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Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a cognitive behavioural therapy-based group treatment programme for patients with borderline personality disorder (BPD). STEPPS has demonstrated its effectiveness for (younger) adults. However, there are no studies into the effects of STEPPS for older adults.
The aim was to explore the outcome of STEPPS in older adults with personality disorders.
In this naturalistic pre- vs post-treatment study, older patients with a personality disorder, reporting emotion regulation difficulties, were included. The primary outcome was BPD symptoms. Secondary outcomes included psychological distress and maladaptive personality functioning.
Twenty-four patients, with a mean age of 63.9 years (SD=4.6), completed the 19-week programme. Nine patients (23.1%) did not complete the treatment. There were no significant differences in age, gender or global severity between completers and patients dropping out. There was a significant pre- vs post-treatment decrease of BPD symptoms, with a large effect size (Cohen’s d=1.577). Self-control improved significantly and demonstrated a large effect size (r=.576). Furthermore, identity integration improved significantly, with a medium effect size (Cohen’s d=.509). No significant differences were reported for most domains of psychological distress and maladaptive interpersonal personality functioning.
The findings in this pilot study suggest STEPPS is a feasible treatment programme for older adults with personality disorders and emotion regulation difficulties. Adaptations to the program, for a better fit for older adults, however, might be needed.
This study examined parental depression and parental reflective functioning (PRF) as predictors of parental proficiency in relational savoring (RS), the association between RS proficiency and a marker of children’s physiological self-regulation, respiratory sinus arrhythmia (RSA), during a stressor, and indirect effects of parental depression and PRF on children’s RSA via parents’ RS. At Time 1 (T1), parents of 8- to 12-year-old children (N = 139) reported on their depressive symptoms and completed a parenting interview, coded for PRF. After 1.5 years (Time 2; T2), parents savored a positive relational memory that involved their children, which was coded for savoring proficiency. Children’s RSA was measured during a stressful task (a series of impossible puzzles). Depressive symptoms (inversely) and PRF (positively) were associated with RS proficiency. Higher parental RS proficiency was associated with children’s higher mean levels of RSA during the stressor. Indirect effects models supported that T2 RS proficiency mediated the negative association between parental T1 depressive symptoms and children’s T2 RSA, and between T1 PRF and children’s T2 RSA. We discuss these findings in terms of implications for parents’ emotion regulation, children’s emotion regulation, children’s mental health, and intervention.
Patients with obsessive-compulsive disorder (OCD) present difficulties in the cognitive regulation of emotions, possibly because of inefficient recruitment of distributed patterns of frontal cortex regions. The aim of the present study is to characterize the brain networks, and their dysfunctions, related to emotion regulation alterations observed during cognitive reappraisal in OCD.
Adult patients with OCD (n = 31) and healthy controls (HC; n = 30) were compared during performance of a functional magnetic resonance imaging cognitive reappraisal protocol. We used a free independent component analysis approach to analyze network-level alterations during emotional experience and regulation. Correlations with behavioral scores were also explored.
Analyses were focused on six networks encompassing the frontal cortex. OCD patients showed decreased activation of the frontotemporal network in comparison with HC (F(1,58) = 7.81, p = 0.007) during cognitive reappraisal. A similar trend was observed in the left frontoparietal network.
The present study demonstrates that patients with OCD show decreased activation of specific networks implicating the frontal cortex during cognitive reappraisal. These outcomes should help to better characterize the psychological processes modulating fear, anxiety, and other core symptoms of patients with OCD, as well as the associated neurobiological alterations, from a system-level perspective.
In this talk I will describe a series of studies conducted at the Centre for the Developing Brain, King’s College London, that seek to increase our understanding of why infants who are born very early (before 32 weeks’ gestation) are more likely to develop socio-emotional problems when they grow up compared to infants who are born at term. As part of the Evaluation of Preterm Imaging study we carried out multimodal MRI at term in over 200 newborns and studied whether we could identify specific patterns of brain development in those infants who might develop problems with emotion regulation and general mental health as they grow-up. At the behavioural level, we found that very preterm children compared to term-born controls had more mental health problems, including anxiety and autism-spectrum behaviours. Preterm children had lower IQ, were less able to regulate their emotions and inhibit unwanted behaviours. Children’s tendency to attribute negative emotions to daily events, which could lead to increased anxiety, was associated with two main neonatal brain features. These were: 1) weaker structural connectivity in a long-range white matter projection tract called the uncinate fasciculus which connects the frontal lobe with the anterior temporal lobe and 2) altered fronto-limbic functional connectivity, both of which play a critical role in several aspects of social and emotional development. These findings show that early brain changes can be used to predict children’s social and emotional outcomes, hence could be used to inform preventative interventions aimed at averting and targeting emerging emotional disorders.
Loneliness, a negative emotion stemming from the perception of unmet social needs, is a major public health concern. Current interventions often target social domains but produce small effects and are not as effective as established emotion regulation (ER)-based interventions for general psychological distress (i.e., depression/anxiety). Given that loneliness and distress are types of negative affect, we aimed to compare them within an ER framework by examining the amount of variance ER strategies accounted for in loneliness versus distress, and comparing the ER strategy profiles characterising them. Participants (N = 582, Mage = 22.31, 77.66% female) completed self-report measures of loneliness, distress, and use of 12 cognitive (e.g., cognitive reappraisal) or behavioural (e.g., expressive suppression) ER strategies. Regression analyses revealed that ER explained comparable variance in these constructs. Latent profile analysis identified seven profiles differing in ER patterns, with no distinct loneliness or distress profile identified. Rather, similar patterns of ER characterised these two constructs, involving the greater use of generally maladaptive strategies and the lesser use of generally adaptive strategies. However, loneliness was additionally characterised by less use of strategies involving social connection/expression. Overall, our study supports the utility of ER for understanding loneliness. Established ER-based frameworks/interventions for distress may have transdiagnostic utility in targeting loneliness.
Self-Harm (SH) is any act of self-injury carried out by somebody irrespective of motivation. SH most commonly functions to relieve negative affect (NA). Tentative evidence suggests reward processing is altered in SH. NA may trigger reward hypersensitivity and therefore SH. Whether NA influences reward processing in SH remains unclear.
To investigate whether self-harmers differ in motivation to obtain SH stimuli than healthy controls (HCs) following NA induction.
After NA induction, SH participants will have a significantly shorter reaction latency (RL) and greater reaction accuracy (RA) than HCs in the SH condition of the Incentive Delay (ID) task.
16-25-year-old SH (n=35) and HC (n=20) participants were recruited online and underwent the Trier Social Stress Test, to induce NA, followed by the ID task, where participants were cued to respond to a target as quickly as possible. On responding, an image of either a SH act (SH Condition), people socializing (Social Condition) or money (Monetary Condition) appeared. Each condition included control trials showing a neutral image. RA was the percentage of trials responded to within the target’s presentation time. RL was the time (seconds) between target appearance and participants’ response.
There was no significant main effect of group, condition or group x condition interaction for RL. There was a significant main effect of condition (p < 0.05) but not of group nor a group x condition interaction for RA.
Reward processing did not differ in the SH group compared to HCs post-NA induction. Future studies could investigate reward processing in longitudinal and larger SH samples.
Research has shown that emotional suppression, a form of emotion regulation, is often used by individuals with disordered eating behaviour. Moreover, eating disorder symptomatology is associated with inappropriate eating behaviours (e.g. excessive consumption of high-calorie foods and comfort foods).
The objective of the present study was to investigate the differences in eating behaviour among adults with different levels of emotional suppression and eating disorder symptomatology.
Two hundred seventy adults (Mage = 29.44 ± 9.32) completed the Three-Factor Eating Questionnaire (eating behaviour), the Eating Attitudes Test (eating disorder symptomatology) and the Emotion Regulation Questionnaire (emotional suppression).
Three clusters were identified through cluster analysis: cluster 1 (N = 115) presenting low emotional suppression and low eating disorder symptomatology; cluster 2 (N = 43) presenting high emotional suppression and high eating disorder symptomatology and cluster 3 (N = 112) presenting high emotional suppression and low eating disorder symptomatology. Our results showed that individuals in cluster 2 had significantly greater levels of cognitive restraint, uncontrolled eating and emotional eating than individuals in clusters 1 and 3. Moreover, individuals in clusters 1 and 3 did not differ significantly in terms of any of the TFEQ subscales.
These preliminary findings may suggest that the tendency to persistently suppress emotions exacerbate disordered eating behaviour. Therefore, this factor together with symptoms of eating disorders should to be considered when planning prevention and intervention programs among adults presenting disordered eating behaviour.
Externalizing disorders involve undercontrolled, impulsive, or aggressive behavior. Included in this category are Conduct Disorder, Oppositional Defiant Disorder, and Attention deficit hyperactivity. Difficulties with emotion regulation are a core feature of externalizing disorders in children and adolescents. Yet, no studies to date have compared the relative efficacy of an ECBT program in this population.
to investigate the effectiveness of an ECBT inspired program in children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD), Conduct Disorder (CD) and Oppositional Defiant Disorder (ODD)
We conducted an experimental study with a pretest posttest design and a control group. 50 subjects with either ADHD, ODD or CD were selected and assigned to the experimental and control group. 25 patients ages 9–18 (13 boys, 12 girls) were enrolled in the ECBT-inspired program with 19 completing treatment. Comparison of pre- and post-test results for each sub-group was performed using the Wilcoxon test.
showed that youths in the ADHD and ODD groups demonstrated a significant reduction in externalizing behavior problems measured by the Child Behavior Checklist (CBCL). In terms of emotional regulation, only the group of patients with ODD showed a significant improvement in the cognitive reappraisal subscale of the emotional regulation questionnaire(ERQ- CA ). Only in the ODD group, significant improvement was found in the identification and external oriented thniking subscale scores of the alexithymia questionnaire for children (AQC).
Such comparisons are necessary to determine the clinical profile of patients who might most benefit from such an intervention.
Deficient emotion regulation is a common and impairing area of difficulty among children and adolescents with externalizing disorders. Emotion focused cognitive behavioral therapy ECBT is a form of CBT that is suggested to be employed to improve dysregulation of anxiety and other kind of emotions in anxious youth.
Examine the efficacy of an Emotion-focused Cognitive-Behavioral Therapy (ECBT) inspired program on emotional regulation difficulties and behavioral problems in children and adolescents with externalizing disorders
We conducted a cross-sectional comparative experimental study. Subjects were 50 patients exhibiting behavioral disorders aged 9 to 18 years , with a diagnosis of attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD).Participants were assigned to ECBT and control groups. ECBT group contributed in 12-h weekly sessions within ECBT-inspired program. The control group received standard care. To assess emotion-related competencies, children were administered the emotion regulation questionnaire (ERQ-CA) and the alexithymia questionnaire for children(AQC). Parents completed the Child Behavior Checklist(CBCL) to measure youth externalizing problems. Tests were administered in pre- and post-test to all subjects. Both groups were matched for age, sex and educationnal level. Comparison of pre- and post-test results was performed using the Student’s t-test.
ECBT demonstrated a significant difference in the reduction of behavioral problems. ECBT effectively increased adaptive emotion regulation strategies (cognitive reappraisal) in the post-test. ECBT also reduced alexithymia scores, particularly difficulty identifying feelings, and externally oriented thinking.
ECBT demonstrated promising initial effectiveness in addressing emotion regulation deficits of children with externalizing behaviors
DSM-5 defines non-suicidal self-injury (NSSI) as socially unaccepted, direct, repeated and deliberate harm done to one’s own body. It is estimated that in a general population approximately 13-29% of adolescents present NSSI, and 70-80% among hospitalized youth. It seems that emotional dysregulation is the core characteristic of NSSI manifesting by self-harm behaviors, impulsiveness, lack of emotional awareness and experiencing high intensity of negative emotion. Emotional dysregulation is a pivotal characteristic of NSSI. Rationale of this theory is provided by the results of psychological and psychophysiological studies as well as those presenting brain activity. Neuroimaging data point to a variant pattern of brain activity of adolescents with NSSI during perception of emotionally negative stimuli i.e. hyperactivity in amygdala – a structure responsible for fear and automatic reaction to exciting stimuli and low activity of inferior frontal gyrus area – a structure responsible for inhibition and interpretation of social interactions. This activity pattern suggests a disorder of cortico-subcortical neuronal connections.
The aim was to verify tDCS as a therapeutic aid for patients who exhibit NSSI despite implementation of pharmacotherapy and psychotherapy.
We investigated the modulation effect of tDCS treatment at the right inferior frontal gyrus (rIFG) in hospitalized adolescents with NSSI.
Preliminary tDCS stimulation results indicate potential usefulness of this method in regulating emotions and improving executive functions.
Prefrontal cortex stimulation may restore balance in aforementioned connections and, as a result, positively influence an emotional regulation i.e. lower the impulsiveness, agitation and, by doing so, decrease NSSI frequency.
In nightmare disorder, dysfunctional emotion regulation goes along with poor subjective sleep quality, which is characterised by pathophysiological features such as abnormal arousal processes and sympathetic influences. Dysfunctional parasympathetic regulation, especially before and during REM phases, is assumed to alter heart rate (HR) and its variability (HRV) of frequent nightmare recallers.
We hypothesised that cardiac variability is attenuated in participants experiencing frequent nightmares as opposed to healthy control subjects during less deep sleep stages and an emotion-evoking picture-rating
Based on the second-nights’ polysomnographic recordings of 24 nightmare disordered (NM) and 30 control (CTL) subjects, we examined HRV during pre-REM, REM, post-REM and slow wave sleep periods, separately. Additionally, ECG recordings of wakeful periods such as resting state before sleep onset and an emotional picture-rating task were also analysed.
According to our results, a significant difference was found in the HR of the NM and CTL groups in the nocturnal segments but not during resting wakefulness before sleep onset, suggesting autonomic dysregulation, specifically during sleep in nightmare disorder. However, despite the accelerated HR of NM subjects at night, they did not exhibit lower HRV. Regarding the emotional task, we also found a contrast between the NM and CTL subjects’ HR and HRV, which might indicate altered processes of emotion regulation in nightmare disorder, but the two groups’ subjective picture ratings did not differ.
In summary, our study suggests that there might be some trait-like autonomic changes during sleep, but also state-like autonomic responses to emotion-evoking pictures in nightmare disorder.
The psychological risk factors of premenstrual dysphoric disorder (PMDD) are not fully understood, but initial evidence points to a potential role of unfavorable cognitive emotion regulation (ER-) strategies. Given the symptom cyclicity of PMDD, ambulatory assessment is ideally suited to capture psychological and physiological processes across the menstrual cycle. Our study examines habitual ER-strategies in women with PMDD and their predictive value for the course of mood and basal cortisol across the cycle in affected women.
Women with and without PMDD (n = 61 each) were compared regarding habitual mindfulness, reappraisal, and repetitive negative thinking (RNT). Momentary affect and cortisol output were assessed over two consecutive days per cycle phase (menstrual, follicular, ovulatory, late luteal).
Women with PMDD reported lower mindfulness, less use of reappraisal and stronger RNT than controls (ps < 0.035). In women with PMDD, higher mindfulness and reappraisal and lower RNT predicted decreased negative and increased positive affect across the menstrual cycle (ps < 0.027). However, women using more favorable ER-strategies displayed stronger mood cyclicity, resulting in stronger mood deterioration in the late luteal phase, thereby resembling women with more unfavorable ER-strategies toward the end of the cycle. Lower mindfulness predicted lower cortisol in the menstrual phase.
Protective ER-strategies seem to be generally linked to better momentary mood in women with PMDD, but do not appear to protect affected women from premenstrual mood deterioration. Habitual mindfulness, in turn, seems to buffer blunted cortisol activity in women with PMDD, especially in the menstrual phase.
Computer scientists Jonathan Gratch and Stacy Marsella trace the influence of the 1988 publication of the OCC model, noting its impact on computational models of the interplay between emotion and cognition and on practical applications such as those relating to emotion recognition and the generation of emotion-related behaviors. They explain how OCC’s detailing of specific rules for reasoning about emotions invigorated work in affective computing and artificial intelligence more generally by giving computer scientists a clear pathway for modeling emotion processes. The model, they suggest, had both “upstream influences” on work concerning the cognitive antecedents of emotions, and “downstream influences” on work focused on modeling some of the consequences of emotions, such as those concerned with coping and decision-making and their relation to changes in beliefs, desires, and intentions. Finally, at a more sociology of science level, the authors suggest that the OCC model contributed significantly to bringing together the emotion research community in psychology and computer science communities interested in modeling affective phenomena.
Emotional regulation is one of the skills children develop in early childhood, and norms of social and emotional behaviour are explicitly taught and implicitly embedded in early childhood curricula. This chapter discusses emotion socialization processes in preschool settings. It outlines how various emotions (sadness, laughter, empathy, compassion and others) are displayed and interpreted in social interaction by using language and embodied resources. The chapter provides examples of how emotion socialization is configured by teachers and children in early childhood education in various countries worldwide.
Childhood maltreatment (CM) represents a potent risk factor for major depressive disorder (MDD), including poorer treatment response. Altered resting-state connectivity in the fronto-limbic system has been reported in maltreated individuals. However, previous results in smaller samples differ largely regarding localization and direction of effects.
We included healthy and depressed samples [n = 624 participants with MDD; n = 701 healthy control (HC) participants] that underwent resting-state functional MRI measurements and provided retrospective self-reports of maltreatment using the Childhood Trauma Questionnaire. A-priori defined regions of interest [ROI; amygdala, hippocampus, anterior cingulate cortex (ACC)] were used to calculate seed-to-voxel connectivities.
No significant associations between maltreatment and resting-state connectivity of any ROI were found across MDD and HC participants and no interaction effect with diagnosis became significant. Investigating MDD patients only yielded maltreatment-associated increased connectivity between the amygdala and dorsolateral frontal areas [pFDR < 0.001; η2partial = 0.050; 95%-CI (0.023–0.085)]. This effect was robust across various sensitivity analyses and was associated with concurrent and previous symptom severity. Particularly strong amygdala-frontal associations with maltreatment were observed in acutely depressed individuals [n = 264; pFDR < 0.001; η2partial = 0.091; 95%-CI (0.038–0.166)). Weaker evidence – not surviving correction for multiple ROI analyses – was found for altered supracallosal ACC connectivity in HC individuals associated with maltreatment.
The majority of previous resting-state connectivity correlates of CM could not be replicated in this large-scale study. The strongest evidence was found for clinically relevant maltreatment associations with altered adult amygdala-dorsolateral frontal connectivity in depression. Future studies should explore the relevance of this pathway for a maltreated subgroup of MDD patients.
This study details the possible escalation of employees' perceptions of pandemic threats into diminished job performance, while considering a mediating role of their sense of job insecurity and a moderating role of their emotion regulation and improvisation skills. Results based on multisource, three-wave data show that employees' perceived pandemic threats compromise their work-related performance, because they believe that their job is at risk. This mediating role of perceived job insecurity is mitigated by employees' greater ability to control their emotions and come up with novel ideas on the spot. This study accordingly pinpoints employees' conviction that they may not be able to keep their jobs as a crucial mechanism by which the hardships of a global pandemic generate negative performance consequences, as well as how organizations can contain this risk by helping employees hone their pertinent personal skills.
After assessing a client a treatment plan is required. The chapter outlines the practical steps in proceeding from a case formulation to a treatment plan. Since many techniques are modified for application in many different clinical problems and psychological disorders, we will concentrate on providing a description of particular procedures that are broadly applicable. The chapter provides practical illustrations of treatment planning with outlines of behaviour therapy, dialectical behaviour therapy, cognitive therapy, and interpersonal psychotherapy. It includes specific examples of clinical cases and explains how these approaches can be subsumed under a transdiagnostic framework of treatment planning. Consideration of transdiagnostic interventions involves targeting negative affect, intolerance of uncertainty, anxiety sensitivity, avoidance and safety behaviours, emotion regulation, and metacognitve therapy.
End-of-life care (EOLC) communication is beneficial but underutilized, particularly in conditions with a variable course such as chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF). Physicians’ emotional distress intolerance has been identified as a barrier to EOLC communication. However, studies of emotional distress intolerance in EOLC have largely relied on anecdotal reports, qualitative data, or observational studies of physician–patient communication. A free-standing measure of multiple dimensions of distress tolerance is warranted to enable the identification of individuals experiencing distress intolerance and to facilitate the effective targeting of interventions to improve distress tolerance.
This study provides preliminary data on the reliability and validity of the Physician Distress Intolerance (PDI) scale. We examine potential subdimensions of emotional distress intolerance.
Family medicine and internal medicine physicians completed the PDI, read vignettes describing patients with COPD or CHF, and indicated whether they initiated or delayed EOLC communication with their patients with similar conditions.
Exploratory and confirmatory factor analyses were performed on separate samples. Confirmatory factor analysis confirmed that a three-factor solution was superior to a two- or one-factor solution. Three subscales were created: Anticipating Negative Emotions, Intolerance of Uncertainty, and Iatrogenic Harm. The full scale and subscales had adequate internal consistency and demonstrated evidence of validity. Higher scores on the PDI, indicating greater distress intolerance, were negatively associated with initiation and positively associated with delay of EOLC communication. Subscales provided unique information.
Significance of results
The PDI can contribute to research investigating and addressing emotional barriers to EOLC communication.
Childhood maltreatment is a potent interpersonal trauma associated with dysregulation of emotional processes relevant to the development of psychopathology. The current study identified prospective links between patterns of maltreatment exposures and dimensions of emotion regulation in emerging adulthood. Participants included 427 individuals (48% Male; 75.9% Black, 10.8% White, 7.5% Hispanic, 6% Other) assessed at two waves. At Wave 1, children (10–12 years) from families eligible for public assistance with and without involvement with Child Protective Services took part in a research summer camp. Patterns of child maltreatment subtype and chronicity (based on coded CPS record data) were used to predict Wave 2 (age 18–24 years) profiles of emotion regulation based on self-report, and affective processing assessed via the Affective Go/No-Go task. Results identified associations between task-based affective processing and self-reported emotion regulation profiles. Further, chronic, multi-subtype childhood maltreatment exposure predicted difficulties with aggregated emotion dysregulation. Exposure to neglect with and without other maltreatment subtypes predicted lower sensitivity to affective words. Nuanced results distinguish multiple patterns of emotion regulation in a sample of emerging adults with high exposure to trauma and socioeconomic stress and suggest that maltreatment disrupts emotional development, resulting in difficulties identifying emotions and coping with emotional distress.
Paranoia is common across the clinical and non-clinical spectrum. Cognitive behavioural therapy for psychosis currently yields modest results, warranting research into symptom-specific maintenance factors to improve outcomes. There is strong evidence of a relationship between insecure attachment and increased paranoia, but little is known about the mediating mechanisms. Emotion dysregulation is associated with both insecure attachment and paranoia, and a candidate causal mechanism.
This study aimed to determine if emotion dysregulation mediates the association between attachment and paranoia.
Sixty-two individuals with elevated paranoia were recruited from NHS services and community settings across the South of England. Mediation analyses were conducted on trait attachment, emotion regulation and paranoia variables, which were collected at one time point.
As predicted, emotion dysregulation mediated the relationship between attachment avoidance and paranoia, and between attachment anxiety and paranoia. Emotion suppression did not mediate the relationship between attachment avoidance and paranoia, possibly due to power. Attachment avoidance correlated with deactivating emotion regulation strategies (e.g. lack of emotional awareness) and attachment anxiety correlated with hyperactivating emotion regulation strategies (e.g. impulse control difficulties). Both deactivating and hyperactivating strategies correlated with paranoia.
Emotion dysregulation is not routinely targeted in cognitive behavioural therapy for psychosis. This study suggests that incorporating emotion regulation strategies in therapy may improve clinical outcomes. Experimental studies are now required to support a causal argument, and pilot intervention studies should investigate if emotion regulation skills development (aligned with attachment style) is effective in reducing non-clinical and clinical paranoia.