(PS2-40) Self-blame and Acceptance in the Relationship Between a Transdiagnostic Treatment and Alcohol Drinking Outcomes

Various thinking patterns such as self-blame, rumination, or catastrophizing have been linked with negative emotions such as anxiety (Jermann et al., 2006; Kraaij et al., 2003; Martin & Dahlen, 2005), whereas adaptive emotion regulation (ER) strategies e.g., acceptance, correlate negatively with psychopathology (Conklin et al., 2015). ER, consisting of strategies to express the occurrence, experience, and intensity of emotions (Gross, 2015), is often targeted by interventions for multiple disorders (Barlow, 2004). One example is the Unified Protocol (UP), a transdiagnostic cognitive-behavioral treatment for anxiety, depression, and related disorders (Barlow et al., 2017). The UP helps patients respond to their emotions more adaptively, such as assessing emotions using present-focused, non-judgmental awareness, practicing cognitive flexibility, and changing emotional and behavioral avoidance patterns (Khakpoor et al., 2019).

This study examines two cognitive ER strategies using subscales of the Cognitive Emotion Regulation Questionnaire – short version (CERQ-short; Garnefski & Kraaij, 2006), self-blame and acceptance, and their mediating relationship between treatment condition and drinking outcomes during a randomized controlled trial evaluating the efficacy of the UP for individuals with co-occurring alcohol use and anxiety disorders (AUD/ANX), compared to an alcohol-focused therapy called Take Control (TC), developed by the National Institute on Alcohol Abuse and Alcoholism. Seventy-five participants were included in the parent trial (M age=43.1 SD=13.1; 57.3% female; 81.3% White), 51 of which were randomized to the UP condition. Timeline Follow-back (Sobell & Sobell, 1992), collecting weekly average drinks, and CERQ-short assessments were administered before and after the 16-session UP or 12-session TC treatments.

Two simple linear regression mediation models were conducted in R to examine the relative direct and indirect effects of the UP vs. TC on change in weekly average drinking through change in self-blame and acceptance from pre-to post-treatment, respectively. We expected that participants in the UP group would show greater reductions in alcohol use, which would be partially mediated by greater increases in acceptance and greater reductions in self-blame, compared to TC.

Results indicated a significant direct effect of treatment condition on change in weekly average drinking (c’=-12.034, p = .028), with UP participants showing greater reduction in drinking compared to TC. However, neither the direct effects of treatment condition on acceptance (a=-0.191, p=.803) and acceptance on weekly average drinking (b=0.541, p=.670), nor the indirect effect (ab=-0.103, p=.829) were significant. This pattern persisted when examining self-blame as a mediator (a=-0.491, p=.499; b=-2.293, p=.072; ab=-1.126, p=.527). The two conditions did not show differential changes in ER strategies. These findings are consistent with a prior study supporting the UP’s efficacy in reducing alcohol consumption in patients diagnosed with AUD/ANX (Ciraulo et al., 2013). However, further exploration of the mechanistic relationships between emotion regulation and transdiagnostic treatment targeting AUD is needed.