title: Intensive inpatient treatment improves emotion-regulation capacities among adults with severe mental illness.
abstract: BACKGROUND
  Impaired capacity for emotion regulation is associated with a broad spectrum of psychiatric disturbances; however, little is known about treatment response in emotion regulation functioning among patients with severe mental illness. This study examined treatment response and the role that experiential avoidance plays in mediating the relationship between attachment anxiety/avoidance and change in emotion regulation.
  
  
  METHODS
  Difficulties in emotion regulation were assessed at admission and at discharge, and rates of improvement and deterioration in emotion regulation were calculated. Attachment anxiety and avoidance were assessed in conjunction with experiential avoidance at baseline in a large cohort (N = 493) of adults admitted to a specialized adult psychiatric hospital.
  
  
  RESULTS
  Inpatient treatment was associated with clinically significant improvement in emotion-regulation capacities for 49 percent of patients completing at least four weeks of treatment. Fifty-six percent of patients attained a status of recovery. Greater attachment avoidance and anxiety were related to positive change in emotion regulation at discharge. Experiential avoidance fully mediated the relationship between insecure attachment and change in emotion-regulation capacities.
  
  
  CONCLUSIONS
  Contrary to expectation, greater attachment insecurity (anxiety and avoidance) as well as greater experiential avoidance predicted improvement in emotion regulation. These counterintuitive findings add to a growing evidence base indicating that severity of psychopathology is associated with greater improvement in hospitalized patients. Results of the mediation analysis suggest that targeting experiential avoidance may be an effective augmentation in the treatment of impaired emotion regulation functioning.
authors.affiliation: The Menninger Clinic, 12301 Main Street, Houston, TX 77035 USA ; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA.
authors.forename: J Christopher
authors.initials: JC
authors.lastname: Fowler
authors.affiliation: The Menninger Clinic, 12301 Main Street, Houston, TX 77035 USA ; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA.
authors.forename: Jon G
authors.initials: JG
authors.lastname: Allen
authors.affiliation: The Menninger Clinic, 12301 Main Street, Houston, TX 77035 USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Hart
authors.affiliation: The Menninger Clinic, 12301 Main Street, Houston, TX 77035 USA.
authors.forename: Hanna
authors.initials: H
authors.lastname: Szlykh
authors.affiliation: The Menninger Clinic, 12301 Main Street, Houston, TX 77035 USA ; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Ellis
authors.affiliation: The Menninger Clinic, 12301 Main Street, Houston, TX 77035 USA ; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA ; Department of Psychology, University of Hawaii, 200 West Kawili St, Hilo, HI 96720 USA.
authors.forename: B Christopher
authors.initials: BC
authors.lastname: Frueh
authors.affiliation: The Menninger Clinic, 12301 Main Street, Houston, TX 77035 USA ; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Oldham
keywords: Attachment Insecurity; Emotion Regulation; Experiential Avoidance; Treatment Response