(PS12-A4) Therapist and Client Ratings of Progress on Targeted Mechanisms During Emotion Regulation Therapy

Emotion Regulation Therapy (ERT) is a manualized treatment that integrates components of traditional cognitive-behavioral and mindfulness/acceptance therapies through an affect science framework in order to modify negative self-referential processing (e.g., worry, rumination) by targeting proposed motivational, regulatory (e.g., attentional and metacognitive strategies), and behavioral mechanisms. As with other CBTs, case conceptualizations play a vital role in ERT, as they can help therapists track clients’ progress and inform personalization of treatment to match clients’ needs. However, less explored is the relationship between therapist case conceptualizations and client-ratings of ERT mechanisms. In the current study, 36 adults (72.2% female, 80.6% White), with generalized anxiety disorder (GAD) or co-occurring GAD and major depressive disorder, participated in an open trial of a 20-session version of ERT. Therapists completed case conceptualizations prior to session 1 (pre-treatment), after session 4, after session 10 (mid-treatment), and after session 16; participants completed self-report questionnaires relevant to each ERT mechanism prior to session 1 (pre-treatment), after session 10 (mid-treatment), and after session 20. Specifically, we examined attention regulation (the ability to broaden/flexibly move attention [i.e., “observing/orienting”] and to focus/sustain attention [i.e., “allowing”]), metacognitive regulation (the ability to see thoughts, feelings, and memories with healthy distance and perspective in time [i.e., “distancing/decentering”] and to speak back with courage and compassion [i.e., “reframing/reappraisal”]), and valued action. To begin, multilevel modeling (MLM) with restricted maximum likelihood method was used to explore change over time in therapist-ratings of ERT mechanisms on case conceptualizations. Growth models revealed significant main effects of time on therapist-ratings of observing (β = .36, SE = .05, p < .001, g = 1.27), allowing (β = .45, SE = .05, p < .001, g = 1.37), distancing (β = .48, SE = .05, p < .001, g = 1.48), reframing (β = .43, SE = .06, p < .001, g = 1.23), and valued action (β = .43, SE = .05, p < .001, g = 1.50). Next, MLM was used to explore covariation between therapist- and client-ratings of ERT mechanisms from pre- to mid-treatment. Results revealed significant time by client-report interactions on therapist-reports of observing (β = .03, SE = .01, p < .001, g = 1.33), allowing (β = .06, SE = .01, p < .001, g = 1.67), distancing (β = .04, SE = .004, p < .001, g = 1.97), and reframing (β = .04, SE = .01, p < .001, g = 1.37), such that covariance between therapist- and client-reports of these mechanisms increased from pre- to mid-treatment. There were, however, no significant main or interaction effects for valued action, suggesting that therapist- and client-ratings of valued action did not covary (ps > .66). These findings point to the importance of simultaneously tracking therapist- and client-ratings of treatment mechanisms. Future directions (e.g., examining whether increase in therapist-client agreement over time predicts outcomes) and limitations will be discussed.