Emotion regulation skills training for adolescents and parents in a clinical setting: a randomised controlled trial

BACKGROUND: Emotion dysregulation is a transdiagnostic construct associated with psychiatric symptomatology. Improving strategies to regulate emotions is an important focus in several psychological treatments. In the current study we investigated the effects of a brief seven-session emotion regulation skills training group for adolescents and parents in a randomised controlled trial in a naturalistic setting. METHODS: This non-blinded, randomised study recruited participants from two child and adolescent psychiatric outpatient clinics during Mars 2019 to January 2023. A total of 118 adolescents, 14 to 17 years old, were assessed and randomised to either a seven-session emotion regulation skills training group or to a control group. The intervention was transdiagnostic and open to all patients with few exclusion criteria. Both groups received treatment as usual consisting of multidisciplinary child and adolescent psychiatric care. Self-reported emotion dysregulation measured with the Difficulties in Emotion Regulation Scale was compared between the two arms after the intervention. Secondary outcomes were alexithymia, emotional awareness, symptoms of depression and anxiety and quality of life. RESULTS: Of 58 adolescents randomised to emotion regulation skills training group, 48 started the intervention and 36 completed it and were included in the final analysis. In the control group, 41 participants of the 60 randomised remained in the final analysis. Of the primary outcome measure Difficulties in Emotion Regulation Scale, only one subscale, Lack of Emotional Clarity, significantly decreased for the emotion regulation skills training group compared to the control group. There were no significant differences in overall emotion dysregulation. Significant reductions of Alexithymia, measured by Toronto Alexithymia Scale, were found in the intervention group compared to the control group. No other significant differences were found between groups in secondary outcomes. Exploratory within-group analyses pointed to a reduction in overall emotion dysregulation, indicating a further effect at three months post-intervention. CONCLUSIONS: The brief group-based emotion regulation skills training for adolescents and parents in child and adolescent psychiatric outpatient clinics, delivered adjunctive to treatment as usual, appears to improve certain aspects of emotion regulation, specifically emotional clarity and alexithymia. While it did not show effects on psychiatric symptoms or quality of life, explorative analyses indicate that it may reduce overall emotion dysregulation over time. Trial registration NCT03900533.