Cognitive reappraisal and expressive suppression dynamics predict changes in distress across psychotherapy: Findings from the PsyCARE study

Abstract

Objective: Few studies have examined whether changes in emotion regulation strategies—cognitive reappraisal (CR) and expressive suppression (ES)—serve as change mechanisms across different psychological treatments. Therefore, we tested whether increases in CR and decreases in ES predict subsequent reductions in client distress and whether these processes are specific to Cognitive Behavioral treatments or represent non-specific mechanisms of change. Method: Participants were 1,116 adult outpatients (76.8% female; M = 34.2, SD = 10.8) treated by 947 licensed psychotherapists in the Italian PsyCARE study. Clients completed the Emotion Regulation Questionnaire (Gross & John, 2003), the Patient Health Questionnaire-9, and the Generalized Anxiety Disorder-7 at baseline, session 12, and 6-month follow-up. Polynomial regression and response surface analysis examined whether changes in CR and ES predicted later changes in distress, adjusting for therapist clustering. Results: Increases in CR and decreases in ES significantly predicted subsequent reductions in client distress. Response surface analysis showed that clients who increased CR and decreased ES by an equal amount exhibited the greatest decreases in distress. These effects were not moderated by treatment type, suggesting that CR and ES are non-specific mechanisms of change. Conclusion: The findings suggest that improving CR while reducing ES predicts improved outcomes across treatment approach, supporting emotional regulation as a general transdiagnostic mechanism of change.