Paths to better emotion regulation in couple therapy: Exploring ACEs and attachment

Objective: Emotion regulation (ER) is increasingly recognized as a key mechanism in couple therapy. However, little is known about how ER changes across treatment or how early adverse events and current attachment experiences shape this process. Methods: Using a sample of 308 married individuals in couple therapy, this study examined changes in ER difficulties across a total of 24 sessions. We also tested whether adverse childhood experiences (ACEs) and current attachment insecurity (anxiety, avoidance) predicted baseline levels and changes in ER. Results: Multilevel modelling showed a small but significant decline in ER difficulties across sessions. Both ACEs and insecure attachment were associated with higher baseline ER difficulties. However, only avoidant attachment predicted greater improvement over time. ACEs and attachment anxiety were unrelated to change. Variance analysis revealed that most variation in ER occurred between individuals (70%) and within individuals over time (23%), with minimal variance at the couple (5%) and therapist (2%) levels. Conclusion: Findings support ER as a dynamic treatment target and underscore the importance of assessing developmental history and current attachment insecurity to guide intervention.