Investigating Potential Mechanisms of Change Within Community Mental Health Treatment for Adolescent Emotional Disorders

Objective Single domain cognitive-behavioral therapy (CBT) protocols for adolescents with anxiety or depression demonstrate strong efficacy in clinical trials but poorer effectiveness in community settings. Transdiagnostic CBT targeting core dysfunctions shared across emotional disorders may address barriers to treatment effectiveness, although relatively little is known about mechanisms of transdiagnostic CBT in community settings.Method This study examined concurrent and prospective associations between distress intolerance and avoidance and improvement in emotional symptoms within an effectiveness trial. Adolescents (N = 196; M = 15 years old; 65% female; 61% White; 59% Non-Hispanic/Latino) were randomly assigned to receive treatment as usual (TAU; n = 68), treatment as usual with measurement-based care (TAU+; n = 60), or the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents with measurement-based care (UP-A; n = 68). Distress intolerance was measured using self-report measures of adolescents’ perceived distress intolerance and distress intolerance during a frustration task. Avoidance was measured using self-report measures of emotional and experiential avoidance. Emotional symptom measures included self-reports of anxiety, depression, related behavioral symptoms, and broad psychosocial functioning.Results Distress intolerance and avoidance improved significantly during treatment across all conditions. There were no differences in amounts of improvement in distress intolerance or avoidance by treatment condition. Within-person improvements in distress intolerance and avoidance were associated with lower levels of concurrent emotional symptoms but were not prospectively associated with lower emotional symptoms at the subsequent assessment.Conclusions Findings can inform efforts to augment emotion-focused interventions implemented in community settings and refine the measurement of purported core dysfunctions of emotional disorders in heterogenous populations.