From psychological to physical health: Exploring temporal precedence throughout emotion regulation therapy

•GAD is associated with painful physical symptoms.•Psychotherapy can ameliorate both psychological and physical distress.•Changes in anxiety and depression during treatment preceded reductions in gastric distress.•Findings highlight utility of using psychotherapy to help physical symptoms in GAD. Generalized anxiety disorder (GAD) is characterized, in part, by physical symptoms such as muscle tension and gastrointestinal (GI) distress. To date, little research has examined how changes in psychological symptoms associated with GAD may impact physical symptoms. This study investigated if reductions in worry, anxiety, and depression precede changes in muscle tension and GI distress throughout psychotherapy. Participants with GAD (N = 85) completed 20 weeks of emotion regulation therapy (ERT) in addition to assessments pre, mid, and post treatment. They completed a physical symptom questionnaire, evaluating muscle tension and GI distress. Participants also completed psychological symptoms questionnaires, including the State Trait Anxiety Inventory (STAI-7), Penn State Worry Questionnaire (PSWQ), and Beck Depression Inventory (BDI-II). Control participants (N = 44) completed these measures at baseline. Participants with GAD had significantly greater muscle tension (p