The relationship between expressive suppression, therapeutic bond, and treatment outcomes of a positive affect intervention for adults with anxiety and/or depression

ABSTRACT

Expressive suppression (ES; reducing emotional expression) is linked with reduced social connectedness in individuals with anxiety or depression. One implication is that people who use ES may have difficulty establishing a bond with their therapist which may impede clinical improvement. We examined this hypothesis in 33 adults with clinically elevated anxiety or depression receiving treatment focused on enhancing positive thoughts, emotions, and behaviors. At baseline, participants rated ES for positive and negative emotions during a standardized conversation task designed to generate connectedness. They also rated measures of early (session 3) perceived therapeutic bond and treatment outcomes (i.e. positive affect and social connectedness). ES of positive (r = -.39, p = .018), but not negative (r = .06, p = .747), emotions was negatively associated with therapeutic bond. Therapeutic bond mediated the relationship between greater ES of positive emotions during affiliation and lower post-treatment positive affect, 95% bias-corrected bootstrap confidence interval [−0.021, −0.000], adjusted for pre-treatment positive affect, as well as lower post-treatment social connectedness [−0.397, −0.015]; however, the indirect effect was not significant when accounting for pre-treatment social connectedness (p > .05). ES of positive emotions may be an important factor in the development of therapeutic bond and therefore treatment outcomes for individuals with anxiety or depression.

KEYWORDS:

• Anxiety
• depression
• therapeutic bond
• working alliance
• expressive suppression
• positive emotions

Disclosure statement

Charles T. Taylor declares that in the past 3 years he has been a paid consultant for Bionomics and receives payment for editorial work for UpToDate and the journal Depression and Anxiety. Murray B. Stein declares that he has in the past 3 years received consulting income from Actelion, Acadia Pharmaceuticals, Aptinyx, atai Life Sciences, Boehringer Ingelheim, Bionomics, BioXcel Therapeutics, Delix Therapeutics Eisai, Clexio, EmpowerPharm, Engrail Therapeutics, Janssen, Jazz Pharmaceuticals, and Roche/Genentech. Dr. Stein has stock options in Oxeia Biopharmaceuticals and EpiVario and receives payment for editorial work for UpToDate and the journal Biological Psychiatry. Samantha N. Hoffman declares no conflict of interest.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/16506073.2024.2321891

Notes

1. We removed pre-registered analyses examining the association between ES of positive/negative emotions and treatment outcomes from the main text as this association was not central to our research question. Results of these analyses are presented in the Supplemental Material.

2. Participants rated other questions measuring affect and connectedness during the social affiliation task that are described in Hoffman et al. (2021).

3. The PANAS and PROMIS PA were administered every other session during treatment. Results remained consistent when the last available datapoint for the PANAS PA (i.e. last observation carried forward) was imputed for the three participants with incomplete post-treatment data.

Additional information

Funding

This research was supported by grants awarded to Charles T. Taylor from the National Institute of Mental Health [R61MH113769]. The project described was partially supported by the National Institutes of Health, Grant [ULTR001442] of CTSA funding beginning August 13, 2015, and beyond. The sponsors had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.