Emotion regulation therapy added to CBT linked to higher abstinence in alcohol use disorder
A 194-person randomized trial found that adding emotion regulation treatment to cognitive behavioral therapy was associated with greater percent days abstinent across 12-month follow-up, compared to CBT plus a health and lifestyles control, with early improvements in adaptive coping partially explaining the effect.
Difficulty managing emotions is strongly linked to problem drinking, yet few studies have tested whether interventions targeting emotion regulation actually improve drinking outcomes. Researchers enrolled 194 adults with moderate-to-severe alcohol use disorder into a 12-week outpatient program and randomly assigned them to either cognitive behavioral therapy plus emotion regulation treatment (CBT + ERT) or CBT plus an active health and lifestyles control (CBT + HLS).
The ERT component included strategies for prolonged emotional exposure, mindfulness, and distress tolerance. At the end of treatment and across all follow-ups (3, 6, and 12 months), the CBT + ERT group showed significantly higher percent days abstinent compared to CBT + HLS. Notably, there were no differences between groups in percent heavy drinking days—meaning the benefit appeared in total abstinence rather than harm reduction. The researchers found that greater adaptive alcohol coping in the first week of treatment partially explained why CBT + ERT participants had higher abstinence rates at end of treatment. No other measured mechanism (negative affect, craving, mindfulness, or cognitive reappraisal) accounted for the difference. Abstinence levels remained stable from end of treatment through the 12-month follow-up in both groups, suggesting sustained benefit. The main limitation is that the control condition was an active treatment rather than treatment-as-usual, which may underestimate the true benefit of ERT.
The study's mechanism finding is notable: early improvements in adaptive coping—learning to cope with stress without alcohol—appeared within the first week and predicted longer-term abstinence success. This suggests that emotion regulation treatment works partly by giving people concrete skills to tolerate negative feelings early, which then cascades into better outcomes. The CBT + ERT effect was consistent across all three follow-up windows (3, 6, 12 months), with no decline in benefit over time. One nuance: the study measured 'percent days abstinent' (any abstinence) rather than complete abstinence, and found no group difference in heavy drinking days specifically—so the benefit wasn't universal across all drinking patterns. The active control (health and lifestyles education) is a methodological strength, as it controls for therapist attention and expectancy, but it may have dampened apparent differences if HLS was genuinely therapeutic.
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Open in Cadence →References
- Emotion Regulation Treatment for Alcohol Use Disorder: Results of a Stage II Randomized Clinical Efficacy Trial. — Alcohol, clinical & experimental research (Read the original)