Clinical Psychology: Research and Practice Innovations

Clinical Psychology: Research and Practice Innovations"

Effect of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders on Exam Anxiety of Girl Students After the COVID-19 Pandemic

Document Type : Original Article

Authors
Mohammadbagher Kajbaf 1
Banafsheh Aleyaran 2
1 Department of Psychology, Faculty of Educational Science and Psychology, University of Isfahan, Isfahan, Iran
2 Department of Psychology, Faculty of Educational Science and Psychology,University of Isfahan, Isfahan, Iran
10.22075/jcp.2025.34825.2938
Abstract
Introduction: One of the consequences of the suspension of face-to-face education during and after the COVID-19 epidemic, was the increase in students' anxiety. the purpose of the present study is to investigate the effectiveness of group training of the Unified Protocol for Transdiagnostic treatment of emotional disorders on exam anxiety of girl students in Isfahan.
Method: this research is semi-experimental with a pre-test-post-test design with a control group. The subject included all middle school female students of Isfahan in the academic year of 2022-2023. 40 people were selected by available sampling method and assigned randomly in two experimental and control groups.The intervention was in the form of 8 group training sessions (90 minutes each session.) of. In order to measure exam anxiety, Sarason's exam anxiety questionnaire was used and data analysis was done in two descriptive and inferential (covariance analysis) statistics by using SPSS24 software.
Results: The results indicated that the average exam anxiety scores in the post-test phase were significantly different between experimental and control groups (Effect size=0.46, p<0.001, F=31.82).
Conclusion: In general, it can be concluded that the group training of the Unified Protocol for Transdiagnostic treatment of emotional disorders is effective in students' exam anxiety after the COVID-19 pandemic
Keywords
group training
Unified Protocol for transdiagnostic treatment of emotional disorders
exam anxiety
girl students
COVID-19 pandemic
Subjects

  1. منابع

    1. Gao GF. From “A” IV to “Z” IKV: attacks from emerging and re-emerging pathogens. Cell. 2018;172(6):1157-9.
    2. Hesari M, Rezaei AM, Talepasand S. predicting academic procrastination based on psychological distress and corona anxiety. Rooyesh-e-Ravanshenasi Journal(RRJ). 2022;11(3):219-32. [Persian]
    3. Organization WH. Mental health and psychosocial considerations during the COVID-19 outbreak, 18 March 2020. World Health Organization; 2020.
    4. Esteves CS, Oliveira CRd, Argimon IIdL. Social distancing: prevalence of depressive, anxiety, and stress symptoms among Brazilian students during the COVID-19 pandemic. Frontiers in Public Health. 2021;8:589966.
    5. Dong L, Bouey J. Public mental health crisis during COVID-19 pandemic, China. Emerging infectious diseases. 2020;26(7):1616.
    6. Shigemura J, Ursano RJ, Morganstein JC, Kurosawa M, Benedek DM. Public responses to the novel 2019 coronavirus (2019‐nCoV) in Japan: Mental health consequences and target populations. Psychiatry and clinical neurosciences. 2020;74(4):281.
    7. Zhou X. Psychological crisis interventions in Sichuan Province during the 2019 novel coronavirus outbreak. Psychiatry Research. 2020;286:112895.
    8. Zarei N, Seyyedkalan, S., Faryadi, S. Correlation between Coronavirus Anxiety and Academic Motivation of Female Students in Public Model High Schools in Sanandaj. Journal of Pouyesh in Education and Consultation (JPEC). 2022;1400(15): 20-34. [Persian]
    9. Sakka S, Nikopoulou VA, Bonti E, Tatsiopoulou P, Karamouzi P, Giazkoulidou A, et al. Assessing test anxiety and resilience among Greek adolescents during COVID-19 pandemic. Journal of Mind and Medical Sciences. 2020;7(2):173-8.
    10. Zaccoletti S, Camacho A, Correia N, Aguiar C, Mason L, Alves RA, et al. Parents’ perceptions of student academic motivation during the COVID-19 lockdown: A cross-country comparison. Frontiers in psychology. 2020;11:592670.
    11. Cachón-Zagalaz J, Sánchez-Zafra M, Sanabrias-Moreno D, González-Valero G, Lara-Sánchez AJ, Zagalaz-Sánchez ML. Systematic review of the literature about the effects of the COVID-19 pandemic on the lives of school children. Frontiers in psychology. 2020;11:569348.
    12. Hiraoka D, Tomoda A. Relationship between parenting stress and school closures due to the COVID‐19 pandemic. Psychiatry and Clinical Neurosciences. 2020;74(9):497.
    13. Pasion R, Dias-Oliveira E, Camacho A, Morais C, Franco RC. Impact of COVID-19 on undergraduate business students: A longitudinal study on academic motivation, engagement and attachment to university. Accounting Research Journal. 2020;34(2):246-57.
    14. Unger S, Meiran WR. Student attitudes towards online education during the COVID-19 viral outbreak of 2020: distance learning in a time of social distance. International Journal of Technology in Education and Science. 2020;4(4):256-66.
    15. Hiremath P, Kowshik CS, Manjunath M, Shettar M. COVID 19: Impact of lock-down on mental health and tips to overcome. Asian journal of psychiatry. 2020;51:102088.
    16. Sohrabi Z, Taherzadeh Gahfaroki S, Hatampour E, Mirogeshlag F, Mohammadpour M. The effect of Corona Anxiety on Academic Well-Being with Respect to the Mediating Role of Academic Hope. Journal of Research in Educational Systems. 2022;15(55):165-77. [Persian]
    17. shomaliahmadabadi m, barkhordariahmadabadi a, poorjanebolahi m. The Role Of covid‐19 anxiety, Worry And Negative Metacognitive Beliefs In Predicting Learning Anxiety of Student In the Covid-19 epidemic. A new approach to children's education quarterly. 2021;3(4):1-10. [Persian]
    18. Rakhmanov O, Shaimerdenov Y, Dane S. The effects of COVID-19 pandemic on anxiety in secondary school students. J Res Med Dent Sci. 2020;8(6):186-90.
    19. Alsaady I, Gattan H, Zawawi A, Alghanmi M, Zakai H. Impact of COVID-19 crisis on exam anxiety levels among bachelor level university students. Mediterranean Journal of Social Sciences. 2020;11(5):33-.
    20. Kazdin AE, Association AP. Encyclopedia of psychology: American Psychological Association Washington, DC; 2000.
    21. Zeidner M. Test anxiety: the state of the art: Springer Science & Business. Media; 1998.
    22. Farsinejad M, Karami A, Asadzadeh H. The effectiveness of cognitive-behavioral therapy on academic dysphoria and test anxiety in high school girl students. 2019. [Persian]
    23. Trifoni A, Shahini M. How does exam anxiety affect the performance of university students. Mediterranean journal of social sciences. 2011;2(2):93-100.
    24. Gregor A. Examination anxiety: Live with it, control it or make it work for you? School Psychology International. 2005;26(5):617-35.
    25. Mohammadyfar MA, Yasamani L, Najafi M. The effectiveness of cognitive-behavioral training on reducing of test anxiety. Journal of Educational Psychology Studies. 2018;15(32):203-22. [Persian]
    26. Reiss N, Warnecke I, Tolgou T, Krampen D, Luka-Krausgrill U, Rohrmann S. Effects of cognitive behavioral therapy with relaxation vs. imagery rescripting on test anxiety: A randomized controlled trial. Journal of affective disorders. 2017;208:483-9.
    27. Pekrun R, Stephens EJ. Test anxiety and academic achievement. 2015.
    28. Yoon G, Ham C-D. Consuming entertainment media: How media effects can vary by users’ controllability. Current Psychology. 2016;35:397-402.
    29. Pisanski K, Nowak J, Sorokowski P. Individual differences in cortisol stress response predict increases in voice pitch during exam stress. Physiology & behavior. 2016;163:234-8.
    30. Alexander D, Haldane J. Medical education: a student perspective. Medical education. 1979;13(5):336-41.
    31. Miller PM, Surtees P. Psychological symptoms and their course in first-year medical students as assessed by the Interval General Health Questionnaire (I–GHQ). The British Journal of Psychiatry. 1991;159(2):199-207.
    32. Sansgiry SS, Sail K. Effect of students' perceptions of course load on test anxiety. American journal of pharmaceutical education. 2006;70(2).
    33. Mansouri S JF. Identifying factors affecting exam anxiety of high school students: a study based on a systematic review. 1st International Conference on Psychology, Social Sciences, Educational Sciences and Philosophy papers. 2023. [Persian]
    34. narimani m, Sadeghzadeh Belil N. Identifying factors affecting exam anxiety in educational organizations using a qualitative approach. Journal of School Psychology. 2024. [Persian]
    35. Chapell MS, Blanding ZB, Silverstein ME, Takahashi M, Newman B, Gubi A, et al. Test anxiety and academic performance in undergraduate and graduate students. Journal of educational Psychology. 2005;97(2):268.
    36. Cassady JC, Johnson RE. Cognitive test anxiety and academic performance. Contemporary educational psychology. 2002;27(2):270-95.
    37. Shafiee Zermitani F SM. The effect of mindfulness-based stress management training on the academic optimism of female students with exam anxiety in the second secondary level of Boushehr during the Corona pandemic. Specialized scientific quarterly Philosophy approach in schools and organizations. 2022;1(1):33-43. [Persian]
    38. Hashemi M. The Effectiveness of Hypnotherapy in Increasing the Academic Self-Efficacy and Reduce Symptoms of Test Anxiety of Adolescents with Entrance Exam. Educational Measurement and Evaluation Studies. 2023;13(43):161-86. [Persian]
    39. Ainsworth HR, Torgerson DJ, Torgerson CJ, Bene J, Grant C, Ford S, et al. The effect of hypnotherapy on exam anxiety and exam performance: A pilot randomised controlled trial. Effective Education. 2010;2(2):143-54.
    40. Amani H, Habibi-kaleybar R, Farid A, Sheykhalizadeh S. Comparison of the Effectiveness of Mindfulness-based on Techniques and Cognitive-Behavioral Therapy on Test Anxiety Symptoms in Female Students. Educational and Scholastic studies. 2023;12(2):176-55. [Persian]
    41. Ghadampour E. Effectiveness of meta-cognitive therapy on of test anxiety in high school girl students of Khorramabad city. Educational Psychology. 2021;17(62):131-44. [Persian]
    42. pour hamidi m, sarvghad s, rezaei A, Baghouli H. The Effectiveness of Cognitive Behavioral intervention on Reducing Anxiety Symptoms and Improving the Quality of Life of First Period High School Male Students with Test Anxiety. Journal of New Approaches in Educational Administration. 2023;14(2):196-84. [Persian]
    43. Shrifi daramadi P, Ghasempoor F. The Effectiveness of Cognitive Therapy-Based Mindfulness Training on Coping with Rumination and Exam Anxiety. Educational Psychology. 2023;19(69):164-98. [Persian]
    44. Seyedi MA EGM, Heidarzade Arbatan V. effect of compassion focused therapy on academic burnout and exam anxiety of girl students in Ilkhchi 12th international conference management & humanistic science research in Iran. 2022;12(12):2716-26. [Persian]
    45. Noei Iran L, Rezaei A, Aghdasi AN. Comparison of the Effecte of Metacognitive Therapy and Dialectical Behavioral Therapy on Students' Educational procrastination and Test Anxiety symptoms in Students. Knowledge & Research in Applied Psychology. 2021;22(2):59-70. [Persian]
    46. Ghasemi SA, Khamesan A, Talebzade Shoshtari L, Masanani Z. Test Anxiety Interventions for Adolescents: A Systematic Review of Iranian Research. Qualitative Research in Behavioral Sciences (QRBS). 2023;2(1):35-48. [Persian]
    47. Cook SC, Schwartz AC, Kaslow NJ. Evidence-based psychotherapy: Advantages and challenges. Neurotherapeutics. 2017;14:537-45.
    48. Emmelkamp PM, David D, Beckers T, Muris P, Cuijpers P, Lutz W, et al. Advancing psychotherapy and evidence‐based psychological interventions. International journal of methods in psychiatric research. 2014;23(S1):58-91.
    49. McHugh RK, Barlow DH. The dissemination and implementation of evidence-based psychological treatments: A review of current efforts. American psychologist. 2010;65(2):73.
    50. Carlucci L, Saggino A, Balsamo M. On the efficacy of the unified protocol for transdiagnostic treatment of emotional disorders: A systematic review and meta-analysis. Clinical psychology review. 2021;87:101999.
    51. Gibbons CJ, DeRubeis RJ. Anxiety symptom focus in sessions of cognitive therapy for depression. Behavior Therapy. 2008;39(2):117-25.
    52. Craske MG, Farchione TJ, Allen LB, Barrios V, Stoyanova M, Rose R. Cognitive behavioral therapy for panic disorder and comorbidity: more of the same or less of more? Behaviour Research and Therapy. 2007;45(6):1095-109.
    53. McManus F, Shafran R, Cooper Z. What does a transdiagnostic approach have to offer the treatment of anxiety disorders? British Journal of Clinical Psychology. 2010;49(4):491-505.
    54. Brown TA, Di Nardo PA, Lehman CL, Campbell LA. Reliability of DSM-IV anxiety and mood disorders: implications for the classification of emotional disorders. Journal of abnormal psychology. 2001;110(1):49.
    55. Dalgleish T, Black M, Johnston D, Bevan A. Transdiagnostic approaches to mental health problems: Current status and future directions. Journal of consulting and clinical psychology. 2020;88(3):179.
    56. Barlow DH, Allen LB, Choate ML. Toward a unified treatment for emotional disorders. The Neurotic Paradox, Volume 1: Routledge; 2020. p. 141-66.
    57. Barlow DH, Farchione TJ. Applications of the unified protocol for transdiagnostic treatment of emotional disorders: Oxford University Press; 2017.
    58. Ellard KK, Fairholme CP, Boisseau CL, Farchione TJ, Barlow DH. Unified protocol for the transdiagnostic treatment of emotional disorders: Protocol development and initial outcome data. Cognitive and behavioral practice. 2010;17(1):88-101.
    59. Barlow DH, Craske MG, Cerny JA, Klosko JS. Behavioral treatment of panic disorder. Behavior therapy. 1989;20(2):261-82.
    60. Linehan M. Cognitive-behavioral treatment of borderline personality disorder: Guilford press; 1993.
    61. Craske MG, Barlow DH. Mastery of your anxiety and worry: Oxford University Press; 2006.
    62. Beck AT, Rush AJ, Shaw BF, Emery G, DeRubeis RJ, Hollon SD. Cognitive therapy of depression: Guilford Publications; 2024.
    63. Beck A. Depressive Symptoms: Causes and Treatment. Philadelphia: University of Pennsylvania Press; 1972.
    64. Farchione TJ, Fairholme CP, Ellard KK, Boisseau CL, Thompson-Hollands J, Carl JR, et al. Unified protocol for transdiagnostic treatment of emotional disorders: a randomized controlled trial. Behavior therapy. 2012;43(3):666-78.
    65. Boswell JF, Anderson LM, Barlow DH. An idiographic analysis of change processes in the unified transdiagnostic treatment of depression. Journal of Consulting and Clinical Psychology. 2014;82(6):1060.
    66. Ellard KK, Deckersbach T, Sylvia LG, Nierenberg AA, Barlow DH. Transdiagnostic treatment of bipolar disorder and comorbid anxiety with the unified protocol: A clinical replication series. Behavior modification. 2012;36(4):482-508.
    67. Pachankis JE, Hatzenbuehler ML, Rendina HJ, Safren SA, Parsons JT. LGB-affirmative cognitive-behavioral therapy for young adult gay and bisexual men: A randomized controlled trial of a transdiagnostic minority stress approach. Journal of consulting and clinical psychology. 2015;83(5):875.
    68. Thompson-Brenner H, Boswell JF, Espel-Huynh H, Brooks G, Lowe MR. Implementation of transdiagnostic treatment for emotional disorders in residential eating disorder programs: A preliminary pre-post evaluation. Psychotherapy Research. 2019;29(8):1045-61.
    69. Cassiello-Robbins C, Southward MW, Tirpak JW, Sauer-Zavala S. A systematic review of Unified Protocol applications with adult populations: Facilitating widespread dissemination via adaptability. Clinical Psychology Review. 2020;78:101852.
    70. Sakiris N, Berle D. A systematic review and meta-analysis of the Unified Protocol as a transdiagnostic emotion regulation based intervention. Clinical psychology review. 2019;72:101751.
    71. Wurm M, Strandberg EK, Lorenz C, Tillfors M, Buhrman M, Holländare F, et al. Internet delivered transdiagnostic treatment with telephone support for pain patients with emotional comorbidity: a replicated single case study. Internet interventions. 2017;10:54-64.
    72. Ehrenreich JT, Goldstein CR, Wright LR, Barlow DH. Development of a unified protocol for the treatment of emotional disorders in youth. Child & family behavior therapy. 2009;31(1):20-37.
    73. Zareie Faskhudi B, Karbalaee Mohammad Meigouni A, Rezabakhsh H, Ghelichi L. Comparison of the Effect of Unified Transdiagnostic Treatment from Emotional Disorders and Emotion Efficacy Therapy on Emotion Regulation among Adults with Stuttering. Journal of Applied Psychological Research. 2021;12(2):185-209. [Persian]
    74. Zemestani M, Imani M. Effectiveness of transdiagnostic treatment on depression/anxiety symptoms and emotion regulation. Contemporary psychology. 2016;11(1):21-32. [Persian]
    75. Farchione TJ, Long LJ, Spencer-Laitt D, Moreno J, Barlow DH. State of the Science: The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders. Behavior Therapy. 2024.
    76. Sauer-Zavala S, Bentley KH, Steele SJ, Tirpak JW, Ametaj AA, Nauphal M, et al. Treating depressive disorders with the Unified Protocol: A preliminary randomized evaluation. Journal of Affective Disorders. 2020;264:438-45.
    77. Bameshgi M, Kimiaei A, Mashhadi A. Effectiveness of a unified protocol on emotion regulation and experiential avoidance in women with comorbid major depressive and generalized anxiety symptoms. Journal of Fundamentals of Mental Health. 2020;22(6):341-8. [Persian]
    78. Askari Z, Zandkarimi G. The Effectiveness of Unified Trans diagnostic Therapy on Cognitive Errors, Rumination and Cognitive Avoidance in Social Anxiety Disorder Patients: A Case Study. Journal of Clinical Psychology. 2022;14(4):65-76. [Persian]
    79. Delavar A. Research methods in psychology and educational sciences. Tehran: Payame noor University; 2017. [Persian]
    80. Sarason IG. Introduction to the study of test anxiety. Test anxiety: Theory, research, and applications. 1980:3-14.
    81. P D. Assessment and treatment of exam anxiety. Journal of psychology. 1997;1(1):31-60.
    82. Dadsetan P DPZ. Measurement and treatment of anxiety and ways to reduce it. Tehran Research Council; 1995. [Persian]
    83. Darvish E, Sharifi PD, H. P., Shahriari Ahmadi PD, M. A Comparison of the Effect of Systematic Motivational Group Counseling Program and Metacognitive Strategies Training upon Exam Anxiety and Academic Adaptability in Female Middle School Students. Quarterly Journal Of Education. 2023;38(4):71-86. [Persian]
    84. Olatunji BO, Cisler JM, Tolin DF. Quality of life in the anxiety disorders: a meta-analytic review. Clinical psychology review. 2007;27(5):572-81.
    85. Sudhir PM, Sharma MP, Mariamma P, Subbakrishna D. Quality of life in anxiety disorders: Its relation to work and social functioning and dysfunctional cognitions: An exploratory study from India. Asian Journal of Psychiatry. 2012;5(4):309-14.
    86. IsHak WW, Greenberg JM, Balayan K, Kapitanski N, Jeffrey J, Fathy H, et al. Quality of life: the ultimate outcome measure of interventions in major depressive disorder. Harvard review of psychiatry. 2011;19(5):229-39.
    87. Ayuso-Bartol A, Gómez-Martínez MÁ, Riesco-Matías P, Yela-Bernabé JR, Crego A, Buz J. Systematic Review and Meta-analysis of the Efficacy and Effectiveness of the Unified Protocol for Emotional Disorders in Group Format for Adults. International Journal of Mental Health and Addiction. 2024:1-27.
    88. Ito M, Horikoshi M, Kato N, Oe Y, Fujisato H, Yamaguchi K, et al. Efficacy of the unified protocol for transdiagnostic cognitive-behavioral treatment for depressive and anxiety disorders: a randomized controlled trial. Psychological Medicine. 2023;53(7):3009-20.
    89. Bullis JR, Eustis EH, Curreri AJ, Cardona ND, Woods BK, Rosellini AJ, et al. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders compared with diagnosis-specific protocols for anxiety disorders: A three-year follow-up. Journal of Mood & Anxiety Disorders. 2023;3:100024.
    90. Sharifi M MS, Mohammadzadeh J, Ahmadi V, Kakabaraei K. Evaluation of the effectiveness of unified protocol for the transdiagnostic treatment and emotion regulation intervention in patients with generalized anxiety disorder in a military hospital. EBNESINA. 2020;22(3):73-7. [Persian]
    91. Z S. Unified Protocol for Transdiagnostic treatment of emotional disorders for children with comorbid anxiety and depressive disorders: a single case study. Psychological research papers. 2020;22(1).
    92. Barlow DH, Farchione T, Fairholme C, Ellard K, Boisseau C, Allen L, et al. Treatments that work. Unified protocol for transdiagnostic treatment of emotional disorders: Therapist guide. 2011.
    93. Payne LA, Ellard KK, Farchione TJ, Fairholme CP, Barlow DH. Emotional disorders: A unified transdiagnostic protocol. 2014.
    94. Alavi Z ZG. Integrated meta-diagnostic protocol and its effect on sensation seeking and fear of negative evaluation of girls affected by Instagram. Psychological Research. 2022;14(41):1-13. [Persian]
    95. Roemer L, Lee JK, Salters-Pedneault K, Erisman SM, Orsillo SM, Mennin DS. Mindfulness and emotion regulation difficulties in generalized anxiety disorder: Preliminary evidence for independent and overlapping contributions. Behavior therapy. 2009;40(2):142-54.
    96. Blackledge JT, Hayes SC. Emotion regulation in acceptance and commitment therapy. Journal of clinical psychology. 2001;57(2):243-55.
    97. Mennin DS, Heimberg RG, Turk CL, Fresco DM. Preliminary evidence for an emotion dysregulation model of generalized anxiety disorder. Behaviour research and therapy. 2005;43(10):1281-310.
    98. Abniki E HN, Brahmand U, Narimani M. Comparisson of effect of Cognitive-Behavior Therapy group and Transdiagnostic Therapy on psychological characteristics and quality of life in students with social anxiety disorder [Dissertation]. Ardabil, University of Mohaghegh Ardabili. 2016.
    99. Gholizadeh H EA, Salimi Bajestani H, Farahbakhsh K. Comparison of the efficacy of Functional Analytic Psychtherapy group with Unified Transdiagnostic treatment onDepression, Anxiety symptoms and marital satysfaction among women with marital distress [Dissertation]. Tehran, Allameh Tabatabaei University 2018. [Persian]
    100. Taylor S. Anxiety sensitivity. 2020.
    101. Schaeuffele C, Bär J, Buengener I, Grafiadeli R, Heuthaler E, Strieder J, et al. Transdiagnostic processes as mediators of change in an internet-delivered intervention based on the unified protocol. Cognitive Therapy and Research. 2022:1-14.

  • Receive Date 03 August 2024
  • Revise Date 23 March 2025
  • Accept Date 26 May 2025
  • First Publish Date 26 May 2025
  • Publish Date 21 March 2025