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Emotion Regulation and Repetitive Negative Thinking Before and After CBT and SSRI Treatment of Internalizing Psychopathologies



Emotion regulation (ER) strategies (i.e., reappraisal, suppression) and repetitive negative thinking (RNT) tendencies (i.e., brooding rumination, worry) are transdiagnostic and contribute to the maintenance of internalizing psychopathologies. Cognitive Behavioral Therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) are both effective in reducing symptom severity, however, their impact on ER and RNT is unclear. Therefore, the goal of the current study was to examine whether CBT and SSRIs improved ER and RNT in a transdiagnostic sample.


The current sample comprised 91 patients with anxiety, depression, and/or posttraumatic stress disorder randomly assigned to receive either CBT (n = 45) or an SSRI (n = 46) and 49 healthy controls as a comparator group. Patients completed measures of clinical symptoms, reappraisal, suppression, brooding rumination, and worry before and after treatment. Controls completed the same measures at baseline.


Compared to controls, patients reported greater symptom severity, suppression, brooding, and worry, and less reappraisal. Both treatments improved symptom severity, ER, and RNT. However, patients who completed CBT reported greater improvement in reappraisal than patients who completed treatment with an SSRI. Finally, change in RNT, but not ER, was associated with symptom improvement.


Findings suggest treatment improves ER and RNT and provides preliminary evidence of a treatment modality effect on reappraisal.

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This work was supported by National Institute of Mental Health of the National Institutes of Health grant R01MH101497 (KLP) and in part by R01MH112705 (HK), T32MH067631 (CF), and the Center for Clinical and Translational Research (CCTS) UL1RR029879.

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Correspondence to Cope Feurer.

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Conflict of Interest

Cope Feurer, Jennifer Francis, Olusola Ajilore, Michelle G. Craske, K. Luan Phan, and Heide Klumpp declare that they have no conflict of interest.

Ethical Approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the local Institutional Review Board at the University of Illinois at Chicago.

Informed Consent

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

Animal Rights

No animal studies were carried out by the authors for this article.

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Feurer, C., Francis, J., Ajilore, O. et al. Emotion Regulation and Repetitive Negative Thinking Before and After CBT and SSRI Treatment of Internalizing Psychopathologies. Cogn Ther Res 45, 1064–1076 (2021).

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  • Psychotherapy
  • Medication
  • Cognitive processes
  • Repetitive negative thinking
  • Emotion regulation