(PS9-58) Change in Cognitive Reappraisal and Symptoms in Major Depression and Social Anxiety During Psychotherapy: A Structural Equation Modeling Approach

Abstract Text: Cognitive reappraisal (‘reappraisal’) is an adaptive emotion regulation strategy shown to increase in patients with internalizing disorders (e.g., depressive disorders, anxiety disorders) following cognitive behavior therapy (CBT). Prior work also shows symptom severity decreases following treatment with CBT or supportive therapy (ST) in patients with major depressive disorder (MDD) or social anxiety disorder (SAD). Yet, the trajectories of reappraisal and symptom change over the course of psychotherapy are unclear. Thus, the objective of the current study was to take an exploratory transdiagnostic approach to advance our understanding of changes in reappraisal as a potential mechanism of symptom change using structural equation modelling (SEM). Unmedicated treatment-seeking participants diagnosed with MDD (n=56) or SAD (n=56) were randomized to 12 sessions of weekly CBT or ST. A validated self-report measure of reappraisal and validated clinician-administered measures of symptom severity (social anxiety, depression) were collected at baseline and every two weeks across treatment. Thus, these measures were collected at 7 time points in total. A composite score was used to evaluate symptom severity in SEM. Bivariate latent growth curve analysis collapsed across treatment arm and diagnostic status was utilized to evaluate the simultaneous trajectories of reappraisal and symptoms. Results revealed significant increases in reappraisal (β = 1.77, p = .017) and decreases in symptom severity (β = -10.99, p < .001) across treatment. The intercepts were negatively correlated (β = -12.03, p = .049), such that reappraisal and symptom severity had a negative association at baseline. Neither baseline reappraisal nor symptom severity predicted later change in either measure (all p’s > .287). Yet, the slope of reappraisal predicted the slope of symptom severity (β = -17.7, p = .016), suggesting that increases in reappraisal were associated with decreases in symptom severity across treatment. Altogether, findings indicate that reappraisal negatively corresponds with symptom severity and reappraisal plays an important dynamic role in psychotherapy response in patients with MDD or SAD. Evidence that baseline symptom severity and reappraisal did not predict later change suggests these factors may not serve as predictors of treatment outcome. Findings have the potential to increase our understanding of psychotherapy mechanisms of change in MDD and SAD, which may inform treatment modification efforts to improve treatment outcomes.