Successful Application of Adaptive Emotion Regulation Skills Predicts the Subsequent Reduction of Depressive Symptom Severity but neither the Reduction of Anxiety nor the Reduction of General Distress during the Treatment of Major Depressive Disorder

<div><p>Objective</p><p>Deficits in general emotion regulation (ER) skills have been linked to symptoms of depression and are thus considered a promising target in the treatment of Major depressive disorder (MDD). However, at this point, the extent to which such skills are relevant for coping with depression and whether they should instead be considered a transdiagnostic factor remain unclear. Therefore, the present study aimed to investigate whether successful ER skills application is associated with changes in depressive symptom severity (DSS), anxiety symptom severity (ASS), and general distress severity (GDS) over the course of treatment for MDD.</p><p>Methods</p><p>Successful ER skills application, DSS, ASS, and GDS were assessed four times during the first three weeks of treatment in 175 inpatients who met the criteria for MDD. We computed Pearson correlations to test whether successful ER skills application and the three indicators of psychopathology are cross-sectionally associated. We then performed latent growth curve modelling to test whether changes in successful ER skills application are negatively associated with a reduction of DSS, ASS, or GDS. Finally, we utilized latent change score models to examine whether successful ER skills application predicts subsequent reduction of DSS, ASS, or GDS.</p><p>Results</p><p>Successful ER skills application was cross-sectionally associated with lower levels of DSS, ASS, and GDS at all points of assessment. An increase in successful skills application during treatment was associated with a decrease in DSS and GDS but not ASS. Finally, successful ER skills application predicted changes in subsequent DSS but neither changes in ASS nor changes in GDS.</p><p>Conclusions</p><p>Although general ER skills might be relevant for a broad range of psychopathological symptoms, they might be particularly important for the maintenance and treatment of depressive symptoms.</p></div

Correlations of ERSQ_total Score and the DASS Scales for Each Assessment Point.

<p>Correlations of ERSQ_total Score and the DASS Scales for Each Assessment Point.</p

Path Diagram of the Bivariate Latent Change Score Model.

<p>ERSQ = Emotion-Regulation Skills Questionnaire, DASS = Depression Anxiety Stress Scale, SERSA = Successful Emotion Regulation Skills Application, DSS = Depressive Symptoms Severity, r = cross-construct error covariance, i = intercept, s = slope, γ = coupling parameter, β = proportion parameter, Δ = latent change score; for purpose of clarity, cross-construct error covariances are only shown for T4, but are also included for the other measurement points; error variances were set equal within constructs; loadings of growth factors and autoregressive proportions were set equal to one; proportion and coupling parameters were set equal across time within constructs; for model identification, means of errors and intercept of observed variables were set equal to zero <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0108288#pone.0108288-Ferrer1" target="_blank">[81]</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0108288#pone.0108288-McArdle5" target="_blank">[89]</a>.</p

Bivariate LCS Models: Stepwise Test of Coupling Effects (Δ χ²/Δ df for comparisons with no-coupling model).

<p>Bivariate LCS Models: Stepwise Test of Coupling Effects (Δ χ²/Δ df for comparisons with no-coupling model).</p

Latent Growth Curve Model: Parameter Estimates for Intercepts, Slopes and Correlations of Slopes and Intercepts.

<p>Latent Growth Curve Model: Parameter Estimates for Intercepts, Slopes and Correlations of Slopes and Intercepts.</p

Bivariate Latent Change Score Model: Estimates of Regression Coefficients.

<p>Bivariate Latent Change Score Model: Estimates of Regression Coefficients.</p

Demographic and Clinical Characteristics at Baseline.

<p><i>Note.</i> TAU = Treatment As Usual, CT = Cognitive Therapy, IQR = Interquartile Range, VAMS = Visual Analogue Mood Scale.</p>a<p>All values represent mean (SD) unless stated otherwise.</p

Flow Chart.

<p>Flow Chart.</p

Forest Plot.

<p>Forest Plot.</p

Additional file 1: Figure 2. of European COMPARative Effectiveness research on blended Depression treatment versus treatment-as-usual (E-COMPARED): study protocol for a randomized controlled, non-inferiority trial in eight European countries

Schedule of enrolment, interventions, and assessments in line with SPIRIT. (DOC 58 kb