Maladaptive emotion regulation is likely a core underlying process that contributes to a wide variety of mental health problems, including depression, anxiety, personality disorders, substance use, and somatic symptom disorders. Emotion regulation problems may develop from adverse childhood experiences and explain the development of psychopathology. So, emotion regulation may be a common vulnerability for mental health problems and, therefore, a core mechanism of psychotherapeutic change. Hence, there is growing interest in transdiagnostic interventions, that is, interventions across a variety of disorders that target emotion regulation as a fundamental basis of the mental health problem. One such intervention approach is experiential dynamic therapy (EDT), which views mental health problems as the consequence of an individual’s attempts at regulating intense conflicted emotions. In this model, mental health issues are rooted in childhood attachment relationships, leading to experiences of a high level of anxiety, resulting in maladaptive emotion regulation strategies or defense mechanisms, which lead to relational problems and/or symptoms. Experiential dynamic therapies (EDT) help patients identify conflicted emotions and change maladaptive defense mechanisms that lead to symptoms. In this meta-analysis of the efficacy of EDTs, Lilliengren and colleagues identified 57 randomized controlled studies representing over 4300 patients. The effects of EDT compared to no-treatment controls on primary outcomes were large at post-treatment (g = −0.96; k = 41) and follow-up (g = −1.11; k = 20). Compared to active treatment controls, effects were small and non-significant post-treatment (g = −0.17; k = 27) but became moderately large and significant at follow-up (g = −0.40; k = 19), suggesting a long-term advantage of EDTs over other interventions. Moderator analyses revealed few significant findings, indicating relative consistency across diagnostic groups, treatment formats and active comparators. Patient drop-out rates are another indicator of outcomes. On average, the dropout rate from EDTs was 13% and there was no significant difference in dropout risk between EDTs and other active treatments (log RR = −0.08; 95% CI [−0.09, 0.08]; p = 0.504; k = 23).
Transdiagnostic treatments are important because they go beyond the limitations of treating surface-level symptoms and focus on psychological vulnerabilities that underlie mental health problems. Given its effectiveness across a variety of diagnoses, EDTs may be particularly useful for treating comorbid problems and complex individuals struggling with emotional regulation difficulties.
Lilliengren, P., Mechler, J., Lindqvist, K., Maroti, D., & Johansson, R. (2025). The efficacy of experiential dynamic therapies: A 10-year systematic review and meta-analysis update. Clinical Psychology and Psychotherapy, 32:e70086 1 of 17, https://doi.org/10.1002/cpp.70086.
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