Title: Context sensitivity
Description: Background: Emotion regulation has been identified as a major contributor to the development of psychopathology and, by extension, to understanding the positive effects of various psychotherapy mechanisms. Little work has been done, however, on the extent to which individual components of emotion regulation operate as prognostic factors in psychological treatment. Context sensitivity and reflective functioning are emerging as important aspects of adaptive emotion regulation capacity and may be related to a portion of patient therapy outcome when investigated as a patient characteristic. Design and Participants: A sample of 130 adults seeking treatment for depression and anxiety through a digital psychotherapy provider were recruited to participate. Individuals presenting with comorbid severe mental illness or psychosis, significant substance abuse concerns, active suicidal ideation, and active manic states were excluded from participation. Methods: Participants completed individual difference measures for Five-factor Personality, reflective functioning (i.e., Reflective Functioning Questionnaire; RFQ), and the context sensitivity (i.e., Context Sensitivity Index; CSI), and were followed over three months of psychotherapy.

Clinical outcomes were measured with diagnosis-specific symptom measures such as the PHQ-9 for depression and the GAD-7 for anxiety at baseline and then every 3 weeks for the duration of treatment. Results: Participants reported significant improvement in depression and anxiety symptoms after three months of treatment (p < .001). CSI and RFQ scores were unassociated with baseline symptom severity. Certainty about others’ thoughts, an RFQ subscale, was inversely associated with outcome (p < .05). CSI scores were unassociated with treatment outcome at 3 months. Lack of insight, an RFQ subscale, significantly improved as a result of treatment when baseline symptoms were high (p < .05). Conclusions: Reflective functioning may be a promising patient characteristic for explaining a modest portion of treatment outcome. Lack of emotional insight improved meaningfully as a result of treatment for individuals with more severe depression and anxiety at baseline. Further research is needed to investigate aspects of emotion regulation as a route towards better understanding outcome in psychotherapy.