Modified Unified Protocol and tDCS for Cognitive Flexibility, Emotion Regulation and Repetitive Negative Thoughts in Women with Suicidal Ideation: A Comparative Study

Document Type : Research Article

Authors

1 Department of Counseling, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran

2 Department of Psychology, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran

3 Department of Psychology, Islamic Azad University, Hamedan Branch, Hamedan, Iran

Abstract

Background: Suicidal ideation, a serious mental health concern, threatens individuals’ well-being and has significant social and psychological consequences. This study aimed to compare the effectiveness of the Modified Unified Protocol (UP) and Transcranial Direct Current Stimulation (tDCS) on cognitive flexibility, emotional regulation strategies, and repetitive negative thinking in women with suicidal ideation.
Methods: This study was quasi-experimental with pre-test and post-test design and a six-month follow-up. The participants included women with suicidal ideation, recruited from counseling centers affiliated with the State Welfare Organization in Ardabil, Iran between 2022 and 2024. Using criterion‑based sampling and random assignment, 75 participants were divided into three groups (n=25 each): Modified Unified Protocol (UP), transcranial Direct Current Stimulation (tDCS), and control. The intervention lasted 12 weeks (UP: individual sessions on emotion regulation & cognitive flexibility; tDCS: 2 mA stimulation at F3/F4 areas). Data were collected at pre-test, post-test, and six-month follow-up using the Cognitive Flexibility Inventory (CFI), the Difficulties in Emotion Regulation Scale–Short Form (DERS-SF), and the Repetitive Thoughts Questionnaire (RTQ). For data analysis, ANCOVA was used to examine between-group differences, and repeated measures ANOVA was used to assess within-group changes over time. All tests were conducted using SPSS version 27, with statistical significance set at P<0.05.
Results: For cognitive flexibility, mean scores increased in the UP group (76.80±10.06 to 100.45±14.12) and tDCS group (79.40±11.07 to 91.35±10.49), with minimal change in the control group. Significant differences were found between UP and control groups (P=0.001) and between tDCS and control groups (P=0.008). In cognitive emotion regulation difficulties, scores decreased in the UP group (72.55±7.72 to 52.25±7.90) and tDCS group (72.45±8.48 to 61.70±9.29), while the control group remained unchanged. Post-test comparisons showed significant differences; UP vs. control (P=0.001), tDCS vs. control (P=0.001), and UP vs. tDCS (P=0.001). Repetitive negative thinking decreased in the UP group (39.20±5.85 to 20.85±5.14), moderately in the tDCS group (29.05±6.72), and showed no change in the control group. All between-group comparisons in post-test were significant (P=0.001).
Conclusions: Both the Modified Unified Protocol (UP) and tDCS were effective in enhancing cognitive flexibility, improving emotion regulation strategies, and reducing repetitive negative thinking in women with suicidal ideation. However, UP showed a more substantial and sustained impact over time, particularly in emotion regulation and repetitive negative thought reduction.

Highlights

Mohammadreza Noroozi Homayoon: (Google Scholar)

Ali Nasiri: (Google Scholar)

 

How to Cite: Noroozi Homayoon MR, Nasiri A, Sadri Damirchi E, Narimani M, Eyvazzadeh Gharajeh H, Habibi N. Modified Unified Protocol and tDCS for Cognitive Flexibility, Emotion Regulation and Repetitive Negative Thoughts in Women with Suicidal Ideation: A Comparative Study. Women. Health. Bull. 2026;13(2):141-152. doi: 10.30476/whb.2026.106763.1352.

Keywords

References

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