A randomized controlled trial of emotion regulation therapy for generalized anxiety disorder with and without co-occurring depression

In a previous correlation-based mediation analysis, both cognitive reappraisal and decentering were associated with better anxiety outcomes, with the largest effects for decentering.

“In a previous correlation-based mediation analysis, both cognitive reappraisal and decentering were shown to be associated with better anxiety outcomes, with the largest effects detected for the latter (Mennin et al., 2018).”

Emotion Regulation Therapy has shown efficacy in open and randomized trials for generalized anxiety disorder with and without co-occurring depression.

“Emotion Regulation Therapy (ERT) has demonstrated efficacy in both open and randomized trials for generalized anxiety disorder (GAD) with and without co-occurring depression.”

Cognitive behavioral therapies have successfully treated generalized anxiety disorder, with moderate-to-large acute effects that are largely maintained at follow-up.

“CBTs have successfully treated GAD, demonstrating moderate to large effects during the acute phase of GAD treatment that are largely maintained throughout follow-up (Cuijpers et al., 2014; Hayes-Skelton, Roemer, & Orsillo, 2013; Mennin, Fresco, O’Toole, & Heimberg, 2018; Wells et al., 2010).”

Correlation-based mediation analyses on a previous randomized controlled trial showed the metacognitive measures statistically mediated outcomes in the ERT condition.

“However, correlation-based mediation analyses on a previous randomized controlled trial did show the particular metacognitive measures to statistically mediate outcomes in the ERT condition (Mennin et al., 2018).”

A recent randomized controlled trial established indirect effects of both decentering and reappraisal, explaining the superior effect of ERT compared with an attention control group.

“in which we were able to establish indirect effects of both decentering and reappraisal, explaining the superior effect obtained for individuals receiving ERT compared with an attention control group (Mennin et al., 2018).”

Eighty percent of patients receiving emotion regulation therapy reached high end-state functioning on generalized anxiety disorder measures.

“a sizeable percentage (80%) of patients receiving ERT reached high end-state functioning on GAD measures.”

In a recent randomized controlled trial, emotion regulation therapy was superior to a modified attention control on several hypothesized mechanisms of improvement, including mindfulness, reappraisal, and emotion regulation.

“In a recent RCT ERT was superior to a modified attention control on a number of hypothesized mechanisms of improvement (e.g., mindfulness, reappraisal, emotion regulation) [66].”

In an RCT of 20-session ERT versus an attention control for generalized anxiety disorder with or without depression, all four proposed mediators showed indirect effects on all primary outcomes.

“In an RCT investigating the efficacy of 20 sessions of ERT compared with an attention control condition in the treatment of generalized anxiety disorder with and without depression, all four proposed mediators (mindfulness, emotion dysregulation, decentering, and cognitive reappraisal) showed an indirect effect on all primary outcomes [14].”

Decentering increases as a result of cognitive behavioral therapies, emotion regulation therapy, and mindfulness-based interventions, and contributes to the beneficial effects of mindfulness-based approaches.

“Decentering increases as a result of cognitive behavioral therapies (Fresco et al., 2007; Hayes-Skelton et al., 2015), emotion regulation therapy (ERT; Mennin et al., 2018; O’Toole et al., 2019), and MBIs (Bieling et al., 2012; Carmody et al., 2009) and contributes to the beneficial effects of mindfulness-based approaches (Hoge et al., 2015).”

The reduction in emotion dysregulation after ERIC is consistent with findings from studies of other cognitive and behavioral interventions targeting emotion regulation in adults with BPD/NSSI and GAD/MDD.

“The reduction in emotion dysregulation after exposure to ERIC is also consistent with findings from studies of other cognitive and behavioral interventions that target emotion regulation in adults with BPD and NSSI (Gratz et al., 2015) and Generalized Anxiety Disorder and Major Depressive Disorder (Mennin et al., 2018, Renna et al., 2017).”

The gains from Mennin et al. (2018) were maintained in post-treatment assessments 3- and 9-months following the end of treatment.

“The gains were maintained in post-treatment assessments 3- and 9-months following the end of treatment.”

Emotion Regulation Therapy (ERT) has demonstrated clinical efficacy for chronic anxiety with or without depression.

“ERT was originally developed to treat chronic anxiety with or without depression and has demonstrated clinical efficacy (20–22).”

Decentering contributes to the salutary benefits of meditation training, MBIs, and mindfulness-enriched CBTs.

“Decentering contributes to the salutary benefits of meditation training [48], MBIs [33, 54, 57, 58] and mindfulness enriched CBTs [59–63].”

Three ERT trials demonstrate strong efficacy.

“To date, three ERT trials demonstrate strong efficacy [61, 62, 83]”