A Daily Diary Study of Adults in a Transdiagnostic Partial Hospitalization Program
Emotion dysregulation is implicated in the development and maintenance of many psychiatric disorders.
Emotion regulation skillsare often incorporated into evidence-based therapies to reduce dysfunctional regulatory patterns like avoidance and rumination while increasing more constructive regulation through reappraisal and acceptance.
However, most treatment research examines one disorder at a time, focuses on a limited number of strategies, and only compares pre-post treatment differences. This overlooks potentially informative day-to-day regulatory changes throughout therapy that might influence outcomes.
Transdiagnostic refers to psychological processes, symptoms, or interventions that are similar across mental health diagnoses. Rather than focusing on disorder-specific manifestations, a transdiagnostic approach examines core mechanisms that underlie multiple disorders. For example, emotion dysregulation is a transdiagnostic process implicated in mood disorders, anxiety disorders, eating disorders, and more. Transdiagnostic interventions target these shared mechanisms of psychopathology. Cognitive behavioral therapy skills training and mindfulness practices are common transdiagnostic treatments.
Key Points
Rationale
Transdiagnostic refers to similar psychological processes, symptoms, or interventions across mental health diagnoses.
Emotion dysregulation is a transdiagnostic process implicated in mood disorders, anxiety disorders, substance use disorders, trauma disorders, eating disorders, and personality disorders (Fowler et al., 2021; Sloan et al., 2017).
Difficulties with emotion regulation are associated with increased psychopathology and functional impairment across diagnoses (Fowler et al., 2021). As such, many evidence-based therapies, includingcognitive behavioral therapy,acceptance and commitment therapy, anddialectical behavior therapy, directly target emotion regulation skills in treatment (Gross & Jazaieri, 2014).
These therapies utilize techniques to reduce maladaptive regulatory patterns like rumination, suppression, and avoidance while increasing more adaptive strategies like cognitive reappraisal and acceptance (Diedrich et al., 2016).
However, most clinical research examines treatment response within single diagnoses without considering transdiagnostic mechanisms (Sloan et al., 2017).
Additionally, studies tend only to assess emotion regulation abilities at pre and post-treatment, which overlooks meaningful within-treatment regulatory fluctuations that likely shape outcomes (Kramer et al., 2016).
For example, how quickly patients acquire more helpful regulation strategies versus drop maladaptive ones during therapy could influence long-term gains, but daily regulatory patterns remain understudied (Blalock et al., 2016).
Method
This study utilized daily diary methods to assess changes in six emotion regulation strategies – acceptance, distraction, suppression, reappraisal, experiential avoidance, and rumination – throughout treatment in a partial psychiatric hospitalization program.
The program treated 364 adults with heterogeneous disorders using cognitive-behavioral and dialectical behavior therapy skills targeting emotion regulation.
Patients completed validated measures of emotion regulation daily during the first seven treatment days. They also completed measures of anxiety, depression, overall psychiatric symptoms, and quality of life at intake and discharge.
Sample
Statistical Analysis
Latent curve modeling with structured residuals to model within-person (daily) and between-person (average) changes in strategy use over seven days of treatment. Associations tested between individual trajectories and symptom/functioning outcomes.
Results
Insight
This study demonstrates that targeting emotion regulation skills in intensive transdiagnostic treatment can lead to broad improvements in heterogeneous patient groups.
Patients successfully increased the use of engagement strategies and decreased the use of problematic disengagement/perseveration strategies after just seven days. Suppression reduction appeared to be a particularly potent change mechanism. Decreased experiential avoidance also facilitated next-day changes in other maladaptive regulation attempts.
Notably, regulatory changes occurred despite most patients entering treatment with moderate-severe symptoms and reporting high initial use of problematic strategies like rumination. This indicates that regulatory patterns are mutable early in treatment regardless of patients’ baseline tendencies. It also highlights the value of intensive interventions for catalyzing meaningful therapeutic change across presenting problems.
By modeling day-to-day regulatory shifts, this study captures clinically useful processes overlooked in pre-post assessments. The ability to pinpoint quick within-treatment changes in emotion regulation that facilitate broader symptom reduction could inform treatment refinement.
For instance, directly targeting experiential avoidance early in treatment may potentiate positive cascading effects on strategy use and outcomes.
Strengths
Limitations
Clinical Implications
These findings support the promise of targeting emotion regulation to address transdiagnostic mechanisms underlying varied disorders.
Community accessibility is essential since treatment-seeking samples have limited diversity. Lowering structural barriers around cost, transportation, work schedules etc. could make intensive treatment feasible for more people.
Future research should clarify optimal timing and methods for enhancing engagement and reducing disengagement/perseveration strategies.
References
Primary reference
Goodman, F. R., Peckham, A. D., Kneeland, E. T., Choate, A. M., Daniel, K. E., Beard, C., & Björgvinsson, T. (2023). How does emotion regulation change during psychotherapy? A daily diary study of adults in a transdiagnostic partial hospitalization program.Journal of Consulting and Clinical Psychology, 91(12), 731–743.https://doi.org/10.1037/ccp0000838
Other references
Blalock, D. V., Kashdan, T. B., & Farmer, A. S. (2016). Trait and daily emotion regulation in social anxiety disorder.Cognitive Therapy and Research, 40(3), 416–425.https://doi.org/10.1007/s10608-015-9739-8
Bullis, J. R., Boettcher, H., Sauer-Zavala, S., Farchione, T. J., & Barlow, D. H. (2019). What is an emotional disorder? A transdiagnostic mechanistic definition with implications for assessment, treatment, and prevention.Clinical Psychology: Science and Practice, 26(2).https://doi.org/10.1111/cpsp.12278
Daros, A. R., Haefner, S. A., Asadi, S., Kazi, S., Rodak, T., & Quilty, L. C. (2021). A meta-analysis of emotional regulation outcomes in psychological interventions for youth with depression and anxiety.Nature Human Behaviour, 5(10), 1443–1457.https://doi.org/10.1038/s41562-021-01191-9
Diedrich, A., Grant, M., Hofmann, S. G., Hiller, W., & Berking, M. (2016). Self-compassion as an emotion regulation strategy in major depressive disorder.Behaviour Research and Therapy, 58,43–51.https://doi.org/10.1016/j.brat.2014.05.006
Fowler, J. C., Charak, R., Elhai, J. D., Allen, J. G., Frueh, B. C., & Oldham, J. M. (2021). Construct validity and factor structure of the difficulties in emotion regulation scale among treatment-seeking adults.Psychiatry Research, 296, Article 113681.https://doi.org/10.1016/j.psychres.2020.113681
Gross, J. J., & Jazaieri, H. (2014). Emotion, emotion regulation, and psychopathology: An affective science perspective.Clinical Psychological Science, 2(4), 387–401.https://doi.org/10.1177/2167702614536164
Kramer, U., Pascual-Leone, A., Despland, J.-N., & de Roten, Y. (2015). One minute of grief: Emotional processing in short-term dynamic psychotherapy for adjustment disorder.Journal of Consulting and Clinical Psychology, 83(1), 187–198.https://doi.org/10.1037/a0037979
Sloan, E., Hall, K., Moulding, R., Bryce, S., Mildred, H., & Staiger, P. K. (2017). Emotion regulation as a transdiagnostic treatment construct across anxiety, depression, substance, eating and borderline personality disorders: A systematic review.Clinical Psychology Review, 57, 141–163.https://doi.org/10.1016/j.cpr.2017.09.002
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Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
