Emotion regulation as a transdiagnostic treatment construct across group cognitive behavioral therapies for adult anxiety and depression

OBJECTIVES: Identifying the mechanisms of change in first-line cognitive behavioral therapy (CBT) protocols for adult anxiety and depression could enhance outcomes for the individual. We explored (a) the effect of four group CBT protocols on general emotion regulation skills, (b) the effect of specific emotion regulation skills on next-session symptom outcomes, and (c) the potential differences in these outcomes across the included protocols. METHOD: This secondary analysis used data from the TRACT-RCT trial investigating the relative efficacy of 14 sessions of transdiagnostic versus disorder-specific CBT group protocols for adult anxiety or depression (n = 291). We assessed the relative changes in general emotion regulation skills measured with the Emotion Regulation Skills Questionnaire at the end of treatment using multilevel modeling. We used cross-lagged panel modeling to test if changes in the use of five specific emotion regulation skills predicted changes in symptoms in the subsequent sessions, adjusting for depression/anxiety symptoms in the previous two sessions. Symptoms were assessed with the Overall Anxiety Severity and Impairment Scale and the Overall Depression Severity and Impairment Scale. RESULTS: Participants' general emotion regulation skills increased in the included CBT protocols, F(2, 767.1) = 32.59, p < .001. We found a significant cross-lagged effect of the emotion exposure skill on next-session symptoms (coefficient = -.25, 95% CI [-0.43, -0.07], p = .005). The effects were similar across CBT protocols. CONCLUSIONS: This study used a rigorous methodology to identify emotion exposure as a relevant transdiagnostic and transtheoretical treatment outcome and a potential mechanism of change across group CBT protocols for adult anxiety and depression. (PsycInfo Database Record (c) 2025 APA, all rights reserved).