Symposia
Treatment - CBT
Alexander R. Daros, Ph.D.
Centre for Addiction and Mental Health
Toronto, Ontario, Canada
Jeffrey Wardell, Ph.D.
Assistant Professor
York University
Toronto, Ontario, Canada
Lena Quilty, PhD, CPsych
Senior Scientist
Centre for Addiction and Mental Health
Toronto, Ontario, Canada
Background. People with depression use ineffective emotion regulation (ER) strategies (e.g., rumination, avoidance, and suppression) more often than effective ones (e.g., cognitive reappraisal, acceptance, and problem-solving). Psychological treatments improve both ER and depression, but research on understanding ER as a mechanism of change often relies on pre- to post-assessments. The aim of the current study was to examine the longitudinal within-person associations between ER and depressive symptom reduction during psychological treatment. We hypothesized that: (1) depression and ineffective ER strategies would decrease over treatment, while effective ER strategies increased; and (2) within-person increases in effective ER and decreases in ineffective ER, would be associated with decreased depressive symptoms over time.
Methods. 60 treatment-seeking adults with moderate depression symptoms at baseline were recruited from the community. Each participant completed a baseline diagnostic interview and questionnaires before being connected to a mobile app designed to send weekly follow-up surveys for 12 weeks as they completed psychotherapy. At each time-point, participants were assessed for depression and six ER strategies. Multilevel modeling was used to predict weekly depression scores from within-person changes in ER strategy use (person-centered). Models controlled for between-person and quadratic effects of time. A random intercept and all significant random slopes were included in the final model.
Results. On average, participants completed 8.82 (SD = 3.09) surveys and neither demographic nor diagnostic variables were related to compliance (ps > .06). Depression, rumination, and avoidance decreased over treatment while cognitive reappraisal and acceptance increased (ps < .01). Expressive suppression and problem solving did not change over treatment and were dropped from analysis. Controlling for demographic variables and general cognitive therapy skills, within-person increases in acceptance and cognitive reappraisal as well as decreases in avoidance were associated with fewer depressive symptoms over time (ps < .001). Averaged between-person effects in rumination and acceptance also emerged (ps < .04).
Conclusions. Results suggest that within-person improvements in specific ER strategies are significantly associated with depression treatment outcome, even after controlling for general cognitive therapy skills. Future research to elucidate their role as mediators of treatment is warranted.