Emotion Regulation Mediates the Relationship Between Therapeutic Alliance and Anxiety in Emerging Adults During Inpatient Psychiatric Treatment

Abstract

Emerging adulthood is a critical developmental period characterized by emotional growth and unstructured living. To date, there is little research on emerging adults-defined as those 18 to 25 years old-with serious mental illnesses and even less on emerging adults in psychiatric hospitals. This study analyzed therapeutic alliance with the clinical team and change in anxiety symptoms in emerging adult psychiatric inpatients with the goal of establishing whether emotion regulation could serve as a mediator between these 2 constructs. Participants were 913 emerging adults (46.7% female; 18 to 25 y of age) who were voluntarily admitted to an intermediate length-of-stay (6 to 8 wk) inpatient psychiatric hospital. Each patient completed measures assessing anxiety symptoms, emotion regulation strategies, and working alliance as an assessment of therapeutic alliance. The results indicated that working alliance had significant indirect effects on change in anxiety symptoms through emotion dysregulation and lack of awareness, limited access to emotion regulation strategies, and lack of emotional clarity. This study emphasizes the need to understand emerging adults and the difficulties characteristic of this developmental period, and that clinicians should be aware that cognitive factors involved in emotion regulation may impact anxiety symptoms in emerging adult populations.

Therapeutic alliance is calming and curing—The interplay between alliance and emotion regulation as predictors of outcome in Internet-based treatments for adolescent depression.

“…Remaining problems with emotion regulation have been suggested as a risk factor for relapse in depression after treatment (Visted et al, 2018). Shepard et al (2022) found that emotion regulation mediated the relationship between early therapeutic alliance and improvement in anxiety for emerging adult inpatients. In their study, patients with lower scores on working alliance were more likely to experience higher emotion dysregulation, which in turn predicted less change in anxiety.…”