A person-centered approach to understanding heterogeneity of youth receiving transdiagnostic treatment for emotional disorders.

Abstract

Objective: Transdiagnostic models of youth psychopathology posit shared, underlying core features of emotional disorders that confer risk for and/or maintain symptoms. Youth may differ in the presence and severity of these underlying core features, and matching intervention strategies to such features may help personalize transdiagnostic interventions. We used latent profile analysis (LPA) to identify profiles of youth based on core underlying transdiagnostic dysfunctions and examined associations of profiles with treatment outcome. Method: LPA was conducted with 298 youth ages 7-18.8 (M age = 12, SD = 3.2; 48.7% female; primarily White and Hispanic/Latinx) with a primary emotional disorder. Indicators for LPA included self-report measures of affect, anxiety sensitivity (AS), distress tolerance (DT), and emotion regulation (ER). Longitudinal associations between profile membership and treatment outcome were examined in a subset of 177 youth (M age = 11.8, SD = 3.2; 52% female; primarily White and Hispanic/Latinx). Results: LPA identified three profiles characterized by differing levels of DT, affect, and ER. A Moderately Distressed and Dysregulated profile had the largest membership (65.1%) and poorer youth-reported anxiety and depression outcomes compared to a Distress Tolerant, Regulated Expressive profile (24.9%). A Distressed, High Affect Avoidant profile (10%) had the greatest baseline severity and the poorest depression outcomes, although most youth improved. Conclusions: Youth characterized by certain profiles of transdiagnostic core processes appear to have the poorest functioning and treatment prognosis, although most youth improved. Targeting these processes more directly and/or earlier in treatment may help to improve outcomes for youth. What is the public health significance of this article?This study examines whether youth with emotional disorders can be grouped into profiles based on broad transdiagnostic features, as well as whether these profiles predict response to transdiagnostic, cognitive-behavioral treatment. It suggests that youth who have difficulty tolerating distress and experience stronger negative reactions to emotions may have more severe symptoms and respond more poorly to treatment.

Sub-types of emotion dysregulation in youth with nonsuicidal self-injury: Latent class analysis of a randomized controlled trial

“…The results from the current study add to the growing field of baseline latent profiles/classes and their relationship with treatment outcomes, showing clinical utility in some cases (Frohlich et al, 2022;Kennedy et al, 2022) but not others (Gunlicks-Stoessel et al, 2019;Norris et al, 2020). For example, Kennedy et al…”

A daily diary study on stressors, hurt feelings, aggression, and somatic symptoms: The role of rejection sensitivity and negative emotion differentiation

“…Thus, emotion response systems may attenuate or exacerbate the association between stressors, hurt feelings, and possible ensuing symptoms. According to the unified protocol model of emotional disorders (Kennedy et al, 2022), certain personality traits (e.g., sensitivity to certain social cues), and emotion regulation strategies, such as frequent use of avoidance or suppression or inflexible use of regulation strategies, play a role in internalizing symptoms and externalizing behaviors. The current study focuses on two cognitive constructs: RS and negative emotion differentiation.…”

“…Empirical research shows that greater emotion differentiation is associated with improved ability to regulate negative emotions and mental health benefits (Ottenstein, 2020). Greater negative emotion differentiation is associated with fewer depression symptoms, less likely to use substance to cope with stressors, and more daily optimism (Brown et al, 2021; Kennedy et al, 2022; Starr et al, 2017; Yang, 2022). More frequent use of disengagement or avoidance strategies may lead to a rapid reduction in distress, which in turn negatively reinforces the use of avoidant strategies in regulating emotions and hinders the development or expansion of more adaptive repertoire of emotion regulation strategies.…”