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.