Emotion regulation training as a treatment element for externalizing problems in adolescence: A randomized controlled micro-trial

Improving interventions for externalizing problems in adolescence may require determining which treatment elements actually produce change. In this micro-trial, we tested a treatment element addressing one widely-hypothesized mechanism underlying externalizing problems: emotion regulation. We tested whether emotion regulation could be improved via training, whether adolescents who received such training would subsequently show reduced externalizing problems, and which training approach and sequence was most effective. We randomized 108 adolescents with elevated externalizing problems (71.3% boys, Mage = 13.66, SD = 1.10) to a control condition or an experimental condition teaching emotion regulation through either a cognitive or behavioral approach, in alternated sequences. Effects of the modules were assessed before and after the modules, and with weekly assessments. The results showed a positive effect of the experimental training on self-reported use of adaptive emotion regulation strategies. However, self-reported externalizing problems decreased more in the control condition than in the experimental condition. No mediation, approach (cognitive versus behavioral) or sequence (cognitive-behavioral versus behavioral-cognitive sequence) effects were found. These findings illustrate that change in a proposed mechanism may not be accompanied by change in targeted problems; this highlights the importance of testing the hypothesized impact of specific treatment elements on targeted mental health problems. This trial was registered in the Dutch Trial Register (NTR7334, July 10th, 2018) and the study protocol was published (te Brinke, Schuiringa, Menting, Deković, & de Castro, 2018).