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ViewAttendees 5

Symposia

Transdiagnostic

Session: Building Toolkits with our Clients: Predictors and Outcomes of Treatment Skills

1 - (SYM 71) Testing Mechanistic Theories of Change in the Unified Protocol: An Examination of Skills Use and Aversive Reactions to Emotions

Saturday, November 18, 2023
12:30 PM – 2:00 PM PST
Location: Ashnola (301), Level 3
According to the functional theory of emotional disorders (Bullis et al., 2019), emotional disorders such as mood, anxiety, and related disorders are maintained in part by (a) aversive appraisals of negative emotions as intolerable followed by (b) maladaptive strategies to regulate those emotions (e.g., avoidance, suppression). The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP; Barlow et al., 2018) is designed to target both putative maintenance factors by teaching patients more adaptive emotion regulation strategies and communicating the adaptive nature of emotions to reduce these aversive appraisals. However, it is unclear if these two aspects of the UP influence each other or subsequent emotional disorder symptom change. A sample of adults with emotional disorders (N = 70; Mage = 33.74, 67% female, 74% White, 74% heterosexual) were randomized to complete 6 or 12 sessions of the UP in a personalized or standardized sequence of UP modules (Sauer-Zavala et al., 2022). Participants completed measures of skillfulness (Dimensions of Skillfulness & Use Scale), aversive reactivity (Multidimensional Experiential Avoidance Questionnaire; Anxiety Sensitivity Index; Beliefs about Emotions Scale), and anxiety and depression (Overall Anxiety/Depression Severity and Impairment Scales) before each session. Using data from the first six sessions completed by all participants, we disaggregated between- and within-person variability in each measure and used hierarchical linear modeling to test if skillfulness and aversive reactivity predicted each other and if either mechanism predicted session-to-session changes in anxiety and depression. Neither within-person changes in aversive reactivity, nor skillfulness, ps > .20, predicted subsequent changes in each other. Greater between-person skillfulness was related to lower between-person aversive reactivity, Bs: –.38 - –.24, ps < .03. When included in the same model, only within-person improvements in skillfulness predicted session-to-session reductions in anxiety and depression, ps < .02. These results suggest that skillfulness and aversive reactivity may exhibit between-person associations but do not influence each other over time in the UP. Further, skillfulness may demonstrate a more direct impact on emotional disorder symptoms than aversive reactivity so therapists may be encouraged to target the degree to which patients understand, use, and find the skills taught in the UP effective.