Emotion Regulation Treatment for Alcohol Use Disorder: Results of a Stage II Randomized Clinical Efficacy Trial

Despite strong links between emotion regulation (ER) difficulties and problem drinking, few studies have directly addressed whether interventions that target ER positively impact drinking outcomes. In a prior Stage 1a/1b behavioral therapies development study, we developed an Emotion Regulation Treatment (ERT) for alcohol use disorder (AUD) that included strategies addressing prolonged direct experiencing of emotion, mindfulness, and coping and distress tolerance. Results demonstrated the feasibility and initial efficacy of ERT as a supplement to cognitive behavioral therapy (CBT) for AUD. Based on this initial success, the current study reports on a fully powered stage II randomized clinical efficacy trial to compare CBT plus ERT (CBT + ERT) to CBT plus an active health and lifestyles (HLS) control (CBT + HLS) and explore potential mechanisms of action.

Adults (n = 194) with moderate-to-severe AUD were enrolled in 12 week outpatient treatment and randomized to either the CBT + ERT or CBT + HLS treatment condition. Analyses evaluated (1) the impact of treatment condition on percent days abstinent (PDA) and percent heavy drinking days (PHDD) at end of treatment (EOT) and 3, 6, and 12 months posttreatment, and (2) whether change trajectories of negative affect, craving, mindfulness, cognitive reappraisal, or adaptive alcohol coping, assessed daily or weekly during treatment, partially accounted for associations between treatment condition and EOT alcohol outcomes.

The CBT + ERT group had greater PDA at all posttreatment follow-ups relative to the CBT + HLS group. There were no group differences in PHDD. Levels of PDA and PHDD did not change across posttreatment follow-ups for either group. The CBT + ERT group exhibited greater adaptive alcohol coping across the first week of treatment, which in turn was associated with higher PDA and lower PHDD at EOT. No other mediation effects were detected.

CBT + ERT was associated with greater PDA at EOT relative to CBT + HLS, an association that was partially explained by greater adaptive coping early in treatment.