Cognitive Therapy and Research

, Volume 42, Issue 2, pp 121–134 | Cite as

Increased Attention Regulation from Emotion Regulation Therapy for Generalized Anxiety Disorder

  • Megan E. Renna
  • Saren H. Seeley
  • Richard G. Heimberg
  • Amit Etkin
  • David M. Fresco
  • Douglas S. Mennin
Original Article


Dysfunction in the ability to sustain, shift and broaden attention has been proposed as a mechanism of normative emotion regulation that is a common target of cognitive-behavioral therapies. Attention regulation deficits are central to generalized anxiety disorder (GAD) and may contribute to a generally rigid, avoidant, response style that produces substantial decrements in well-being and functioning. Emotion Regulation Therapy draws upon mindfulness-based regulatory skills to facilitate attentional change during an initial phase of treatment. Two studies examined task-based changes in flexibly shifting attention in response to conflicting emotional contexts and sustaining attention despite distressing emotional contexts. In Study 1, at pre-treatment, patients with GAD, as compared to controls performed significantly more poorly on an emotional conflict adaptation task (i.e., less ability to flexibly shift attention) and improved in conflict adaptation by mid-treatment (when attention regulation skills were being trained). This task-related change predicted increases in mindful observing abilities over the course of acute treatment but was not directly associated with clinical outcomes. In Study 2, a choice reaction time (RT) task was utilized to measure the ability to sustain attention by discriminating between two tones while overcoming the interference of aversive visual stimuli. At pre-treatment, participants with GAD demonstrated slower RTs (i.e., more difficulty sustaining attention on the tonal prompt) compared to controls and demonstrated more rapid RTs from pre- to mid-treatment. This improved task performance was related to clinical improvement and decreased functional impairment. RT change was also associated with greater nonreactivity towards experiences. Overall, these findings suggest that targeting mindful regulation skills improve attention regulation in individuals with GAD and may partially account for efficacious clinical outcomes throughout treatment.


Emotion regulation therapy Generalized anxiety disorder Emotional interference Attention regulation Mindfulness Conflict adaptation Emotional Stroop 



This study was funded by the National Institute of Mental Health (NIMH; 1R34 MH070682).

Compliance with Ethical Standards

Conflict of interest

Megan E. Renna, Saren H. Seeley, Richard G. Heimberg, Amit Etkin, David M. Fresco, Douglas S. Mennin declares that they have no conflict of interest.

Ethical Approval

This study was approved by the IRB board of Yale University and Temple University.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Research Involving Human Participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


David M. Fresco was supported by National Heart, Lung, and Blood Institute Grant R01HL119977 and National Institute of Nursing Research Grant P30NR015326.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Megan E. Renna
    • 1
  • Saren H. Seeley
    • 2
  • Richard G. Heimberg
    • 3
  • Amit Etkin
    • 4
    • 5
    • 6
  • David M. Fresco
    • 7
    • 8
  • Douglas S. Mennin
    • 1
  1. 1.Teachers CollegeColumbia UniversityNew YorkUSA
  2. 2.The University of ArizonaTucsonUSA
  3. 3.Temple UniversityPhiladelphiaUSA
  4. 4.Department of Psychiatry and Behavioral SciencesStanford Neuroscience InstituteStanfordUSA
  5. 5.Stanford UniversityStanfordUSA
  6. 6.Sierra Pacific Mental Illness Research Education and Clinical CenterPalo Alto VALivermoreUSA
  7. 7.Kent State UniversityKentUSA
  8. 8.Case Western Reserve Medical CenterClevelandUSA

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