Exploring the Mechanisms in Cognitive Behavioural Therapy for Anxious Children: Does Change in Emotion Regulation Explain Treatment Effect?

Reductions in Anxiety are Associated with Decreased Expressive Suppression and Increased Cognitive Reappraisal After Cognitive-Behavioral Treatment: A Naturalistic Study in Youth

Broad deficits in emotion regulation skills have been observed in children with anxiety-related disorders. These deficits typically improve during cognitive-behavioral therapy (CBT), but few studies have examined changes in expressive suppression and cognitive reappraisal in youth with anxiety disorders and/or obsessive-compulsive disorder (OCD) during CBT, especially in real-world settings. In a naturalistic treatment-seeking sample, 123 youth completed measures of anxiety, depression, and emotion regulation strategy use before and after 15 sessions of CBT. For anxious youth, anxiety and expressive suppression decreased over treatment, while cognitive reappraisal increased. Reductions in expressive suppression and increases in cognitive reappraisal were significantly associated with improvements in anxiety and remained significantly associated with post-treatment anxiety after accounting for baseline anxiety and depression. Changes in expressive suppression and cognitive reappraisal over the course of treatment were not found for youth with primary OCD. Thus, CBT improves emotion regulation abilities in anxious youth, and these improvements are associated with anxiety reduction; improvements in emotion regulation do not appear to drive changes in OCD symptoms. Further research is needed to determine whether changes in emotion regulation strategies mediate changes in anxiety among youth receiving CBT.

Emotion-focused skills training for parents with anxious children. A pilot study

Anxiety disorders are common among children and adolescents. Effective treatments exist, but meta-analyses indicate that 40% of children continue to have significant symptoms posttreatment. Alternative therapeutic interventions are needed. Emotion-focused parental interventions have been found to be effective in targeting children's internalizing difficulties, but no research has examined remission. In this pilot trial, we examined whether Emotion Focused Skills Training (EFST) was associated with remission of diagnosis in children with anxiety. Nine 8-14-year-olds diagnosed with anxiety were recruited at a mental health clinic in Norway. Both parents of each child attended a 2-day EFST program followed by five 1-hour weekly sessions. Pre- and posttreatment diagnosis and severity were evaluated using a multiinformant approach using the Spence Children's Anxiety Scale and the Anxiety Disorders Interview Schedule. After treatment, 33% no longer met criteria for any anxiety diagnosis, 66% obtained remission from their primary anxiety diagnosis, and 89% from at least one.

When Is It Time to Revise or Adapt Our Prevention Programs? Introduction to Special Issue on Using Baseline Target Moderation to Assess Variation in Prevention Impact

Adaptation of preventive interventions to increase their impact can be advanced by identifying subgroups or specific contexts where program effects appear stronger or weaker. But how do we know where to look for effect heterogeneity in ways that will inform successful adaptation? This paper introduces a special issue that brings together research across prevention science sub-disciplines that adopted baseline target moderated mediation (BTMM) designs to search for effect heterogeneity and guide adaptation of established prevention programs. For this special issue intervention  scientists analyzed data from randomized trials using BTM and BTMM models, evaluating evidence for variation in intervention impact for trials spanning different health outcomes, different developmental periods, and different social units. This introduction provides a brief summary of the various patterns of effect reported in these papers, noting that the most common pattern involved compensatory effects (those beginning the trial with greater risk or fewer protective factors benefit the most), but other patterns including rich-get-richer and partially iatrogenic effects were also detected. This paper ends with a discussion of methodological and substantive implications of these findings for future prevention research, including next-generation prevention trials.

Baseline Target Moderation and Baseline Target Moderation Mediation Approaches: Reflections on Cultural Adaptation and Social Justice

Baseline target moderation (BTM) and baseline target moderated mediation (BTMM) constitute critical methodological and analytical approaches for the future of prevention science. However, the continuing refinement and utilization of these approaches carry important challenges when considering equity challenges that remain present in the prevention science field. Accordingly, this commentary is focused on examining cultural and contextual considerations associated with the set of articles included in this study, as well as directions for enhancing future research by embracing a solid grounding on equity perspectives. For example, to which extent do BTM and BTMM approaches include variables of relevance such as perceived discrimination, economic adversity, and other cultural and contextual domains that impact the lives of underserved diverse populations? In addition to providing a review of the articles included in this issue, recommendations are included for informing future prevention research according to equity perspectives.

Elements in Mental Health Interventions Associated with Effects on Emotion Regulation in Adolescents: A Meta-Analysis

PURPOSE

Adolescence is a sensitive period for developing mental health problems. Interventions targeting emotion regulation have shown promising transdiagnostic effects for this group, but optimization efforts are called for. In the current study, we used an element-based approach to identify potentially active ingredients in interventions measuring emotion regulation, to guide further optimization.

METHODS

We coded practice elements in 30 studies based on a systematic review of mental health interventions measuring emotion regulation in adolescents (N = 2,389 participants, mean age 13-17 years). Using a three-level modeling approach, we then investigated the difference in effect on emotion regulation between studies of interventions with and without these practice elements.

RESULTS

We identified 75 practice elements and 15 element categories used in the included interventions. Results showed significantly stronger effects on emotion regulation when interventions included the practice elements Setting goals for treatment (difference in d = 0.40, 95% CI [0.09, 0.70], p = .012) and Psychoeducation about acceptance (difference in d = 0.58, 95% CI [0.09, 1.07], p = .021). Furthermore, a total of 11 elements and four overall categories were identified as potentially active ingredients, based on an effect size difference of > 0.20 between interventions with and without the elements.

CONCLUSION

The results can direct experimental research into the selection of practices that are most likely key to mechanisms of change in interventions addressing emotion regulation for adolescents. The challenge of measuring emotion regulation is discussed.