(PS5-19) Cognitive-behavioral Therapy Leads to Changes in Emotion Regulation Strategies in Youth with Anxiety Disorders but Not Obsessive-compulsive Disorder

Background: Deficits in emotion regulation have been observed in children with anxiety disorders and those with obsessive-compulsive disorder (OCD). Though emotion regulation typically improves over the course of cognitive-behavioral therapy (CBT), few studies have examined such changes in youth in real-world settings.

Method: In a naturalistic treatment-seeking sample, youth with primary OCD (n = 55) and youth with primary anxiety disorders (social anxiety disorder, generalized anxiety disorder, panic disorder, agoraphobia, specific phobia, or separation anxiety disorder; n = 68) completed measures of anxiety, depression, and emotion regulation strategy use (expressive suppression and cognitive reappraisal) before and after 15 sessions of CBT.

Results: For anxious youth, anxiety and expressive suppression decreased over treatment, while cognitive reappraisal increased. Reductions in expressive suppression and increases in cognitive reappraisal were significantly associated with improvements in anxiety and remained significantly associated with post-treatment anxiety after accounting for baseline anxiety and depression. Changes in expressive suppression and cognitive reappraisal over the course of treatment were not found for youth with primary OCD and were not associated with reductions in obsessive-compulsive symptoms.

Discussion: In real-world clinical settings, CBT improves emotion regulation abilities in anxious youth, and these improvements are associated with anxiety reduction. However, improvements in emotion regulation do not appear to drive changes in OCD symptoms. Further research is needed to determine whether changes in emotion regulation strategies mediate changes in anxiety among youth receiving CBT, to compare the effect of specific treatment approaches on emotion regulation change, and to examine other potential mechanisms of change in the treatment of youth with OCD.