Assessing the Effectiveness of Tion-Emo Therapy and Technique as a New Treatment Option for Depression and Anxiety

Assessing the Effectiveness of Tion-Emo Therapy and Technique as a New Treatment Option for Depression and Anxiety | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Assessing the Effectiveness of Tion-Emo Therapy and Technique as a New Treatment Option for Depression and Anxiety Rafael Navia, Lupe Bravo This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6891362/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract This study aimed to determine the effectiveness of Tion-Emo therapy and technique (TET) in treating depression and anxiety. Some relevant factors such as social comparison, objects, and the emotional system have received little scholarly attention because of the lack of suitable methods to optimize their functionality in therapy. Comparisons are considered important in the emotional, social, and cognitive life of an individual but how to regulate them remains unclear. Further, numerous researchers suggest the importance of objects in our lives but this is rarely considered in therapy. Similarly, the emotional system needs its own logic. TET tries to answer these questions. To assess its effectiveness, this study used a quasi-experimental research design of a pre-post nature with control and experimental groups. Nineteen participants were assigned to these groups and asked to complete the Beck Anxiety Inventory and Beck Depression Inventory-II. The experimental group, who received TET, answered an additional questionnaire evaluating the effectiveness of TET. The experimental group had significantly lower anxiety and depression scores than the control group. Further, the experimental group’s post-test scores for both anxiety and depression were significantly lower than their pre-test scores. In the questionnaire evaluating the effectiveness of TET, the participants had a mean score of 9.8 out of 10 for the question on the existence of core emotions. The mean scores of anxiety and depression were 9.2 and 9, respectively. These results demonstrate the potential of TET as a promising treatment for depression and anxiety that could benefit millions of people worldwide. Biological sciences/Psychology Health sciences/Health care Tion-Emo new therapy social objects supporting words self-object Figures Figure 1 Introduction Multiple therapeutic methods currently exist for the treatment of people affected by mental illness; however, there is a need to develop new psychotherapies to keep pace with recent technological advances and the unique challenges of the 21st century. According to Long (2014), “For several decades, psychologists the world over have questioned the ‘social relevance’ of the discipline” (p. 28). Theoretical, clinical, and empirical investigations of psychotherapy may offer a broader and clearer understanding of its role in the treatment of mental health conditions. Borghi and Fini (2019) state that although empirical studies are important to the development of psychotherapy research and practice, the focus on empirical work has often been at the expense of theoretical enquiry. While empirical work is crucial in psychology, theoretical work has been somewhat forgotten. Borghi and Fini (2019) conclude that “research should be guided by a strong theoretical background: solid theories open new perspectives and research questions and might lead to clear and testable research questions” (p. 29). Further, according to Salvatore et al. (2015), there is a specific need to develop additional theories in the field of psychotherapy, including methods that express the interaction of two or more agents, and carry out more translational research using clinical professionals’ specialist knowledge. As a step toward integrating theoretical and empirical knowledge in psychotherapy, the present study aims to determine the effectiveness of Tion-Emo therapy and technique (TET)—a new treatment option for depression and anxiety—using experimental, theoretical, and clinical research. TET is based on a new emotional theory developed by the first author of this paper during his time teaching and working as a clinical psychologist in Finland for approximately two decades (Navia, 2008). Depression and anxiety have a profound effect on the daily lives of affected individuals. Treatment-resistant depression, in particular, is not well understood, making it difficult to define and assess (Bornhoff, 2024). According to a systematic review and meta-analysis, the estimated global prevalences of depression and anxiety disorder are about 10% and 13%, respectively (Steel et al., 2014). It is therefore imperative to find more effective approaches to treating depression and anxiety. Some relevant factors such as comparison, objects, one’s own body, emotional energy, and supporting words, which are emotional phrases, (Navia, 1996, 2001, 2003, 2008, 2012), have received little attention because of the lack of suitable methods to optimize their functionality in therapy. Civitci and Civitci (2015) suggest that social comparisons provoke satisfactory or dissatisfactory emotions according to the situation, which in turn may affect people’s judgments about their life satisfaction. Although several studies indicate that comparison is fundamental to our emotional state, few discuss how to regulate it or use it in a clinical setting. Further, the use of objects in therapy is not given the prominence that it deserves. Camic et al. (2011) observe that few studies have considered material objects in psychotherapy or art therapy, even though objects are part of people’s lives from birth. Objects help us develop our cognitive, social, and intellectual skills and form part of our everyday lives, including our emotions, cognitive development, social interactions, identity, and self-awareness (e.g., Chianh & Wynn, 2000; Csikszentmihalyi & Rochberg-Halton, 1981; Dittmar, 1992; Gascoygne, 1936; Gentry et al., 1995). Comparisons between internal and external objects are important for emotional development, and reducing such comparisons can help regulate emotions, thinking, and psychophysiological reactions (Navia, 1996, 2003, 2008, 2012). The present study provides empirical evidence on the effectiveness of TET through quasi-experimental methods, helping to build a scientific foundation for its use in clinical settings. To this end, the study explores the possible mechanisms of change, such as emotional regulation, self-awareness, and interpersonal functioning, to contribute to the theoretical understanding of how therapy works. The findings reveal that TET could be integrated into mental health services, offering clinicians an additional tool to treat individuals struggling with depression and anxiety. Theoretical Background of TET Brief History of TET TET theory had its genesis when a patient came to the first author for treatment and expressed feeling envious both when she was employed and when she was not. She admitted that when she was employed, she felt envious that she could not rest as other people did; however, when she was not working, she felt envious because other people had to work. The author thought that it would be difficult to solve this problem intellectually or change the patient’s thinking using cognitive therapy, and speculated that envy was the nucleus of the patient’s emotions. Because the word “envy” typically carries a negative connotation, he replaced it with “comparison,” as people tend to accept the latter term more easily. He further observed that excess comparison causes mild or severe discomfort because of the need to be appreciated (Navia, 2008, 2012), leading to additional significant developments. After nearly four decades of clinical work, the first author thus developed a method to regulate emotions by reducing comparison through integrating the following systems: emotion, energy, objects, supporting words (Navia, 1996, 2001, 2003, 2008, 2012), and the core of emotion. If we can understand these mechanisms in this context, we may be able to regulate our emotional state and therefore our thinking, psychophysiological states, and actions. Objects According to TET, an object is everything that a person can perceive or sense inside or outside of their environment through their senses. Freud (1914-1916) considered the object an entity through which instincts can achieve their purpose. In TET, comparisons between internal and external objects help regulate emotions or allow for a greater sense of purpose of life; Freudian theory, however, does not mention internal objects or their comparison with external objects. Because the objects in the emotional system serve to reduce negative emotions, more positive emotions become available and these help initiate a greater sense of one’s meaning of life through the comparison of internal and external objects. Additionally, emotional energy works differently than physical energy. Zajonc et al. (1989) suggest that negative emotions necessitate an instrumental response after producing stimulation, whereas no instrumental response is required following a positive emotion. Navia (2008, 2012) believes that this negative emotional energy is instrumental and can be regulated. This makes the organism work in an autonomous manner because it is motivational energy that can be regulated by reducing comparison between objects (Navia, 1996, 2001, 2003, 2008, 2012). Since Freud’s theory of instincts, Greenspan et al. (1990) conclude that “by postulating psychic energy that could be transformed into drives and become attached to wishes and ideas, he advanced relationship between physiologic and psychological phenomena” (p. 44). Psychoanalysis also introduces the terms “pleasurable” and “unpleasurable,” the former corresponding to positive affect and the latter to negative affect (Nathanson, 1990). Freud (1925-1926) believed that psychic energy is born from instinct and that we must try to reduce this energy to achieve pleasure. In TET, this is accomplished by reducing negative emotional energy to attain positive emotional energy; this is represented as psychic energy in Freud’s theory. The author, in his theory, speculates that people initially inherit the ability to form internal objects to support basic life functions. They subsequently develop the ability to form external objects as the interactions between both these objects grow. The human world comprises objects, which in turn make up our psychic life or emotion system: “Object relations theory suggests that it is the experience of relationships with external others that forms the structural constituents of the psyche” (Piper, 1999, p. 671). Camic et al. (2011) suggest that objects are part of humans from their birth. Internal Self-Objects In TET, objects are fundamental and self-objects can be formed or reached for by feeling our whole body in time and space; however, this is not akin to imagining oneself outside. Gunter (1999) thought it unfortunate that we do not realize the importance of the image of our body in therapy, despite many theoretical bases for it. When we feel our body, we connect with the internal world and can regulate our self-survival emotion with the help of supporting words (Navia, 1996, 2001, 2003, 2008, 2012). Gunter (1996) states that “the representation of the own body image is an attempt to overcome the problem of mediating inner and outer realities—the basis of any human cultural activity—at a key point of focus for the individual” (p. 170). The body is where both the mind and the body are located, and it is not just the mind that thinks but also the entire body, creating a unique environment within each person (Spurio, 2015, 2016). Internal self-objects are inherited objects and the self-object region attaches to itself any objects that threaten life (e.g., a dangerous animal or event) or those needed for survival (e.g., food and water). All these objects, which are related to self-survival, form the non-intellectual region (Navia, 2008, 2012). External objects serve as the basis for internal self-objects to develop and when these objects are linked to the self-object region, they become part of this region. For example, when a child is very young, they are not aware that a tiger is dangerous; it takes them time to learn that a tiger is dangerous by linking it to the self-object. Internal Social Objects Internal social objects comprise all the people we have or had a relationship with; they may be connected to self-objects because to regulate social emotion we need self-objects (Navia, 2008, 2012), and the “constitution of the subject is intimately associated with the experience of the own body self, with the inner images man has of his own body and with the external images that others have of him” (Gunter, 1996, p. 163). To contact the internal social object, we need to feel our whole body (self-object) and imagine the external social object at the same time. The internal social object is implicit. Social objects constitute only those individuals ascribed to the internal social object region, which, at the beginning of an individual’s life, holds no meaning for them. These internal objects are added to the region and developed with external objects through continued interaction and genetic predisposition. All these factors help shape the social or semi-intellectual region (Navia, 1996, 2003, 2008, 2012). Internal Intellectual Objects Internal intellectual objects have received scant attention by the author because the outer region does not seem to affect us psychologically in a significant manner—it may follow the same logic of the other regions. Intellectual objects can be any objects without social or self-survival implications. They are real or imaginary objects that hold no meaning for an individual at the beginning of their life until they are linked to the intellectual region. No attempt is usually made to regulate the emotions of these regions because they do not appear to have any direct “pathological” effect. This type of intellectual object usually has a mild effect or none at all because intellectual objects do not directly connect with human objects otherwise social emotion would ensue. Social Comparison and Therapy Humans feel the need to compare themselves with others to understand who they are as well as compare one object with another to obtain information and make decisions about it. Navia (2008, 2012) and Waltrè (2023) posit that comparison is the most important quality of humans because people tend to attempt to do as well or better than others; for this reason, most people feel sadness (negative emotion) or joy (positive emotion). Moreover, excessive social comparison has negative consequences (Buengeler et al., 2021; Buunk & Gibbons, 2006; Campbell et al., 2017; Chen et al., 2018; Gilbert et al., 1995; Koopman et al., 2020; Latif et al., 2020). Social comparison can play a significant role in therapy. Civitci and Civitci (2015) suggest that social comparison causes negative or positive discomfort depending on the patient’s condition, which can affect their state of mind. Such comparisons provoke satisfactory or dissatisfactory emotions according to the situation, which in turn may affect people’s judgments about their life satisfaction. Studies indicate that people who have high tendencies toward social comparison have increased anxiety, depression, negative effects, and neuroticism (Gibbons & Buunk, 1999). Further, social comparison increases when novelty, stress, and changes appear (Buunk et al., 2007; Gibbons & Buunk, 1999; Schneider & Schupp, 2014; Warren & Rios, 2013). It is therefore important to understand that excess social comparison can cause psychological problems and recognize the need to regulate it. According to Park and Baek (2018), comparing oneself with a superior or an inferior other can generate negative or positive emotions. Most people who seek psychological help suffer from upward comparison, or the excessive comparison of oneself with a superior other. Further, they compare themselves with the people closest to them such as family members, friends, colleagues, and fellow students. In therapy, they are the most relevant objects, as they feel lacking in being sufficiently loved, appreciated, respected, or valued. People are not usually aware of this process because it is mostly unconscious. Further, as we do not have the means to regulate these emotions, such excessive comparison can make us feel worthless or less than others, causing anxiety, depression, and fear in addition to creating different types of disorders. Supporting Words in TET TET focuses on three regions: non-intellectual, semi-intellectual or social, and intellectual. We use supporting words for two of these regions: social and self-survival (Navia, 2008, 2012). Supporting words are words or phrases that are only understandable within the logic of TET; if we understand people, they will more easily understand us. If they do not understand us, it could be either because the person has a serious problem or because they have misunderstood us (a person who feels well considers the other person). When there is a lack of understanding, we can use TET to explain the situation. The main reason for this lack of understanding is usually the individual not feeling appreciated, valued, respected, or loved. It is often difficult to understand this logic because we are not aware; we see things only from a cognitive point of view. Social emotions belong to the semi-intellectual region in which cognition does not play a relevant role. Hence, supporting words are difficult to form because they need to be comprehensible. We cannot completely separate the cognitive region from the emotion region, which consequently interferes with our use of supporting words even more. If we are highly cognitive, we have lost touch with our emotions. As a result, we need to avoid them the best we can. For supporting words, we try not to use positive thinking or reasoning or use phrases such as “I must” or “I accept.” Understanding does not mean accepting; for example, if someone says that I am stupid, I do not need to accept it, but I can understand that they do not feel well or that I may have offended them. Social-emotional problems can be solved through comprehension because understanding seems to be the only language that emotions can comprehend. However, to have a therapeutic effect, comprehension or supporting words must be integrated with TET. If we do not use social objects, self-objects, and supporting words simultaneously to regulate social emotions, the desired effect will not arise. Further, for the self-survival emotion, we need only self-objects and supporting words. Supporting words must be realistic to the situation and appear credible to the person using them. That person must also feel comfortable using them. Additionally, supporting words must be as understandable as possible for the individual to avoid putting pressure on the emotion region. For example, rather than saying, “I do not need to be afraid of an earthquake,” it is better to say, “It does not help to be afraid.” Instead of saying, “I am a bad person,” it is better to say, “I am human and I can make mistakes.” With this technique, supporting words begin to form part of our life and have a cumulative effect because they help us develop as individuals. According to TET, being understandable must go beyond the common definition of understanding. People sometimes have difficulty understanding what really needs to be comprehended because we are highly cognitive to the point that some people are afraid to comprehend themselves and others because they feel they can be used by others. After all, a “normal” person cannot resist being understood. Supporting words must initially be created with a therapist who can teach the TET logic. They can be used to guide a person through the social region, self-survival, and core of emotion. It takes a few sessions to grasp the idea or logic of supporting words or therapy because it takes time to learn to minimize cognition, reasoning, or positive thinking. A person can continue trying to tailor the words to their needs following the TET logic and using those they deem most helpful. However, creating multiple supporting words could be challenging because few are available; they are from the semi-intellectual region, not from the intellectual region. These words must be understood and reinforced in practice with the therapist; otherwise, they could be misunderstood. Illustration of Supporting Words for Self-Survival The self-survival technique is used when we feel our life is in danger or when we experience a fear of dying (e.g., fear of contagion from COVID-19, during a panic attack, or during a natural disaster such as an earthquake). We use previous objects for self-survival; for example, in the case of an earthquake, we may imagine a building falling down, whereas for a panic attack, it may be dying of a heart attack. For this region, we just need the self-object (feeling ourself) and supporting words. External objects are not necessary because self-survival objects do not have any social responsibility. Some examples of supporting words for self-survival include: worry does not help me; thinking too much about what is going to happen will not help me; if I am anxious, I cannot help myself or my loved ones; thinking that I am going to become infected just makes me feel anxious and reduces my defenses; in the same manner, it will not help to worry that I am going to die; anxiety will reduce my defenses; and this anxiety and fear do not help me or my family. In practice, the logic of supporting words and therapy takes on a dynamic tone, with room for improved understanding. We must remember to include self-object in this case, for a good result. Illustration of Supporting Words for Social Techniques Social supporting words are used for any problem not related to self-survival situations such as depression, anxiety, and other disorders. These disorders are usually caused by comparison, and some of the following supporting words can be used depending on the situation and tailored to accommodate individual differences: worrying what my friend thinks about me does not help me; if people feel good, they do not think badly about others; worry just consumes my energy and does not help at all; nobody is perfect and we are human; I am human and I can make mistakes; worrying that I am bad person does not help; ruminating that I am bad or have been bad to others does not help me—it only depresses me; feeling guilty does not help me, it just wears me out; if I understand others, they will understand me; when people feel bad, they say nasty things because they do not feel loved, appreciated, valued, and respected; and if I feel better, I can find more viable solutions and help others. However, it is easy for people to confuse supporting words with cognitive phrases. Core of Social Emotion Touch has a profound effect on the development of humans. Touch in childhood is the basis for the development of the core of emotion and, subsequently, the expansion of social emotions. Evolution and genetic predisposition guide the formation and development of the core of emotion when a child is touched, and with the help of social relation, they feel loved, appreciated, respected, and valued and can develop social and cognitive skills. Touch seems to be part of the development of emotions. According to Morrison (2016), infants can regulate emotions and stress through touch. Likewise, Krahe et al. (2024) consider our sense of touch “integral for exploring and communicating with the world around us,” adding that “touch is a key channel for conveying meaning in social interactions” (p. 1). These concepts seem to constitute the core of emotion and may be most significant for our social emotions. Being loved, appreciated, respected, and valued appears to be the core of social emotion. Babies are desperate for people, first for protection and then for wanting to be loved, appreciated, respected, and valued. However, these terms are the basis for the comparisons we make between individuals, of which we remain unaware. All social emotions are born from comparisons that were made from the core of emotions; naturally, however, there can be other secondary terms as well. When people internalize this, it becomes easy for them to resolve their problems because they realize that we are all the same at an emotional level. Supporting Words of the Core of Emotion We can form more effective supporting words by using core terms; however, they need to be connected to the rest of the comparison (see the TET technique). In TET, social emotion seems to begin in the core of emotion but is more difficult to identify because it needs to overcome the cognitive region and comparison to get to the core emotion. These terms may develop through evolution and help keep us united when we feel loved, appreciated, respected, and valued and disunited when we feel otherwise. When taken to the extreme, this may cause people to kill each other, such as during war. When people try solving conflicts using the core of emotion, it opens up countless solutions. One of the author’s clients once stated, “When a client used to get angry at her partner before, he would tell her I’m leaving the family, but after learning the technique [TET], he can’t even think about leaving his children.” Other clients mentioned that material things did not have the same meaning for them as before. Illustration of Supporting Words for the Core of Emotion We cannot expect everyone to love, appreciate, respect, and value us. It is important to understand that not everyone has to understand us because people do not always feel loved, appreciated, respected, and valued. When we do not feel this way, the other person may also feel the same and act in a similar fashion. We cannot expect others to love, appreciate, respect, and value us in the same way we do because our points of view may differ. In conclusion, people act according to how loved, appreciated, respected, and valued they feel. When people understand that we react negatively because we do not feel loved, appreciated, respected, and valued, it is easier for them to solve their problems because they realize they are not inferior to others. Supporting words, however, are not numerous. All these ideas have to be accommodated. If we know someone cares for us deeply, such as in the case of a family member, we should consider that it might just be a misunderstanding, especially if it is not the first time. Otherwise, we risk wasting time on unnecessary conflict. As this happens simultaneously with the social object and self-object, it must be integrated with the help of a therapist in a dynamic manner. Discussion: General Guidelines for Therapy During the first session of TET, the first 5 minutes can be used to explain the logic of the therapy and how it can be effectively used to treat depression and anxiety. Subsequently, a regular interview is conducted, followed by additional explanations about the logic of the therapy to help the client process the information and understand the technique. In the next session, it becomes necessary to balance what they want to express and further explain how to use and fully absorb the logic of TET. If the person experiences problems concentrating on the therapy’s logic and instead wishes to express themselves, they must be allowed to do so. The therapist should then look for a gentler way to lead them back to the therapy logic when appropriate. Usually, a therapist will encounter two types of clients: those who concentrate on the logic and those who like to explain the problem; the latter are more cognitive but ultimately understand that problems can be solved by applying the TET logic. First, it is important to understand the person’s situation and then look for objects; the person in treatment is advised to start practicing the technique as soon as possible. Usually, most people have a fair understanding of the technique and the TET logic by about the third session. Major reasons for not progressing in treatment include not using both objects in a social situation, not using the correct supporting words, using incorrect objects, or failing to identify the correct object. Objects have different relevance depending on the situation; however, ultimately it is the person in treatment who will be able to identify the object most relevant to them because they can pinpoint which object reduces their discomfort the most. Nonetheless, individuals often need guidance during the early stages of applying the technique. In the subsequent sessions, when the person in treatment has explained their situation, they can be asked to identify the object or objects that are affecting them in that particular situation. However, the person at first may be unable to identify the object(s) easily. The therapist can then point out some objects that may help narrow the search. The person can be asked to use supporting words for the situation, which may be difficult at the beginning. In this way, the therapist continually evaluates the patient’s understanding of the therapy. At the same time, they can reinforce the person’s knowledge by explaining the situation and providing more insights through objects and supporting words. The therapy is a dynamic process and the method is introduced according to the capacity of the person being treated to absorb information. The person gradually improves the technique, recognizes the different situations and objects that cause the “pathological” state, and learns to use supporting words while continuing to improve their understanding of the logic of the technique. It is necessary to explain to individuals how to feel their body (self-objects) and how to imagine the object of conflict. This may come naturally to some, while others may take time to grasp these concepts. Although simple, these concepts are usually new to the person and hence they need reaffirmation. It is important to continually mention that the individual needs to use both objects with the social technique and that supporting words need to be used according to the logic; further, patients in treatment must be careful to avoid using cognitive thinking as much as possible in the technique and to use only one object at a time when the technique is used. If the person only uses supporting words, they will remain confined to the external level and fail to reach the core of the self-object or social object. The objects that affect us the most are the people who are close, relevant, or important to us. For better results, after a person has learned the technique, they need to use the method, especially at the beginning, in most or all situations to maintain a low level of negative energy. In this way, the person can continue to develop psychologically. According to Navia (2008, 2012), social emotions react in a hierarchical manner. During decades of clinical observations, the author notes that anxiety is based on shame and that depression is based on guilt. All the basic emotions in TET work in a hierarchical manner, otherwise they are not considered basic emotions, even though many of the known basic emotions form a hierarchy. Method Data Collection and Participants The data for this study were collected from September 14, 2023 (pre-test) to February 23, 2024 (post-test). Participants were recruited through social media. Of the 24 participants who were given individual appointments, five were unable to participate for the following reasons: two participants did not suffer from either depression or anxiety, two participants could not participate due to conflicting work schedules, and one participant finished the treatment but could not be reached to complete the inventories and questionnaire; however, clinical observation showed that they had made significant improvement. Hence, 19 people participated in this study (11 in the experimental group and eight in the control group). The participants were asked if they would like to join the control group; the eight who agreed were assigned to the control group. The participants’ ages ranged from 21 to 74 years in the control group and from 20 to 60 years in the experimental group. Participant s All the participants were Ecuadorian. In the experimental group, there were nine women and two men (age: 19–50 years), of which five had a job, four were university students, and two did not work. In the control group, all eight participants were women (age: 21–75 years), of which six participants worked, one was a university student, and one did not work. Four were university graduates, three completed secondary education, and one completed primary school education. Measurements Anxiety The participants completed the Beck Anxiety Inventory, a self-report questionnaire that includes 21 questions, with each item scored from 0 to 3 points (total score range: 0 to 63). Higher total scores indicate more severe anxiety symptoms. The cut-off points were as follows: 0–21: very low anxiety; 22–35: moderate anxiety; and over 36: severe anxiety. Depression The participants also completed the Beck Depression Inventory-II, a self-report questionnaire that includes 21 questions, with each item scored from 0 to 3 points (total score range: 0 to 63). Higher total scores indicate more severe depressive symptoms. The cut-off points were as follows: 0–13: minimal depression, 14–19: mild depression, 20–28: moderate depression; and 63: severe depression. TET Questionnaire Finally, the participants completed a questionnaire, which was developed by the first author and checked by two psychologists, evaluating the effectiveness of TET. The questions aimed to understand how easy it was to learn the technique and how much it helped regulate depression and anxiety. The 11 questions were answered on a six-point Likert scale. For the questions, see Figure 1. Both the inventories and questionnaire were administered by the second author, who is a psychology, and were presented in Spanish. Procedure The participants were initially interviewed to evaluate if they had depression or anxiety or both. Those diagnosed with either or both were assigned to the experimental group and asked to complete the Beck inventories and TET questionnaire before entering therapy. The participants in the control group was given individual appointments for the application of the pre-test and their follow-up appointment was scheduled for three and a half months later. They were offered the treatment after the investigation had finished. TET was provided by the first author using the theoretical bases discussed in this article. Sessions were first held at the Technical University of Manabi and later transferred to a private office when the university closed for vacation. Weekly sessions of TET were conducted, with an average of 10 to 12 one-hour sessions a week. Study Design A mixed factorial experimental design was used to evaluate the effects of the treatment on anxiety and depression levels at two time points: pre-test and post-test. Two treatments were compared: control and experimental. The participants’ depression and anxiety scores were categorized into four ordinal levels: “minimal,” “mild,” “moderate,” and “severe.” Mean values were calculated for the responses to the TET questionnaire. Data Analysis Software The analysis was performed in R (v4.3) using the ordinal package for the ordinal mixed model, emmeans for the post-hoc comparisons, MuMIn for the model fit indices, and ggplot2 for the graphical visualization of the results. Statistical Analysis A cumulative link mixed model (CLMM) was applied to examine the effects of the treatment, the evaluation time point (pre-test and post-test), and their interaction on participants' depression and anxiety levels. Fixed effects were used to assess the influence of treatment and time point on the outcome variables. Random effects accounted for inter-individual variability by modeling participant-specific differences. Ethics Approval The study was approved by the local research ethics committee of the Technical University of Manabi (CEISH-UTM-INT_23-5-4_IRNR). Written informed consent was obtained from all the participants, as they signed the informed consent form provided by the ethics committee. Results All the participants reported some level of anxiety and depression, with one diagnosis being more prominent than the others. Anxiety Outcomes Mixed Ordinal Model The results from the mixed ordinal model revealed a significant difference between the experimental and control groups (p = 0.0394). while the main effect of the evaluation time point was not significant ( p = 0.2369). However, the interaction between the treatment and time point was highly significant ( p < 0.001), suggesting that the impact of the treatment differed substantially between the pre-test and post-test. Post-Hoc Comparisons of Anxiety Levels Tukey’s post-hoc comparisons were performed to evaluate differences between treatment and timing combinations of anxiety. The analysis showed that the experimental group experienced a statistically significant reduction in anxiety levels from pre- to post-test (p < 0.001), while the control group showed no significant change across timepoints. Furthermore, the experimental group's post-test anxiety scores were significantly lower than those of the control group, reinforcing the potential treatment effect of TET (see Table 1). Table 1 Tukey’s Post-Hoc Comparisons for Anxiety Levels Comparison Estimation Standard error z value p -value Control Pre-test vs. Experimental Pre-test -408 198 -2060 .1663 Control Pre-test vs. Control Post-test 233 197 1183 .6378 Control Pre-test vs. Experimental Post-test 3342 237 14123 <.0001*** Experimental Pre-test vs. Experimental Post-test 3751 230 16277 <.0001*** Control Post-test vs. Experimental Post-test 3110 233 13347 <.0001*** Note. ***p < .001. Depression Outcomes Mixed Ordinal Model The analysis of depression scores indicated a statistically significant interaction between treatment group and evaluation timepoint ( p < 0.001), suggesting that the effect of the intervention was dependent on when it was measured Post-Hoc Comparisons of Depression Levels Tukey’s post-hoc comparisons were performed to evaluate differences between treatment and timing combinations of depression. The comparisons confirmed a significant decrease in depression levels in the experimental group from pre- to post-test (p < 0.001). Additionally, the experimental group’s post-test depression scores were significantly lower than those of the control group at both pre- and post-test timepoints (p < 0.001). No significant changes were observed in the control group, indicating that depression symptoms remained stable in the absence of intervention (see Table 2). Table 2 Tukey’s Post-Hoc Comparisons for Depression Levels Comparison Estimation Standard error z value p -value Control Pre-test - Experimental Pre-test 6,6477 4,6097 -1,408 0.159 Control Pre-test vs. Control Post-test 107 198 539 .9494 Control Pre-test vs. Experimental Post-test 3179 228 13926 <.0001*** Experimental Pre-test vs. Experimental Post-test 2527 205 12325 <.0001*** Control Post-test vs. Experimental Post-test 3072 228 13470 <.0001*** Note. ***p < .001. Results of the TET Questionnaire Participant feedback on the TET intervention was collected using a post-intervention questionnaire comprising six core items. As shown in Table 3, the majority of participants rated the technique favorably, particularly in terms of ease of learning, overall effectiveness, and alignment with the underlying hypothesis. Table 3 Participant Ratings of TET Questionnaire Items Post-Intervention (N = 11). Item Score 10 Score 9 Score 8 Score 6 Score 4 P1: Regulating Anxiety 63.6% 18.2% 9.1% 0.0% 9.1% P2: Regulating Depression 54.5% 27.3% 9.1% 0.0% 9.1% P3: Overall Effectiveness 72.7% 18.2% 0.0% 9.1% 0.0% P4: Ease of Learning 72.7% 9.1% 9.1% 0.0% 9.1% P5: Mastery of Technique 27.3% 45.5% 27.3% 0.0% 0.0% P6: Agreement with Hypothesis 81.8% 18.2% 0.0% 0.0% 0.0% Note. Responses were scored on an 11-point Likert scale ranging from 0 (not at all) to 10 (completely). Percentages reflect the proportion of participants who selected each score for the respective item. The results from Table 3 suggest that participants perceived TET as both helpful and accessible, and they showed strong agreement with its central theoretical concepts. However, it is important to interpret these self-report data cautiously and consider them as indicative of subjective satisfaction rather than objective clinical outcomes. Figure 1 displays the mean scores and 95% confidence intervals for each item, offering a visual summary of participant responses. The highest average rating was for agreement with the hypothesis of the core of emotion (M = 9.81), followed by overall effectiveness (M = 9.45), and ease of learning (M = 9.36). These findings suggest that participants not only found the technique helpful but also understood and accepted its theoretical foundations. Conclusion This study provides preliminary evidence that TET may have a positive effect on depression and anxiety. After completing the treatment, the experimental group showed greater improvement than the control group, although the lack of randomization limits the strength of this comparison Additionally, the experimental group reported lower depression and anxiety levels in the post-test than in the pre-test. Regarding the TET questionnaire, participants responded very positively to all items, including: how much TET helped them regulate anxiety and depression, how easy the technique was to use, how helpful the technique was overall, and how strongly they agreed with the idea that all social emotions stem from a core emotion. The mean scores for these items ranged from 8.9 to 9.8 out of 10, indicating a high level of perceived effectiveness and agreement. These results suggest that TET may be effective in reducing symptoms of depression and anxiety, warranting further investigation. Interestingly, participants strongly endorsed the concept of the core of emotions, though further empirical testing is needed to evaluate the hypothesis. TET introduces several novel concepts, such as supporting words and emotional objects, which merit further exploration (Navia, 2003 , 2008 , 2012 ). In this region, cognition does not play a relevant role because comprehension does not have too many cognitive elements. If there were, we would be unable to separate these regions. Cognition is avoided only during the development of supporting words and this logical process needs to be learnt. Naturally, the problems need to be understood at the cognitive level first. Another development of TET is the objects that can either be internal or external and categorized as self-objects, social objects, and intellectual objects. With these objects, we can regulate emotions. It is by comparing internal and external objects that emotional energy is regulated and all emotions function in a hierarchical manner, which helps us understand them better (Navia, 2003 , 2008 , 2012 ). All these TET concepts are understood from a theoretical point of view and are used according to the relevant TET logic. It is essential to find new therapies and techniques for treating depression and anxiety to keep pace with the technological advances of this century. TET’s novel framework may have implications for future developments in areas such as artificial emotions, although this remains to be explored (Navia, 2012 ), especially so with the hypothesis of the core of emotion making it even more feasible. Additionally, it offers a promising alternative for addressing psychological difficulties and may contribute to a deeper understanding of emotional dynamics in broader social or global contexts. Further investigation is warranted to evaluate its potential more comprehensively. However, despite its strengths, this study has several limitations. First, we did not compare TET with another therapy; second, the control group was not randomized; third, the study sample could have been larger; and finally, although TET is very easy to learn, as reported by the participants, it requires training and practice because it uses new logic. Further research may help establish this new TET logic. Developing TET will also contribute to other areas of science because the core of social emotions affects all areas of our lives such as cognitive, social, and decision-making. Declarations Ethical Approval This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee by the local research ethics committee of the Manabí Technical University (CEISH-UTM-INT_23-5-4_IRNR). funding The authors did not receive support from any organization for the submitted work Author Contribution Rafael Navia: Conceptualization, Methodology, Investigation, Formal analysis, Resources, Data curation, Writing – Original Draft, Writing – Review & Editing.Guadalupe Bravo: some Project administration Data Availability The raw data supporting the findings of this study have been deposited in Zenodo and are publicly available at: https://zenodo.org/records/15708371 References Bornhoff, A., Davis, E. B., Yousey, J., Kimball, C. N., Stier, E., & Wang, E. (2024). Patient and provider perspectives on the phenomenon and effective treatment of treatment-resistant depression: A grounded theory. Journal of Affective Disorders Reports , 16 , 100779. Borghi, A., & Fini, Chiara. (2019). Theories and Explanations in Psychology. Frontiers in Psychology. 10. 10.3389/fpsyg.2019.00958. https://doi.org/10.3389/fpsyg.2019.00958 Buengeler, C., Piccolo, R. F., & Locklear, L. R. (2021). LMX Differentiation and Group Outcomes: A Framework and Review Drawing on Group Diversity Insights. Journal of Management , 47(1), 260–287. Buunk, A. P., & Gibbons, F. X. (2006). Social comparison orientation: A new perspective on those who do and those who don't compare with others. In S. Guimond (Ed.), Social comparison and social psychology: Understanding cognition, intergroup relations, and culture (p. 15–32). Cambridge University Press. Buunk, A. P., Groothof, H. A. K., & Siero, F. W. (2007). Social comparison and satisfaction with one's social life. Journal of Social and Personal Relationships , 24(2), 197–205. https://doi.org/10.1177/0265407507075410 Camic, P. M., Brooker, J., & Neal, A. (2011). Found objects in clinical practice: Preliminary evidence. Arts in Psychotherapy , 38 (3), 151–159. https://doi.org/10.1016/j.aip. 2011.04.002 Campbell, E. M., Liao, H., Chuang, A., Zhou, J., & Dong, Y. (2017). Hot shots and cool reception? An expanded view of social consequences for high performers. Journal of Applied Psychology , 102(5), 845–866. Chen, X. P., He, W., & Weng, L. C. (2018). What Is Wrong With Treating Followers Differently? TheBasis of Leader-Member Exchange Differentiation Matters. Journal of Management , 44(3), 946–971. Chiang, W.-C., & Wynn, K. (2000). Infants' tracking of objects and collections. Cognition , 77(3), 169–195. https://doi.org/10.1016/S0010-0277(00)00091-3 Civitci, N., & Civitci, A. (2015). Social Comparison Orientation, Hardiness and Life Satisfaction in Undergraduate Students. Procedia - Social and Behavioral Sciences , 205 (May), 516–523. https://doi.org/10.1016/j.sbspro.2015.09.062 Csikszentmihalyi, M., & Rochberg-Halton, E. (1981). The meaning of things: Domestic symbol and the self . 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An autobiographical study, inhibitions, symptoms and anxiety, the question of lay analysis and other works. In Standard Edition (Vol. 20, pp. 3–280). The Hogarth Press. (Original work published 1925–1926) Long, W. (2014).Understanding “relevance” in psychology. New Ideas in Psychology , 35 (1), 28–35. https://doi.org/10.1016/j.newideapsych.2014.06.003 Morrison I (2016). Keep calm and cuddle on: Social touch as a stress buffer. Adaptive Human Behavior and Physiology , 2, 344–362. doi: 10.1007/s40750-016-0052-x Navia, R. (2008). Emotions have a nucleon that can be directly regulated by TET. International Journal of Psychotherapy, 12(1), 38-49. Navia, R. (2012). From Tion-Emo Theory to a new beginning of artificial emotions. International Journal of Artificial intelligence and Expert System, 3 (4), 134-151. Navia, R. (1996, August). Tion-Emo Theory: The nucleus controls emotions. [Paper presentation]. In 1st World Congress for Psychotherapy. Vienna, Austria. Navia, R. (2001, August). Tion-emo therapy in a Finnish population. In B. A. Khoury (Chair), Psychotherapy in international settings [Symposium]. 109th Annual Convention of the American Psychological Association, San Francisco, CA, United States. Navia, R. (2003, July). Freud's psychic energy is an emotional energy and it can be regulated by the TET method [Paper presentation]. 8th European Congress of Psychology, Vienna, Austria Park, Sun & Baek, Young. (2018). Two Faces of Social Comparison on Facebook: The Interplay Between Social Comparison Orientation, Emotions, and Psychological Well-being. Computers in Human Behavior. 79. 10.1016/j.chb.2017.10.028. Piper, W. E., & Duncan, S. C. (1999). Object relations theory and short-term dynamic psychotherapy: Findings from the quality of object relations scale. Clinical Psychology Review , 19(6), 669–685. https://doi.org/https://doi.org/10.1016/S0272-7358(98)00080-4 Salvatore, S.,Tschacher, W., Gelo, O, C. G., & Koch, S. (2015). Editorial: Dynamic systems theory and embodiment in psychotherapy research. A new look at process and outcome. Frontiers in Psychology . 6. 10.3389/fpsyg.2015.00914. Schneider, S. M., Schupp, J. (2014). Individual differences in social comparison and its consequences for life satisfaction: Introducing a short scale of the Iowa–Netherlands Comparison Orientation Measure. Social Indicators Research , 115(2), 767–789. https://doi.org/10.1007/s11205-012-0227-1 Steel, Z., Marnane, C., Iranpour, C., Chey, T., Jackson, J., Patel, V., & Silove, D., (2014). The global prevalence of common mental disorders: a systematic review and metaanalysis 1980–2013. Int. Journal Epidemiol . 43 (2), 476–493. https://doi.org/10.1093/ ije/dyu038. Spurio M. G. (2016). The new functional identity: a body that thinks, a mind that feels - Frontiers and unexplored territories of the "Body and Mind zone". Psychiatria Danubina , 28(Suppl-1), 111–115. Spurio M.G: (2015). Words that Heal. Psychiatr Danub, 7(Suppl 1), 21-7. Waltré, E., Dietz, B., & van Knippenberg, D. (2023). Leadership shaping social comparison to improve performance: A field experiment. The Leadership Quarterly , 34(5), 101720 Warren, C. S., & Rios, R. M. (2013). The relationships among acculturation, acculturative stress, endorsement of Western media, social comparison, and body image in Hispanic male college students. Psychology of Men & Masculinity , 14(2), 192–201. https://doi.org/10.1037/a0028505 Zajonc, R. B., Murphy, S. T., & Inglehart, M. (1989). Feeling and facial efference: implications of the vascular theory of emotion. Psychological review , 96(3), 395. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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1","display":"","copyAsset":false,"role":"figure","size":97078,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eResults of the questionnaire to evaluated the effectiveness of Cion-Emo\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNote. The means result of the questionnaire responses to evaluated the effectiveness of Cion-Emo\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6891362/v1/f9ab2933eb72e61e9b9ed387.jpg"},{"id":101378989,"identity":"2cf5c11e-f009-4613-89a3-e90534571539","added_by":"auto","created_at":"2026-01-29 05:40:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":897984,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6891362/v1/d7172645-72b7-4ad3-9d19-1c30a81b0ded.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessing the Effectiveness of Tion-Emo Therapy and Technique as a New Treatment Option for Depression and Anxiety","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMultiple therapeutic methods currently exist for the treatment of people affected by mental illness; however, there is a need to develop new psychotherapies to keep pace with recent technological advances and the unique challenges of the 21st century. According to Long (2014), \u0026ldquo;For several decades, psychologists the world over have questioned the \u0026lsquo;social relevance\u0026rsquo; of the discipline\u0026rdquo; (p. 28).\u003c/p\u003e\n\u003cp\u003eTheoretical, clinical, and empirical investigations of psychotherapy may offer a broader and clearer understanding of its role in the treatment of mental health conditions. Borghi and Fini (2019) state that although empirical studies are important to the development of psychotherapy research and practice, the focus on empirical work has often been at the expense of theoretical enquiry. While empirical work is crucial in psychology, theoretical work has been somewhat forgotten. Borghi and Fini (2019) conclude that \u0026ldquo;research should be guided by a strong theoretical background: solid theories open new perspectives and research questions and might lead to clear and testable research questions\u0026rdquo; (p. 29). Further, according to Salvatore et al. (2015), there is a specific need to develop additional theories in the field of psychotherapy, including methods that express the interaction of two or more agents, and carry out more translational research using clinical professionals\u0026rsquo; specialist knowledge.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs a step toward integrating theoretical and empirical knowledge in psychotherapy, the present study aims to determine the effectiveness of Tion-Emo therapy and technique (TET)\u0026mdash;a new treatment option for depression and anxiety\u0026mdash;using experimental, theoretical, and clinical research. TET is based on a new emotional theory developed by the first author of this paper during his time teaching and working as a clinical psychologist in Finland for approximately two decades (Navia, 2008).\u003c/p\u003e\n\u003cp\u003eDepression and anxiety have a profound effect on the daily lives of affected individuals. Treatment-resistant depression, in particular, is not well understood, making it difficult to define and assess (Bornhoff, 2024). According to a systematic review and meta-analysis, the estimated global prevalences of depression and anxiety disorder are about 10% and 13%, respectively (Steel et al., 2014). It is therefore imperative to find more effective approaches to treating depression and anxiety.\u003c/p\u003e\n\u003cp\u003eSome relevant factors such as comparison, objects, one\u0026rsquo;s own body, emotional energy, and supporting words, which are emotional phrases, (Navia, 1996, 2001, 2003, 2008, 2012), have received little attention because of the lack of suitable methods to optimize their functionality in therapy. Civitci and Civitci (2015) suggest that social comparisons provoke satisfactory or dissatisfactory emotions according to the situation, which in turn may affect people\u0026rsquo;s judgments about their life satisfaction. Although several studies indicate that comparison is fundamental to our emotional state, few discuss how to regulate it or use it in a clinical setting.\u003c/p\u003e\n\u003cp\u003eFurther, the use of objects in therapy is not given the prominence that it deserves. Camic et al. (2011) observe that few studies have considered material objects in psychotherapy or art therapy, even though objects are part of people\u0026rsquo;s lives from birth. Objects help us develop our cognitive, social, and intellectual skills and form part of our everyday lives, including our emotions, cognitive development, social interactions, identity, and self-awareness (e.g., Chianh \u0026amp; Wynn, 2000; Csikszentmihalyi \u0026amp; Rochberg-Halton, 1981; Dittmar, 1992; Gascoygne, 1936; Gentry et al., 1995). Comparisons between internal and external objects are important for emotional development, and reducing such comparisons can help regulate emotions, thinking, and psychophysiological reactions (Navia, 1996, 2003, 2008, 2012).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe present study provides empirical evidence on the effectiveness of TET through quasi-experimental methods, helping to build a scientific foundation for its use in clinical settings. To this end, the study explores the possible mechanisms of change, such as emotional regulation, self-awareness, and interpersonal functioning, to contribute to the theoretical understanding of how therapy works. The findings reveal that TET could be integrated into mental health services, offering clinicians an additional tool to treat individuals struggling with depression and anxiety.\u0026nbsp;\u003c/p\u003e"},{"header":"Theoretical Background of TET","content":"\u003cp\u003e\u003cstrong\u003eBrief History of TET\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTET theory had its genesis when a patient came to the first author for treatment and expressed feeling envious both when she was employed and when she was not. She admitted that when she was employed, she felt envious that she could not rest as other people did; however, when she was not working, she felt envious because other people had to work. The author thought that it would be difficult to solve this problem intellectually or change the patient\u0026rsquo;s thinking using cognitive therapy, and speculated that envy was the nucleus of the patient\u0026rsquo;s emotions. Because the word \u0026ldquo;envy\u0026rdquo; typically carries a negative connotation, he replaced it with \u0026ldquo;comparison,\u0026rdquo; as people tend to accept the latter term more easily. He further observed that excess comparison causes mild or severe discomfort because of the need to be appreciated (Navia, 2008, 2012), leading to additional significant developments.\u003c/p\u003e\n\u003cp\u003eAfter nearly four decades of clinical work, the first author thus developed a method to regulate emotions by reducing comparison through integrating the following systems: emotion, energy, objects, supporting words (Navia, 1996, 2001, 2003, 2008, 2012), and the core of emotion. If we can understand these mechanisms in this context, we may be able to regulate our emotional state and therefore our thinking, psychophysiological states, and actions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to TET, an object is everything that a person can perceive or sense inside or outside of their environment through their senses. Freud (1914-1916) considered the object an entity through which instincts can achieve their purpose. In TET, comparisons between internal and external objects help regulate emotions or allow for a greater sense of purpose of life; Freudian theory, however, does not mention internal objects or their comparison with external objects. Because the objects in the emotional system serve to reduce negative emotions, more positive emotions become available and these help initiate a greater sense of one\u0026rsquo;s meaning of life through the comparison of internal and external objects.\u003c/p\u003e\n\u003cp\u003eAdditionally, emotional energy works differently than physical energy. Zajonc et al. (1989) suggest that negative emotions necessitate an instrumental response after producing stimulation, whereas no instrumental response is required following a positive emotion. Navia (2008, 2012) believes that this negative emotional energy is instrumental and can be regulated. This makes the organism work in an autonomous manner because it is motivational energy that can be regulated by reducing comparison between objects (Navia, 1996, 2001, 2003, 2008, 2012).\u003c/p\u003e\n\u003cp\u003eSince Freud\u0026rsquo;s theory of instincts, Greenspan et al. (1990) conclude that \u0026ldquo;by postulating psychic energy that could be transformed into drives and become attached to wishes and ideas, he advanced relationship between physiologic and psychological phenomena\u0026rdquo; (p. 44). Psychoanalysis also introduces the terms \u0026ldquo;pleasurable\u0026rdquo; and \u0026ldquo;unpleasurable,\u0026rdquo; the former corresponding to positive affect and the latter to negative affect (Nathanson, 1990). Freud (1925-1926) believed that psychic energy is born from instinct and that we must try to reduce this energy to achieve pleasure. In TET, this is accomplished by reducing negative emotional energy to attain positive emotional energy; this is represented as psychic energy in Freud\u0026rsquo;s theory.\u003c/p\u003e\n\u003cp\u003eThe author, in his theory, speculates that people initially inherit the ability to form internal objects to support basic life functions. They subsequently develop the ability to form external objects as the interactions between both these objects grow. The human world comprises objects, which in turn make up our psychic life or emotion system: \u0026ldquo;Object relations theory suggests that it is the experience of relationships with external others that forms the structural constituents of the psyche\u0026rdquo; (Piper, 1999, p. 671). Camic et al. (2011) suggest that objects are part of humans from their birth.\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eInternal\u0026nbsp;\u003c/em\u003e\u003cem\u003eSelf-Objects\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eIn TET, objects are fundamental and self-objects can be formed or reached for by feeling our whole body in time and space; however, this is not akin to imagining oneself outside. Gunter (1999) thought it unfortunate that we do not realize the importance of the image of our body in therapy, despite many theoretical bases for it. When we feel our body, we connect with the internal world and can regulate our self-survival emotion with the help of supporting words (Navia, 1996, 2001, 2003, 2008, 2012). Gunter (1996) states that \u0026ldquo;the representation of the own body image is an attempt to overcome the problem of mediating inner and outer realities\u0026mdash;the basis of any human cultural activity\u0026mdash;at a key point of focus for the individual\u0026rdquo; (p. 170). The body is where both the mind and the body are located, and it is not just the mind that thinks but also the entire body, creating a unique environment within each person (Spurio, 2015, 2016).\u003c/p\u003e\n\u003cp\u003eInternal self-objects are inherited objects and the self-object region attaches to itself any objects that threaten life (e.g., a dangerous animal or event) or those needed for survival (e.g., food and water). All these objects, which are related to self-survival, form the non-intellectual region (Navia, 2008, 2012). External objects serve as the basis for internal self-objects to develop and when these objects are linked to the self-object region, they become part of this region. For example, when a child is very young, they are not aware that a tiger is dangerous; it takes them time to learn that a tiger is dangerous by linking it to the self-object.\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eInternal Social Objects\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eInternal social objects comprise all the people we have or had a relationship with; they may be connected to self-objects because to regulate social emotion we need self-objects (Navia, 2008, 2012), and the \u0026ldquo;constitution of the subject is intimately associated with the experience of the own body self, with the inner images man has of his own body and with the external images that others have of him\u0026rdquo; (Gunter, 1996, p. 163). To contact the internal social object, we need to feel our whole body (self-object) and imagine the external social object at the same time. The internal social object is implicit. Social objects constitute only those individuals ascribed to the internal social object region, which, at the beginning of an individual\u0026rsquo;s life, holds no meaning for them. These internal objects are added to the region and developed with external objects through continued interaction and genetic predisposition. All these factors help shape the social or semi-intellectual region\u0026nbsp;(Navia, 1996, 2003, 2008, 2012).\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eInternal Intellectual Objects\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eInternal intellectual objects have received scant attention by the author because the outer region does not seem to affect us psychologically in a significant manner\u0026mdash;it may follow the same logic of the other regions. Intellectual objects can be any objects without social or self-survival implications. They are real or imaginary objects that hold no meaning for an individual at the beginning of their life until they are linked to the intellectual region. No attempt is usually made to regulate the emotions of these regions because they do not appear to have any direct \u0026ldquo;pathological\u0026rdquo; effect. This type of intellectual object usually has a mild effect or none at all because intellectual objects do not directly connect with human objects otherwise social emotion would ensue.\u003c/p\u003e\n\u003ch2\u003eSocial Comparison and Therapy\u003c/h2\u003e\n\u003cp\u003eHumans feel the need to compare themselves with others to understand who they are as well as compare one object with another to obtain information and make decisions about it. Navia (2008, 2012) and Waltr\u0026egrave; (2023) posit that comparison is the most important quality of humans because people tend to attempt to do as well or better than others; for this reason, most people feel sadness (negative emotion) or joy (positive emotion). Moreover, excessive social comparison has negative consequences (Buengeler et al., 2021; Buunk \u0026amp; Gibbons, 2006; Campbell et al., 2017; Chen et al., 2018; Gilbert et al., 1995; Koopman et al., 2020; Latif et al., 2020).\u003c/p\u003e\n\u003cp\u003eSocial comparison can play a significant role in therapy. Civitci and Civitci (2015) suggest that social comparison causes negative or positive discomfort depending on the patient\u0026rsquo;s condition, which can affect their state of mind. Such comparisons provoke satisfactory or dissatisfactory emotions according to the situation, which in turn may affect people\u0026rsquo;s judgments about their life satisfaction. Studies indicate that people who have high tendencies toward social comparison have increased anxiety, depression, negative effects, and neuroticism (Gibbons \u0026amp; Buunk, 1999). Further, social comparison increases when novelty, stress, and changes appear (Buunk et al., 2007; Gibbons \u0026amp; Buunk, 1999; Schneider \u0026amp; Schupp, 2014; Warren \u0026amp; Rios, 2013). It is therefore important to understand that excess social comparison can cause psychological problems and recognize the need to regulate it.\u003c/p\u003e\n\u003cp\u003eAccording to Park and Baek (2018), comparing oneself with a superior or an inferior other can generate negative or positive emotions. Most people who seek psychological help suffer from upward comparison, or the excessive comparison of oneself with a superior other. Further, they compare themselves with the people closest to them such as family members, friends, colleagues, and fellow students. In therapy, they are the most relevant objects, as they feel lacking in being sufficiently loved, appreciated, respected, or valued. People are not usually aware of this process because it is mostly unconscious. Further, as we do not have the means to regulate these emotions, such excessive comparison can make us feel worthless or less than others, causing anxiety, depression, and fear in addition to creating different types of disorders.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupporting Words in TET\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTET focuses on three regions: non-intellectual, semi-intellectual or social, and intellectual. We use supporting words for two of these regions: social and self-survival (Navia, 2008, 2012). Supporting words are words or phrases that are only understandable within the logic of TET; if we understand people, they will more easily understand us. If they do not understand us, it could be either because the person has a serious problem or because they have misunderstood us (a person who feels well considers the other person). When there is a lack of understanding, we can use TET to explain the situation. The\u0026nbsp;main reason for this lack of understanding is usually the individual not feeling appreciated, valued, respected, or loved. It is often difficult to understand this logic because we are not aware; we see things only from a cognitive point of view.\u003c/p\u003e\n\u003cp\u003eSocial emotions belong to the semi-intellectual region in which cognition does not play a relevant role. Hence, supporting words are difficult to form because they need to be comprehensible. We cannot completely separate the cognitive region from the emotion region, which consequently interferes with our use of supporting words even more. If we are highly cognitive, we have lost touch with our emotions. As a result, we need to avoid them the best we can. For supporting words, we try not to use positive thinking or reasoning or use phrases such as \u0026ldquo;I must\u0026rdquo; or \u0026ldquo;I accept.\u0026rdquo; Understanding does not mean accepting; for example, if someone says that I am stupid, I do not need to accept it, but I can understand that they do not feel well or that I may have offended them.\u003c/p\u003e\n\u003cp\u003eSocial-emotional problems can be solved through comprehension because understanding seems to be the only language that emotions can comprehend. However, to have a therapeutic effect, comprehension or supporting words must be integrated with TET. If we do not use social objects, self-objects, and supporting words simultaneously to regulate social emotions, the desired effect will not arise. Further, for the self-survival emotion, we need only self-objects and supporting words.\u003c/p\u003e\n\u003cp\u003eSupporting words must be realistic to the situation and appear credible to the person using them. That person must also feel comfortable using them. Additionally, supporting words must be as understandable as possible for the individual to avoid putting pressure on the emotion region. For example, rather than saying, \u0026ldquo;I do not need to be afraid of an earthquake,\u0026rdquo; it is better to say, \u0026ldquo;It does not help to be afraid.\u0026rdquo; Instead of saying, \u0026ldquo;I am a bad person,\u0026rdquo; it is better to say, \u0026ldquo;I am human and I can make mistakes.\u0026rdquo; With this technique, supporting words begin to form part of our life and\u0026nbsp;have a cumulative effect because they help us develop as individuals.\u003c/p\u003e\n\u003cp\u003eAccording to TET, being understandable must go beyond the common definition of understanding. People sometimes have difficulty understanding what really needs to be comprehended because we are highly cognitive to the point that some people are afraid to comprehend themselves and others because they feel they can be used by others. After all, a \u0026ldquo;normal\u0026rdquo; person cannot resist being understood.\u003c/p\u003e\n\u003cp\u003eSupporting words must initially be created with a therapist who can teach the TET logic. They can be used to guide a person through the social region, self-survival, and core of emotion. It takes a few sessions to grasp the idea or logic of supporting words or therapy because it takes time to learn to minimize cognition, reasoning, or positive thinking. A person can continue trying to tailor the words to their needs following the TET logic and using those they deem most helpful. However, creating multiple supporting words could be challenging because few are available; they are from the semi-intellectual region, not from the intellectual region. These words must be understood and reinforced in practice with the therapist; otherwise, they could be misunderstood.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eIllustration of Supporting Words for Self-Survival\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThe self-survival technique is used when we feel our life is in danger or when we experience a fear of dying (e.g., fear of contagion from COVID-19, during a panic attack, or during a natural disaster such as an earthquake). We use previous objects for self-survival; for example, in the case of an earthquake, we may imagine a building falling down, whereas for a panic attack, it may be dying of a heart attack. For this region, we just need the self-object (feeling ourself) and supporting words. External objects are not necessary because self-survival objects do not have any social responsibility.\u003c/p\u003e\n\u003cp\u003eSome examples of supporting words for self-survival include: worry does not help me; thinking too much about what is going to happen will not help me; if I am anxious, I cannot help myself or my loved ones; thinking that I am going to become infected just makes me feel anxious and reduces my defenses; in the same manner, it will not help to worry that I am going to die; anxiety will reduce my defenses; and this anxiety and fear do not help me or my family. In practice, the logic of supporting words and therapy takes on a dynamic tone, with room for improved understanding.\u0026nbsp;We must remember to include self-object in this case, for a good result.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIllustration of Supporting Words for Social Techniques\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSocial supporting words are used for any problem not related to self-survival situations such as depression, anxiety, and other disorders. These disorders are usually caused by comparison, and some of the following supporting words can be used depending on the situation and tailored to accommodate individual differences: worrying what my friend thinks about me does not help me; if people feel good, they do not think badly about others; worry just consumes my energy and does not help at all; nobody is perfect and we are human; I am human and I can make mistakes; worrying that I am bad person does not help; ruminating that I am bad or have been bad to others does not help me\u0026mdash;it only depresses me; feeling guilty does not help me, it just wears me out; if I understand others, they will understand me; when people feel bad, they say nasty things because they do not feel loved, appreciated, valued, and respected; and if I feel better, I can find more viable solutions and help others. However, it is easy for people to confuse supporting words with cognitive phrases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCore of Social Emotion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Touch has a profound effect on the development of humans. Touch in childhood is the basis for the development of the core of emotion and, subsequently, the expansion of social emotions. Evolution and genetic predisposition guide the formation and development of the core of emotion when a child is touched, and with the help of social relation, they feel loved, appreciated, respected, and valued and can develop social and cognitive skills.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTouch seems to be part of the development of emotions. According to Morrison (2016), infants can regulate emotions and stress through touch. Likewise, Krahe et al. (2024) consider our sense of touch \u0026ldquo;integral for exploring and communicating with the world around us,\u0026rdquo; adding that \u0026ldquo;touch is a key channel for conveying meaning in social interactions\u0026rdquo; (p. 1). These concepts seem to constitute the core of emotion and may be most significant for our social emotions. Being loved, appreciated, respected, and valued appears to be the core of social emotion. Babies are desperate for people, first for protection and then for wanting to be loved, appreciated, respected, and valued. However, these terms are the basis for the comparisons we make between individuals, of which we remain unaware. All social emotions are born from\u0026nbsp;comparisons that were made from the core of emotions; naturally, however, there can be other secondary terms as well. When people internalize this, it becomes easy for them to resolve their problems because they realize that we are all the same at an emotional level.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSupporting Words of the Core of Emotion\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe can form more effective supporting words by using core terms; however, they need to be connected to the rest of the comparison (see the TET technique). In TET, social emotion seems to begin in the core of emotion but is more difficult to identify because it needs to overcome the cognitive region and comparison to get to the core emotion. These terms may develop through evolution and help keep us united when we feel loved, appreciated, respected, and valued and disunited when we feel otherwise. When taken to the extreme, this may cause people to kill each other, such as during war.\u003c/p\u003e\n\u003cp\u003eWhen people try solving conflicts using the core of emotion, it opens up countless solutions. One of the author\u0026rsquo;s clients once stated, \u0026ldquo;When a client used to get angry at her partner before, he would tell her I\u0026rsquo;m leaving the family, but after learning the technique [TET], he can\u0026rsquo;t even think about leaving his children.\u0026rdquo; Other clients mentioned that material things did not have the same meaning for them as before.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eIllustration of Supporting Words for the Core of Emotion\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe cannot expect everyone to love, appreciate, respect, and value us. It is important to understand that not everyone has to understand us because people do not always feel loved, appreciated, respected, and valued. When we do not feel this way, the other person may also feel the same and act in a similar fashion. We cannot expect others to love, appreciate, respect, and value us in the same way we do because our points of view may differ. In conclusion, people act according to how loved, appreciated, respected, and valued they feel.\u003c/p\u003e\n\u003cp\u003eWhen people understand that we react negatively because we do not feel loved, appreciated, respected, and valued, it is easier for them to solve their problems because they realize they are not inferior to others. Supporting words, however, are not numerous. All these ideas have to be accommodated. If we know someone cares for us deeply, such as in the case of a family member, we should consider that it might just be a misunderstanding, especially if it is not the first time. Otherwise, we risk wasting time on unnecessary conflict. As this happens simultaneously with the social object and self-object, it must be integrated with the help of a therapist in a dynamic manner.\u003c/p\u003e"},{"header":"Discussion: General Guidelines for Therapy","content":"\u003cp\u003eDuring the first session of TET, the first 5 minutes can be used to explain the logic of the therapy and how it can be effectively used to treat depression and anxiety. Subsequently, a regular interview is conducted, followed by additional explanations about the logic of the therapy to help the client process the information and understand the technique. In the next session, it becomes necessary to balance what they want to express and further explain how to use and fully absorb the logic of TET. If the person experiences problems concentrating on the therapy\u0026rsquo;s logic and instead wishes to express themselves, they must be allowed to do so. The therapist should then look for a gentler way to lead them back to the therapy logic when appropriate. Usually, a therapist will encounter two types of clients: those who concentrate on the logic and those who like to explain the problem; the latter are more cognitive but ultimately understand that problems can be solved by applying the TET logic.\u003c/p\u003e\n\u003cp\u003eFirst, it is important to understand the person\u0026rsquo;s situation and then look for objects; the person in treatment is advised to start practicing the technique as soon as possible. Usually, most people have a fair understanding of the technique and the TET logic by about the third session. Major reasons for not progressing in treatment include not using both objects in a social situation, not using the correct supporting words, using incorrect objects, or failing to identify the correct object. Objects have different relevance depending on the situation; however, ultimately it is the person in treatment who will be able to identify the object most relevant to them because they can pinpoint which object reduces their discomfort the most. \u0026nbsp;Nonetheless, individuals often need guidance during the early stages of applying the technique.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;In the subsequent sessions, when the person in treatment has explained their situation, they can be asked to identify the object or objects that are affecting them in that particular situation. However, the person at first may be unable to identify the object(s) easily. The therapist can then point out some objects that may help narrow the search. The person can be asked to use supporting words for the situation, which may be difficult at the beginning. In this way, the therapist continually evaluates the patient\u0026rsquo;s understanding of the therapy. At the same time, they can reinforce the person\u0026rsquo;s knowledge by explaining the situation and providing more insights through objects and supporting words. The therapy is a dynamic process and the method is introduced according to the capacity of the person being treated to absorb information. The person gradually improves the technique, recognizes the different situations and objects that cause the \u0026ldquo;pathological\u0026rdquo; state, and learns to use supporting words while continuing to improve their understanding of the logic of the technique.\u003c/p\u003e\n\u003cp\u003eIt is necessary to explain to individuals how to feel their body (self-objects) and how to imagine the object of conflict. This may come naturally to some, while others may take time to grasp these concepts. Although simple, these concepts are usually new to the person and hence they need reaffirmation. It is important to continually mention that the individual needs to use both objects with the social technique and that supporting words need to be used according to the logic; further, patients in treatment must be careful to avoid using cognitive thinking as much as possible in the technique and to use only one object at a time when the technique is used. If the person only uses supporting words, they will remain confined to the external level and fail to reach the core of the self-object or social object. The objects that affect us the most are the people who are close, relevant, or important to us. For better results, after a person has learned the technique, they need to use the method, especially at the beginning, in most or all situations to maintain a low level of negative energy. In this way, the person can continue to develop psychologically.\u003c/p\u003e\n\u003cp\u003eAccording to Navia (2008, 2012), social emotions react in a hierarchical manner. During decades of clinical observations, the author notes that anxiety is based on shame and that depression is based on guilt. All the basic emotions in TET work in a hierarchical manner, otherwise they are not considered basic emotions, even though many of the known basic emotions form a hierarchy.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003e\u003cstrong\u003eData Collection and Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data for this study were collected from September 14, 2023 (pre-test) to February 23, 2024 (post-test). Participants were recruited through social media. Of the 24 participants who were given individual appointments, five were unable to participate for the following reasons: two participants did not suffer from either depression or anxiety, two participants could not participate due to conflicting work schedules, and one participant finished the treatment but could not be reached to complete the inventories and questionnaire; however, clinical observation showed that they had made significant improvement. Hence, 19 people participated in this study (11 in the experimental group and eight in the control group). The participants were asked if they would like to join the control group; the eight who agreed were assigned to the control group. The participants\u0026rsquo; ages ranged from 21 to 74 years in the control group and from 20 to 60 years in the experimental group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipant\u003c/strong\u003e\u003cstrong\u003es\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the participants were Ecuadorian. In the experimental group, there were nine women and two men (age: 19\u0026ndash;50 years), of which five had a job, four were university students, and two did not work. In the control group, all eight participants were women (age: 21\u0026ndash;75 years), of which six participants worked, one was a university student, and one did not work. Four were university graduates, three completed secondary education, and one completed primary school education.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeasurements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAnxiety\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe participants completed the Beck Anxiety Inventory, a self-report questionnaire that includes 21 questions, with each item scored from 0 to 3 points (total score range: 0 to 63). Higher total scores indicate more severe anxiety symptoms. The cut-off points were as follows: 0\u0026ndash;21: very low anxiety; 22\u0026ndash;35: moderate anxiety; and over 36: severe anxiety.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDepression\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe participants also completed the Beck Depression Inventory-II, a self-report questionnaire that includes 21 questions, with each item scored from 0 to 3 points (total score range: 0 to 63). Higher total scores indicate more severe depressive symptoms. The cut-off points were as follows: 0\u0026ndash;13: minimal depression, 14\u0026ndash;19: mild depression, 20\u0026ndash;28: moderate depression; and 63: severe depression.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTET Questionnaire\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFinally, the participants completed a questionnaire, which was developed by the first author and checked by two psychologists, evaluating the effectiveness of TET. The questions aimed to understand how easy it was to learn the technique and how much it helped regulate depression and anxiety. The 11 questions were answered on a six-point Likert scale. For the questions, see Figure 1. Both the inventories and questionnaire were administered by the second author, who is a psychology, and were presented in Spanish.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProcedure\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants were initially interviewed to evaluate if they had depression or anxiety or both. Those diagnosed with either or both were assigned to the experimental group and asked to complete the Beck inventories and TET questionnaire before entering therapy. The participants in the control group was given individual appointments for the application of the pre-test and their follow-up appointment was scheduled for three and a half months later. They were offered the treatment after the investigation had finished. TET was provided by the first author using the theoretical bases discussed in this article. Sessions were first held at the Technical University of Manabi\u003cem\u003e\u0026nbsp;\u003c/em\u003eand later transferred to a private office when the university closed for vacation. Weekly sessions of TET were conducted, with an average of 10 to 12 one-hour sessions a week.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA mixed factorial experimental design was used to evaluate the effects of the treatment on anxiety and depression levels at two time points: pre-test and post-test. Two treatments were compared: control and experimental. The participants\u0026rsquo; depression and anxiety scores were categorized into four ordinal levels: \u0026ldquo;minimal,\u0026rdquo; \u0026ldquo;mild,\u0026rdquo; \u0026ldquo;moderate,\u0026rdquo; and \u0026ldquo;severe.\u0026rdquo; Mean values were calculated for the responses to the TET questionnaire.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis Software\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe analysis was performed in R (v4.3) using the \u003cem\u003eordinal\u003c/em\u003e package for the ordinal mixed model, \u003cem\u003eemmeans\u003c/em\u003e for the post-hoc comparisons, \u003cem\u003eMuMIn\u003c/em\u003e for the model fit indices, and \u003cem\u003eggplot2\u003c/em\u003e for the graphical visualization of the results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cumulative link mixed model (CLMM) was applied to examine the effects of the treatment, the evaluation time point (pre-test and post-test), and their interaction on participants\u0026apos; depression and anxiety levels. Fixed effects were used to assess the influence of treatment and time point on the outcome variables. Random effects accounted for inter-individual variability by modeling participant-specific differences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the local research ethics committee of the Technical University of Manabi\u003cem\u003e\u0026nbsp;\u003c/em\u003e(CEISH-UTM-INT_23-5-4_IRNR). Written informed consent was obtained from all the participants, as they signed the informed consent form provided by the ethics committee.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAll the participants reported some level of anxiety and depression, with one diagnosis being more prominent than the others.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnxiety Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMixed Ordinal Model\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results from the mixed ordinal model revealed a significant difference between the experimental and control groups (p = 0.0394). while the main effect of the evaluation time point was not significant (\u003cem\u003ep\u003c/em\u003e = 0.2369). However, the interaction between the treatment and time point was highly significant (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001), suggesting that the impact of the treatment differed substantially between the pre-test and post-test.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePost-Hoc Comparisons of Anxiety Levels\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTukey\u0026rsquo;s post-hoc comparisons were performed to evaluate differences between treatment and timing combinations of anxiety. The analysis showed that the experimental group experienced a statistically significant reduction in anxiety levels from pre- to post-test (p \u0026lt; 0.001), while the control group showed no significant change across timepoints. Furthermore, the experimental group\u0026apos;s post-test anxiety scores were significantly lower than those of the control group, reinforcing the potential treatment effect of TET (see Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTukey\u0026rsquo;s Post-Hoc Comparisons for Anxiety Levels\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"643\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 293px;\"\u003e\n \u003cp\u003eComparison\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003eEstimation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003eStandard error\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cem\u003ez\u003c/em\u003e value\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 293px;\"\u003e\n \u003cp\u003eControl Pre-test vs. Experimental Pre-test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-408\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e-2060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e.1663\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 293px;\"\u003e\n \u003cp\u003eControl Pre-test vs. Control Post-test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e233\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e1183\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e.6378\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 293px;\"\u003e\n \u003cp\u003eControl Pre-test vs. Experimental Post-test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e3342\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e237\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e14123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026lt;.0001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 293px;\"\u003e\n \u003cp\u003eExperimental Pre-test vs. Experimental Post-test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e3751\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e230\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e16277\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026lt;.0001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 293px;\"\u003e\n \u003cp\u003eControl Post-test vs. Experimental Post-test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e3110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e233\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e13347\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026lt;.0001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNote. ***p \u0026lt; .001.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDepression Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMixed Ordinal Model\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe analysis of depression scores indicated a statistically significant interaction between treatment group and evaluation timepoint (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001), suggesting that the effect of the intervention was dependent on when it was measured\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePost-Hoc Comparisons of Depression Levels\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTukey\u0026rsquo;s post-hoc comparisons were performed to evaluate differences between treatment and timing combinations of depression. The comparisons confirmed a significant decrease in depression levels in the experimental group from pre- to post-test (p \u0026lt; 0.001). Additionally, the experimental group\u0026rsquo;s post-test depression scores were significantly lower than those of the control group at both pre- and post-test timepoints (p \u0026lt; 0.001). No significant changes were observed in the control group, indicating that depression symptoms remained stable in the absence of intervention (see Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTukey\u0026rsquo;s Post-Hoc Comparisons for Depression Levels\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"643\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 293px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComparison\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEstimation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStandard error\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ez\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eControl Pre-test - Experimental Pre-test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e6,6477\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e4,6097\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e-1,408\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0.159\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 293px;\"\u003e\n \u003cp\u003eControl Pre-test vs. Control Post-test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e539\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e.9494\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 293px;\"\u003e\n \u003cp\u003eControl Pre-test vs. Experimental Post-test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e3179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e13926\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026lt;.0001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 293px;\"\u003e\n \u003cp\u003eExperimental Pre-test vs. Experimental Post-test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e2527\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e12325\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026lt;.0001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 293px;\"\u003e\n \u003cp\u003eControl Post-test vs. Experimental Post-test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e3072\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e13470\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026lt;.0001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote. ***p \u0026lt; .001.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults of the TET Questionnaire\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipant feedback on the TET intervention was collected using a post-intervention questionnaire comprising six core items. As shown in Table 3, the majority of participants rated the technique favorably, particularly in terms of ease of learning, overall effectiveness, and alignment with the underlying hypothesis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eParticipant Ratings of TET Questionnaire Items Post-Intervention (N = 11).\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eScore 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eScore 9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eScore 8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eScore 6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eScore 4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eP1: Regulating Anxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e63.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e18.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e9.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e9.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eP2: Regulating Depression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e54.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e27.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e9.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e9.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eP3: Overall Effectiveness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e72.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e18.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e9.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eP4: Ease of Learning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e72.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e9.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e9.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e9.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eP5: Mastery of Technique\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e27.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e45.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e27.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eP6: Agreement with Hypothesis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e81.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e18.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u0026nbsp;Note. Responses were scored on an 11-point Likert scale ranging from 0 (not at all) to 10 (completely). Percentages reflect the proportion of participants who selected each score for the respective item.\u003c/p\u003e\n\u003cp\u003eThe results from Table 3 suggest that participants perceived TET as both helpful and accessible, and they showed strong agreement with its central theoretical concepts. However, it is important to interpret these self-report data cautiously and consider them as indicative of subjective satisfaction rather than objective clinical outcomes.\u003c/p\u003e\n\u003cp\u003eFigure 1 displays the mean scores and 95% confidence intervals for each item, offering a visual summary of participant responses. The highest average rating was for agreement with the hypothesis of the core of emotion (M = 9.81), followed by overall effectiveness (M = 9.45), and ease of learning (M = 9.36). These findings suggest that participants not only found the technique helpful but also understood and accepted its theoretical foundations.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study provides preliminary evidence that TET may have a positive effect on depression and anxiety. After completing the treatment, the experimental group showed greater improvement than the control group, although the lack of randomization limits the strength of this comparison Additionally, the experimental group reported lower depression and anxiety levels in the post-test than in the pre-test.\u003c/p\u003e\u003cp\u003eRegarding the TET questionnaire, participants responded very positively to all items, including: how much TET helped them regulate anxiety and depression, how easy the technique was to use, how helpful the technique was overall, and how strongly they agreed with the idea that all social emotions stem from a core emotion. The mean scores for these items ranged from 8.9 to 9.8 out of 10, indicating a high level of perceived effectiveness and agreement. These results suggest that TET may be effective in reducing symptoms of depression and anxiety, warranting further investigation.\u003c/p\u003e\u003cp\u003eInterestingly, participants strongly endorsed the concept of the core of emotions, though further empirical testing is needed to evaluate the hypothesis. TET introduces several novel concepts, such as supporting words and emotional objects, which merit further exploration (Navia, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2003\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2008\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). In this region, cognition does not play a relevant role because comprehension does not have too many cognitive elements. If there were, we would be unable to separate these regions. Cognition is avoided only during the development of supporting words and this logical process needs to be learnt. Naturally, the problems need to be understood at the cognitive level first.\u003c/p\u003e\u003cp\u003eAnother development of TET is the objects that can either be internal or external and categorized as self-objects, social objects, and intellectual objects. With these objects, we can regulate emotions. It is by comparing internal and external objects that emotional energy is regulated and all emotions function in a hierarchical manner, which helps us understand them better (Navia, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2003\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2008\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). All these TET concepts are understood from a theoretical point of view and are used according to the relevant TET logic.\u003c/p\u003e\u003cp\u003eIt is essential to find new therapies and techniques for treating depression and anxiety to keep pace with the technological advances of this century. TET\u0026rsquo;s novel framework may have implications for future developments in areas such as artificial emotions, although this remains to be explored (Navia, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2012\u003c/span\u003e), especially so with the hypothesis of the core of emotion making it even more feasible. Additionally, it offers a promising alternative for addressing psychological difficulties and may contribute to a deeper understanding of emotional dynamics in broader social or global contexts. Further investigation is warranted to evaluate its potential more comprehensively.\u003c/p\u003e\u003cp\u003eHowever, despite its strengths, this study has several limitations. First, we did not compare TET with another therapy; second, the control group was not randomized; third, the study sample could have been larger; and finally, although TET is very easy to learn, as reported by the participants, it requires training and practice because it uses new logic. Further research may help establish this new TET logic. Developing TET will also contribute to other areas of science because the core of social emotions affects all areas of our lives such as cognitive, social, and decision-making.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eEthical Approval\u003c/h2\u003e\u003cp\u003e This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee by the local research ethics committee of the Manab\u0026iacute; Technical University (CEISH-UTM-INT_23-5-4_IRNR).\u003c/p\u003e\u003c/p\u003e\u003ch2\u003efunding\u003c/h2\u003e\u003cp\u003eThe authors did not receive support from any organization for the submitted work\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eRafael Navia: Conceptualization, Methodology, Investigation, Formal analysis, Resources, Data curation, Writing \u0026ndash; Original Draft, Writing \u0026ndash; Review \u0026amp; Editing.Guadalupe Bravo: some Project administration\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe raw data supporting the findings of this study have been deposited in Zenodo and are publicly available at: https://zenodo.org/records/15708371\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBornhoff, A., Davis, E. B., Yousey, J., Kimball, C. 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The new functional identity: a body that thinks, a mind that feels - Frontiers and unexplored territories of the \u0026quot;Body and Mind zone\u0026quot;. \u003cem\u003ePsychiatria Danubina\u003c/em\u003e, 28(Suppl-1), 111\u0026ndash;115.\u003c/li\u003e\n\u003cli\u003eSpurio M.G: (2015). Words that Heal. \u003cem\u003ePsychiatr Danub,\u003c/em\u003e 7(Suppl 1), 21-7.\u003c/li\u003e\n\u003cli\u003eWaltr\u0026eacute;, E., Dietz, B., \u0026amp; van Knippenberg, D. (2023). Leadership shaping social comparison to improve performance: A field experiment. \u003cem\u003eThe Leadership Quarterly\u003c/em\u003e, 34(5), 101720\u003c/li\u003e\n\u003cli\u003eWarren, C. S., \u0026amp; Rios, R. M. (2013). The relationships among acculturation, acculturative stress, endorsement of Western media, social comparison, and body image in Hispanic male college students. \u003cem\u003ePsychology of Men \u0026amp; Masculinity\u003c/em\u003e, 14(2), 192\u0026ndash;201. https://doi.org/10.1037/a0028505 \u003c/li\u003e\n\u003cli\u003eZajonc, R. B., Murphy, S. T., \u0026amp; Inglehart, M. (1989). Feeling and facial efference: implications of the vascular theory of emotion. \u003cem\u003ePsychological review\u003c/em\u003e, 96(3), 395. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Tion-Emo, new therapy, social objects, supporting words, self-object","lastPublishedDoi":"10.21203/rs.3.rs-6891362/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6891362/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis study aimed to determine the effectiveness of Tion-Emo therapy and technique (TET) in treating depression and anxiety. Some relevant factors such as social comparison, objects, and the emotional system have received little scholarly attention because of the lack of suitable methods to optimize their functionality in therapy. Comparisons are considered important in the emotional, social, and cognitive life of an individual but how to regulate them remains unclear. Further, numerous researchers suggest the importance of objects in our lives but this is rarely considered in therapy. Similarly, the emotional system needs its own logic. TET tries to answer these questions. To assess its effectiveness, this study used a quasi-experimental research design of a pre-post nature with control and experimental groups. Nineteen participants were assigned to these groups and asked to complete the Beck Anxiety Inventory and Beck Depression Inventory-II. The experimental group, who received TET, answered an additional questionnaire evaluating the effectiveness of TET. The experimental group had significantly lower anxiety and depression scores than the control group. Further, the experimental group\u0026rsquo;s post-test scores for both anxiety and depression were significantly lower than their pre-test scores. In the questionnaire evaluating the effectiveness of TET, the participants had a mean score of 9.8 out of 10 for the question on the existence of core emotions. The mean scores of anxiety and depression were 9.2 and 9, respectively. These results demonstrate the potential of TET as a promising treatment for depression and anxiety that could benefit millions of people worldwide.\u003c/p\u003e","manuscriptTitle":"Assessing the Effectiveness of Tion-Emo Therapy and Technique as a New Treatment Option for Depression and Anxiety","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-09 10:04:01","doi":"10.21203/rs.3.rs-6891362/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bf5500b0-d68e-4d00-ba44-0ad8c6e0df3c","owner":[],"postedDate":"October 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":55950725,"name":"Biological sciences/Psychology"},{"id":55950726,"name":"Health sciences/Health care"}],"tags":[],"updatedAt":"2026-01-29T05:39:58+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-09 10:04:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6891362","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6891362","identity":"rs-6891362","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}