# Patterns of cognitive-emotional change after cognitive-behavioural treatment in emotional disorders: A 12-month longitudinal cluster analysis

## TL;DR

This study found that patients with emotional disorders who improved more in cognitive-emotional processes after therapy had better outcomes in symptoms and quality of life.

## Contribution

The novel contribution is identifying distinct cognitive-emotional improvement patterns linked to treatment outcomes in emotional disorders.

## Key findings

- Two clusters emerged: one with more improvement in cognitive-emotional processes and one with less improvement.
- Greater improvement correlated with lower emotional symptoms and better functioning and quality of life.
- TAU+TD-CBT, income, anxiety, and quality of life predicted cluster membership.

## Abstract

The aim of this study was to use cluster analysis based on the trajectory of five cognitive-emotional processes (worry, rumination, metacognition, cognitive reappraisal and expressive suppression) over time to explore differences in clinical and performance variables in primary care patients with emotional symptoms.

We compared the effect of adding transdiagnostic cognitive-behavioural therapy (TD-CBT) to treatment as usual (TAU) according to cluster membership and sought to determine the variables that predicted cluster membership. 732 participants completed scales about cognitive-emotional processes, anxiety and depressive symptoms, functioning, and quality of life (QoL) at baseline, posttreatment, and at 12 months. Longitudinal cluster analysis and logistic regression analyses were carried out.

A two-cluster solution was chosen as the best fit, named as “less” or “more” improvement in cognitive-emotional processes. Individuals who achieved more improvement in cognitive-emotional processes showed lower emotional symptoms and better QoL and functioning at all three time points. TAU+TD-CBT, income level, QoL and anxiety symptoms were significant predictors of cluster membership.

These results underscore the value of adding TD-CBT to reduce maladaptive cognitive-emotional regulation strategies. These findings highlight the importance of the processes of change in therapy and demonstrate the relevance of the patient’s cognitive-emotional profile in improving treatment outcomes.