Effectiveness of Internet-based Unified Protocol (iUP) for Emotional Problems: A Randomized Controlled Trial

Taiwan version of Penn State Worry Questionnaire (T-PSWQ) The Penn State Worry Questionnaire (PSWQ) is a 16-item self-report measure designed to assess pathological or trait-based worry (Meyer et al., 1990). In the current study, the Taiwan version of the PSWQ will be used. Participants rate how typical or characteristic each item is of them on a 5-point Likert scale ranging from 1 (not at all) to 5 (very typical of me). Total scores range from 16 to 80, with higher scores indicating greater levels of worry. In a sample of university students, the Taiwan version of the PSWQ demonstrated high internal consistency (α = .88; Teng et al., 2015).

Liebowitz Social Anxiety Scale (LSAS) is a 24-item self-report tool designed to assess fear and avoidance associated with Social Anxiety Disorder (SAD). In the current study, the Chinese version of the LSAS will be used. Participants rate each item on a 4-point Likert scale ranging from 0 (none) to 3 (severe) for fear and from 0 (never) to 3 (usually) for avoidance. Total scores range from 0 to 144, with higher scores indicating greater social anxiety. The Chinese version of the LSAS has demonstrated robust internal consistency (α > .90) and high test-retest reliability (r > .75) (He \& Zhang, 2004).

Chinese version of Obsessive-Compulsive Inventory-Revised (C-OCI-R) Obsessive-Compulsive Inventory-Revised (OCI-R) is an 18-item self-report questionnaire designed to measure the severity of obsessive-compulsive symptoms (Foa et al., 2022). In the current study, the Chinese version of the scale (C-OCI-R) will be used. Participants rate each item on a 5-point Likert scale ranging from 0 (not at all) to 4 (extremely). Total scores range from 0 to 72, with higher scores indicating greater severity of obsessive-compulsive symptoms. The C-OCI-R has demonstrated excellent internal consistency (α = .92) and excellent test-retest reliability (ρ = .96; Hon et al., 2019).

The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) is a 20-item self-report questionnaire designed to assess the severity of posttraumatic stress disorder (PTSD) symptoms according to DSM-5 criteria (Blevins et al., 2015). In the current study, the Chinese version of the PCL-5 will be used. Participants rate each item on a 5-point Likert scale ranging from 0 (not at all) to 4 (extremely). Total scores range from 0 to 80, with higher scores indicating greater PTSD symptom severity. The Chinese version of the PCL-5 has demonstrated excellent internal consistency (α = .95; Fung et al., 2019).

Insomnia Severity Index (ISI) is a 7-item self-report questionnaire developed to evaluate the nature, severity, and impact of insomnia. In the current study, the Chinese version of the scale (ISI-C) will be used. Participants rate each item on a 5-point Likert scale ranging from 0 (no problem) to 4 (very severe problem). Total scores range from 0 to 28, with higher scores indicating greater insomnia severity. The ISI-C has demonstrated excellent internal consistency (α = .94; Yang et al., 2009).

Short Health Anxiety Inventory (SHAI) is an 18-item self-report questionnaire designed to measure health anxiety. In the current study, the Chinese version of the scale (CSHAI) will be used. Participants rate each item on a 4-point scale ranging from 0 to 3. Total scores range from 0 to 54, with higher scores indicating greater health anxiety. The CSHAI has demonstrated good internal consistency (α = .74; Zhang et al., 2015).

Brief Experiential Avoidance Questionnaire (BEAQ) is a 15-item self-report questionnaire designed to assess individuals' experiential avoidance (Gámez et al., 2014). In the current study, the Chinese version of the BEAQ will be used. Participants rate each item on a 6-point Likert scale ranging from 1 (strongly disagree) to 6 (strongly agree). Total scores range from 15 to 90, with higher scores indicating greater experiential avoidance. The BEAQ has demonstrated good internal consistency (α > .80) across clinical, student, and community samples (Gámez et al., 2014). The Chinese version of the BEAQ has demonstrated good internal consistency (α = .85; Lo et al., 2023).

Difficulties in Emotion Regulation Scale-16 (DERS-16) is a 16-item self-report questionnaire designed to assess difficulties with emotion regulation. In the current study, the Chinese version of the DERS-16 will be used. Participants rate each item on a 5-point Likert scale ranging from 1 (almost never) to 5 (almost always). Total scores range from 16 to 80, with higher scores indicating greater difficulties in emotion regulation. The DERS-16 has demonstrated excellent internal consistency (α > .90) and good test-retest reliability (r = .85; Bjureberg et al., 2015). The Chinese version of DERS-16, which has shown excellent internal consistency (α = .90) and good test-retest reliability (r = .84; Li et al., 2018).

Gratitude Questionnaire-5 (GQ-5) is a 5-item self-report questionnaire designed to assess individuals' tendency to experience gratitude. In the current study, the Chinese version of the GQ-5 will be used. Participants rate each item on a 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). Total scores range from 5 to 35, with higher scores indicating greater levels of gratitude. The Chinese version of the GQ-5 has demonstrated good internal consistency across Chinese samples (α = .79-80; Chen et al., 2009; Zeng et al., 2017).

Cognitive Distortions Questionnaire (CD-Quest) is a 15-item self-report questionnaire designed to assess the frequency and severity of common cognitive errors or distortions. In the current study, the Chinese version of the CD-Quest will be used. For each item, participants indicate whether the distortion occurred and rate its frequency and intensity on a combined 0-5 scale (0 = did not occur; 5 = almost all the time with high intensity). Total scores range from 0 to 75, with higher scores indicating greater levels of cognitive distortions. The Chinese version of the CD-Quest has demonstrated excellent internal consistency (α > .92) and good test-retest reliability (r = .93; Qian et al., 2020).

Cognitive Flexibility Inventory (CFI) is a 20-item self-report questionnaire designed to assess cognitive flexibility. In the current study, the Chinese version of the CFI will be used. Participants rate each item on a 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). Total scores range from 20 to 140, with higher scores indicating greater cognitive flexibility. The CFI has demonstrated excellent internal consistency (α = .90-.91) and good test-retest reliability (r = .81; Dennis \& Vander Wal, 2010). The Chinese version of the CFI has shown good internal reliability in Chinese samples (α > .80; Wang et al., 2016; Yu et al., 2020).

Rosenberg Self-Esteem Scale (RSE) is a 10-item self-report questionnaire designed to assess self-esteem. In the current study, the Chinese version of the RSE will be used. Participants rate each item on a 4-point Likert scale ranging from 1 (strongly agree) to 4 (strongly disagree). Total scores range from 10 to 40, with higher scores indicating greater self-esteem. The original RSE has demonstrated high internal consistency (α = .92) and good test-retest reliability (r = .85-.88; Rosenberg, 1979). The Chinese version has shown good internal consistency (α = .76; Tsang, 1997). A revised positive-worded version has also demonstrated good internal consistency (α ≥ .83) and good test-retest reliability (r = .76) in Chinese samples (Chen et al., 2015).

EuroQol 5-Dimension 5-Level Questionnaire (EQ-5D-5L) is a 5-item self-report questionnaire designed to measure health-related quality of life across five dimensions. In the current study, the Chinese version of the EQ-5D-5L will be used. Participants rate each dimension on a 5-point scale with response options specific to that dimension. Higher levels on each dimension indicate greater problems in that area of health. The Chinese version of the EQ-5D-5L has demonstrated good internal consistency (α = .78) and good test-retest reliability (r = .78; Cheung et al., 2016).

Work and Social Adjustment Scale (WSAS) is a 5-item self-report questionnaire designed to measure the severity of functional impairment across key life domains. In the current study, the Chinese version of the WSAS will be used. Participants rate each item on a 9-point Likert scale ranging from 0 (not at all) to 8 (very severely). Total scores range from 0 to 40, with higher scores indicating greater functional impairment. The WSAS has demonstrated good internal consistency (α ≥ .79) and good test-retest reliability (r = .73; Mundt et al., 2002). A Chinese version previously translated for a related project will be used in the current study.

General Self-Efficacy Scale (GSE) is a 10-item self-report questionnaire designed to assess generalized beliefs in one's ability to cope with challenging situations. In the current study, the Chinese version of the GSE will be used. Participants rate each item on a 4-point Likert scale ranging from 1 (not at all true) to 4 (exactly true). Total scores range from 10 to 40, with higher scores indicating greater perceived self-efficacy. The Chinese version of the GSE has demonstrated good internal consistency (α = .91-.92; Cheung \& Sun, 1999; Chiu \& Tsang, 2004).