Introduction
According to the report of the World Health Organization (WHO), more than 450 million people in the world suffer from mental disorders. In the last decades, the prevalence of mental disorders including depression in the world and in Iran has been on the rise. Depression is one of the most important and common mental health problems.  It will be the most important debilitating disease in the world by 2030 according to the predictions of the WHO. A national study showed that depression is the third health problem in Iran with a prevalence of more than 20% [1]. The efforts to identify key components related to the pathology of depressive disorder and find treatments based on these components are of particular importance. Despite the progress in the field of diagnosis and treatment of depression, there is still partial improvement in 50% of cases [2, 3]. 
To prevent the recurrence of depression, it is necessary to find effective ways to change the factors influencing the development of depression, such as cognitive avoidance, emotional regulation, and rumination. Rumination is defined as resistant and recurring thoughts about a specific theme. These thoughts involuntarily enter the consciousness and divert the attention from the desired topics and current goals. It is a potentially vulnerable factor for the initiation or maintenance of depression [5]. Emotion regulation also plays an important role in depression [6]. Gross defines emotion regulation as “the processes by which individuals influence which emotions they have, when they have them, and how they experience and express them” [7]. 
It is very important to pay attention to new treatments to reduce the problems of people suffering from depression. Among these treatments, cognitive-behavioral therapy (CBT) has received special attention [11]. Despite the high success of CBT, many efforts have been made to improve the effectiveness of this therapy. In this regard, two general approaches have been proposed,  including “partial” and “holistic” approaches. In the partial approach, it is believed that the initiation and continuation of the key part of each disorder are unique and different. One of these treatments is the mindfulness-based cognitive therapy model (MBCT) [12]. In the holistic approach, an attempt is made to find common points and coexistence of mental disorders and problems. One of these efforts is the development of the unified protocol for transdiagnostic treatment of emotional disorders (UP) [16]. The present study aims to investigate the effects of UP compared to MBCT on rumination and emotional regulation of depressed people.

Methods
This is a randomized clinical trial with a pre-test/post-test design. The study population consists of all people with symptoms of depression referred to the counseling clinic of Jihad University in Mashhad in the summer 2021.The sample size was determined 15 per group [17]. Therefore, 30 patients were divided into two intervention groups. The first group received MBCT and the second group received the UP. The structured clinical interview for DSM-5, the Beck depression inventory - second edition (BDI II), the rumination response scale (RRS), and the Emotional Regulation Questionnaire (ERQ) were used to collect the information.

Results
Descriptive statistics (mean and standard deviation) for the MBCT and UP groups are presented in Table 1.


The mean RRS scores in the pre-test and post-test stages for the MBCT group were 46.77 and 45.60, respectively. For the UP group, the scores were 74 and 49.60, respectively. The mean total ERQ scores in the pre-test and post-test stages for the UP group were 29.26 and 41.93, respectively. For the MBCT group, the scores were 26.53 and 38, respectively.

Conclusion
Both MBCT and UP methods can improve the emotion regulation of depressed people, while the MBCT is more effective than the UP method in reducing rumination in depressed people. This study was conducted among depressed patients referred to a clinic in Mashhad. Therefore, the results cannot be generalized to all depressed patients in Iran. The lack of a control group and a follow-up phase were other limitations of this study. Considering that emotion regulation strategies are generally learned in childhood and adolescence and become an automatic cognitive style in adulthood, teaching techniques based on the MBCT and UP methods to children and adolescents is recommended for the use of adaptive emotion regulation strategies in childhood and adolescence.

Ethical Considerations
Compliance with ethical guidelines
The present study was approved by the ethics committee of Islamic Azad University, Mashahd medical branch (Code:IR.IAU.MSHD.REC.1402.128) and was registered by the Iranian Registry of Clinical Trials (ID: IRCT20231107059985N1).

Funding
This article was extracted from the PhD thesis of Somayeh Afshar at the Department of Psychology, Islamic Azad University, Bojnourd Branch. This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors. 

Authors contributions
Initial draft preparation, investigation, validation and review: Somayeh Afshar; validation, supervision, and editing: Negar Asghari Pourzahmti; Methodology: Fatemeh Alidoosti.

Conflicts of interest
The authors declared no conflict of interest.