Effects of emotion regulation skills training on worry and emotional distress tolerance: a multiple baseline single-case experimental design

There has recently been increased interest in the study of transdiagnostic mechanisms and therapies. Targeting transdiagnostic mechanisms rather than using a single disorder approach should increase efficiency of therapeutic interventions, but only if the proper mechanisms can be identified. Low distress tolerance and difficulties with emotion regulation are hypothesized as transdiagnostic mechanisms associated with anxiety disorders and worry. Due to the high comorbidity and prevalence of anxiety disorders and their shared symptoms of pathological worry, understanding these transdiagnostic mechanisms is important to the development of more effective and efficient treatments. This study used a multiple baseline, single-case experimental design to evaluate the efficacy of emotion regulation skills training for pathological worry and low distress tolerance in outpatients with anxiety disorders. Eight participants (6 women, 2 men) with at least one diagnosed anxiety disorder were randomized into a 2- or 4-week baseline period. The average age of participants was 29.1 (SD = 8.2; range 19 to 42). Participants completed weekly and daily assessments throughout the study, attended 7 sessions of treatment, and underwent a final diagnostic assessment 4 weeks after completing treatment. Emotion regulation skills training was hypothesized to increase distress tolerance, reduce worry, and lead to a remission in anxiety disorder diagnoses. Overall, the hypotheses were partially supported. Six participants displayed a reliable reduction in worry and 5 experienced an increase in distress tolerance at the follow-up assessment. Most participants still met criteria for at least one anxiety disorder after completing the study, indicating continued functional impairment from symptoms. Only 2 participants experienced complete remission of all clinical diagnoses. The results failed to show a consistent pattern of improvement, indicating that emotion regulation skills training alone may not be sufficient for robust, sustained reductions in anxiety disorder symptoms. However, results do support that worry and emotional distress tolerance can be changed through emotion regulation skills training. The small sample size limits the test of hypotheses. Suggestions for future research based on this study include incorporating interpersonal emotion regulation strategies with this treatment approach, repeating the treatment module to facilitate mastery of skills, or utilizing a group format for skills development