The purpose of this randomized controlled clinical trial is to evaluate the effectiveness of an Acceptance and Commitment Therapy (ACT)-oriented psychoeducation program based on the Tidal Model in patients diagnosed with depression who are receiving transcranial magnetic stimulation (TMS) treatment at a university hospital psychiatry clinic.

The primary objective of this study is to determine whether participation in the psychoeducation program improves meaning in life and conscious self-care compared to usual treatment alone. The main questions this study aims to answer are:

• Does the ACT-oriented psychoeducation program increase participants' level of meaning in life?
• Does the program improve conscious self-care behaviors in individuals with depression?

Participants will be randomly assigned to either an intervention group or a control group. The intervention group will receive an 8-week structured psychoeducation program in addition to standard TMS treatment. The control group will continue to receive standard treatment without additional psychoeducation.

Participants in the intervention group will attend weekly psychoeducation sessions focusing on psychological flexibility, values clarification, coping strategies, and self-care practices. Outcome measures will be collected at baseline, immediately after the intervention, and one month after completion of the program.

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

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

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

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

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

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

Inclusion Criteria:

Age between 18 and 65 years

Receiving treatment for depression for at least 6 months

Within the 6-month period following TMS treatment

Able to communicate in Turkish without difficulty

No hearing problems, cognitive impairments, or additional psychiatric disorders

Willing to participate and has provided written informed consent

Exclusion Criteria:

Participant withdraws voluntarily from the study

Relapse of depression during the study period requiring psychiatric hospitalization

• Sİtuation in which participants do not attend two consecutive sessions

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

Individual patient data will not be shared to protect participant privacy and confidentiality. Only aggregated, anonymized results will be published.