Abstract
Objective: There is a demonstrated link between the mental health and substance use comorbidities experienced by young adults, however the vast majority of psychological interventions are disorder specific. Novel psychological approaches that adequately acknowledge the psychosocial complexity and transdiagnostic needs of vulnerable young people are urgently needed. A modular skills-based program for emotion regulation and impulse control (ERIC) addresses this gap. The current one armed open trial was designed to evaluate the impact that 12 weeks exposure to ERIC alongside usual care had on young people's ability to regulate emotions, as well as examine potential moderating mechanisms.Methods: Seventy nine young people (50.6% male; M = 19.30; SD = 2.94) were enrolled to the 12 week intervention period. Twenty one practitioners from youth and community health services delivered relevant ERIC modules adjunct to usual care. Linear mixed effects regression (with random intercept) was used to examine change over time across the primary outcome of emotion dysregulation and secondary outcomes of depression, anxiety, stress, experiential avoidance and mindfulness. Moderation analyses were conducted to test whether the magnitude of change in emotion dysregulation moderated change over time in secondary outcomes.Results: Analyses revealed significant improvement in the primary outcome of emotion dysregulation with a moderate effect size (Mean Change = −10.24, 95% CI (−14.41, −6.06; Cohen's dav = −0.53), in addition to decreases in the secondary outcomes of depression, anxiety, stress and experiential avoidance. No improvements in mindfulness were reported. Moderation analyses revealed that the residualised change over time in emotion dysregulation moderated the change over time in symptoms of distress, depression, anxiety, stress, experiential avoidance, and mindfulness.Conclusion: Reductions in the severity of emotion dysregulation, depression, anxiety, stress and experiential avoidance are promising, and were evident despite the complexity of the participants and the diversity of the service setting. The improvements found in each outcome were only observed for those young people whose emotion regulation also improved, providing preliminary evidence for the role of emotion regulation as a key treatment target in this population.
Highlights
IntroductionVulnerable Young PeopleAdolescents and young adults (aged 16–25; young people), accessing primary mental health, alcohol and other drug (AOD), youth justice, and community health services, are arguably one of the most vulnerable groups in society (Mitchell et al, 2016; Howe et al, 2017)
These findings are consistent with a previous study of the ERIC intervention with acutely vulnerable young people in residential drug rehabilitation (Sloan et al, 2018) and emotion regulation intervention studies in other cohorts of vulnerable young people including those with borderline personality disorder (BPD) and Baseline (T1) M(SD)
= mean change, *p < 0.05; **p < 0.01; ***p < 0.001; 95% CI = 95% Confidence interval. aAll analyses adjusted for age, gender, service type and Aboriginal and/or Torres Strait Islander status.;bDERS-Total, Difficulties in Emotion Regulation Scale; DASS-Total, Depression Anxiety and Stress Scale; dDASS-Depression, Depression Anxiety and Stress Scale – Depression Scale; eDASS-Anxiety, Depression Anxiety and Stress Scale – Anxiety Scale; f DASS-Stress, Depression Anxiety and Stress Scale – Stress Scale; gAAQ-II, Acceptance and Action Questionnaire; CAMS, Cognitive and Affective Mindfulness Scale-Revised
Summary
Vulnerable Young PeopleAdolescents and young adults (aged 16–25; young people), accessing primary mental health, alcohol and other drug (AOD), youth justice, and community health services, are arguably one of the most vulnerable groups in society (Mitchell et al, 2016; Howe et al, 2017). A recent meta-analysis of five decades of youth psychological therapy found that empirical studies of treatment for concurrent disorders was limited (only 10 of 447 included trials), and produced strikingly smaller effect sizes than did single disorder treatment studies, with the impact of treatment on concurrent comorbidity not significant at post treatment follow up (Weisz et al, 2017). This in-depth appraisal highlights that treatment studies for concurrent conditions are in their infancy; participants with coexisting diagnoses are commonly excluded from trials (Weisz et al, 2017). Novel psychological approaches are needed that adequately acknowledge the psychosocial complexity and transdiagnostic needs of vulnerable young service users but that can be readily applied within real world clinical settings
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