(PS4-A1) The Impact of Emotion Dysregulation on Depression and Anxiety Symptoms in a Sample of Underserved Adolescents

Background: Adverse childhood experiences (ACEs) and resulting accumulative stress have been shown to increase the likelihood that youth will experience internalizing symptoms, such as anxiety and depression. Accumulative stress also contributes to emotion regulation difficulties, which turn exacerbates internalizing symptoms. Dialectical Behavior Therapy (DBT) is an evidence-based psychotherapy that aims to address the emotion regulation difficulties underlying many mental health problems. A school-based DBT skills intervention was piloted to examine the effectiveness of the program in reducing internalizing symptoms in at-risk adolescents, as well as elucidate the relationship between these symptoms and emotion dysregulation.

Methods: A total of 36 adolescents (47.4% male, 44.7% female, 2.6% nonbinary) aged 15 to 18 (M=16.67, SD=0.68) were recruited from a continuation high school in an underserved community after pre-screening as at-risk for emotion regulation difficulties. The student sample was diverse in terms of race (10.5% Black/African American), ethnicity (88.9% Hispanic/Latino), and sexual orientation (30.6% LGBTQ+). Students consented to participate in a 12-session, school-based DBT-skills group intervention, and completed the Revised Child Anxiety and Depression Scales (RCADS) and Difficulties in Emotion Regulation (DERS) measures at both baseline and post-assessment. Paired t-tests were conducted to compare pre-post mean differences of both measures, and DERS scores were examined as a possible moderator of pre-post RCADS scores.

Results: At baseline, 27.8% of participants exceeded the borderline clinical thresholds for anxiety and depression. Paired t-test results did not reveal any significant differences between pre-post scores for either the RCADS or DERS (ps >.05). However, the relationship between these two variables was significant, given that greater emotion regulation difficulties significantly predicted greater internalizing symptoms at both pre- and post-assessment (ps< .001). Further, emotion dysregulation significantly moderated the effect of pre-test internalizing symptoms on post-test symptoms, such that greater pre-test internalizing symptoms predicted greater post-test symptoms for adolescents with increased emotion dysregulation (F[1,32]=4.43, R²Δ=.025, p< .05).

Conclusion: Although the intervention did not yield significant improvements in pre-post emotion dysregulation or internalizing symptom scores, simple regression and moderation analysis findings appear to support the hypothesis that emotion regulation difficulties exacerbate the severity and course of internalizing symptoms. It is likely that improvements in emotion regulation may have a protective effect against the development of anxiety and depression in adolescents. Future studies with adolescents can further explore the effectiveness of using DBT skills to target emotion dysregulation and precipitate internalizing symptom improvements.