Anxiety and depressive disorders are prevalent among youth and are often experienced concurrently or sequentially during development (Kroes et al., 2001; Costello, Erklani, & Angold, 2006). These disorders are also associated with weaker cognitive behavioral treatment (CBT) outcomes when experienced simultaneously in youth (e.g. Berman, Weems, Silverman, & Kurtines, 2000). Treatment research has begun to investigate the feasibility and efficacy of treating comorbid emotional disorders using transdiagnostic treatment approaches (Barlow et al., 2010; Ehrenreich et al., 2008). Evidence from adult and adolescent populations indicates that these more broadly focused treatment programs may offer benefits above and beyond disorder- and domain-specific protocols, leading to improvements in diagnostic severity and emotion regulation across a range of disorders and emotions (Ellard, Fairholme, Boisseau, Farchione, & Barlow, 2010; Ehrenreich-May & Remmes, 2010). The current study extends transdiagnostic treatment research to school-age children, ages 7-12, in a mental health clinic setting by investigating preliminary post-treatment outcomes and treatment acceptability in a recent open trial (N enrolled= 16; N completed treatment=13) of the Emotion Detectives Treatment Protocol (EDTP; Ehrenreich-May & Laird, 2009). Results revealed that participants experienced significant improvements in clinical severity ratings of principal and all related diagnoses, as well as in parent reported anxious and parent and child reported depressive symptoms at the post-treatment assessment. Additionally, parents reported gains in child coping and improvements in dysregulation across emotional domains (including worry, sadness, and anger). The EDTP had good retention rates, moderately good attendance, and parents and children reported high levels of treatment satisfaction. The results of this open trial provide preliminary evidence for the utility and acceptability of a transdiagnostic group protocol to treat both clinical anxiety disorders, as well as self- and parent-reported anxious and depressive symptoms for youth within a mental health setting. These results suggest that children may uniquely benefit from a more generalized, emotion-focused treatment modality, such as the EDTP, that can offer flexibility in its treatment targets to families as well as mental health clinicians.

Nonsuicidal self-injury (NSSI; i.e., the deliberate destruction of one’s own bodily tissue without suicidal intent and for reasons not socially sanctioned) is prevalent and associated with clinically serious consequences. There is a need for evidence-based, stand-alone treatments for this behavior as it presents across the full range of psychiatric disorders. Developing time-efficient and cost-effective interventions for NSSI has proven difficult given that the core components of treatment remain largely unknown. The aim of this study was to examine the specific effects on NSSI of mindful emotion awareness training and cognitive reappraisal, two transdiagnostic treatment strategies that directly address the functional processes that often maintain self-injury (i.e., relief or escape from aversive thoughts or feelings). Using a counterbalanced, combined series (multiple baseline and phase change) single-case experimental design, the unique and combined impact of these two four-week interventions was evaluated among diagnostically heterogeneous, self-injuring adults (N = 10; mean age = 21.3, range = 18 to 30 years). Hypotheses were that each intervention would produce clinically meaningful reductions in NSSI; adding the alternative intervention would have additive benefit for those who did not respond to the initial intervention alone; and reductions in NSSI would be maintained over a four-week follow-up phase. Results showed that 8 of 10 participants demonstrated clinically meaningful reductions in NSSI by the follow-up phase; six participants responded to one intervention alone, whereas adding the alternative intervention was associated with additive benefit for two participants. Group-based analyses indicated a statistically significant effect of study phase on NSSI (p < .001), with fewer NSSI urges and acts occurring after the interventions were introduced. The interventions were also associated with moderate to large reductions in anxiety (d = 0.89 – 1.09), depression (d = 0.79 – 1.09), and interference caused by symptoms (d = 0.61), and with improvements in skills-based mechanisms: mindful emotion awareness (d = 1.44) and reappraisal (d = 1.30). The results suggest that increasing mindful emotion awareness and cognitive reappraisal may be two key therapeutic strategies for reducing NSSI. Transdiagnostic, emotion-focused interventions delivered in time-limited formats can serve as practical yet powerful treatment approaches, especially for lower-risk self-injuring individuals.

Abstract  Individual psychological factors have been recognized to play an important role in the development of stress-related symptomatology. Despite extensive comorbidity between stress-related ill health and mood disorders, the advances in research on emotion regulation and transdiagnostics, have not been recognized in stress research to any considerable degree. In the current study, using a single subject design with multiple baselines across individuals (n=6), a transdiagnostic treatment intervention targeting maladaptive emotional regulation strategies was implemented on patients suffering from stress-related symptomatology. Results show that symptoms of exhaustion decreased in five of six participants on post-measures, with considerable convergence between measures of depression, anxiety and stress. Further investigation of treatment effects, alongside the processes linking emotion regulation and stress-related symptomatology are needed. / Sammanfattning  Individuella psykologiska faktorer spelar en viktig roll i utvecklingen av stressrelaterade symtom. Trots en omfattande samsjuklighet mellan å ena sidan stressrelaterad ohälsa, å andra sidan depression och ångest, har framsteg inom emotionsforskning och transdiagnostik inte uppmärksammats i någon stor utsträckning inom stressforskningen. I den aktuella studien användes en single subject design med multipla baslinjer mellan individer (n=6), för att implementera en emotionsinriktad transdiagnostisk behandling på patienter som lider av stressrelaterade symtom. Resultaten visar att fem av sex deltagare visade minskade tecken på utmattning efter genomgången behandling, med avsevärd konvergens mellan mått på depression, ångest och stress. För att kunna påvisa behandlingseffekter, samt förklara de processer som förbinder emotionsreglering och stressrelaterade symtom, behövs ytterligare forskning på området.