Emotion regulation difficulties in pediatric obsessive-compulsive disorder: A modifiable treatment target

Background: Pre-treatment emotion regulation difficulties are extensively reported in pediatric obsessive-compulsive disorder (OCD), yet information regarding whether they are addressed by current interventions and/or moderate treatment outcomes, particularly differentiating between different types of psychotherapy, is lacking. Methods: Seventy-nine adolescents with OCD (11-17 years) completed the Difficulties in Emotion Regulation Scale (DERS) before and after being randomized to 16 weeks of either family-based cognitive behavioral therapy with exposure and response prevention (FCBT) or family-based psychoeducation with relaxation training (FPRT). A cohort of 59 age- and sex-matched adolescents without psychiatric disorders was included to establish temporal stability of emotion regulation and a normative reference level on the DERS. Results: Adolescents in the FCBT group demonstrated post-intervention improvements in emotion regulation, whereas those in the FPRT group did not. Change in OCD symptom severity was neither moderated nor mediated by emotion regulation difficulties in either the FCBT or FPRT group. Sensitivity analyses on treatment completers yielded similar results. Conclusions: The findings confirm emotion regulation difficulties as modifiable targets for psychotherapy in pediatric OCD and suggest that FCBT is effective in improving emotion regulation abilities, while FPRT is not.