Table of Contents:
Ample empirical studies provide evidence for the efficacy of psychotherapeutic treatments of mood disorders. Despite the availability of effective pharmacological and psychological treatments, many patients treated with these interventions fail to attain complete remission but show substantial residual symptoms. Moreover, a clinical significant number of relapses after the treatment is discontinued and a chronic course of the disorder have been found. In sum, these findings provide support for a limited short- and long-term efficacy of contemporary treatment methods.
To date systematic reviews show significant association between deficits in emotion regulation and affective disorders. However, prospective studies examining the reciprocal relationship of both concepts over the course of inpatient therapy are still rare. Therefore, this dissertation deals with the improvement of the existing psychotherapeutic interventions and focuses on deficits in emotion regulation as a potentially relevant factor for the development and maintenance of depression and anxiety disorders.
Study 1 and 2 examine the long-term effect of emotion regulation on symptoms of anxiety and depression. Moreover, we investigated which specific emotion regulation skills (Berking, 2015; Berking & Whitley, 2014) were associated with subsequent symptom load. An online-assessment revealed that emotion regulation skills predicted subsequent anxiety and depressive symptom severity five years after baseline assessment. In contrast, the cross-lagged effects of anxiety and depression on subsequent emotion regulation have not been significant in both studies. These findings provide preliminary evidence for the hypothesis that deficits in emotion regulation contribute to the development and maintenance of anxiety and depression. Moreover, explorative analyses examining the reciprocal relationship between the specific emotion regulation skills and subsequent symptom load show that acceptance, tolerance and clarity of undesired affective states as well as the willingness to confront those had the strongest prospective effects on subsequent anxiety symptom severity. A comparison of the effect sizes for different emotion regulation skills on subsequent symptoms of depression suggests that most of the skills included have similiar predicitve value. In sum, study 1 and 2 provide evidence for the importance of emotion regulation on the development and mainteance of mood disorders in a nonclinical sample.
Study 3 assessed the reciprocal relationship between emotion regulation and symptoms of depression, anxiety disorders, and general disstress over the course of the first three weeks of inpatient treatment. Latent growth curve models were conducted to test whether changes in successful emotion regulation skill application would be negatively associated with a reduction of symptom load or whether the opposite direction would be empirically supported. During the course of treatment for Major Depressive Disorder successful emotion regulation skills application negatively predicted changes in subsequent depressive symptom severity. However, successful emotion regulation skills application did neither predict subsequent anxiety symptom severity nor general disstress.
In sum the present dissertation provides evidences that (1) emotion regulation is a relevant factor for the development and maintenace of anxiety and depressive symptom severity in a nonclinical sample; (2) over the course of inpatient therapy more adaptive emotion regulation skills lead to a reduction of depressive symptoms. Therefore, a systematic emotion regulation training may be an important target that enhances the efficacy of cognitive behavioral therapy for MDD; (3) the transdiagnostic relevance of emotion regulation over the course of inpatient treatment needs to be further examined.