Testing Reciprocal Within-Person Changes in Aversive Reactions to Emotions and Skill Use in the Unified Protocol

Emotional disorders are thought to be maintained in large part by the experience of frequent and intense negative emotions and aversive reactions to these emotions. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) was designed to teach patients skills to manage aversive reactions and reduce the frequency and intensity of negative emotions. However, it is unclear how skill use and aversive reactions are related to each other in this treatment. Participants (N = 70; M_age = 33.75, 67% female, 74% White, 74% heterosexual) completed measures of aversive reactivity, skillfulness, anxiety, and depression before each session. We used hierarchical linear modeling to explore if within-person changes in aversive reactivity predicted residualized session-to-session changes in skill use and if within-person changes in skill use predicted residualized session-to-session changes in aversive reactivity. We then used multilevel mediation analyses to test whether aversive reactivity or skill use mediated the effect of the other construct on changes in anxiety and depression. Within-person increases in skillfulness significantly predicted session-to-session improvements in cognitive skills and mindfulness but did not predict improvements in any aspect of aversive reactivity. Within-person changes in aversive reactivity did not significantly predict changes in skillfulness. Between-person changes in skillfulness were significantly related to changes in between-person aversive reactivity. Only the indirect effect of skillfulness through mindfulness on anxiety/depression was significant. These results suggest that aversive reactivity and skillfulness may be relatively independent constructs.