Emotion regulation and self blame as mediators and moderators of trauma-specific treatment.

Abstract

Objective: Efficacy of trauma-specific cognitive–behavioral therapies (Trauma-Focused CBT; Alternatives for Families CBT) in treating sequelae (posttraumatic stress disorder, PTSD; depression; conduct problems) for affected youth and families is established. Despite the emphasis on emotional and cognitive processes in explanatory models of sequelae and the inclusion of components to address these impairments, this is the first study to examine how emotion dysregulation and attributions of blame mediate or moderate treatment changes. Method: About 118 youth with trauma histories, ages 4–17 years old, and caregivers who completed treatment were included in the analyses, providing self- and/or caregiver-reported assessments that yielded indices of trauma history, behavioral and emotional symptomatology, emotion dysregulation, and self-blame. Results: PTSD symptoms and conduct problems significantly decreased across treatment. Analyses provided support for emotion dysregulation as a moderator of the reduction of PTSD symptoms and conduct behavior problems across treatment. Self-blame was a partial mediator and a moderator of conduct problems. Conclusions: Baseline emotion dysregulation and self-blame influenced trajectories of treatment reductions of PTSD and/or conduct problems, extending emotion and cognitive theories of symptom development to explain treatment-related changes. Patterns of change suggest a framework for selecting components to match clinical presentations.

Emotion regulation difficulties in traumatized youth: a meta-analysis and conceptual review

“…In order to guide clinicians towards the best treatments for their patients, and to effectively help children and adolescents, randomized controlled trials that include emotion regulation as study outcome are needed. It should also be studied if difficulties in emotion regulation are a moderator of PTSD improvement, as high baseline levels of anger or emotion dysregulation did not seem to modify the efficacy of conventional PTSD trauma-exposure treatments for youth, but this has not been tested in controlled studies [74,75]. Improving the evidence in all the above mentioned aspects would definitely have an impact on improving the quality and effectiveness of the services provided in clinics for such vulnerable young traumatized survivors.…”

Contextual factors influence the selection of specific and broad types of emotion regulation strategies

“…The specific ER strategies in this study include ones that are used to regulate negative emotion (NE), a prime focus of much ER research (Gross, ). Particularly, expression suppression, rumination (Aldao et al ., ), blame (Sharma‐Patel & Brown, ), and denial (Boland & Cappeliez, ) are considered putatively maladaptive strategies that mediate NE and psychopathological distress. On the other hand, acceptance (Kotsou, Leys, & Fossion, ), benefit finding (Baker, Williams, Witvliet, & Hill, ), problem‐solving (Mori, Takano, & Tanno, ), and reappraisal (Gruber et al ., ) are putatively adaptive strategies that may attenuate the negative consequences of NE.…”

An Emotion Regulation and Impulse Control (ERIC) Intervention for Vulnerable Young People: A Multi-Sectoral Pilot Study

“…Studies with repeated measurement of emotion regulation throughout treatment will help understand this relationship and provide greater evidence for causation. Nonetheless, this finding is consistent with the growing body of literature proposing that emotion regulation is a mechanism of change in treatment for emotional and behavioral disorders (for a review, see Sloan et al, 2017 ), with recent studies demonstrating that a change in emotion regulation difficulties mediates improvements in cognitive and affective features of BPD and NSSI in young people (Bjureberg et al, 2017 ); aggression, anxiety, and depressive outcomes in children (Burke and Loeber, 2016 ); BPD symptoms and deliberate self-harm in adult women (Gratz et al, 2015 ); attachment and interpersonal problem in adult survivors of childhood maltreatment (Keating et al, 2018 ); and PTSD symptoms and conduct problems in children and adolescents (Sharma-Patel and Brown, 2016 ). Taken together, the findings from the present study and the current literature suggest emotion dysregulation is an important treatment target across the range of psychopathological symptomatology relevant to vulnerable young people.…”