Results of the random-effects meta-analysis were presented using the standard mean difference, along with a 95% confidence interval (CI). RESULTS: Out of the seven randomized clinical/control trial (RCT) studies with a total of 946 subjects included in the review, five studies reported a significant result, indicating that the interventions had a statistically significant effect on the QOL of women suffering NVP and in two studies did not have a significant result. A subgroup analysis was done based on the type of quality-of-life measurements. The pooled standardized mean difference (SMD) of four articles (Nausea and Vomiting Pregnancy Quality of Life, NVPQOL) with a total of 335 subjects was -2.91, and CI of -4.72 to -1.11, p value = .002, I2 = 97.2%. The pooled SMD of three articles (SF36) with a total of 611 subjects was -0.05, and CI of -0.23 to -0.12, p value = .550, I2 = 10%. CONCLUSIONS: The overall results of the analysis indicated that educational intervention had a small positive impact on the QOL of women experiencing NVP. However, to draw a better conclusion, it is recommended to conduct further studies with larger sample sizes and longer follow-up periods.

Deficits in specific executive functions manifest by severity in major depressive disorder: a comparison of antidepressant naïve inpatient, outpatient, subclinical, and healthy control groups.

Introduction: Previous research has highlighted the executive function (EF) deficits present in depressed patients; however, conflicting results exist regarding the impact of depression severity on the size of these deficits. This study aimed to compare deficits in EF between antidepressant naïve inpatient and outpatient depressed, a group with subclinical depression symptoms, and a healthy control group while controlling for education, sex, and age. Methods: In cross-sectional research, 245 antidepressant naive participants (46 inpatient, 68 outpatient, 65 subclinical, and 67 healthy control individuals) were recruited by convenience sampling. The Structured Clinical Interview for DSM-5 Disorders (SCID-5) and Beck Depression Inventory-II (BDI-II) were used to assess depression. EF was measured using several neuropsychological tests, including the Stroop Color-Word Test, the Wisconsin Card Sorting Test, and the N-back Test, which assessed the components of Inhibition, Shifting, and Updating, respectively. Multivariate analysis of covariance revealed a significant difference between the groups in EF components (p < 0.001). Pairwise comparisons further showed that inpatient and outpatient patients had more depressive symptoms and worse EF performance than subclinical and healthy control groups (p < 0.05). Results: In the analysis of EF measures, a significant difference was found among the four groups, with post-hoc tests revealing variations in specific EF components. Overall, patients with more severe depressive symptoms show more deficits in EF. Additionally, correlations between clinical characteristics and EF measures varied across patient groups, but many correlations became non-significant after adjusting for the false discovery rate (FDR). Discussion: This study emphasizes the impact of depression severity on deficits in the EF of depressed patients and at-risk populations. Consequently, it is important to consider executive dysfunctions as an underlying vulnerability in the development and persistence of depressive disorder.

Personality Traits and the Clinical Environment`s Stress Resources in Nursing Students.

Background: The clinical environment always has been the most stressful course of nursing education. Personality traits can be influential factors in stress resources and responding to stress. The present study investigates the correlation between personality traits and nursing students' stress resources in the clinical environment. Material and Methods: This descriptive correlational study was planned and performed on Zanjan University of Medical Sciences nursing students. The research population was 215 students selected by stratified random sampling method from all nursing students in the third to eighth semesters. We used an electronic questionnaire for data gathering, including three sections: demographic characteristics, NEO personality traits, and stress resources in the clinical environment. The data were analyzed using descriptive and inferential statistics. Results: The most and least stressful resources were related to the score of unpleasant emotions and interpersonal relationships. We found a significant positive correlation between neuroticism personality traits and all four stress resources (p < 0.05). The results also showed a significant correlation between all scores of personality traits and perceived stress from unpleasant emotions except the openness to experience trait (p < 0.05). Furthermore, the relationship between age, gender, semester, interest, and stress resources in the clinical environment was statistically significant (p < 0.05). Conclusions: Paying attention to the nursing student's clinical performance to maintain the patient's health is vital and unavoidable. Therefore, more than ever in the preclinical course of nursing education, improving the psychological readiness and simulation training method can reduce the harmful effects of the clinical environment's stress resources on their clinical performance.

Caregiving burden, depression, and anxiety among family caregivers of patients with cancer: An investigation of patient and caregiver factors.

Background: Caring for patients with cancer can result in significant burden, anxiety, and depression among family caregivers, leading to alterations in their mental and physical wellbeing. Evidence on the level of cancer caregivers' burden, depression, anxiety, their role in assisting their patients, and other patient and caregiver factors that play in improving/worsening the outcomes, is limited. This study explored the prevalence of caregiving burden, depression, and anxiety with a focus on the patient and caregiver-related factors among cancer family caregivers. Methods: A cross-sectional study was conducted on the population of caregivers of adult patients with cancer in Zanjan, Iran between 2019 and 2020. The Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), and the Zarit Burden Inventory (ZBI) were used to measure outcome variables. Clinical and basic characteristics of the caregivers and patients were also collected. An independent samples t-test, analysis of variance, Pearson's correlation coefficient, and stepwise linear regression were performed using SPSS software version 26. Results: Mean ± standard deviation age of the caregivers (167 men and 133 women) was 40.77 ± 12.56. Of the caregivers, 46.3, 53, and 30.7% showed severe depression, anxiety, and burden, respectively. There was a significant positive correlation between ZBI with both BDI [r (298) = 0.19, p < 0.01] and BAI [r (298) = 0.20, p < 0.01]. Caregiving ≥24 months (B = 14.36, p < 0.001), outpatient care setting (B = -12.90, p < 0.001), being retired (B = -12.90, p < 0.001), depression (B = 0.28, p < 0.001), supplemental health insurance (B = -7.79, p < 0.001), being illiterate (B = 7.77, p < 0.01), surgery (B = 8.55, p < 0.01), ECOG1 (B = 4.88, p < 0.01), and patient's age (B = 0.11, p < 0.05) were found to be significant predictors of caregiving burden. Conclusion: High levels of depression, anxiety, and burden were observed among the caregivers of patients with cancer. These findings underline the importance of paying close attention to the needs and psychological challenges of this population.

Psychometric Properties of the Iranian Version of Contrast Avoidance Questionnaires: Could Contrast Avoidance Be a New Transdiagnostic Construct?

The contrast avoidance model (CAM) hypothesizes that individuals with chronic worry recruit worry to create and maintain a negative emotional state to avoid sudden increases in negative emotions. Preliminary evidence using the contrast avoidance questionnaires (CAQs) suggests that there might be a similar mechanism across mood and other anxiety disorders. To continue to assess the CAQs, they should be adapted for other languages and evaluated across multiple symptom domains. The present study aimed to develop the Persian versions of the CAQs and examine the transdiagnostic nature of CAM across two studies. A large Persian-speaking college student sample (Total n = 1438) was used to evaluate the factor structure of the CAQs (Study 1) and the psychometric properties of CAQs (Study 2). Results supported the two-factor structure of the CAQ-W (worry) and CAQ-GE (general emotion). Results showed that CAQ-W was a significant predictor of anxiety-related measures. However, CAQ-GE and IUS-12 significantly predicted depressive and other symptoms over the CAQ-W. Results demonstrated excellent psychometric properties. They indicate that contrast avoidance, measured via CAQ-GE, could be a transdiagnostic construct, and CAQ-W may be more sensitive to anxiety-specific contrast avoidance among Persian speaking and/or Iranian individuals.

The effectiveness of adapted group mindfulness-based stress management program on perceived stress and emotion regulation in midwives: a randomized clinical trial.

BACKGROUND: Midwives' stress can have negative consequences on their emotional state, burnout, and poor quality of midwifery care. This study aimed to determine the effectiveness of an adapted mindfulness-based stress management program on perceived stress and the emotional regulation of midwives. METHODS: The study was a parallel randomized clinical trial on the midwives working in general hospitals of Zanjan, Iran. In this study, 121 midwives registered to participate based on the census sampling method were screened using a cut point of ≥ 28 in the Perceived Stress Scale (PSS). From the initial sample, 42 subjects had inclusion criteria assigned to two groups of control (n = 21) and intervention (n = 21) using online random allocation. The intervention group received an 8-week adapted mindfulness-based stress management program. This program emanates from the Kabat-Zinn's MBSR program, which has been adjusted according to the Iranian culture. The ANCOVA and repeated measure analysis of variance test were used to compare groups over time. RESULTS: The results showed that the group intervention effectively affected perceived stress (P = 0.001) and difficulty in emotion regulation during the post-intervention period (P = 0.001). Moreover, the interventions were effective in emotion regulation (P = 0.003), but it was not effective on perceived stress (P = 0.125) at the 3-month follow-up. CONCLUSIONS: This adapted mindfulness-based program successfully reduced stress and increased emotion regulation strategies in midwives; however, the long-term outcomes of this treatment program need further consideration.

The efficacy of transdiagnostic cognitive behavioural therapy on reducing negative affect, anxiety sensitivity and improving perceived control in children with emotional disorders - a randomized controlled trial.

In response to the high rate of comorbidity among different types of emotional disorders in children, Transdiagnostic Unified Protocol of Emotional disorder in children (UP-C) was developed to address common underlying mechanisms in the development and maintenance of emotional disorders using empirically supported cognitive and behavioural strategies. Although, studies supported the effectiveness of this protocol in the treatment of wide range of emotional disorders, further studies are needed to examine its effect on transdiagnostic factors. The present study aimed to investigate the efficacy of the UP-C on negative affect, anxiety sensitivity and perceived control in children with emotional disorders. During this randomized controlled trial, 34 children aged 7 to 13 with emotional disorders were randomly assigned to treatment (n=18) and control (n=16) groups. The treatment group and their parents received 15 sessions of UP-C. Negative Affect Schedule for Children (PANASNA- C), Children's Anxiety Sensitivity Index (CASI), Anxiety Control Questionnaire-Children (ACQ-C) were carried out in all phases (pre-treatment, post-treatment, 3 and 8 months follow- up). The results showed that following UP-C, negative affect (hedges'g=2.01) and anxiety sensitivity (hedges'g=1.05) were significantly reduced, and perceived control (hedges'g= -2.36) was significantly improved. The results remained relatively constant during the follow-ups. Findings provide evidence that the UP-C has significant effect on negative affect, anxiety sensitivity and perceived control as roots of emotional disorders.

Psychometric properties and factor structure of the Repetitive Thinking Questionnaire: Persian versions of the RTQ-31 and RTQ-10.

INTRODUCTION: Repetitive thinking as a transdiagnostic factor plays an essential role in the development and maintenance of emotional disorders. Two versions of the Repetitive Thinking Questionnaire (RTQ-31 and RTQ-10) are the best-known measures used for assessing repetitive thinking in clinical and non-clinical samples. The present study was conducted to evaluate the psychometric properties and factor structure of Persian versions of them. METHODS: Participants were 592 students assessed with the RTQ-31, the RTQ-10, the Ruminative Response Scale, the Perseverative Thinking Questionnaire, the Beck Depression Inventory-second edition, the Beck Anxiety Inventory, and the Depression, Anxiety, Stress Scale-21. Exploratory and confirmatory factor analysis were used to determine construct validity. RESULTS: The findings showed that the RTQ-31 and the RTQ-10 demonstrated excellent internal consistency and good test-retest reliability (α = 0.946: r = 0.844) and (α = 0.903: r = 0.776) respectively. Also, five items from the original version were omitted due to inadequate factor loadings. This study showed that the resulting 26-item version has a two-factor structure, while the short version has a one-dimensional structure. Finally, it was found that repetitive thinking has a positive and powerful relationship with other measures of rumination and with symptoms of depression, anxiety, and stress. CONCLUSION: Persian versions of the RTQ have good factor structures and psychometric properties and can be used in clinical populations and related studies.

Psychometric properties and factor structure of the Repetitive Thinking Questionnaire: Persian versions of the RTQ-31 and RTQ-10

Abstract Introduction: Repetitive thinking as a transdiagnostic factor plays an essential role in the development and maintenance of emotional disorders. Two versions of the Repetitive Thinking Questionnaire (RTQ-31 and RTQ-10) are the best-known measures used for assessing repetitive thinking in clinical and non-clinical samples. The present study was conducted to evaluate the psychometric properties and factor structure of Persian versions of them. Methods: Participants were 592 students assessed with the RTQ-31, the RTQ-10, the Ruminative Response Scale, the Perseverative Thinking Questionnaire, the Beck Depression Inventory-second edition, the Beck Anxiety Inventory, and the Depression, Anxiety, Stress Scale-21. Exploratory and confirmatory factor analysis were used to determine construct validity. Results: The findings showed that the RTQ-31 and the RTQ-10 demonstrated excellent internal consistency and good test-retest reliability (α = 0.946: r = 0.844) and (α = 0.903: r = 0.776) respectively. Also, five items from the original version were omitted due to inadequate factor loadings. This study showed that the resulting 26-item version has a two-factor structure, while the short version has a one-dimensional structure. Finally, it was found that repetitive thinking has a positive and powerful relationship with other measures of rumination and with symptoms of depression, anxiety, and stress. Conclusion: Persian versions of the RTQ have good factor structures and psychometric properties and can be used in clinical populations and related studies.

Emotion Regulation Difficulties and Academic Procrastination.

OBJECTIVE AND BACKGROUND: Academic procrastination as deliberate postponement of academic tasks, despite being aware of its consequences, is a common phenomenon among students. Current conceptualizations of procrastination support the rule of emotion regulation difficulties in the psychopathology of this phenomenon. In this regard, the current study is aimed to investigate the role of difficulty in emotion regulation in academic procrastination. METHOD: The present study is a cross-sectional study. Participants were 250 students who completed Tuckman Procrastination Scale (TPS), and Difficulties in Emotion Regulation Scale (DERS). RESULT: Correlation analyses showed that the TPS has a significant positive association on overall DERS and all but one of the six dimensions (DERS-Awareness) of emotion regulation difficulties (p < 0.01). This association remained significant after controlling for anxiety and depression. Further, the multivariate regression showed that the only DERS dimension that could predict TPS was DERS-Strategies. Finally, individuals with a high level of procrastination reported greater DERS scores than those with a lower level. DISCUSSION: Results indicate that difficulty in emotion regulation, especially the ones' believe about his/her ability in regulating unpleasant emotions effectively, is important in procrastination. However, despite the limited association between DERS and TPS, the findings raise some potentially useful implications for procrastination studies and interventions.

The Effect of Cognitive Behavioural Group Therapy on the Workplace and Decisional Procrastination of Midwives: A Randomized Controlled Trial.

BACKGROUND: Procrastination in the general population is a prevalent phenomenon. Procrastination in midwives, who are responsible for health care services, can have serious consequences and reduce health care productivity. Cognitive Behavioral Group Therapy (CBGT) is believed to reduce procrastination, but few studies have investigated its effectiveness. The aim of the present study was to determine the effect of CBGT on the workplace and decisional procrastination of midwives. MATERIALS AND METHODS: This randomized, controlled trial was conducted on 47 participants who were eligible to participate in the study. The participants were randomly assigned to the CBGT (n = 24) and control (n = 23) groups. The intervention group received 7 sessions of CBGT and the control group received no intervention. Decisional and workplace procrastination were assessed at the pre-treatment, post-treatment, and 2-month follow-up phases. Repeated measures Analysis of Variance (ANOVA) and Analysis of Covariance (ANCOVA) were used for data analysis. RESULTS: At the posttest and follow-up phases, workplace procrastination (Post-test: F1,40= 11.78, p = 0.001; Follow-up: F1,40= 11.12, p = 0.002), soldiering (Post-test: F1,40= 13.77, p = 0.001; Follow-up: F1,40= 4.15, p = 0.049), cyberslacking (Post-test: F1,40= 4.20, p = 0.047; Follow-up: F1,40= 13.34, p = 0.001), and decisional procrastination (Post-test: F1,40= 6.66, p = 0.014; Follow-up: F1,40= 6.12, p = 0.018) significantly decreased in the CBGT group compared to the control group. CBGT explained 23% of the changes in the total workplace procrastination score and 22% of the changes in the component of soldiering (p < 0.05). CONCLUSIONS: CBGT significantly reduced workplace and decisional procrastination in midwives.

Emotion regulation as the mediator of reductions in anxiety and depression in the Unified Protocol (UP) for transdiagnostic treatment of emotional disorders: double-blind randomized clinical trial.

OBJECTIVE: An important subject in evaluation of the efficacy of treatments is to examine how the intervention is effective and to identify the consequences of that treatment. In this regard, the current study investigates the role of emotion regulation as the mediator of the treatment outcomes of therapy using the Unified Protocol (UP) for transdiagnostic treatment of emotional disorders. METHOD: This article describes a double-blind randomized clinical trial. A sample of 26 individuals was selected based on cut-off scores for the Beck Depression Inventory and Beck Anxiety Inventory and their final diagnoses were confirmed with the Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV). The sample was randomly divided into two groups: control and treatment (13 patients each). The treatment group received 20 one-hour UP sessions. The Beck Depression Inventory, the Beck Anxiety Inventory, and the Difficulties in Emotion Regulation Scale were administered at two stages, pre-treatment and post-treatment. RESULTS: The UP reduced anxiety and depression in patients through improvement in emotion regulation. Furthermore, the results showed that the difficulty engaging in goal-directed behavior and non-acceptance of emotional response subscales were capable of predicting 62% of variance in anxiety scores. In turn, two subscales, difficulty engaging in goal-directed behavior and lack of emotional clarity, predicted 72% of variance in depression scores. CONCLUSION: Emotion regulation can be considered as a potential mediating factor and as predictive of outcomes of transdiagnostic treatment based on the UP. CLINICAL TRIAL REGISTRATION: Iranian Registry of Clinical Trials, IRCT2017072335245N1.

Emotion regulation as the mediator of reductions in anxiety and depression in the Unified Protocol (UP) for transdiagnostic treatment of emotional disorders: double-blind randomized clinical trial / Regulação emocional como mediadora de reduções em ansiedade e depressão no Protocolo Unificado para o tratamento transdiagnóstico de transtornos psicológicos: ensaio clínico randomizado duplo-cego

Abstract Objective: An important subject in evaluation of the efficacy of treatments is to examine how the intervention is effective and to identify the consequences of that treatment. In this regard, the current study investigates the role of emotion regulation as the mediator of the treatment outcomes of therapy using the Unified Protocol (UP) for transdiagnostic treatment of emotional disorders. Method: This article describes a double-blind randomized clinical trial. A sample of 26 individuals was selected based on cut-off scores for the Beck Depression Inventory and Beck Anxiety Inventory and their final diagnoses were confirmed with the Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV). The sample was randomly divided into two groups: control and treatment (13 patients each). The treatment group received 20 one-hour UP sessions. The Beck Depression Inventory, the Beck Anxiety Inventory, and the Difficulties in Emotion Regulation Scale were administered at two stages, pre-treatment and post-treatment. Results: The UP reduced anxiety and depression in patients through improvement in emotion regulation. Furthermore, the results showed that the difficulty engaging in goal-directed behavior and non-acceptance of emotional response subscales were capable of predicting 62% of variance in anxiety scores. In turn, two subscales, difficulty engaging in goal-directed behavior and lack of emotional clarity, predicted 72% of variance in depression scores. Conclusion: Emotion regulation can be considered as a potential mediating factor and as predictive of outcomes of transdiagnostic treatment based on the UP. Clinical trial registration: Iranian Registry of Clinical Trials, IRCT2017072335245N1.

Resumo Objetivo: É importante, na avaliação da eficácia de tratamentos, examinar como a intervenção tem efeito e identificar suas consequências. O presente estudo investiga o papel da regulação emocional enquanto mediadora de desfechos do tratamento que emprega o Protocolo Unificado (PU) para o tratamento transdiagnóstico de transtornos psicológicos. Método: Este artigo descreve um ensaio clínico randomizado duplo-cego. Uma amostra de 26 indivíduos foi selecionada com base em escores pré-estabelecidos para o Inventário de Depressão de Beck e o Inventário de Ansiedade de Beck, e seus diagnósticos finais foram confirmados utilizando o instrumento Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV). A amostra foi dividida aleatoriamente em dois grupos: controle e tratamento (13 pacientes em cada). O grupo tratamento recebeu 20 sessões de PU de 1 hora cada. O Inventário de Depressão de Beck, Inventário de Ansiedade de Beck Beck e Escala de Dificuldades de Regulação Emocional foram administrados em duas etapas, antes e depois do tratamento. Resultados: O PU reduziu a ansiedade e a depressão em pacientes, ao melhorar a regulação emocional. Além disso, os resultados mostraram que as subescalas dificuldade de se engajar em comportamentos orientados por objetivos e não aceitação de resposta emocional responderam por 62% da variância nos escores de ansiedade. Nos escores de depressão, duas subescalas, dificuldade de se engajar em comportamentos orientados por objetivos e falta de claridade emocional, explicaram 72% da variância. Conclusão: A regulação emocional pode ser considerada o principal fator mediador e também preditora de desfechos do tratamento transdiagnóstico baseado no PU. Registro do ensaio clínico: Iranian Registry of Clinical Trials, IRCT2017072335245N1.

Reductions in transdiagnostic factors as the potential mechanisms of change in treatment outcomes in the Unified Protocol: a randomized clinical trial.

Transdiagnostic approaches emphasize on the share underlying features of emotional disorders. In their view, these transdiagnostic factors play an important role in the etiology, maintenance, and treatment of emotional disorders. This study aimed to investigate the transdiagnostic factors as the potential mechanisms of change in the Unified Protocol (UP) for the transdiagnostic treatment of emotional disorders outcomes. The present study is a randomized clinical trial. Twenty-six individuals were selected based on the Beck anxiety inventory and Beck depression inventory and randomly assigned into two groups of control and treatment (n=13). The treatment group received 20 one-hour individual UP sessions. Beck Depression Inventory, Beck Anxiety Inventory, Difficulty in emotion regulation scale, Intolerance of Uncertainty scale and Acceptance and Action questionnaire were carried out in all three phases. UP enhances the difficulty in emotion regulation (large effect size, SEsg=1.81), intolerance of uncertainty (SEsg=1.91), and experiential avoidance (SEsg=1.78). In addition, the results of linear regression show the association between changes in anxiety and depression with changes in transdiagnostic factors. The difficulty in emotion regulation, intolerance of uncertainty and experiential avoidance can be considered as the potential mechanism of change in improving UP outcomes.