Which emotion regulation strategies are mediating the outcome of acceptance and commitment therapy compared to cognitive-behaviour therapy in the treatment of anxiety symptoms?

In 30 seconds

This randomized controlled trial examined whether changes in emotion regulation strategies explained differences between acceptance and commitment therapy (ACT) and cognitive-behaviour therapy (CBT) for anxiety symptoms in 314 older adults. Participants completed self-report measures of anxiety and proposed mediators five times during treatment. ACT differentially affected acceptance, suppression, and distraction, while changes in most mediators were associated with anxiety outcomes at the same time point. However, no emotion regulation variable mediated ACT’s effect; cognitive reappraisal alone predicted subsequent anxiety levels, and anxiety also predicted later reappraisal, irrespective of treatment.

Key findings

• ACT differentially affected acceptance, suppression, and distraction compared with CBT.
• Changes in all proposed mediators except acceptance had significant cross-sectional associations with anxiety outcomes.
• Cognitive reappraisal predicted subsequent anxiety levels, and anxiety predicted subsequent reappraisal, irrespective of treatment.
• None of the emotion regulation variables mediated the effect of ACT.

Why it matters

The findings distinguish concurrent associations from evidence that a process precedes and explains treatment outcomes. Although several emotion regulation strategies changed differently between therapies or tracked with anxiety, the longitudinal analyses did not support them as mediators of ACT’s effect. This cautions against assuming that a strategy associated with symptom change is necessarily the mechanism producing it.

What to keep in mind

Anxiety severity and proposed mediators were assessed using self-report questionnaires; the abstract does not report other study limitations.