Emotion regulation therapy (ERT) was designed to address the neurobehavioural deficits underlying emotional distress using a theoretically derived, mechanism-focused framework. ERT integrates affective science with CBT principles, mindfulness meditation, and experiential interventions. Through training attentional and metacognitive regulation skills, ERT promotes adaptive behavioural responses to help patients take action with clarity, intentionality, and agency. A primary goal of ERT is to increase motivational awareness by improving early detection of emotional responses to threats and rewards in evocative, momentary contexts. This chapter reviews two decades of research on ERT demonstrating its efficacy, as well as support for the treatment mechanisms underlying observed clinical improvement. Additionally, we discuss current projects and future directions, including explorations of mechanism sequencing and dosing to optimise treatment, adaptions for diverse populations and contexts, integration of mHealth technology to augment and to deliver ERT, and use of advanced methodologies to further support treatment personalisation.