Introduction
Depression is a common mood disorder characterized by persistent sadness, loss of interest, and suicidal thoughts. It profoundly impacts functioning and well-being. In severe cases, depression is accompanied by intense shame and suicidal ideation. Shame plays a significant role in the onset and progression of depression. Two effective approaches are the Unified Protocol for Transdiagnostic Treatment and Dialectical Behavior Therapy. This study compares their effectiveness on shame and suicidal ideation in depressed patients.
Method
This quasi-experimental study employed a pre-test, post-test, control group, and one-month follow-up. The population included depressed individuals visiting three clinics in Shiraz during summer 2023. From 112 individuals, 45 were selected based on a cutoff score of 19 on the Beck Depression Inventory (Beck, 1996) and randomly assigned to three groups of 15. Due to attrition, each group decreased to 11. All three groups completed the Beck Depression Inventory, Experience of Shame Scale (Andrews et al., 2002), and Beck Scale for Suicide Ideation (Beck, 1961). The Unified Protocol group received 12 sessions and the DBT group 11 sessions (90 minutes each). Data were analyzed using repeated measures ANOVA.
Results
Both interventions significantly reduced shame (F = 14.310, df = 1.603, P < .001) and suicidal ideation (F = 23.789, df = 1.146, P < .001) compared to the control group. These effects remained at follow-up for shame (Time × Group: F = 6.609, df = 3.206, P < .01) and suicidal ideation (F = 7.101, df = 2.292, P < .01). No significant difference was found between the two interventions (P > .05). Both groups showed significant reductions from pre-test to post-test and follow-up but not between post-test and follow-up, indicating stable effects.
Discussion
Both Unified Protocol and DBT effectively reduced shame and suicidal ideation with sustained effects. Their shared focus on emotional acceptance may explain similar outcomes. Limitations include small sample size and single-city recruitment. Future studies should use larger samples.