A Comparison of the Effectiveness of Unified Protocol (UP) Transdiagnostic Treatment and Cognitive Behavioral Therapy (CBT) on Emotional Dysregulation and Distress Tolerance in Patients with Generalized Anxiety Disorder (GAD)

Negar Jarban

Authors

Negar Jarban MA, Department of Psychology, ShQ.C., Islamic Azad University, Shahr-e Qods, Iran Corresponding author https://orcid.org/0009-0005-0405-6524

Keywords:

Unified Protocol, Cognitive Behavioral Therapy, Emotional Dysregulation, Distress Tolerance, Generalized Anxiety Disorder, Transdiagnostic Treatment

Abstract

Purpose: The present study aimed to compare the effectiveness of Unified Protocol (UP) transdiagnostic treatment and Cognitive Behavioral Therapy (CBT) on emotional dysregulation and distress tolerance in patients with Generalized Anxiety Disorder (GAD).

Methods and Materials: This study employed a quasi-experimental design with a pretest–posttest and follow-up structure, including two experimental groups and one control group. The statistical population consisted of individuals diagnosed with GAD in Tehran, from which sixty participants were selected through purposive sampling and randomly assigned to UP, CBT, and control groups. Data were collected using the Difficulties in Emotion Regulation Scale (DERS) and the Distress Tolerance Scale (DTS). The UP and CBT interventions were administered in twelve 90-minute group sessions, while the control group received no intervention. Data analysis was conducted using repeated measures ANOVA and Bonferroni post hoc tests in SPSS-27.

Findings: The results revealed significant effects of time, group, and the interaction between time and group on emotional dysregulation and distress tolerance (p < 0.001). Both UP and CBT interventions significantly reduced emotional dysregulation and increased distress tolerance compared to the control group. Furthermore, the UP intervention demonstrated significantly greater effectiveness than CBT in improving both variables at posttest and follow-up stages, with large effect sizes indicating substantial intervention impact.

Conclusion: The findings indicate that both UP and CBT are effective interventions for improving emotional dysregulation and distress tolerance in patients with GAD; however, the Unified Protocol appears to be more effective, likely due to its transdiagnostic focus on core emotional processes. These results support the application of UP as a comprehensive and flexible treatment approach for anxiety disorders.

Downloads

Download data is not yet available.

References

Allahmoradi, M., Yaghoubi, M., Ebrahimi, F., Pourmohammadghouchani, K., & Norouziani, Z. (2026). Comparison of the Effectiveness of Cognitive Behavioral Therapy and Acceptance and Commitment Therapy on Referential Thoughts, Cognitive Flexibility, and Distress Tolerance in Patients with Major Depression. Psychological Dynamics in Mood Disorders, 1-18. https://maherpub.com/pdmd/article/view/628

Arani, A. M., Hosseini, S., Lotfinia, S., Ebrahimi, L. S., Mousavi, S. E., Mohammadzadeghan, R., & Hosseini, S. M. (2023). The Comparative Efficacy of Unified Transdiagnostic Protocol (UP) and Mindfulness-Based Stress Reduction Protocol (MBSR) on Emotion Regulation and Uncertainty Intolerance in Infertile Women Receiving IVF. Journal of Clinical Psychology in Medical Settings, 30(3), 578-588. https://doi.org/10.1007/s10880-022-09917-1

Masjedi Arani, A. M., Hosseini, S., Lotfinia, S., Ebrahimi, L. S., Mousavi, S. E., Mohammadzadeghan, R., & Hosseini, S. M. (2023). The comparative efficacy of unified transdiagnostic protocol (UP) and mindfulness-based stress reduction protocol (MBSR) on emotion regulation and uncertainty intolerance in infertile women receiving IVF. Journal of Clinical Psychology in Medical Settings, 30(3), 578–588. https://doi.org/10.1007/s10880-022-09917-1

Mehrdadfar, M., Ghasemzadeh, S., Ghobari-Bonab, B., Hasanzadeh, S., & Vakili, S. (2023). Effectiveness of unified protocols for online transdiagnostic treatment on social-emotional skills and parent-child interaction in school-aged children with cochlear implants. International Journal of Pediatric Otorhinolaryngology, 167, 111490. https://doi.org/10.1016/j.ijporl.2023.111490

Mirtabar, S. M., Barat, S., Kheirkhah, F., Mostafazadeh, A., Shirafkan, H., Pahlavan, Z., & Faramarzi, M. (2024). Effectiveness of an Internet-Based Transdiagnostic Unified Protocol Intervention for the Treatment of Depressive and Anxiety Disorders in Women with Threatened Abortion: A Feasibility Study. International Journal of Psychiatry and Behavioral Sciences, 18(4), e147292. https://doi.org/10.5812/ijpbs-147292

Mohajerin, B., Lynn, S. J., & Cassiello-Robbins, C. (2023). Unified Protocol vs Trauma-Focused Cognitive Behavioral Therapy Among Adolescents With PTSD. Behavior therapy, 54(5), 823-838. https://doi.org/10.1016/j.beth.2023.03.003

Nargesi, F., fathiashtiani, a., davodi, I., & ashrafi, e. (2019). The effect of unifled transdiagnostic treatment on anxiety sensitivity, distress tolerance and obsessive-compulsive symptoms in individuals with obsessive-compulsive disorder. Psychological Achievements, 26(2), 49-66. https://doi.org/10.22055/psy.2019.26369.2121

Nedaei, A., Ghamri, H., Sheykholeslami, A., & Sadri, E. (2025). The Effectiveness of "Cognitive-Behavioral Therapy" on the Difficulties of Emotional Regulation, Intolerance of Uncertainty and Thought Fusion in People Suffering From Comorbid Depression and Anxiety. Journal of Health Promotion Management, 13(5), 12-29. https://jhpm.ir/article-1-1588-fa.html

Paulet, T., & Weiner, L. (2025). Imagery-based cognitive therapy to reduce emotional dysregulation and mood instability in bipolar disorder: a case-series study. Behavioural and Cognitive Psychotherapy, 53(1), 1-16. https://doi.org/10.1017/S1352465824000420

Rahimi, M., & Bahramipour, M. (2024). The effectiveness of unified transdiagnostic treatment on emotional awareness, cognitive emotion regulation, and positive and negative affect in anxious children. Clinical Psychology and Personality, 22(1). https://doi.org/10.22070/cpap.2024.16501.1252

Ranjbar, S. (2024). The Effectiveness of Unified Protocol Transdiagnostic Treatment on Emotion Regulation and Parent-Child Relationship of Parents of Children With Learning Disabilities. Journal of Learning Disabilities, 13(4), 12-23. https://doi.org/10.22098/jld.2024.15431.2177

Razaei, M., & Pourmohammad Ghouchani, K. (2025). Effectiveness of cognitive behavioral therapy and acceptance and commitment therapy on cognitive flexibility in adolescents with generalized anxiety disorder.

Samaeelvand, N., Sadeghi, M., & Ghadampour, E. (2023). Comparison of Effectiveness of Integrated Models of Attachment Narrative Therapy and Unified Transdiagnostic on Cognitive Emotion Regulation Strategies in Distressed Couples. Journal of Family Counseling & Psychotherapy, 13(1). https://fcp.uok.ac.ir/article_62339.html?lang=en

Sharafati, H., Taheri, E., & Amiri, M. (2023). Comparison of the effectiveness of metacognitive therapy and Barlow's unified transdiagnostic treatment on the severity of clinical symptoms and experiential avoidance in patients with generalized anxiety disorder. Journal of Fundamentals of Mental Health (Majalleh-ye Osul-e Behdasht-e Ravani), 25(6), 403-409.

Sharafi, M., Jafari, D., & Bahrami, M. (2023). Comparing the effectiveness of transdiagnostic unified treatment and cognitive-behavioral therapy on depression and anxiety symptoms in adolescents with generalized anxiety disorder. Behavioral Sciences Research, 21(1), 138-150. https://www.sid.ir/paper/1099756/fa

Sharafi, M., Jafari, D., & Bahrami, M. (2023). The effects of cognitive behavioral therapy and unified transdiagnostic therapy on the emotional regulation of adolescents with generalized anxiety disorder [Research]. Rooyesh-e-Ravanshenasi Journal(RRJ), 11(12), 183-194. http://frooyesh.ir/article-1-4351-en.html

Xu, J., Akhter, S., & Apuke, O. (2025). The Effectiveness of Combining Interactive Media-Based Cognitive Behaviour Therapy with Art and Music Therapies for Ameliorating Generalized Anxiety Disorder of Children Exposed to Abduction. Psychiatry research, 349, 116498. https://doi.org/10.1016/j.psychres.2025.116498

Yaqubi, M., Ebrahimi, F., Pourmohammad Ghouchani, K., & Norouziani, Z. (2026). Comparison of cognitive behavioral therapy and acceptance and commitment therapy on referential thoughts, cognitive flexibility, and distress tolerance in patients with major depressive disorder. Psychological Dynamics in Emotional Disorders, 1-18. https://doi.org/https://maherpub.com/pdmd/article/view/628

Zemestani, M., Ezzati, S., Nasiri, F., Gallagher, M. W., Barlow, D. H., & Kendall, P. C. (2023). A Culturally Adapted Unified Protocol for Transdiagnostic Treatment of Anxiety Disorders in Adolescents (UP-A): A Randomized Waitlist-Controlled Trial. Psychological medicine, 54(2), 385-398. https://doi.org/10.1017/s0033291723001903

Zhong, Z. M., Jiang, H., Wang, H., & Liu, Y. (2025). The Association Between Mindfulness and Athletes' Distress Tolerance: The Mediating Roles of Cognitive Reappraisal and Mental Toughness. Behavioral Sciences, 15(3), 298. https://doi.org/10.3390/bs15030298