Biological and Behavioral Patterns of Emotion Dysregulation and Multisystemic Therapy Outcomes Open Access

Winiarski, Dominika Anne (2013)

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The present study examined whether cortisol and behavioral measures of emotion dysregulation assessed during the course of Multisystemic Therapy were associated with successful therapeutic outcome. The participants in the study were 180 adolescents (n=120 males), ranging in age from 12 to 17, enrolled in a Multisystemic Therapy program in clinics in the Denver Metropolitan area. Treatment outcome was assessed through therapist report and official arrest records. Changes in cortisol reactivity and changes in scores on an emotion dysregulation subscale of the Child Behavior Checklist (CBCL) were used as indicators of dysregulation changes throughout the course of therapy. Hierarchical linear modeling analyses were utilized to examine whether positive treatment response was associated with (a) cortisol reactivity measures collected early in treatment, (b) changes in these cortisol reactivity measures over the course of treatment (from early in treatment to mid-treatment to immediately post-treatment), (c) behavioral reports of emotion dysregulation reported early in treatment, and (d) changes in behavioral reports of emotion dysregulation over the course of treatment. In addition, sex was explored as a moderator of the above associations. Results confirmed that both cortisol and behavioral measures of emotional dysregulation early in treatment and over the course of therapy predicted treatment success. Furthermore, this relationship was moderated by sex such that girls were more likely to evidence a pattern of increasing emotion regulation prior to successful therapy outcome. Clinical implications are discussed.

Keywords: Multisystemic Therapy, cortisol, emotion dysregulation, delinquency

Table of Contents

Table of Contents

Assessing Treatment Outcome in Delinquent Youth...3
Emotion Dysregulation in Externalizing Behavior and Delinquency...3
Behavioral Measures of Emotion Dysregulation...5
Cortisol Reactivity in Children with Externalizing Disorders...6
The Importance and Utility of MST...9


Cortisol Measure of Emotion Dysregulation...12
Behavioral Measure of Emotion Dysregulation...13
Successful MST Response...14
Control Variables...15
Statistical Analyses...16


Descriptive Analyses...16
Preliminary Data Analysis...17
Unconditional Model: Cortisol Reactivity and Behavioral Outcomes...18
Testing for Confounds...19
Hypothesis Testing...20
Cortisol Reactivity Over Time...20
Behavior Dysregulation Over Time...21

Potential Limitations and Future Directions...26
Table 1: Emotion Dysregulation Items from the Child Behavior Checklist...39
Table 2: Descriptive Statistics for Predictor and Outcome Variables...40
Table 3: Intercorrelations for Study Variables...41
Table 4: HLM Results- Cortisol Reactivity Over Time and MST Treatment Outcome...42
Table 5: HLM Results- Behavioral Regulation Over Time and MST Treatment Outcome...43

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