Successful Emotion Regulation Skills Application Predicts Subsequent Reduction of Symptom Severity During Treatment of Major Depressive Disorder

Objective: Deficits in emotion regulation (ER) skills are considered a putative maintaining factor for major depressive disorder (MDD) and hence a promising target in the treatment of MDD. However, to date, the association between the successful application of arguably adaptive ER skills and changes in depressive symptom severity (DSS) has yet to be investigated over the course of treatment. Thus, the primary aim of this study was to clarify reciprocal prospective associations between successful ER skills application and DSS over the course of inpatient cognitive behavioral therapy for MDD. Additionally, we explored whether such associations would differ across specific ER skills. Method: We assessed successful ER skills application and DSS 4 times during the first 3 weeks of treatment in 152 inpatients (62.5% women, average age 45.6 years) meeting criteria for MDD. We first tested whether successful skills application and depression were cross-sectionally associated by computing Pearson's correlations. Then, we utilized latent curve modeling to test whether changes in successful skills application were negatively associated with changes in DSS during treatment. Finally, we used latent change score models to clarify whether successful skills application would predict subsequent reduction of DSS. Results: Cross-sectionally, successful ER skills application was associated with lower levels of DSS at all assessment times, and an increase of successful skills application during treatment was associated with a decrease of DSS. Moreover, successful overall ER skills application predicted subsequent changes in DSS (but not vice versa). Finally, strength of associations between successful application and DSS differed across specific ER skills. Among a broad range of potentially adaptive skills, only the abilities to tolerate negative emotions and to actively modify undesired emotions were significantly associated with subsequent improvement in DSS. Conclusions: Systematically enhancing health-relevant ER skills with specific interventions may help reduce DSS in patients suffering from MDD.