The Relationships Among Emotion Regulation and Symptom Improvement During Trauma-Focused Cognitive Behavioural Therapy in a Community Sample

Objective. Children who have experienced trauma have been demonstrated to have problems with emotion regulation and there is a strong link between such difficulties and psychopathology in childhood. As such, numerous clinical interventions have been designed to help children learn to regulate their emotions in adaptive, socially appropriate ways. Despite the interest in helping children learn adaptive skills, it is not currently known whether these interventions effectively help children improve emotion regulation. Moreover, it is unknown whether improvements in emotion regulation lead to positive changes in psychopathology, particularly in children who have experienced trauma. The purpose of the current study was to look at the relationships between emotion regulation and symptomatology in a sample of children who have been exposed to trauma. Method. A community sample of traumatized children and their non-offending caregivers received Trauma-Focused Cognitive Behavioural Therapy. Data were collected at five time periods: (1) waitlist (n = 30), (2) pre-assessment (n = 107), (3) pre-treatment (n = 78), (4) post-treatment (n = 58), and (5) six-month follow-up (n = 44). Questionnaires measured emotion regulation [inhibition, dysregulation, lability/negativity, emotion regulation (ER) skill] and symptomatology [child-reported posttraumatic stress (PTS), parent-reported PTS, internalizing and externalizing symptoms]. Results. Results indicated that there was an association between emotion regulation and symptoms prior to beginning therapy, most consistently a link between lability/negativity and symptoms. Furthermore, as a group, children did improve in all maladaptive forms of emotion regulation throughout TF-CBT, but not ER skill, which is an adaptive form of emotion regulation. All improvement effect sizes were small. Finally, to the extent that children decreased their maladaptive acting out strategies (lability/negativity and dysregulation), their symptoms improved throughout TF-CBT therapy. Improvements in inhibition throughout therapy also predicted improvements in child-reported PTS symptoms. Conclusions. These findings suggest that emotion regulation is indeed a worthy target for clinical intervention and that improvements in emotion regulation can be made. However, the small magnitude of improvement suggests that further attention must be paid to the ways in which interventions target emotion regulation. Given that this area of investigation is in its infancy, suggestions for future research are discussed.