Affect regulation training reduces symptom severity in depression - A randomized controlled trial

Matthias Berking, Eva Eichler, Maike Luhmann, Alice Diedrich, Wolfgang Hiller, Winfried Rief, Matthias Berking, Eva Eichler, Maike Luhmann, Alice Diedrich, Wolfgang Hiller, Winfried Rief

Abstract

Deficits in general emotion regulation skills have been shown to be associated with various mental disorders. Thus, general affect-regulation training has been proposed as promising transdiagnostic approach to the treatment of psychopathology. In the present study, we aimed to evaluate the efficacy of a general affect-regulation as a stand-alone, group-based treatment for depression. For this purpose, we randomly assigned 218 individuals who met criteria for major depressive disorder (MDD) to the Affect Regulation Training (ART), to a waitlist control condition (WLC), or to a condition controlling for common factors (CFC). The primary outcome was the course of depressive symptom severity as assessed with the Hamilton Rating Scale for Depression and the Beck Depression Inventory. Multi-level analyses indicated that participation in ART was associated with a greater reduction of depressive symptom severity than was participation in WLC (d = 0.56), whereas the slight superiority of ART over CFC (d = 0.25) was not statistically significant. Mediation analyses indicated that changes in emotion regulation skills mediated the differences between ART/CFC and WLC. Thus, the findings provide evidence for enhancing emotion regulation skills as a common mechanism of change in psychological treatments for depression. The study was registered with ClinicalTrials.gov (NCT01330485) and was supported by grants from the German Research Association (DFG; BE 4510/3-1; HI 456/6-2). Future research should compare the (cost-) efficacy of ART with that of disorder-specific interventions.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Patient flow.
Fig 1. Patient flow.
ART = Affect Regulation Training; CFC = common factor control condition; WLC = waitlist control condition; ITT = intention to treat.
Fig 2. Affect regulation mediates the effects…
Fig 2. Affect regulation mediates the effects of both active treatments on depression.
ER = emotion regulation; BDI-II = Beck Depression Inventory II; HRSD = Hamilton Rating Scale for Depression; *p

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