Specifying the mechanisms and targets of emotion regulation: A translational framework from affective science to psychological treatment.

Southward, Matthew W.; Sauer‐Zavala, Shannon; Cheavens, Jennifer S.

doi:10.1037/cps0000003

Cited by 37 publications

(56 citation statements)

References 130 publications

(219 reference statements)

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“…Mindfulness and cognitive flexibility, as measured by the SMQ and the reappraisal subscale of the ERQ, might capture the overarching aim of the UP best with their focus on how individuals react to distressing thoughts and images (and by that probably also emotions). These findings also tap into the debate whether it is more beneficial to decrease maladaptive or increase adaptive emotion regulation strategies in treatment (e.g., Southward et al, 2021). In our study, the adaptive emotion Fig.…”

Section: Discussionsupporting

confidence: 64%

Transdiagnostic Processes as Mediators of Change in an Internet-Delivered Intervention Based on the Unified Protocol

Schaeuffele

Buengener

et al. 2021

Cogn Ther Res

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Background Transdiagnostic treatments target shared mechanisms between disorders to facilitate change across diagnoses. The Unified Protocol (UP) aims at changing dysfunctional reactions towards emotions by increasing mindful emotion awareness and cognitive flexibility, as well as decreasing anxiety sensitivity and emotion avoidance. Method We investigated whether these transdiagnostic processes were malleable by treatment and mediated the relationship between treatment and outcome in an internet-delivered adaptation of the UP. N = 129 participants with mixed anxiety, depressive, and somatic symptom disorders were randomized to treatment or waitlist. Results The treatment yielded significant changes in all transdiagnostic processes over time in comparison to a waitlist condition. In separate mediator models, significant mediating effects were found for mindfulness, cognitive flexibility, behavioral activation, and experiential avoidance. When all mediators were combined in a multiple mediator model, the indirect effects through mindfulness and cognitive flexibility emerged as significant. Conclusion These findings add to the growing body of research on transdiagnostic processes as mediators of change and emphasize mindfulness and cognitive flexibility as a transdiagnostic treatment target. However, these results should be interpreted cautiously, as temporal precedence could not be established.

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Section: Discussionsupporting

confidence: 64%

Transdiagnostic Processes as Mediators of Change in an Internet-Delivered Intervention Based on the Unified Protocol

Schaeuffele

Buengener

et al. 2021

Cogn Ther Res

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“…Suppression also more clearly distinguished profiles than reappraisal, the latter of which was highest in the class with the poorest outcomes. Results are consistent with findings that maladaptive ER strategies are more strongly related to psychopathology than adaptive ones, and changes in maladaptive strategies are more closely related to treatment outcomes (Southward et al, 2021). Focusing on mindfulness and acceptance-based treatment strategies for reducing suppression may have more potential to improve outcomes than traditional CBT strategies focused on increasing reappraisal.…”

Section: Discussionsupporting

confidence: 88%

A person-centered approach to understanding heterogeneity of youth receiving transdiagnostic treatment for emotional disorders.

Kennedy¹,

Tonarely²,

Halliday³

et al. 2022

Journal of Consulting and Clinical Psychology

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Objective: Transdiagnostic models of youth psychopathology posit shared, underlying core features of emotional disorders that confer risk for and/or maintain symptoms. Youth may differ in the presence and severity of these underlying core features, and matching intervention strategies to such features may help personalize transdiagnostic interventions. We used latent profile analysis (LPA) to identify profiles of youth based on core underlying transdiagnostic dysfunctions and examined associations of profiles with treatment outcome. Method: LPA was conducted with 298 youth ages 7-18.8 (M age = 12, SD = 3.2; 48.7% female; primarily White and Hispanic/Latinx) with a primary emotional disorder. Indicators for LPA included self-report measures of affect, anxiety sensitivity (AS), distress tolerance (DT), and emotion regulation (ER). Longitudinal associations between profile membership and treatment outcome were examined in a subset of 177 youth (M age = 11.8, SD = 3.2; 52% female; primarily White and Hispanic/Latinx). Results: LPA identified three profiles characterized by differing levels of DT, affect, and ER. A Moderately Distressed and Dysregulated profile had the largest membership (65.1%) and poorer youth-reported anxiety and depression outcomes compared to a Distress Tolerant, Regulated Expressive profile (24.9%). A Distressed, High Affect Avoidant profile (10%) had the greatest baseline severity and the poorest depression outcomes, although most youth improved. Conclusions: Youth characterized by certain profiles of transdiagnostic core processes appear to have the poorest functioning and treatment prognosis, although most youth improved. Targeting these processes more directly and/or earlier in treatment may help to improve outcomes for youth. What is the public health significance of this article?This study examines whether youth with emotional disorders can be grouped into profiles based on broad transdiagnostic features, as well as whether these profiles predict response to transdiagnostic, cognitive-behavioral treatment. It suggests that youth who have difficulty tolerating distress and experience stronger negative reactions to emotions may have more severe symptoms and respond more poorly to treatment.

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“…These results suggest therapists should target not only how many skills patients use but also how effectively they use their skills. Future researchers should clarify how skill use, effectiveness, and quality (i.e., how well a person uses skills; Southward & Cheavens, 2020a) impact emotional outcomes in naturalistic settings and interventions (Southward et al, 2021).…”

Section: Skill Use and Effectivenessmentioning

confidence: 99%

Multilevel associations of daily skill use and effectiveness with anxiety, depression, and stress in a transdiagnostic sample undergoing dialectical behavior therapy skills training

Southward

Eberle

Neacsiu

2021

Cognitive Behaviour Therapy

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Dialectical Behavior Therapy (DBT) is effective at treating disorders of emotion dysregulation. However, it is unclear which mechanisms contribute to these effects. The aim of this study was to characterize the within-person associations of two theoretically relevant mechanisims of change, skill use and skill effectiveness, with anxiety, stress, and depression. Participants (n = 19, Mage = 31.8, 68% female) with a primary anxiety or depressive disorder completed daily reports (N = 1344) of DBT skill use, perceived effectiveness, anxiety, stress, and depression during a 16-session DBT skills training group. DBT skill use increased across treatment, p < .01, but effectiveness did not, p = .64. Within persons, participants used more skills on days with greater stress and anxiety, p < .01, which predicted next-day decreases in stress and anxiety, p = .03. On days when participants reported higher effectiveness, they used more skills than their personal average when experiencing more intense negative affect, p < .01. These results suggest using more skills, especially when used more effectively, is a mechanism by which DBT skills groups address emotional dysfunction for those with transdiagnostic emotional disorders.

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Specifying the mechanisms and targets of emotion regulation: A translational framework from affective science to psychological treatment.

Cited by 37 publications

References 130 publications

Transdiagnostic Processes as Mediators of Change in an Internet-Delivered Intervention Based on the Unified Protocol

Transdiagnostic Processes as Mediators of Change in an Internet-Delivered Intervention Based on the Unified Protocol

A person-centered approach to understanding heterogeneity of youth receiving transdiagnostic treatment for emotional disorders.

Multilevel associations of daily skill use and effectiveness with anxiety, depression, and stress in a transdiagnostic sample undergoing dialectical behavior therapy skills training

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