Category: Treatment - CBT
Alexander Daros, Ph.D.
Centre for Addiction and Mental Health
Toronto, Ontario, Canada
Elizabeth Eustis, Ph.D.
Boston University Center for Anxiety and Related Disorders
Boston, Massachusetts
Alexander Daros, Ph.D.
Centre for Addiction and Mental Health
Toronto, Ontario, Canada
Jeremy Eberle, M.A.
Graduate Student
University of Virginia
Charlottesville, Virginia
Kiran Kaur, M.S.
Student
University of Utah
Salt Lake City, Utah
Martina Fruhbauerova, M.S.
Doctoral Student
University Of Kentucky
Lexington, Kentucky
Emotional disorders, such as depression and anxiety, account for the largest percentage of disability-adjusted life years among psychiatric disorders (Murray et al., 2013). Many psychological interventions are effective at treating symptoms of depression and anxiety (Cuijpers et al., 2021), yet researchers are still examining how they produce therapeutic change (Kazdin, 2009). In this symposium, we present novel research on three hypothesized mechanisms of therapeutic change: (1) skills use, (2) emotion regulation, and (3) the therapeutic alliance. We outline the main findings and take-aways of this symposium below.
Intervention-specific skills use is hypothesized to be a key mechanism for successful treatment outcomes across many psychological interventions (Forman et al., 2012; Radkovsky et al., 2014; Southward et al., 2022; Webb et al., 2014). Here, Wyatt et al. show that greater within-person dialectical behavior therapy (DBT) skills use was associated with lower concurrent emotion dysregulation across DBT group skills training and a comparison group therapy. Similarly, greater within-person mindfulness and perceived control were also associated with lower concurrent emotion dysregulation. Lagged multilevel mediation analyses were also undertaken.
Improved emotion regulation is a transdiagnostic treatment target associated with positive outcomes for depression and anxiety, regardless of the intervention’s theoretical orientation (Daros et al., 2021; Moltrecht et al., 2021; Sloan et al., 2017). Daros et al. demonstrate that within-person improvements in emotion regulation strategies (acceptance, cognitive reappraisal, and avoidance) were associated with lower levels of depressive symptoms across three months of psychotherapy. Moreover, Kaur and Asnaani highlight how interoceptive exposure led to improvements in distress tolerance and state anxiety in a remotely delivered single-session experiment of three therapeutic techniques.
Research has long considered therapeutic alliance to be a key mechanism of therapeutic change (Baier et al., 2020; Lorenzo-Luaces et al. 2014). Fruhbauerova et al. describe how within-person therapeutic alliance acted as a mediator between skills implementation and session-to-session improvements in depression and anxiety during the Unified Protocol treatment. This work goes beyond previous studies by examining the impact of one mechanism on another.
Collectively, this symposium highlights how translational science can inform the study and identification of proposed mechanisms, using basic experimental research in a single-session design, as well as longitudinal assessments and week-to-week predictions of change over the course of treatment. We also contrast statistical methods that can be used to establish a mediator versus a moderator of treatment response. Our overarching goal is to encourage researchers to use theory-driven, experimental research that can fulfill the multiple criteria necessary to test mechanistic hypotheses. Increasing our knowledge of mechanisms underlying treatment outcome is imperative to improving theories of emotional disorders and deploying enhanced psychological treatments in a post-pandemic world with high service demand.
Presenter: Alexander R. Daros, Ph.D. – Centre for Addiction and Mental Health
Co-author: Jeffrey Wardell, Ph.D. – York University
Co-author: Lena Quilty, PhD, CPsych – Centre for Addiction and Mental Health
Presenter: Jeremy W. Eberle, M.A. – University of Virginia
Co-Author: Kristin Wyatt, Ph.D. – 1) Arise Psychological Wellness & Consulting, PLLC 2) Duke University School of Medicine
Co-author: Allison K. Ruork, Ph.D. – Rutgers University
Co-author: Craig Enders, PhD – University of California, Los Angeles
Co-author: Andrada D. Neacsiu, Ph.D. – Duke University Medical Center
Presenter: Kiran Kaur, M.S. – University of Utah
Co-author: Anu Asnaani, Ph.D. – University of Utah
Presenter: Martina Fruhbauerova, M.S. – University Of Kentucky
Co-author: Matthew W. Southward, Ph.D. – University of Kentucky
Co-author: Douglas R. Terrill, PhD – Univeristy of Kentuckyl
Co-author: Stephen A. Semcho, M.A. – University of Kentucky
Co-author: Nicole E. Stumpp, M.S. – University of Kentucky
Co-author: Shannon Sauer-Zavala, Ph.D. – University of Kentucky