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Purpose <p>Emotion regulation (ER) strategy use typically improves during treatment for depression, but most research does not consider between- and within-person fluctuations over time during psychotherapy. In individuals with depression receiving psychotherapy, this study aimed to model both between- and within-person variations within a multilevel structure of daily ER strategies and examined how ER strategies changed over time and with depression.</p> Methods <p>Participants were 56 adults diagnosed with depression and receiving virtual psychotherapy. Over 12 weeks, participants completed 21 days of experience sampling across three “burst” weeks (four surveys/day), reporting ER strategies, motivation to change emotions, and perceived difficulties in ER. A series of multilevel models were used for analyses.</p> Results <p>Multilevel exploratory factor analysis identified two between-person and four within-person ER strategy groupings, with Avoidant and Engagement ER emerging at both levels. Multilevel growth models found decreased depression, use of Avoidant ER, and perceived ER difficulties over time. Within-persons, reduced depression was associated with less Avoidant and Engagement ER, decreased motivation to change, and reduced ER difficulties. Between-persons, those experiencing less depression at discharge reported greater overall ER use, less Avoidant ER, motivation to change, and more ER difficulties.</p> Conclusions <p>Reduced depression was associated with less within-person Avoidant and Engagement ER and between-person Avoidant ER, but not between-person engagement ER, underscoring importance of examining maladaptive ER to understand treatment responses. Moreover, both within- and between-person levels of variability are important to consider for depression psychotherapy research.</p>

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Multilevel Structure of Emotion Regulation Strategies and Daily Associations with Treatment Outcomes During Virtual Psychotherapy for Depression: An Experience Sampling Study

  • 期刊论文

  • 发表日期：

    2025年11月13日

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  • Olive Chung-Hui Huang,
  • Alexander R. Daros,
  • Matthew W. Southward,
  • Jeffrey D. Wardell,
  • Lena C. Quilty

摘要

Purpose

Emotion regulation (ER) strategy use typically improves during treatment for depression, but most research does not consider between- and within-person fluctuations over time during psychotherapy. In individuals with depression receiving psychotherapy, this study aimed to model both between- and within-person variations within a multilevel structure of daily ER strategies and examined how ER strategies changed over time and with depression.

Methods

Participants were 56 adults diagnosed with depression and receiving virtual psychotherapy. Over 12 weeks, participants completed 21 days of experience sampling across three “burst” weeks (four surveys/day), reporting ER strategies, motivation to change emotions, and perceived difficulties in ER. A series of multilevel models were used for analyses.

Results

Multilevel exploratory factor analysis identified two between-person and four within-person ER strategy groupings, with Avoidant and Engagement ER emerging at both levels. Multilevel growth models found decreased depression, use of Avoidant ER, and perceived ER difficulties over time. Within-persons, reduced depression was associated with less Avoidant and Engagement ER, decreased motivation to change, and reduced ER difficulties. Between-persons, those experiencing less depression at discharge reported greater overall ER use, less Avoidant ER, motivation to change, and more ER difficulties.

Conclusions

Reduced depression was associated with less within-person Avoidant and Engagement ER and between-person Avoidant ER, but not between-person engagement ER, underscoring importance of examining maladaptive ER to understand treatment responses. Moreover, both within- and between-person levels of variability are important to consider for depression psychotherapy research.