Cognitive reappraisal and expressive suppression as processes of change in transdiagnostic guided self-help cognitive...

Processes of change in cognitive behavioral therapies (CBTs) remain frequently debated, perhaps due to methodological difficulties in conducting rigorous process research. We investigated two contrasting emotion regulation strategies, cognitive reappraisal and expressive suppression, as processes of change in CBT disaggregating within- from between-person changes.

We examined whether week-to-week changes in cognitive reappraisal and expressive suppression (Emotion Regulation Questionnaire) predicted subsequent changes in distress (Kessler-6 Psychological Distress Scale) and well-being (World Health Organization-5 Well-Being Index) pooling two trials of a guided self-help CBT based on acceptance and commitment therapy. We used a random-intercept cross-lagged panel model to disaggregate between- versus within-person changes. Participants (N = 274) were 82% female, 80% non-Hispanic White, and mean age 37 years (SD = 13).

At the within-person level, week-to-week changes in reappraisal were consistently associated with subsequent changes in distress but less consistently with well-being. Changes in expressive suppression were less consistently associated with subsequent changes in distress or well-being. The associations between reappraisal and distress were robust to different model specifications, including detrending.

Cognitive reappraisal may be involved in the process of change in CBTs, including the so-called "third-wave" CBTs, which have traditionally de-emphasized its importance. (PsycInfo Database Record (c) 2026 APA, all rights reserved).