(PS9-60) Core Dysfunctions in Youth Emotional Disorders: How Are They Related and How Effectively Are They Targeted by a Transdiagnostic Treatment Protocol?

Abstract Text: Emotional disorders are highly prevalent and often comorbid in youth, which may be attributed to shared core dysfunctions across disorders, such as elevated anxiety sensitivity (AS), decreased distress tolerance (DT), and difficulties with emotion regulation (ER). The implication of these factors in the development and maintenance of emotional disorders in youth makes them important treatment targets and is often the rationale for transdiagnostic treatment protocols. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C/A) aims to target AS, DT, and ER. The present study aims to better understand the relationship between AS, DT, and ER in youth with emotional disorders and how they may function as mechanisms of change in the UP-C/A.

We analyzed AS, DT, and ER in a sample of 592 treatment-seeking youth with emotional concerns (Mage=11.63, 52.2% female, 67.5% Hispanic/Latine). Children completed self-report questionnaires pre- and post-treatment to measure AS (Child Anxiety Sensitivity Index), DT (Distress Tolerance Scale), and ER (Emotion Regulation Questionnaire). Emotional disorder symptoms were assessed with the Revised Child Anxiety and Depression Scale (RCADS). Bivariate correlations were calculated to analyze the relationships between AS, DT, ER and emotional disorder symptoms pre- and post-treatment. Paired samples t-tests were performed to analyze change in core dysfunctions and emotional disorder symptoms after receiving the UP-C/A. Difference scores were calculated and linear regressions were performed to examine if changes in core dysfunctions predicted symptom change.

At baseline, AS, DT, and ER were significantly associated with each other and with emotional symptoms, with DT most highly correlated with RCADS score (r=-0.518, p < 0.001). Post-treatment, AS remained significantly associated with DT and ER, while DT and ER were no longer correlated. All core dysfunctions remained significantly associated with emotional symptoms, with the strongest correlation between AS and RCADS score (r=0.561, p< 0.001). After receiving the UP-C/A, significant improvements were seen in AS (t=5.054, p< 0.001), DT (t=-5.416, p< 0.001), and ER (t=1.909, p=0.029) and overall emotional disorder symptoms were significantly reduced (t=7.517, p< 0.001). Linear regression analyses showed changes in AS (R2=0.470, p< 0.001), DT (R2=0.150, p< 0.001), and ER (R2=0.044, p=0.009) predicted symptom change independently and when considered collectively (R2=0.484, p< 0.001).

These findings indicate AS, DT, and ER are all interrelated constructs that are both independently and collectively associated with emotional disorder symptoms pre- and post-treatment. Improvements in core dysfunctions and emotional symptoms post-treatment suggests AS, DT, and ER were targeted by the UP-C/A and resulted in emotional symptom reductions. These findings emphasize the importance of understanding shared core dysfunctions in youth emotional disorders and how they are targeted by treatment protocols. Future work should further parse the individual contributions of AS, DT, and ER to emotional disorder symptoms to identify which factors may be most effectively targeted in treatment.