Emotion regulation in short-term dynamic therapy: Attachment-moderated changes and bidirectional temporal associations with symptoms.

This study examined changes in emotion regulation difficulties during short-term dynamic psychotherapy and their temporal relationship with symptom change, considering attachment styles as potential moderators. Sixty-three patients with mild to moderate depression and/or anxiety underwent 16 weeks of supportive–expressive therapy. Emotion regulation difficulties, symptoms, and attachment styles were assessed using self-report measures. Contrary to hypotheses, no overall improvement in emotion regulation difficulties was observed. However, patients with high attachment avoidance showed increased emotional clarity, while those with anxious attachment demonstrated greater acceptance of negative emotions over time. A deterioration in emotion regulation strategies was observed across all patients, particularly among those with avoidant attachment. Cross-lagged panel analysis revealed complex temporal dynamics: bidirectional relationships between emotion regulation and symptoms during early sessions, decoupling in intermediate sessions, and unidirectional effects (regulation predicting symptoms) in late sessions. These findings highlight the complex phase-dependent dynamics of emotion regulation change in short-term psychodynamic psychotherapy. The results emphasize the importance of considering both treatment phase and attachment styles when addressing emotion regulation difficulties in therapy. (PsycInfo Database Record (c) 2025 APA, all rights reserved) Question: How do attachment styles influence emotion regulation changes during short-term dynamic psychotherapy, and what temporal patterns emerge between emotion regulation difficulties and symptoms across treatment phases? Findings: Emotion regulation changes differently according to attachment style, and emotion regulation-symptom dynamics shift systematically across treatment phases from bidirectional to unidirectional relationships. Meaning: Clinicians should adapt interventions to both patient attachment style and current treatment phase, given the evolving dynamics between emotion regulation and symptoms. Next Steps: Future research should investigate optimal treatment duration and follow-up outcomes, and examine whether these temporal patterns generalize across diverse therapeutic modalities and treatment phases.