Emotion regulation training is a skills-based intervention that teaches people strategies to manage difficult emotions.
It focuses specifically on enhancing abilities in identifying emotions, selecting appropriate regulation techniques like reappraisal or acceptance, and implementing those strategies effectively.
The goal is to improve regulation in daily life to reduce distress, improve wellbeing, and prevent progression to future mental health problems when experienced regularly over time.
Key Points
Rationale
Prior research shows that subclinical symptoms of psychosis, depression, and anxiety are common, co-occur, influence each other, and confer heightened risk for developing mental disorders (Lewinsohn et al., 2000; McGrath et al., 2015; Regeer et al., 2006; Bosman et al., 2019).
Teaching emotion regulation skills early could potentially prevent the progression of mental disorders (Guloksuz & van Os, 2018).
While some clinical interventions successfully target emotion regulation (Cludius et al., 2020), it is unknown if resource-intensive group training is more effective for at-risk individuals than self-help approaches. Comparing interventions can inform resource allocation in prevention.
Method
Thisrandomized controlled trialrecruited 138 participants with subclinical symptoms of psychosis, depression, or anxiety.
Participants wererandomly allocatedto either 8 sessions of group-based ART (Springer, New York) focused on teaching emotion regulation skills, or 8 weeks of self-help BT.
Participants completed biweekly measures during the intervention, 6-month, and 12-month follow-ups.
Primary outcomes were differences in rates of transitions to mental disorders between groups at 12 months and changes in emotion regulation in daily life measured through experience-sampling.
Secondary symptoms and psychopathology outcomes were also examined.
Sample
The 138 German participants were predominately female (62%), Caucasian (92%) and had an average age of 25 years. Most were college students.
Statistical Analysis
Binary logistic regression analyzed the difference in 12-month transition rates between groups. Mixed modelANOVAsand ANCOVAs evaluated changes in psychopathology, symptoms, and emotion regulation over time points between groups.
Results
ART participants showed significantly greater pre-post improvement in emotion regulation in daily life compared to BT (p= .012). However, rates of transitions to mental disorders did not differ between groups at 12 months.
From pre- to post-intervention, both groups showed significant reductions in general psychopathology, depression, anxiety, and eccentric behavior (p< .001), with no difference between groups.
Insight
While group-based ART enhanced daily life emotion regulation skills more than self-help BT, it did not prevent substantially more transitions to mental disorders.
Both interventions produced similar improvements in a range of symptom and psychopathology outcomes.
The resource-intensive ART may, therefore, not provide enough additional clinical benefit over BT to justify its requirements in at-risk samples, at least based on the outcomes measured here.
Strengths
Limitations
Implications
The lack of difference in transition rates and most clinical outcomes suggests self-help approaches may deserve greater prioritization over intensive, specialized group trainings for emotion regulation enhancement and prevention in at-risk populations.
The choice of treatment approach may depend on the specific emotion regulation difficulties individuals exhibit, however. Stepped care models, which only provide intensive interventions if self-help fails, could be economical.
References
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Cludius, B., Mennin, D., & Ehring, T. (2020). Emotion regulation as a transdiagnostic, emotion regulation as a transdiagnostic process process.Emotion, 20(1), 37.https://doi.org/10.1037/emo0000646
Gross, J. J. (2015). The extended process model of emotion regulation: Elaborations, applications, and future directions.Psychological Inquiry, 26(1), 130–137.https://doi.org/10.1080/1047840x.2015.989751
Guloksuz, S., & van Os, J. (2018). Need for evidence-based early intervention programmes: A public health perspective.Evidence-Based Mental Health, 21(4), 128–130.https://doi.org/10.1136/ebmental-2018-300030
Hartmann, J. A., Nelson, B., Ratheesh, A., Treen, D., & McGorry, P. D. (2019). At-risk studies and clinical antecedents of psychosis, bipolar disorder and depression: A scoping review in the context of clinical staging.Psychological Medicine, 49(2), 177–189.https://doi.org/10.1017/S0033291718001435
Lewinsohn, P. M., Solomon, A., Seeley, J. R., & Zeiss, A. (2000). Clinical implications of “subthreshold” depressive symptoms.Journal of Abnormal Psychology, 109(2), 345–351.https://doi.org/10.1037/0021-843X.109.2.345
Ludwig, L., Werner, D., & Lincoln, T. M. (2019). The relevance of cognitive emotion regulation to psychotic symptoms—A systematic review and meta-analysis.Clinical Psychology Review, 72, 101746.https://doi.org/10.1016/j.cpr.2019.101746
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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.
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.
