Tidal Model-Based ACT for Depression

Depression is a chronic mental health condition that affects emotional regulation, motivation, and functional capacity. Even with pharmacological treatment and advanced interventions such as transcranial magnetic stimulation (TMS), many individuals continue to experience residual symptoms, including diminished sense of meaning in life, cognitive-emotional avoidance, and reduced self-care behaviors. These residual symptoms may contribute to prolonged recovery and relapse.

Meaning in life has been identified as an important psychological protective factor in recovery from depression. Individuals with a weaker sense of meaning may experience more severe or persistent depressive symptoms. Interventions targeting psychological flexibility, values clarification, and behavioral activation may support long-term recovery.

Acceptance and Commitment Therapy (ACT) offers a comprehensive approach that addresses both existential meaning and behavioral self-care processes. In addition, the Tidal Model, a nursing-based recovery framework, emphasizes person-centered care and individual narratives in mental health treatment.

This randomized controlled trial will be conducted in the psychiatry clinic of a university hospital. Patients receiving TMS treatment for depression will be randomly assigned to either the intervention group or the control group. The intervention group will participate in an 8-week ACT-oriented psychoeducation program based on the Tidal Model, while the control group will continue to receive standard treatment.

Outcome measures will be collected at three time points: baseline (pre-intervention), immediately after the intervention (post-test), and one month after completion (follow-up). The primary objective is to evaluate the effect of the psychoeducation program on meaning in life and conscious self-care.

The findings are expected to contribute to the development of structured nursing-based psychosocial interventions for individuals with treatment-resistant depression.

• Tidal Model-based ACT (Behavioral): This intervention combines standard Transcranial Magnetic Stimulation (TMS) treatment with an 8-session Acceptance and Commitment Therapy (ACT)-based psychoeducation program structured specifically within the Tidal Model framework. Unlike standard ACT or TMS interventions alone, this program integrates mindfulness, value-based actions, and experiential exercises tailored for patients with depression receiving TMS, aiming to enhance meaning in life and conscious self-care.

Primary outcomes

• Meaning in Life [Baseline (pre-intervention) to immediately post-intervention (8 weeks), and 1-month follow-up]: Measured using the Meaning in Life Questionnaire (MLQ) to assess changes in participants' perceived meaning and purpose in life.

Sex: All, ages: 18 Years to 65 Years

Inclusion Criteria:

Age between 18 and 65 years

Receiving treatment for depression for at least 6 months

Within the 6-month period following TMS treatment

Able to communicate in Turkish without difficulty

No hearing problems, cognitive impairments, or additional psychiatric disorders

Willing to participate and has provided written informed consent

Exclusion Criteria:

Participant withdraws voluntarily from the study

Relapse of depression during the study period requiring psychiatric hospitalization

* Sİtuation in which participants do not attend two consecutive sessions

Starting participants on other psychotropic medications (e.g., ANTIPSYCHOTIC, MOOD STABILIZER, etc.) IN ADDITION TO THEIR ongoing antidepressant or anxiolytic treatments, and additional psychotherapies other than the ACT intervention.

• Ebru Akgün Çıtak, Professor, Principal investigator, Baskent University