Emotion dysregulation as a cross-cutting target for inpatient psychiatric intervention

Background This prospective, open effectiveness trial examined trajectories of change in a cross-cutting measure of emotion dysregulation in an intensive multimodal inpatient treatment for adults experiencing serious mental illness (SMI). Methods Adult inpatients with SMI (N=994) completed an average of 38.6 days of inpatient treatment. Latent growth curve (LGC) methods were used to model emotion dysregulation trajectories, estimating expected remission based on individual patterns of change. Results Absolute reductions in experiential avoidance (d=1.03, CI_95% [.94, 1.10]) and emotional dysregulation were substantial with large effect size improvements (d=.98, CI_95% [.90, 1.05]). Initial scores for experiential avoidance and emotion dysregulation were higher for patients with diagnoses of bipolar, depressive, anxiety, and personality disorders; whereas, male gender was associated with lower initial scores. Substance use diagnoses were associated with rapid improvement in experiential avoidance and specific emotion dysregulation involving goal-directed behavior and impulse control. Presence of a personality disorder predicted rapid improvement in overall emotion dysregulation and clarity of emotional experiences. Conclusions Adults with SMI demonstrated substantial improvement in experiential avoidance and emotion dysregulation over the course of intensive inpatient treatment, with significant variability in patterns of change. Substance use and personality disorders were associated with rapid improvements in specific aspects of emotion dysregulation.