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Insomnia disorder in adolescence is prevalent, persistent and associated with adverse outcomes, including reduced quality of life. Cognitive behavioural therapy for insomnia (CBT-i) has shown promise as an effective treatment for adolescents. Recent research has highlighted the role of emotion regulation in insomnia, suggesting that the inclusion of emotion regulation techniques may enhance CBT-i.
To evaluate the feasibility and preliminary effectiveness of a CBT-i treatment program for insomnia in early adolescence, augmented with emotion regulation strategies, using a case-series design.
Three participants (mean 11.67 years) completed the program that consisted of seven, weekly individual therapy sessions and parental participation. Participants monitored their sleep daily during the intervention, and insomnia diagnostic status and severity, use of emotion regulation strategies and quality of life were assessed at baseline, post-intervention and at 6-week follow-up.
At post-treatment, none of the participants met criteria for insomnia and all reported statistically reliable reductions in symptoms. Improvements were maintained at follow-up for two participants. Sleep onset latency was reduced and improvements in quality of life were evident. There were no changes in the use of emotion regulation strategies following treatment. Adolescents and parents reported high program satisfaction.
This preliminary evaluation provides support for the effectiveness of the CBT-i program tested. However, given that emotion regulation did not change and yet improvements in sleep were evident, the usefulness of augmenting the program with emotion regulation strategies requires further evaluation.
Previous research showed that automatic emotion regulation is associated with activation of subcortical areas and subsequent feedforward processes to cortical areas. In contrast, cognitive awareness of emotions is mediated by negative feedback from cortical to subcortical areas. Pregenual anterior cingulate cortex (pgACC) is essential in the modulation of both affect and alexithymia. We considered the interplay between these two mechanisms in the pgACC and their relationship with alexithymia.
In 68 healthy participants (30 women, age = 26.15 ± 4.22) we tested associations of emotion processing and alexithymia with excitation/inhibition (E/I) balance represented as glutamate (Glu)/GABA in the pgACC measured via magnetic resonance spectroscopy in 7 T.
Alexithymia was positively correlated with the Glu/GABA ratio (N = 41, p = 0.0393). Further, cognitive self-awareness showed an association with Glu/GABA (N = 52, p = 0.003), which was driven by a correlation with GABA. In contrast, emotion regulation was only correlated with glutamate levels in the pgACC (N = 49, p = 0.008).
Our results corroborate the importance of the pgACC as a mediating region of alexithymia, reflected in an altered E/I balance. Furthermore, we could specify that this altered balance is linked to a GABA-related modulation of cognitive self-awareness of emotions.
Developing the ability to regulate one's emotions in accordance with
contextual demands (i.e., emotion regulation) is a central developmental task of
early childhood. These processes are supported by the engagement of the
autonomic nervous system (ANS), a physiological hub of a vast network tasked
with dynamically integrating real-time experiential inputs with internal
motivational and goal states. To date, much of what is known about the ANS and
emotion regulation has been based on measures of respiratory sinus arrhythmia, a
cardiac indicator of parasympathetic activity. In the present study, we draw
from dynamical systems models to introduce two nonlinear indices of cardiac
complexity (fractality and sample entropy) as potential indicators of these
broader ANS dynamics. Using data from a stratified sample of preschoolers living
in high- (i.e., emergency homeless shelter) and low-risk contexts
(N = 115), we show that, in conjunction with
respiratory sinus arrhythmia, these nonlinear indices may help to clarify
important differences in the behavioral manifestations of emotion regulation. In
particular, our results suggest that cardiac complexity may be especially useful
for discerning active, effortful emotion regulation from less effortful
regulation and dysregulation.
This paper presents the translation, adaptation and validation of a broadly used scale to measure emotion regulation strategies (i.e. The Emotion Regulation Questionnaire Children and Adolescents –ERQ-CA; Gullone & Taffe, 2012) in a sample of early adolescents. The 10-item scale was applied to a sample of 248 adolescents (128 boys) aged 13 to 14 years. Semi-confirmatory factor analysis supported the original two-factor structure: Cognitive Reappraisal and Expressive Suppression (SRMR = .05; RMSEA = .06; CFI = .96). These two factors demonstrate adequate internal consistency and evidence for convergent validity with other scales that refer to emotional intelligence, affect, and behavior. Thus, Cognitive Reappraisal scores were associated with higher self-perceived emotional abilities, positive affect and personal adjustment (ps < .05). Conversely, Expressive Suppression scores were associated with lower self-perceived emotional abilities, positive affect, and personal adjustment (ps < .01), with higher scores on negative affect, school and clinical maladjustment (ps < .01), as well as stress and depression symptoms (ps < .001). Overall, these findings suggest that the questionnaire may be a useful and reliable instrument for the assessment of emotion regulation strategies in early adolescents for future research in Spanish speaking countries.
Objectives: Expressive suppression (i.e., effortful regulation of overt affect) has a deleterious impact on executive functioning (EF). This relationship has potential ramifications for daily functioning, especially among older adults, because a close relationship exists between EF and functional independence. However, past research has not directly examined whether expressive suppression impacts instrumental activities of daily living (IADL). The present study examined this association among older adults. Methods: One hundred ten community-dwelling older adults completed a self-report measure of acute (past 24 hr) and chronic (past 2 weeks) expressive suppression, a timed test of IADL, and the Behavioral Dyscontrol Scale as a measure of EF. Results: High chronic expressive suppression was related to slow IADL performance beyond covariates (age, IQ, depression), but only for individuals with low EF. High acute expressive suppression was associated with lower accuracy on IADL tasks beyond covariates (IQ, depression), but this association was fully explained by EF. Conclusions: The current results suggest that expressive suppression is associated with less efficient and more error-prone IADL performance. EF fully accounted for the relationship between acute expressive suppression and IADL performance, showing that suppression is a risk factor for both poorer EF performance and functional lapses in daily life. Furthermore, individuals with weaker EF may be particularly vulnerable to the effect of chronic expressive suppression. (JINS, 2019, 25, 718–728)
In this article we adopt the view that emotion dysregulation is characterized by emotion regulation dynamics that are defined as dysfunctional based on contextual criteria. We regard the construct of emotion regulation as valuable because it permits the integration of the classic view of emotions as interfering with human functioning and contemporary views of emotion as adaptive and beneficial. To define patterns that reflect emotion dysregulation, we explain our views of emotion as a dynamic process, and emotion regulation as the bidirectional interplay between emotions and actions/thoughts (extrinsic factors) and the contextual factors that constitute the criteria for that interplay reflecting dysregulation. This conceptualization of emotion regulation and dysregulation leads to methods for studying the intrinsic dynamics of emotion, extrinsic factors that change the intrinsic dynamics of emotion, and how emotion regulation changes over time at multiple time scales. We then apply this thinking to several emotion dysregulation patterns. Emotion regulation is a complex construct, embracing emotion as regulator and as regulated, as self- and other-regulated, and as incorporating both top-down and bottom-up regulatory processes. We highlight an emerging line of research on the development of emotion regulation in early childhood and indicate how this work can inform understanding of emotion dysregulation and the emergence of psychopathology.
Difficulties with emotion regulation can take many forms, including increased sensitivity to emotional cues and habitual use of maladaptive cognitive or behavioral regulation strategies. Despite extensive research on emotion regulation and youth adjustment, few studies integrate multiple measures of emotion regulation. The present study evaluated the underlying structure of emotion regulation processes in adolescence using both task- and survey-based measures and determined whether differences in these emotion regulation latent factors mediated the association between peer victimization and internalizing psychopathology. Adolescents aged 16–17 years (n = 287; 55% female; 42% White) recruited in three urban centers in the United States completed baseline and follow-up assessments 4 months apart. Three models of emotion regulation were evaluated with confirmatory factor analysis. A three-factor model fit the data best, including cognitive regulation, behavioral regulation, and emotional reactivity latent factors. Task-based measures did not load onto these latent factors. Difficulties with behavioral regulation mediated the association between peer victimization and depression symptoms, whereas cognitive regulation difficulties mediated the association with anxiety symptoms. Findings point to potential targets for intervention efforts to reduce risk for internalizing problems in adolescents following experiences of peer victimization.
Through autonomic and affective mechanisms, adverse childhood experiences (ACEs) may disrupt the capacity to regulate negative emotions, increasing craving and exacerbating risk for opioid use disorder (OUD) among individuals with chronic pain who are receiving long-term opioid analgesic pharmacotherapy. This study examined associations between ACEs, heart rate variability (HRV) during emotion regulation, and negative emotional cue-elicited craving among a sample of female opioid-treated chronic pain patients at risk for OUD. A sample of women (N = 36, mean age = 51.2 ± 9.5) with chronic pain receiving long-term opioid analgesic pharmacotherapy (mean morphine equivalent daily dose = 87.1 ± 106.9 mg) were recruited from primary care and pain clinics to complete a randomized task in which they viewed and reappraised negative affective stimuli while HRV and craving were assessed. Both ACEs and duration of opioid use significantly predicted blunted HRV during negative emotion regulation and increased negative emotional cue-elicited craving. Analysis of study findings from a multiple-levels-of-analysis approach suggest that exposure to childhood abuse occasions later emotion dysregulation and appetitive responding toward opioids in negative affective contexts among adult women with chronic pain, and thus this vulnerable clinical population should be assessed for OUD risk when initiating a course of extended, high-dose opioids for pain management.
Although numerous studies reveal altered respiratory sinus arrhythmia (RSA) among children, adolescents, and adults who exhibit emotion dysregulation, effects of temperamental vulnerability and parental mental health on RSA remain unclear. We evaluated the relationship among emotion regulation, RSA, and RSA reactivity in a pooled sample of 24 vulnerable and 31 resilient adolescents (mean age = 13.69 years; 60% girls), including associations with temperamental vulnerability and parental depressive symptoms. Participants watched a neutral film clip while their resting RSA was recorded, and then completed a reward and frustration task, using an affective Posner paradigm. Temperament and emotion regulation were assessed via self-report and parent report, and parents reported on their own depressive symptoms. Low resting RSA was associated with temperamental negative emotionality, whereas greater RSA reactivity to frustration was associated with maladaptive emotion regulation strategies. No significant relations were found between RSA and parental depressive symptoms. This study elucidates the role of RSA as a biomarker of individual differences in emotion dysregulation and temperamental vulnerability and stresses the importance of considering multiple units of analyses, as well as functional domains, when studying emotional responding and regulation in adolescents.
While dialectical behaviour therapy (DBT) appears efficacious in reducing suicidal and self-harming behaviour, it is unclear whether DBT reduces emotion regulation (ER) difficulties, a purported mechanism of change of treatment. This review aims to investigate and evaluate the current evidence to understand the effectiveness of DBT in improving ER difficulties. A qualitative synthesis of studies investigating the effectiveness of DBT on self-reported ER difficulties as measured by the Difficulties in Emotion Regulation Scale (DERS) was performed, identifying eligible studies using PsycINFO, PubMed, MEDLINE and EMBASE databases. Fourteen studies were identified. Current evidence indicates that DBT does not show consistent benefits relative to existing psychological treatments in improving ER difficulties. The literature is compromised by significant methodological limitations increasing risk of bias across study outcomes. Furthermore, high variability across DBT programs and a lack of investigation regarding adherence and participant engagement within interventions was observed. Further research is needed in order to conclude regarding the effectiveness of DBT in improving ER difficulties. Consistent use of active treatment conditions, greater standardisation of DBT-based interventions, in addition to further examination of participant engagement level in DBT-based interventions in the long term may assist understanding as to whether DBT improves ER difficulties.
As teachers seek to educate and transform lives, often with limited resources and time, they can experience varying levels of stress and emotional exhaustion, particularly if effective emotion regulation strategies are not employed. The experience of teacher stress may be heightened in alternative schools that provide educational opportunities for students who present with complex needs and are ‘at-risk’ of withdrawing from the conventional school system. This case study explored the perceived outcomes of a 6-week school-based mindfulness program to manage stress and support the emotion regulation of four teachers at a metropolitan Australian alternative school. The study took a mixed-methods approach to data collection, which included self-report questionnaires, interview responses and journal reflections. A number of limitations, such as small sample size and lack of experimental design, had an impact on the generalisability of the study’s findings. However, a range of beneficial outcomes emerged in association with the mindfulness program, revealing that participants experienced increased levels of both mindfulness and emotion regulation ability, in conjunction with decreased stress and emotional exhaustion levels.
Difficulties in regulating affect are core characteristics of a wide range of mental health conditions and are associated with deficits in cognitive control, particularly in affective contexts, affective control. The current study explored how affective control relates to mental health over the course of adolescence. We developed an Affective Control Task, which was administered to young adolescents (11–14 years; n = 29); mid-adolescents (15–18 years; n = 31), and adults (22–30 years; n = 31). The task required individuals to sort cards according to continuously changing rules: color, number, or item type. There was a neutral condition in which items were shapes, and an affective condition, in which items were emotional facial expressions. Better affective control was associated with fewer mental health difficulties (p < .001, R2 = .15). Affective control partially accounted for the association between age group and mental health problems, z = 2.61, p = .009, Akaike information criterion = 484, with the association being strongest in young adolescents, r (27) = −.44, p = .018. Affective control further accounted for variance in the association between self-reported (but not experimental) emotion regulation and mental health (z = −3.44, p < .001, Akaike information criterion = 440). Poor affective control, especially in young adolescents, is associated with more mental health problems and higher levels of emotion regulation difficulties. Improving affective control therefore may constitute a promising target for prevention.
At multiple developmental periods spanning from middle childhood through adolescence, we investigated the development of aggressive-victims. Multiple-informant data collected across four grade levels (1, 5, 8, and 11; N = 482; 50% females) was used to perform person-centered analyses including latent profile and latent transition analyses in order to examine the co-occurring development of multiple forms (i.e., physical, verbal, and relational) of aggression and peer victimization. Results indicated that there were two distinct subgroups of aggressive-victims, one of which was more relational in form (i.e., relational aggressive-victims), and children in these two subgroups were distinguishable with respect to their individual characteristics (emotion dysregulation, withdrawn behaviors, and moral disengagement) and relational experiences (peer rejection and friendships). Furthermore, the findings elucidated the mechanisms by which developmental continuity and change (i.e., transitions) among the subgroups occurred across childhood and adolescence.
Disturbances in emotion regulation (ER) are characteristic of both patients with bipolar disorder (BD) and schizophrenia (SZ). We investigated the temporal dynamics of brain activation during cognitive ER in BD and SZ to understand the contribution of temporal characteristics of disturbed ER to their unique and shared symptomatology.
Forty-six participants performed an ER-task (BD, n = 15; SZ, n = 16; controls, n = 15) during functional magnetic resonance imaging, in which they were instructed to use cognitive reappraisal techniques to regulate their emotional responses. Finite impulse response modeling was applied to estimate the temporal dynamics of brain responses during cognitive reappraisal (v. passive attending) of negative pictures. Group, time, and group × time effects were tested using multivariate modeling.
We observed a group × time interaction during ER in the ventrolateral prefrontal cortex (VLPFC), supplementary motor area (SMA) and inferior occipital gyrus. Patients with SZ demonstrated initial hyper-activation of the VLPFC and SMA activation that was not sustained in later regulatory phases. Response profiles in the inferior occipital gyrus in SZ showed abnormal activation in the later phases of regulation. BD-patients showed general blunted responsivity in these regions.
These results suggest that ER-disturbances in SZ are characterized by an inefficient initialization and failure to sustain regulatory control, whereas in BD, a failure to recruit regulatory resources may represent initial deficits in formulating adequate representations of the regulatory needs. This may help to further understand how ER-disturbances give rise to symptomatology of BD and SZ.
Refugees commonly experience difficulties with emotional processing, such as alexithymia, due to stressful or traumatic experiences. However, the functional connectivity of the amygdala, which is central to emotional processing, has yet to be assessed in refugees. Thus, the present study investigated the resting-state functional connectivity of the amygdala and its association with emotional processing in North Korean (NK) refugees.
This study included 45 NK refugees and 40 native South Koreans (SK). All participants were administered the Toronto Alexithymia Scale (TAS), Beck Depression Inventory (BDI), and Clinician-administered PTSD Scale (CAPS), and differences between NK refugees and native SK in terms of resting-state functional connectivity of the amygdala were assessed. Additionally, the association between the strength of amygdala connectivity and the TAS score was examined.
Resting-state connectivity values from the left amygdala to the bilateral dorsolateral prefrontal cortex (dlPFC) and dorsal anterior cingulate cortex (dACC) were higher in NK refugees than in native SK. Additionally, the strength of connectivity between the left amygdala and right dlPFC was positively associated with TAS score after controlling for the number of traumatic experiences and BDI and CAPS scores.
The present study found that NK refugees exhibited heightened frontal–amygdala connectivity, and that this connectivity was correlated with alexithymia. The present results suggest that increased frontal–amygdala connectivity in refugees may represent frontal down-regulation of the amygdala, which in turn may produce alexithymia.
Emotion regulation dysfunction is characteristic of psychotic disorders, but little is known about how the use of specific types of emotion regulation strategies differs across phases of psychotic illness. This information is vital for understanding factors contributing to psychosis vulnerability states and developing targeted treatments. Three studies were conducted to examine emotion regulation across phases of psychosis, which included (a) adolescent community members with psychotic-like experiences (PLEs; n = 262) and adolescents without PLEs (n = 1,226); (b) adolescents who met clinical high-risk criteria for a prodromal syndrome (n = 29) and healthy controls (n = 29); and (c) outpatients diagnosed with schizophrenia or schizoaffective disorder (SZ; n = 61) and healthy controls (n = 67). In each study, participants completed the Emotion Regulation Questionnaire and measures of psychiatric symptoms and functional outcome. The three psychosis groups did not differ from each other in reported use of suppression; however, there was evidence for a vulnerability-related, dose-dependent decrease in reappraisal. Across each sample, a lower use of reappraisal was associated with poorer clinical outcomes. Findings indicate that emotion regulation abnormalities occur across a continuum of psychosis vulnerability and represent important targets for intervention.
Cognitive behavioral therapy (CBT) is an effective treatment for many patients suffering from major depressive disorder (MDD), but predictors of treatment outcome are lacking, and little is known about its neural mechanisms. We recently identified longitudinal changes in neural correlates of conscious emotion regulation that scaled with clinical responses to CBT for MDD, using a negative autobiographical memory-based task.
We now examine the neural correlates of emotional reactivity and emotion regulation during viewing of emotionally salient images as predictors of treatment outcome with CBT for MDD, and the relationship between longitudinal change in functional magnetic resonance imaging (fMRI) responses and clinical outcomes. Thirty-two participants with current MDD underwent baseline MRI scanning followed by 14 sessions of CBT. The fMRI task measured emotional reactivity and emotion regulation on separate trials using standardized images from the International Affective Pictures System. Twenty-one participants completed post-treatment scanning. Last observation carried forward was used to estimate clinical outcome for non-completers.
Pre-treatment emotional reactivity Blood Oxygen Level-Dependent (BOLD) signal within hippocampus including CA1 predicted worse treatment outcome. In contrast, better treatment outcome was associated with increased down-regulation of BOLD activity during emotion regulation from time 1 to time 2 in precuneus, occipital cortex, and middle frontal gyrus.
CBT may modulate the neural circuitry of emotion regulation. The neural correlates of emotional reactivity may be more strongly predictive of CBT outcome. The finding that treatment outcome was predicted by BOLD signal in CA1 may suggest overgeneralized memory as a negative prognostic factor in CBT outcome.
Homeless girls suffer labour and sexual exploitation, abuse, discrimination and social exclusion at a higher rate than the rest of the population. However, worldwide information on homeless girls and intervention programmes for this group are scarce. This study examined the preliminary efficacy of a brief cognitive behavioural group therapy tailored to Mexican homeless girls. The intervention targeted subjective well-being and these determinants: symptoms of anxiety, symptoms of depression, assertive behaviours and functional emotion regulation skills. Results revealed statistically significant differences in symptoms of anxiety and depression, assertiveness, emotion regulation strategies and subjective well-being with treatment effects that ranged from moderate to large. Symptoms of anxiety and depression, and dysfunctional emotion regulation strategies decreased. Assertive skills, functional emotion regulation strategies, and subjective well-being increased. Outcomes were clinically relevant. At 2-month follow-up, participants showed improvement from pre-treatment on all measures. The current study provides unique findings in terms of a promising preliminary intervention that helps restore homeless girls to a healthier social/emotional developmental path especially in the context of Latin American cities. As a result, the clinical implications of this research highlight the urgent need to design effective interventions based on the observed characteristics and identified needs among homeless girls.
The main objective of the study was to examine the relationships between parental rejection, maladaptive emotion regulation strategies, and the emotional eating style of youngsters who finished an inpatient multidisciplinary weight loss treatment program and were back in their home environment.
Participants were 52 youngsters (age 11–17 years) with an average percent over ideal BMI of 186.11% (SD = 27.54) before treatment and 136.37% (SD = 19.65) at a mean follow-up of 4 months. Participants completed questionnaires assessing maternal and paternal rejection, maladaptive emotion regulation strategies, and emotional eating. Data were analysed using bootstrapping procedure.
Mediation analyses showed that maladaptive emotion regulation partially mediated the association between maternal rejection and the youngsters’ emotional eating style. Paternal rejection was directly related to emotional eating.
The results suggest that the family climate may have an impact on the eating style of the youngsters after weight loss treatment.
Objectives: Expressive suppression (ES) is an emotion-regulation strategy that is associated with poorer performance on subsequently administered tests of executive functioning (EF). It is not known, however, how far into the future ES interferes with EF. This study examined whether (a) ES negatively affects performance on EF tests repeated 1 year after the initial administration (presumably through interference with learning, leading to a reduced practice effect), and (b) whether such an effect, if seen, is unique to EF or whether it also affects lower-order cognitive processes needed for EF test performance. Methods: Sixty-six non-demented community-dwelling older adults were randomly assigned to either an ES group or control group. Executive and non-executive tests were administered before and immediately following the exposure to an emotionally evocative video, and then again at 1-year follow-up. Groups were compared at 1-year follow-up on tests of EF and lower-order processes, to examine whether the previously demonstrated impact of ES on EF is evident only immediately following the experimental manipulation (Franchow & Suchy, 2017), or also at 1-year follow-up. Results: The results showed that participants who engaged in ES continued to exhibit poorer performance on EF tests 1 year later. This effect was not present for performance on tests of lower-order processes. Conclusions: These results suggest that the use of ES before an EF task can interfere with the ability to benefit from exposure to that task, thereby negatively affecting future performance. (JINS, 2019, 25, 29–38)