University of Isfahan Research in Cognitive and Behavioral Sciences 2251-7642 16 1 2026 08 23 The Effectiveness of a Unified Protocol of Trans-Diagnostic Treatment on The Emotion Regulation Strategies of Anxious Student Girls The Effectiveness of a Unified Protocol of Trans-Diagnostic Treatment on The Emotion Regulation Strategies of Anxious Student Girls 25 52 30419 10.22108/cbs.2026.146580.2067 FA SOGAND GHASEMZADEH PAssociate Professor, Department of Psychology, Faculty of Psychology and Education of Exceptional Children, University of Tehran, Tehran, Iran Aliakbar Arjmandnia Professor, Department of Psychology, Faculty of Psychology and Education of Exceptional Children, University of Tehran, Tehran, Iran 0000-0001-8030-8416 Faezeh Shabanali Fami Master of Psychology and Education of Exceptional Children, Department of Psychology, Faculty of Psychology and Education of Exceptional Children, University of Tehran, Tehran, Iran Aynaz Holakouee Master of Psychology and Education of Exceptional Children, Department of Psychology, Faculty of Psychology and Education of Exceptional Children, University of Tehran, Tehran, Iran Journal Article 2025 09 06 The present study aimed to examine the effectiveness of a unified transdiagnostic treatment program on emotion regulation strategies in anxious adolescent girls. A quasi-experimental pretest-posttest design with experimental and control groups was employed. The study population consisted of female middle school students in Tehran, from whom 24 participants were selected through convenience sampling following screening with the Achenbach Youth Self-Report and a semi-structured clinical interview. Participants were randomly assigned to an experimental group (n = 12) and a control group (n = 12). The experimental group received a 12-session unified transdiagnostic intervention based on Barlow’s protocol, while the control group was placed on a waitlist. Emotion regulation strategies were assessed using the Emotion Regulation Questionnaire (Gross & John) and the Difficulties in Emotion Regulation Scale (Gratz & Roemer). Data were analyzed using non-parametric tests, including the Wilcoxon signed-rank test, Mann–Whitney U test, and analysis of covariance. Results indicated a significant increase in cognitive reappraisal and a significant decrease in emotional suppression in the experimental group compared to the control group (p < .01). Moreover, all subscales of difficulties in emotion regulation, as well as the total score, showed a significant reduction in the experimental group, whereas no significant changes were observed in the control group. These findings suggest that the unified transdiagnostic treatment is effective in enhancing adaptive emotion regulation strategies and reducing emotion regulation difficulties in anxious adolescent girls. Given its flexibility, cost-effectiveness, and focus on shared emotional mechanisms, this approach appears to be a promising intervention for adolescents with emotional disorders and may be particularly suitable for school-based mental health programs. Introduction Anxiety disorders during adolescence are among the most common mental health problems and are associated with wide-ranging consequences in emotional, academic, social, and familial domains. This developmental period, due to the simultaneous occurrence of biological, cognitive, and social changes, is characterized by increased emotional sensitivity and affective fluctuations, making adolescents more vulnerable to experiencing anxiety and emotional inefficiencies. Research evidence indicates that adolescent girls, compared to boys, report higher levels of anxiety and difficulties in emotion regulation, highlighting the necessity of designing and implementing targeted interventions for this group. From a theoretical perspective, emotion regulation, as one of the key transdiagnostic constructs, plays a central role in explaining the development, maintenance, and comorbidity of emotional disorders. Deficits in emotion regulation can lead to repeated use of maladaptive strategies such as emotional avoidance, suppression, and impulsive reactions; strategies that may reduce distress in the short term but reinforce the cycle of anxiety in the long term. Accordingly, focusing on improving emotion regulation processes, particularly within transdiagnostic approaches, has recently become a research and clinical priority. Unified transdiagnostic treatment, by targeting shared emotional mechanisms, provides a coherent framework for intervention across a broad spectrum of anxiety disorders. The present study aimed to examine the effectiveness of this treatment on emotion regulation strategies among anxious adolescent girls. Method The current study employed a quasi-experimental design with a pretest, a posttest and a control group. After initial screening and diagnostic interviews, 24 first-year high school girls, were randomly assigned to experimental and control groups. The experimental group participated in twelve sessions of unified transdiagnostic treatment based on Barlow’s protocol, while the control group was placed on a waitlist. Research instruments included the Cognitive Emotion Regulation Questionnaire and the Difficulties in Emotion Regulation Scale. Data were analyzed using non-parametric tests and analysis of covariance. Findings indicated that the unified transdiagnostic intervention had significant, broad, and multidimensional effects on emotion regulation in anxious students. At the level of emotion regulation strategies, results showed a significant increase in the use of cognitive reappraisal in the experimental group compared to the control group (p < 0.01). This increase reflects an improvement in adolescents’ ability to reinterpret emotionally challenging situations and reduce the perceived threat of events. Simultaneously, scores for emotional suppression in the experimental group significantly decreased, indicating a reduced tendency to suppress emotions and an increased willingness to experience and process feelings. At the level of emotion regulation difficulties, there was a significant decrease in the total score of the Difficulties in Emotion Regulation Scale in the experimental group. Component analysis revealed that non-acceptance of negative emotions was one of the most prominent components reduced following the intervention. This finding suggests that participants were able to accept unpleasant emotions as a natural part of human experience without exhibiting judgmental or avoidant responses. Such a change plays a crucial role in reducing the intensity of anxiety experiences. Additionally, difficulties in controlling emotional impulses significantly decreased. This finding indicates an improvement in adolescents’ ability to inhibit immediate, impulsive, and emotion-driven reactions in stressful situations. Given that impulse control deficits are associated with risky behaviors, academic underperformance, and interpersonal problems in anxious adolescents, this result carries substantial clinical significance. Furthermore, the component of lack of emotional awareness also showed a significant reduction, reflecting an increased ability to identify, label, and differentiate experienced emotions. Another notable finding of the study was a significant reduction in limitations in accessing effective emotion regulation strategies. This result suggests that the unified transdiagnostic intervention was able to expand participants’ coping strategy repertoire and enhance their sense of efficacy in managing intense emotions. In contrast, the control group showed no significant changes in emotion regulation strategies or related difficulties, emphasizing the decisive role of the intervention. Results In the discussion and interpretation of findings, it can be stated that the observed pattern of changes aligns closely with the theoretical framework of unified transdiagnostic treatment. The increase in cognitive reappraisal indicates enhanced cognitive flexibility, a capacity that allows adolescents to move away from absolutist, catastrophic, and threat-focused interpretations. This cognitive change likely results from training in identifying maladaptive thoughts and practicing cognitive restructuring within an emotional experience context. The decrease in emotional suppression and avoidance can be considered one of the most important outcomes of the intervention. Unified transdiagnostic treatment, with an emphasis on emotion-focused exposure and tolerance, teaches adolescents that experiencing negative emotions is not inherently dangerous and can be managed without avoidance or suppression. This attitudinal shift toward emotions plays a key role in breaking the anxiety–avoidance cycle. The reduction in difficulties in controlling emotional impulses also reflects improved behavioral emotion regulation. This outcome indicates that the intervention not only led to cognitive and emotional changes but also moderated maladaptive behavioral responses. From a clinical perspective, this change may contribute to decreased family conflicts, improved peer relationships, and enhanced academic adjustment. Overall, the findings of the present study suggest that unified transdiagnostic treatment, by simultaneously targeting cognitive, emotional, and behavioral components of emotion regulation, can produce profound and significant changes in the emotional patterns of anxious adolescents. By focusing on shared underlying processes, this approach becomes an efficient option for preventive and therapeutic interventions in educational and clinical settings. The results support the application of this treatment in school-based mental health programs, and its use may play a critical role in preventing the chronicity of emotional disorders during adolescence. The present study aimed to examine the effectiveness of a unified transdiagnostic treatment program on emotion regulation strategies in anxious adolescent girls. A quasi-experimental pretest-posttest design with experimental and control groups was employed. The study population consisted of female middle school students in Tehran, from whom 24 participants were selected through convenience sampling following screening with the Achenbach Youth Self-Report and a semi-structured clinical interview. Participants were randomly assigned to an experimental group (n = 12) and a control group (n = 12). The experimental group received a 12-session unified transdiagnostic intervention based on Barlow’s protocol, while the control group was placed on a waitlist. Emotion regulation strategies were assessed using the Emotion Regulation Questionnaire (Gross & John) and the Difficulties in Emotion Regulation Scale (Gratz & Roemer). Data were analyzed using non-parametric tests, including the Wilcoxon signed-rank test, Mann–Whitney U test, and analysis of covariance. Results indicated a significant increase in cognitive reappraisal and a significant decrease in emotional suppression in the experimental group compared to the control group (p < .01). Moreover, all subscales of difficulties in emotion regulation, as well as the total score, showed a significant reduction in the experimental group, whereas no significant changes were observed in the control group. These findings suggest that the unified transdiagnostic treatment is effective in enhancing adaptive emotion regulation strategies and reducing emotion regulation difficulties in anxious adolescent girls. Given its flexibility, cost-effectiveness, and focus on shared emotional mechanisms, this approach appears to be a promising intervention for adolescents with emotional disorders and may be particularly suitable for school-based mental health programs. Introduction Anxiety disorders during adolescence are among the most common mental health problems and are associated with wide-ranging consequences in emotional, academic, social, and familial domains. This developmental period, due to the simultaneous occurrence of biological, cognitive, and social changes, is characterized by increased emotional sensitivity and affective fluctuations, making adolescents more vulnerable to experiencing anxiety and emotional inefficiencies. Research evidence indicates that adolescent girls, compared to boys, report higher levels of anxiety and difficulties in emotion regulation, highlighting the necessity of designing and implementing targeted interventions for this group. From a theoretical perspective, emotion regulation, as one of the key transdiagnostic constructs, plays a central role in explaining the development, maintenance, and comorbidity of emotional disorders. Deficits in emotion regulation can lead to repeated use of maladaptive strategies such as emotional avoidance, suppression, and impulsive reactions; strategies that may reduce distress in the short term but reinforce the cycle of anxiety in the long term. Accordingly, focusing on improving emotion regulation processes, particularly within transdiagnostic approaches, has recently become a research and clinical priority. Unified transdiagnostic treatment, by targeting shared emotional mechanisms, provides a coherent framework for intervention across a broad spectrum of anxiety disorders. The present study aimed to examine the effectiveness of this treatment on emotion regulation strategies among anxious adolescent girls. Method The current study employed a quasi-experimental design with a pretest, a posttest and a control group. After initial screening and diagnostic interviews, 24 first-year high school girls, were randomly assigned to experimental and control groups. The experimental group participated in twelve sessions of unified transdiagnostic treatment based on Barlow’s protocol, while the control group was placed on a waitlist. Research instruments included the Cognitive Emotion Regulation Questionnaire and the Difficulties in Emotion Regulation Scale. Data were analyzed using non-parametric tests and analysis of covariance. Findings indicated that the unified transdiagnostic intervention had significant, broad, and multidimensional effects on emotion regulation in anxious students. At the level of emotion regulation strategies, results showed a significant increase in the use of cognitive reappraisal in the experimental group compared to the control group (p < 0.01). This increase reflects an improvement in adolescents’ ability to reinterpret emotionally challenging situations and reduce the perceived threat of events. Simultaneously, scores for emotional suppression in the experimental group significantly decreased, indicating a reduced tendency to suppress emotions and an increased willingness to experience and process feelings. At the level of emotion regulation difficulties, there was a significant decrease in the total score of the Difficulties in Emotion Regulation Scale in the experimental group. Component analysis revealed that non-acceptance of negative emotions was one of the most prominent components reduced following the intervention. This finding suggests that participants were able to accept unpleasant emotions as a natural part of human experience without exhibiting judgmental or avoidant responses. Such a change plays a crucial role in reducing the intensity of anxiety experiences. Additionally, difficulties in controlling emotional impulses significantly decreased. This finding indicates an improvement in adolescents’ ability to inhibit immediate, impulsive, and emotion-driven reactions in stressful situations. Given that impulse control deficits are associated with risky behaviors, academic underperformance, and interpersonal problems in anxious adolescents, this result carries substantial clinical significance. Furthermore, the component of lack of emotional awareness also showed a significant reduction, reflecting an increased ability to identify, label, and differentiate experienced emotions. Another notable finding of the study was a significant reduction in limitations in accessing effective emotion regulation strategies. This result suggests that the unified transdiagnostic intervention was able to expand participants’ coping strategy repertoire and enhance their sense of efficacy in managing intense emotions. In contrast, the control group showed no significant changes in emotion regulation strategies or related difficulties, emphasizing the decisive role of the intervention. Results In the discussion and interpretation of findings, it can be stated that the observed pattern of changes aligns closely with the theoretical framework of unified transdiagnostic treatment. The increase in cognitive reappraisal indicates enhanced cognitive flexibility, a capacity that allows adolescents to move away from absolutist, catastrophic, and threat-focused interpretations. This cognitive change likely results from training in identifying maladaptive thoughts and practicing cognitive restructuring within an emotional experience context. The decrease in emotional suppression and avoidance can be considered one of the most important outcomes of the intervention. Unified transdiagnostic treatment, with an emphasis on emotion-focused exposure and tolerance, teaches adolescents that experiencing negative emotions is not inherently dangerous and can be managed without avoidance or suppression. This attitudinal shift toward emotions plays a key role in breaking the anxiety–avoidance cycle. The reduction in difficulties in controlling emotional impulses also reflects improved behavioral emotion regulation. This outcome indicates that the intervention not only led to cognitive and emotional changes but also moderated maladaptive behavioral responses. From a clinical perspective, this change may contribute to decreased family conflicts, improved peer relationships, and enhanced academic adjustment. Overall, the findings of the present study suggest that unified transdiagnostic treatment, by simultaneously targeting cognitive, emotional, and behavioral components of emotion regulation, can produce profound and significant changes in the emotional patterns of anxious adolescents. By focusing on shared underlying processes, this approach becomes an efficient option for preventive and therapeutic interventions in educational and clinical settings. The results support the application of this treatment in school-based mental health programs, and its use may play a critical role in preventing the chronicity of emotional disorders during adolescence.

https://cbs.ui.ac.ir/article_30419_60b4216dcf0d8e950999f0ac06985593.pdf