A Meta-Analytic Review of Emotion Regulation Focused Psychosocial Interventions for Adolescents

Interweaving Threads: Untangling the Moderating Relationship of Parent-Child Conflict and Closeness in the Association Between Interparental Conflict and Emotion Regulation

The capacity to regulate emotions is central to children's physical, emotional, and mental well-being as they develop. The influence of adverse childhood experiences on diminished emotion regulation (ER) has been linked to internalizing and externalizing problem behaviours in both children and adolescents. This cross-sectional study, including 479 Canadian emerging adults aged 17-19 years, examined how exposure to different levels of interparental conflict (IPC) during childhood was associated with ER (i.e., expressive suppression and cognitive reappraisal) during emerging adulthood, and how parent-child closeness and parent-child conflict moderated this link. Findings revealed that at higher levels of parent-child closeness, IPC was associated with increased expressive suppression, while there were no significant differences in expressive suppression at lower levels of parent-child closeness. Similarly, IPC was more strongly associated with reduced cognitive reappraisal in the context of high parent-child conflict compared to low conflict. Findings from this work will inform interventional therapeutic and counselling practices to support the well-being of children and families.

A feasibility study of a preventative, transdiagnostic intervention for mental health problems in adolescence: building resilience through socioemotional training (ReSET)

BACKGROUND

Adolescence is a developmental period during which an estimated 75% of mental health problems emerge (Solmi et al. in Mol Psychiat 27:281-295, 2022). This paper reports a feasibility study of a novel indicated, preventative, transdiagnostic, school-based intervention: Building Resilience Through Socioemotional Training (ReSET). The intervention addresses two domains thought to be causally related to mental health problems during adolescence: social relationships and emotion processing. Social relationships were targeted using principles from interpersonal psychotherapy, while emotion processing was targeted using cognitive-emotional training focused on three areas of emotion processing: Emotion perception, emotion regulation and interoception. The aims of this feasibility study were to (i) assess the acceptability of integrating group-based psychotherapy with individual cognitive-emotional training, (ii) evaluate the feasibility of our recruitment measures, and (iii) assess the feasibility of delivering our research measures.

METHODS

The feasibility study involved 41 adolescents, aged 12-14, who were randomly assigned to receive the ReSET intervention or their school's usual mental health and wellbeing provision.

RESULTS

Qualitative data from intervention participants suggested the programme was experienced as a cohesive intervention, with participants able to draw on a combination of skills. Further, the cognitive-training tasks were received positively (with the exception of the interoception training task). The recruitment and research measures were successfully delivered in the school-based setting, with 97.5% retention of participants from baseline to post-intervention assessment. Qualitative data was overwhelmingly positive regarding the benefits to participants who had completed the intervention. Moreover, there was only limited data missingness.

CONCLUSIONS

We conclude that a trial of the ReSET intervention in a school setting is feasible. We discuss the implications of the feasibility study with regard to optimising school-based interventions and adaptations made in preparation for a full-scale randomised controlled trial, now underway.

A Narrative Review to Identify Promising Approaches for Digital Health Interventions to Support Emotion Regulation for Adolescents With Attention-Deficit/Hyperactivity Disorder

Emotion regulation difficulties affect many adolescents with attention-deficit/hyperactivity disorder (ADHD), and previous research has highlighted a need for accessible interventions to support them in this domain, especially in real-life contexts. Digital health interventions (DHIs) can be embedded in adolescents' daily lives and thus offer considerable promise for meeting this need. However, there is a lack of information to guide the development of suitable emotion regulation DHIs for this population. The goal of this study is, therefore, to identify recommendations to guide the development of emotion regulation DHIs for adolescents with ADHD. This narrative review synthesizes diverse relevant evidence to inform their development, including promising therapeutic approaches and components and relevant design and development considerations. We find that there is very little direct evidence of "what works" for emotion regulation DHIs and emotion regulation interventions more generally for adolescents with ADHD; however, we identify promising therapeutic approaches for new DHIs. We also recommend following a co-design or coproduction approach with adolescents with ADHD, including exploring elements designed to motivate and engage young people to support sustained adherence. We conclude that DHIs are a promising approach for emotion regulation interventions for adolescents with ADHD, could draw on a range of existing therapeutic approaches, and should be co-designed with users themselves.

A six-week group program of emotion focused family therapy for parents of children with mental health challenges: protocol for a randomized controlled trial

BACKGROUND

Children with mental health difficulties are at increased risk of many adverse psychological, academic, and social outcomes. Emotion regulation is a key transdiagnostic factor in the development and maintenance of mental health challenges. Parents and the family system (e.g., parental functioning, parenting, parent-child relationship) play a central role in children's development of emotion regulation and, in turn, their mental health. Therefore, continued efforts are needed to understand the effectiveness of emotion-focused treatments for child mental health difficulties, particularly those that include a family-based approach. Emotion Focused Family Therapy (EFFT) is an intervention for parents of children with mental health difficulties that teaches parents advanced skills to support their child's emotional development, potentially leading to improvements in the psychological functioning of the affected child as well as the family. Despite this, EFFT's efficacy has yet to be tested empirically via a randomized controlled trial.

METHODS

A six-week group modality of EFFT was developed based on the standard manualized version of a two-day group modality of EFFT. Efficacy of the six-week group modality of EFFT will be tested in a randomized controlled trial among parents of children aged 7 to 15 with anxiety, depression, or behavioral challenges. Parents will be randomized to the intervention condition or waitlist control condition. Online questionnaires and in-lab assessments will be conducted at pre-treatment, post-treatment, 4-month follow-up and 1-year follow-up. Intervention effects on primary (parent psychological symptoms, child psychological symptoms, parent emotion regulation, child emotion regulation, parent-child co-regulation) and secondary (parental emotion socialization, parent emotion blocks, parental self-efficacy, perceived parental stress, treatment satisfaction, treatment fidelity) outcomes will be analyzed by linear mixed models.

DISCUSSION

The study protocol describes the randomized controlled trial of EFFT, a parent group intervention for parents of children with anxiety, depression, and behavioral challenges. Findings contribute to the understanding of the efficacy of EFFT as a time-limited, transdiagnostic intervention for the treatment of child mental health challenges with potential positive impacts on parent and family functioning. TRIAL REGISTRATION [2A]: ClinicalTrials.gov: NCT05603000. Prospectively registered October 13, 2022. PROTOCOL VERSION [3]: Version 1.1 November 2023.

Differential patterns of emotion regulation in sexual minority adolescents in residential treatment

OBJECTIVE

Sexual minority adolescents experience disproportionate mental health problems, including increased anxiety, depression, and suicidal thoughts and behaviors. Minority Stress Theory posits that sexual minority people experience significantly more stress (e.g., via discrimination or prejudice) in their everyday lives, which can underlie these mental health disparities. Though group differences in mental health symptoms are well-documented, there has been less focus on symptom trajectories, which is critical for identifying effective mental health interventions.

METHOD

Seventy adolescents ages 13-19 years enrolled in a short-term, acute residential psychiatric treatment program provided self-report measures of depressive symptoms, anxiety, and emotion regulation difficulties at baseline, discharge (∼2 weeks), and one-month post-treatment follow-up. Adolescents self-reported sexual orientation and were stratified into sexual minority (SM, n = 37) or heterosexual (n = 33) groups.

RESULTS

Depressive and anxiety symptoms and emotion dysregulation scores were significantly reduced at follow-up, compared to baseline. While there were no significant group x time interactions for depressive and anxiety symptoms, the SM group entered the program with worse emotion dysregulation scores, which improved more over time compared to the heterosexual group.

CONCLUSION

These findings show that although sexual minority individuals can make substantial gains during residential treatment, emotion regulation difficulties are a particularly relevant treatment target. Emotion regulation, a transdiagnostic construct that typically develops substantially during adolescence, might be of critical importance when identifying effective treatment interventions for sexual minority youth.

LIMITATIONS

Adolescents in this sample demonstrated limited racial diversity and likely displayed a higher degree of psychopathology than the general population.

Emotion Regulation Moderates the Prospective Association between ERN and Anxiety in Early Adolescence: An Age-Specific Moderation of Cognitive Reappraisal but not Expressive Suppression

The increasing prevalence of anxiety problems during adolescence underscores the importance of a better understanding of the development of anxiety. Existing literature has documented a prospective association between error responsivity - characterized by the ERP component of error-related negativity (ERN) - and anxiety in youths. However, it remains unclear to what extent the ERN-anxiety relationship may be moderated by emotion regulation, another attribute critical to the development of anxiety. We collected two waves of data from 115 healthy early adolescents (66 girls; Mean age/SD at T1 = 11.00/1.16 years), approximately one year apart. Participants completed an EEG Go/No-Go task and reported on their anxiety symptoms at T1 and T2; they also reported on their emotion regulation tendencies (i.e., cognitive reappraisal [CR] and expressive suppression [ES]) at T2. The ERN was quantified via a principal component analysis. We found a moderating effect of ES on the ERN-anxiety association. Specifically, a larger T1 ERN predicted greater T2 anxiety symptoms for youths with higher, but not lower, ES. Interestingly, the moderating effect of CR on the ERN-symptom association was conditioned on age. Among older youths (upper age tercile) only, the association between T1 ERN and T2 symptoms was significant for those with lower, but not higher, CR. These findings contribute novel evidence on the moderating effect of emotion regulation on the prospective ERN-anxiety relationship in early adolescence. Our results elucidate age-specific patterns in the moderating effect of CR. Future studies can leverage these findings to tailor emotion regulation interventions for youths of different ages.

Risk Factors and Clinical Predictors of Suicidal Behaviors and Non-Suicidal Self-Injury Among Pediatric Psychiatry Emergency Admissions Pre- and Post-Pandemic: A Retrospective Cohort Study

BACKGROUND

Suicidal behavior (SB) and non-suicidal self-injury (NSSI) are significant public health concerns among adolescents. The COVID-19 pandemic may have exacerbated these issues.

METHODS

This retrospective cohort study analyzed data from 341 adolescents (aged 6-18 years) presenting to a Romanian pediatric psychiatry emergency department during the years 2019 (pre-pandemic) and 2022 (post-pandemic). All participants underwent a thorough psychiatric assessment, and, together with their caregivers, were questioned on a wide range of potentially relevant issues, such as family, social, school, and life history factors. Logistic regression and random forest models were used to identify predictors of SB and NSSI.

RESULTS

SB was significantly predicted in regression models based on a prior suicidal ideation (OR = 68.410; p < 0.001), having a parent living abroad (OR = 11.438; p = 0.020), depression (OR = 6.803; p < 0.001), and conflicts with peers (OR = 0.325, p = 0.042), teachers (OR = 0.119, p = 0.024), or both (OR = 0.166, p = 0.012). The random forest model featured a slightly different order of the main predictors and highlighted the importance of additional predictors, such as prior suicide attempts, gender, and past non-suicidal self-injury. NSSI was mainly predicted by a history of self-harm (OR = 52.437; p < 0.001), the number of comorbid psychiatric disorders (OR = 1.709; p = 0.003), and conduct disorder (OR = 0.184; p < 0.001), to which are added, according to random forest models, new predictors, such as borderline personality disorder, suicidal ideation, and school performance. Post-pandemic increases were observed in depression, suicidal ideation, and possible psycho-traumatic negative life event exposure.

CONCLUSIONS

This study underscores the complex interplay of individual, familial, and societal factors influencing adolescent self-harm. Comprehensive interventions are needed, with early intervention crucial for those with a history of self-harm. Further research using prospective designs is recommended.

The connecting brain in context: How adolescent plasticity supports learning and development

Puberty initiates significant neurobiological changes that amplify adolescents' responsiveness to their environment, facilitating neural adaptation through processes like synaptic pruning, myelination, and neuronal reorganization. This heightened neuroplasticity, combined with their burgeoning social curiosity and appetite for risk, propels adolescents to explore diverse new environments and forge social bonds. Such exploration can accelerate experiential learning and the formation of social networks as adolescents prepare for adult independence. This review examines the complex interplay between adolescent neuroplasticity, environmental influences, and learning processes, synthesizing findings from recent studies that illustrate how factors such as social interactions, school environments, and neighborhood contexts influence both the transient activation and enduring organization of the developing brain. We advocate for incorporating social interaction into adolescent-tailored interventions, leveraging their social plasticity to optimize learning and development during this critical phase. Going forward, we discuss the importance of longitudinal studies that employ multimodal approaches to characterize the dynamic interactions between development and environment, highlighting recent advancements in quantifying environmental impacts in studies of developmental neuroscience. Ultimately, this paper provides an updated synopsis of adolescent neuroplasticity and the environment, underscoring the potential for environmental enrichment programs to support healthy brain development and resilience at this critical development stage.

Violence as an obstacle to HIV medication adherence and viral suppression: A daily diary investigation among adolescent boys

For the 1.6 million adolescents currently living with HIV, adherence to antiretroviral therapy (ART) is vitally important for reducing HIV-associated morbidity and mortality, and for preventing onward HIV transmission. Unfortunately, ART adherence is particularly low among adolescents. One important barrier to adherence is exposure to violence; however, the impact of cumulative versus acute exposure to violence on adherence is unclear. We tested whether violence exposure was associated with ART adherence and viral load over a one-year period among adolescent boys living with HIV in Soweto, South Africa. Participants (N = 239) completed weekly ecological momentary assessment (EMA) surveys of their recent experiences with violence and ART adherence. They provided biological samples at baseline and at the one-year follow-up to measure viral load. Higher average exposure to violence over the course of the study year was significantly associated with lower ART adherence (i.e., a cumulative impact). When we restricted violence exposure to intimate partner violence only, we found that participants were significantly less likely to take their HIV medication on days when they experienced physical intimate partner violence (i.e., an acute impact). We also found a significant positive association between exposure to violence over the course of the study and participants' viral load at follow-up, even after controlling for baseline viral load. Our findings suggest that violence impacts two important HIV care outcomes through multiple pathways and highlight the importance of differentiating cumulative versus acute victimization in violence research. To improve health outcomes among adolescents with HIV and prevent new infections, it will be necessary to include boys in violence prevention and support services and to address violence exposure in HIV care.

Using Active and Passive Smartphone Data to Enhance Adolescents' Emotional Awareness in Forensic Outpatient Setting: A Qualitative Feasibility and Usability Study

BACKGROUND

Delinquent behavior in adolescence is a prevalent issue, often associated with difficulties across multiple life domains, which in turn perpetuates negative life outcomes. While current treatment programs show partial success in improving behavioral changes and reducing recidivism, comprehensive conclusions regarding the overall efficacy of these interventions have yet to be established. In forensic outpatient settings, the discrepancy between adolescents' limited emotional awareness and the predominant emphasis on cognitive reflection, combined with low treatment adherence, may be factors that undermine treatment efficacy. New technologies, such as smartphone apps, may offer a solution by integrating real-life data into treatment to improve emotional and behavioral patterns. The low-threshold use of smartphone data can be useful in addressing these treatment challenges.

OBJECTIVE

This study aimed to explore the feasibility and usability of Feelee (Garage2020), a smartphone app that integrates active emoji and passive behavioral data, as a potential addition to treatment for adolescents in a forensic outpatient setting.

METHODS

We conducted a prepilot study with adolescents (n=4) who used the Feelee app over a 2-week period. App usage included completing a brief emoji survey 3 times a day (active data) and allowing Feelee to track the call logs, Bluetooth devices in proximity, cell tower IDs, app usage, and phone status (passive data). During treatment sessions, both adolescents and clinicians reviewed and discussed the active and passive data. Semistructured interviews were conducted with adolescents and clinicians (n=7) to gather experiences and feedback on the feasibility and usability of incorporating smartphone data into treatment.

RESULTS

The study showed that adolescents (n=3) succeeded in using Feelee for the full 2 weeks, and data were available for discussion in at least 1 session per participant. Both adolescents and clinicians (n=7) stated that Feelee was valuable for viewing, discussing, and gaining insight into their emotions, which facilitated targeted actions based on the Feelee data. However, neither adolescents nor clinicians reported increased engagement in treatment as a result of using Feelee. Despite technical issues, overall feedback on the Feelee app, in addition to treatment, was positive (n=7). However, further improvements are needed to address the high battery consumption and the inaccuracies in the accelerometer.

CONCLUSIONS

This qualitative study provides an in-depth understanding of the potential benefits of integrating active and passive smartphone data for adolescents in a forensic outpatient setting. Feelee appears to contribute to a better understanding of emotions and behaviors, suggesting its potential value in enhancing emotional awareness in treatment. Further research is needed to assess Feelee's clinical effectiveness and explore how it enhances emotional awareness. Recommendations from adolescents and clinicians emphasize the need for prepilot studies to address user issues, guiding technical improvements and future research in forensic outpatient settings.

Using Heart Rate and Behaviors to Predict Effective Intervention Strategies for Children on the Autism Spectrum: Validation of a Technology-Based Intervention

Many children on the autism spectrum engage in challenging behaviors, like aggression, due to difficulties communicating and regulating their stress. Identifying effective intervention strategies is often subjective and time-consuming. Utilizing unobservable internal physiological data to predict strategy effectiveness may help simplify this process for teachers and parents. This study examined whether heart rate data can predict strategy effectiveness. Teachers and coders from the research team recorded behavioral and heart rate data over three months for each participating student on the autism spectrum using the KeepCalm app, a platform that provides in-the-moment strategy suggestions based on heart rate and past behavioral data, across 226 instances of strategy interventions. A binary logistic regression was performed to assess whether heart rate reduction, time to return to heart rate baseline, and documented skills and challenging behaviors predicted strategy effectiveness. Results suggested that heart rate reduction may be a significant predictor, and supported the existing practice of using behavioral patterns as proxies for strategy effectiveness. Additional analyses indicate proactive strategies are more effective and are associated with greater reduction in heart rate, relative to reactive strategies. Further exploration of how internal physiological data can complement observable behaviors in assessing intervention strategy effectiveness is warranted given the novelty of our findings.

The Outcomes of Trauma-Informed Practice in Youth Justice: An Umbrella Review

Findings of high rates of complex trauma among justice-involved young people have engendered interest in developing trauma-informed youth justice systems. Although there have been several reviews of trauma-informed practice in youth justice settings, uncertainty remains about whether this approach can produce the outcomes expected of youth justice services. In this study we summarize findings from recent systematic reviews and meta-analyses to provide an overview of evidence relevant to implementing trauma-informed youth justice. We conducted an umbrella review of systematic reviews published between 2017 and 2023 that included group-based primary studies of trauma-informed interventions for justice-involved young people. Reviews were located via searches of PsycINFO, PubMedCentral, Embase, Criminal Justice Abstracts with Full Text, and ProQuest. Data extracted from each review included the number and type of primary studies reviewed, and outcomes related to trauma symptomatology, mental health and wellbeing, and justice system involvement. Nine systematic reviews met our inclusion criteria. Improvements in trauma symptoms, mental health and wellbeing, and justice system involvement were documented in each review. The strongest evidence related to the impact of trauma-focused interventions on posttraumatic stress disorder symptoms, but less evidence was available to demonstrate outcomes of organizational level and systemic components of trauma-informed practice. Each review highlighted the need to strengthen the methodological quality of primary studies. Trauma-informed practice should be seriously considered as part of any effort to implement evidence-based youth justice. This should extend beyond treatment of trauma symptomatology to incorporate a broader approach to trauma-informed practice that is organizationally embedded.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40653-024-00634-5.

The effects of mindfulness-based techniques on self-rumination, cognitive reappraisal and expressive suppression among patients with major depression: a nursing perspective

Background

Patients with major depressive disorder (MDD) often struggle with adaptive strategies like self-reflection and cognitive reappraisal, relying instead on maladaptive ones like self-rumination and emotional suppression. Mindfulness-based techniques (MBTs) have been identified as a promising complementary psychological intervention for this population.

Aims

To evaluate the effects of MBTs on mindful attention awareness, self-rumination, self-reflection, cognitive reappraisal and expressive suppression in patients with MDD between patients who receive MBTs and those who do not.

Methods

This quasi-experimental research was carried out at the Psychiatric Outpatient Clinics. A representative sample of 120 patients with MDD were randomly recruited to either a study group (n = 60) or a control group (n = 60). The Mindful Attention Awareness Scale (MAAS), The Rumination-Reflection Questionnaire (RRQ) and The Emotion Regulation Questionnaire (ERQ) were utilised to collect data.

Results

After participation in MBTs, the study group had significantly greater improvements in the mean scores of MAAS, RRQ, Cognitive Reappraisal and Expressive Suppression compared to the control group (p < 0.001 each).

Recommendations

The study recommends developing and implementing training programmes for nurses to equip them with the skills and knowledge to effectively deliver MBTs as part of patient care. Conducting longitudinal studies is necessary to assess the sustainability of these improvements.

Psychological interventions for depression in children and adolescents: A bibliometric analysis

BACKGROUND

Depression has gradually become a common psychological disorder among children and adolescents. Depression in children and adolescents affects their physical and mental development. Psychotherapy is considered to be one of the main treatment options for depressed children and adolescents. However, our understanding of the global performance and progress of psychological interventions for depression in children and adolescents (PIDCA) research is limited.

AIM

To identify collaborative research networks in this field and explore the current research status and hotspots through bibliometrics.

METHODS

Articles and reviews related to PIDCA from January 2010 to April 2023 were identified from the Web of Science Core Collection database. The Charticulator website, CiteSpace and VOSviewer software were used to visualize the trends in publications and citations, the collaborative research networks (countries, institutions, and authors), and the current research status and hotspots.

RESULTS

Until April 16, 2023, 1482 publications were identified. The number of documents published each year and citations had increased rapidly in this field. The United States had the highest productivity in this field. The most prolific institution was the University of London. Pim Cuijpers was the most prolific author. In the context of research related to PIDCA, both reference co-citation analysis and keywords co-occurrence analysis identified 10 research hotspots, including third-wave cognitive behavior therapy, short-term psychoanalytic psychotherapy, cognitive behavioral analysis system of psychotherapy, family element in psychotherapy, modular treatment, mobile-health, emotion-regulation-based transdiagnostic intervention program, dementia risk in later life, predictors of the efficacy of psychological intervention, and risks of psychological intervention.

CONCLUSION

This bibliometric study provides a comprehensive overview of PIDCA from 2010 to present. Psychological intervention characterized as psychological-process-focused, short, family-involved, modular, internet-based, emotion-regulation-based, and personalized may benefit more young people.

Emotion Regulation Predicts Depressive Symptoms in Adolescents: A Prospective Study

Emotion regulation as a proximal factor has been linked with depressive symptoms. However, studies have mainly focused on a limited number of strategies and have mostly been cross-sectional in design. This is particularly evident when examining the protective effects of adaptive strategies. This study aimed to investigate the prospective relationship between putatively adaptive and maladaptive emotion regulation strategies and depressive symptoms among adolescents. Additionally, a person-oriented approach was applied to identify latent classes of adolescents based on their depressive symptoms and compared these classes in terms of their adaptive and maladaptive strategies. Two waves of data from a prospective study, which included 1371 youth (mean age: 15.66 years; SD = 0.49 years; 55.1% girls), were analysed. The two points of data collection were spaced approximately half a year apart. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale, and putatively adaptive and maladaptive emotion regulation strategies were assessed with the Cognitive Emotion Regulation Questionnaire. Seven strategies (acceptance, positive refocusing, positive reappraisal, putting into perspective, self-blame, rumination, and catastrophizing) were categorised into adaptive and maladaptive factors using exploratory structural equation modeling. After controlling for gender, age, and depressive symptoms at Time 1, both maladaptive and adaptive emotion regulation strategies at Time 1 predicted depressive symptoms at Time 2. Three subgroups emerged based on the intensity of depressive symptoms across the waves: the stable low, stable moderate, and stable high depressive symptom groups. The use of maladaptive emotion regulation strategies (such as rumination, self-blame, and catastrophizing) at Time 1 was more pronounced in the stable moderate and high symptom groups compared to the stable low depressive symptom group. The comparable prospective associations between putatively adaptive and maladaptive strategies with symptoms suggest the need to identify factors that may mitigate the negative impact of maladaptive emotion regulation and/or promote adaptive emotion regulation to buffer the effects of everyday stressors.

Web-Based Self-Compassion Training to Improve the Well-Being of Youth With Chronic Medical Conditions: Randomized Controlled Trial

BACKGROUND

Up to one-third of young people live with chronic physical conditions (eg, diabetes, asthma, and autoimmune disease) that frequently involve recurrent pain, fatigue, activity limitations, stigma, and isolation. These issues may be exacerbated as young people transition through adolescence. Accordingly, young people with chronic illness are at a high risk of psychological distress. Accessible, evidence-based interventions for young people with chronic illnesses are urgently needed to improve well-being, support adaptation, and enhance daily functioning. Self-compassion, which is an adaptive means of relating to oneself during times of difficulty, is a promising intervention target for this population.

OBJECTIVE

This study aims to test the efficacy of a 4-week, self-guided, web-based self-compassion training program for improving well-being among young Australians (aged 16-25 years) living with a chronic medical condition. The primary outcomes were self-compassion, emotion regulation difficulties, and coping; the secondary outcomes were well-being, distress, and quality of life. We also sought to test whether changes in primary outcomes mediated changes in secondary outcomes and gather feedback about the strengths and limitations of the program.

METHODS

We conducted a single-blind, parallel-group, randomized controlled trial comparing a 4-week, fully automated, web-based self-compassion training program with a waitlist control. Participants were recruited via the internet, and outcomes were self-assessed at 4 (T1) and 12 weeks (T2) after the baseline time point via a web-based survey. A mixed methods approach was used to evaluate the program feedback.

RESULTS

Overall, 151 patients (age: mean 21.15, SD 2.77 years; female patients: n=132, 87.4%) were randomized to the intervention (n=76, 50.3%) and control (n=75, 49.7%) groups. The loss-to-follow-up rate was 47.4%, and program use statistics indicated that only 29% (22/76) of young people in the experimental group completed 100% of the program. The main reported barrier to completion was a lack of time. As anticipated, treatment effects were observed for self-compassion (P=.01; partial η2=0.05; small effect); well-being (P≤.001; partial η2=0.07; medium effect); and distress (P=.003; partial η2=0.054; small-medium effect) at the posttest time point and maintained at follow-up. Contrary to our hypotheses, no intervention effects were observed for emotion regulation difficulties or maladaptive coping strategies. Improvements in adaptive coping were observed at the posttest time point but were not maintained at follow-up. Self-compassion, but not emotion regulation difficulties or coping, mediated the improvements in well-being.

CONCLUSIONS

Minimal-contact, web-based self-compassion training can confer mental health benefits on young people with chronic conditions. This group experiences substantial challenges to participation in mental health supports, and program engagement and retention in this trial were suboptimal. Future work should focus on refining the program content, engagement, and delivery to optimize engagement and treatment outcomes for the target group.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry 12619000572167; https://tinyurl.com/5n6hevt.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s12889-020-8226-7.

Future Directions in Youth Irritability Research

Research on irritability in children and adolescents has proliferated over the last 20 years. The evidence shows the clinical and developmental significance of irritable mood and behavior in youth, and it has led to significant changes in mental health classification, diagnosis, and services. At the same time, this research (including our own) has led to relatively little new in terms of practical, empirically based guidance to improve interventions and outcomes. In this article, we briefly summarize some of these developments and current evidence-based practices. We then put forth two key substantive challenges (the "whats") for future research to address: (a) the need for more effective treatments, especially evaluating and adapting evidence-based treatments that are already well-established for problems related to irritability (e.g., cognitive-behavioral therapies for internalizing and externalizing problems); and (b) the need for a better mechanistic understanding of irritability's phenomenology (e.g., phasic vs. tonic irritability, how frustration unfolds) and putative underlying mechanisms (e.g., cognitive control, threat and reward dysfunction). Lastly, we suggest three methodological approaches (the "hows") that may expedite progress in such areas: (a) ecological momentary assessment, (b) digital health applications, and (c) leveraging existing datasets. We hope this article will be useful for students and early-career researchers interested in tackling some of these important questions to better meet the needs of severely irritable youth.

Parental warmth, adolescent emotion regulation, and adolescents' mental health during the COVID-19 pandemic

Introduction

The United States (U.S.) Surgeon General Advisory has characterized the COVID-19 pandemic as a youth mental health crisis. Thus, elucidating factors affecting adolescents' mental health during the pandemic is important for supporting youth through current and future challenges. Parenting influences adolescents' ability to cope with stressors, and emotion regulation strategy use may underlie these effects.

Methods

This longitudinal study of 206 adolescents (49% female; 46.6% Latine) from the U.S. evaluated pathways from perceived parental warmth and affection at age 12 to changes in adolescents' internalizing and externalizing problems from before the pandemic (age 14) to the initial phase of the U.S COVID-19 pandemic in Spring 2020 (age 15) through adolescents' pre-pandemic cognitive reappraisal and expressive suppression emotion regulation strategy use at age 14.

Results

Parental warmth and affection predicted decreased internalizing, but not externalizing, problems during the initial phase of the pandemic, and this effect was explained by adolescents' reduced reliance on expressive suppression as an emotion regulation strategy.

Conclusion

These findings illuminate parenting and emotion regulation strategy selection as modifiable processes to support adolescents' mental health in this crisis and beyond.

Neurocognitive and self-reported psychosocial and behavioral functioning in siblings of individuals with neurodevelopmental conditions: a study using remote self-administered testing

OBJECTIVE

This study compared and explored the neurocognitive profiles of siblings of persons with and without neurodevelopmental conditions (NDCs) and associations between objective test performance and self-reported psychosocial functioning.

METHODS

Siblings of persons with and without NDCs (64 NDC and 64 control siblings; mean age 19.88 years, range 11-27 years, 73.44% female, 75.78% White Caucasian) completed self-report questionnaires and self-administered computerized neurocognitive tests of executive functioning (EF). Using Bayesian analyses, we examined cross-sectional associations between self-reported psychosocial functioning and cognitive test performance, and predictors of EF over 15 months.

RESULTS

NDC siblings had poorer working memory, inhibition, attention, and shifting compared to controls, as measured by experimental paradigms on the backward Corsi span, N-Back 2-back task, Stop Signal Task, Sustained Attention to Response Task, and the Wisconsin Card Sorting Test (effect size δ ranging 0.49 to 0.64). Bayesian cross-sectional networks revealed negative emotion reactivity and working memory difficulties were central to the NDC sibling network. Over 15 months, poorer EF (k low test scores) was predicted by negative emotion reactivity, sleep problems, and anxiety, over and above effects of age and subclinical autistic and ADHD traits. Siblings of autistic individuals and persons with fetal alcohol spectrum disorder had higher rates of neurocognitive and psychiatric difficulties than other NDCs and controls (Bayes factors >20).

CONCLUSIONS

Neurocognitive difficulties were associated with transdiagnostic vulnerability to poorer wellbeing in NDC siblings. These findings demonstrate the feasibility of remote online cognitive testing and highlight the importance of individualized prevention and intervention for NDC siblings.

Evaluation of community-based health promotion interventions in children and adolescents in high-income countries: a scoping review on strategies and methods used

BACKGROUND

In recent decades, community-based interventions have been increasingly adopted in the field of health promotion and prevention. While their evaluation is relevant for health researchers, stakeholders and practitioners, conducting these evaluations is also challenging and there are no existing standards yet. The objective of this review is to scope peer-reviewed scientific publications on evaluation approaches used for community-based health promotion interventions. A special focus lies on children and adolescents' prevention.

METHODS

A scoping review of the scientific literature was conducted by searching three bibliographic databases (Medline, EMBASE, PsycINFO). The search strategy encompassed search terms based on the PCC (Population, Concept, Context) scheme. Out of 6,402 identified hits, 44 articles were included in this review.

RESULTS

Out of the 44 articles eligible for this scoping review, the majority reported on studies conducted in the USA (n = 28), the UK (n = 6), Canada (n = 4) and Australia (n = 2). One study each was reported from Belgium, Denmark, Germany and Scotland, respectively. The included studies described interventions that mostly focused on obesity prevention, healthy nutrition promotion or well-being of children and adolescents. Nineteen articles included more than one evaluation design (e.g., process or outcome evaluation). Therefore, in total we identified 65 study designs within the scope of this review. Outcome evaluations often included randomized controlled trials (RCTs; 34.2%) or specific forms of RCTs (cluster RCTs; 9.8%) or quasi-experimental designs (26.8%). Process evaluation was mainly used in cohort (54.2%) and cross-sectional studies (33.3%). Only few articles used established evaluation frameworks or research concepts as a basis for the evaluation.

CONCLUSION

Few studies presented comprehensive evaluation study protocols or approaches with different study designs in one paper. Therefore, holistic evaluation approaches were difficult to retrieve from the classical publication formats. However, these publications would be helpful to further guide public health evaluators, contribute to methodological discussions and to inform stakeholders in research and practice to make decisions based on evaluation results.

Shared genetic influences between depression and conduct disorder in children and adolescents: A systematic review

INTRODUCTION

The co-occurrence between major depression disorder (MDD) and conduct disorder (CD) is common across development and represents a significant risk factor for future psychiatric problems and long-term impairment. Large-scale quantitative genetic studies suggest that the MDD-CD co-occurrence may be partly explained by shared genetic vulnerability factors, in line with transdiagnostic models of psychopathology, but no systematic synthesis of the literature is currently available.

METHODS

We therefore conducted a systematic review of the available genetic literature on the co-occurrence between MDD and CD in children and adolescents. We identified 10 eligible studies, including 5 cross-sectional bivariate/multivariate twin studies, 3 longitudinal bivariate/multivariate twin studies, and 2 latent profile/trajectory twin studies.

RESULTS

Most of the reviewed studies found a strong contribution of shared genetic factors on the covariation between depression and conduct problems, in line with the prominent effect of a common genetic liability across development.

LIMITATIONS

The scientific literature on this psychiatric comorbidity is still limited, as it solely consists of twin studies from high income countries.

CONCLUSION

Considering the joint burden of MDD and CD on youth, families and society worldwide, future studies are needed to better investigate the shared risk processes of these frequently co-occurring conditions, in order to inform new treatments through personalized medicine.

Internet-based emotion-regulation training added to CBT in adolescents with depressive and anxiety disorders: A pilot randomized controlled trial to examine feasibility, acceptability, and preliminary effectiveness

BACKGROUND

Dysfunctional emotion regulation (ER) is associated with symptoms of depression and anxiety in adolescents. This pilot study aimed to examine the acceptability and feasibility of a guided internet-based emotion regulation training (ERT) added to cognitive behavioral therapy (CBT). Furthermore, we aimed to examine the feasibility of the randomized study design and to provide a first estimate of the effectiveness of CBT + ERT compared with CBT alone in adolescents with depressive or anxiety disorders.

METHODS

In a pilot randomized controlled trial (RCT) with a parallel group design, 39 patients (13-18 years) with depressive or anxiety disorder were assigned to CBT + ERT (n = 21) or CBT (n = 18). Assessments at baseline, three-months and six-months follow-up included treatment adherence, satisfaction, depressive symptoms, anxiety symptoms, and ER strategies.

RESULTS

Adherence to ERT was 66.5 %, and treatment satisfaction was adequate. 76.5 % of eligible patients participated in the study. Linear mixed-model analyses showed significantly reduced anxiety symptoms (p = .003), depressive symptoms (p = .017), and maladaptive ER (p = .014), and enhanced adaptive ER (p = .008) at six months follow-up in the CBT + ERT group compared to controls.

LIMITATIONS

The sample size was small, and results regarding effectiveness remain preliminary. Data-collection took place during COVID-19, which may have influenced the results.

CONCLUSIONS

Both the intervention and the study design were found to be feasible. In a larger RCT, however, improvement of recruitment strategy is necessary. Preliminary results indicate potential effectiveness in decreasing anxiety, depression, and emotion dysregulation in adolescents. The next step should be the development of an improved internet-based ERT and its evaluation in a larger RCT.

TRIAL REGISTRATION

Registered on January 14th, 2020 in The Netherlands Trial Register (NL8304).

Early-childhood temperament moderates the prospective associations of coping with adolescent internalizing and externalizing symptoms

While appraisal and coping are known to impact adolescent psychopathology, more vulnerable or resilient responses to stress may depend on individual temperament. This study examined early life temperament as a moderator of the prospective relations of pre-adolescent appraisal and coping with adolescent psychopathology. The sample included 226 (62% female, 14–15 years) adolescents with assessments starting at 3 years of age. Adolescents were predominately White (12% Black 9% Asian, 11% Latinx, 4% Multiracial, and 65% White). Observed early-childhood temperament (fear, frustration, executive control, and delay ability) were tested as moderators of pre-adolescent coping (active and avoidant) and appraisal (threat, positive) on internalizing and externalizing symptoms during the pandemic. Interaction effects were tested using regression in R. Sex and family context of stress were covariates. Early-childhood temperament was correlated with pre-adolescent symptoms, however, pre-adolescent appraisal and coping but not temperament predicted adolescent psychopathology. Frustration moderated the relations of active and avoidant coping and positive appraisal to symptoms such that coping and appraisal related to lower symptoms only for those low in frustration. Executive control moderated the associations of avoidant coping with symptoms such that avoidance reduced the likelihood of symptoms for youth low in executive control. Findings underscore the role of emotionality and self-regulation in youth adjustment, with the impact of coping differing with temperament. These findings suggest that equipping youth with a flexible assortment of coping skills may serve to reduce negative mental health outcomes.

Feasibility and Acceptability of a School-Based Emotion Regulation Prevention Intervention (READY-Nepal) for Secondary School Students in Post-Earthquake Nepal

BACKGROUND

Child and adolescent mental health problems are major contributors to the global burden of disease in low- and middle-income country (LMIC) settings. To advance the evidence base for adolescent mental health interventions in LMICs, we evaluated the feasibility and acceptability of a school-based emotion regulation prevention intervention (READY-Nepal) for adolescents who had a recent exposure to a humanitarian disaster.

METHODS

A mixed-method, non-randomized controlled trial was conducted with Nepali secondary school students in one heavily affected post-earthquake district. Students (N = 102; aged 13 to 17 years) were enrolled in the intervention (n = 42) and waitlist control (n = 60) conditions. Feasibility and acceptability were examined via attendance, and by qualitative interviews with a subset of students (n = 15), teachers (n = 2), and caregivers (n = 3). Preliminary efficacy was examined on primary outcome (emotion regulation) and secondary outcomes (anxiety symptoms, posttraumatic stress symptoms, functional impairment, resilience, coping skills), which were measured at baseline and post-intervention (four weeks).

RESULTS

Delivering the intervention was feasible and acceptable, as demonstrated by low dropout (8%) and high program attendance (6.7 of 8 sessions). Qualitative data suggested high uptake of anger regulation skills, but lower uptake of mindfulness skills. Despite this, there were no significant differences by condition on primary or secondary outcomes at four-week follow-up. Students provided suggestions for improvement of the program.

CONCLUSION

Further research on longitudinal outcome measurement, use of alternatives to retrospective self-report data, and rigorous development of culturally grounded models of emotion regulation is necessary to explore the utility of school-based emotion regulation interventions in Nepal and other LMICs.

Effectiveness of an add-on guided internet-based emotion regulation training (E-TRAIN) in adolescents with depressive and/or anxiety disorders: study protocol for a multicenter randomized controlled trial

BACKGROUND

During adolescence, depressive and anxiety disorders are among the most common mental health disorders. Both disorders tend to persist, are predictive for other mental disorders, and are associated with severe impairment in diverse areas. Although Cognitive Behavioral Therapy (CBT) has proven to be an effective treatment, a considerable number of adolescents do not respond to CBT and residual symptoms often remain. Therefore, it is of great importance to improve treatment outcomes for depressed and/or anxious adolescents. Dysfunctional emotion regulation appears to be a transdiagnostic factor in the development and maintenance of aforementioned disorders. Enhancing emotion regulation skills may therefore reduce symptom severity. In light of this, we developed a guided internet-based emotion regulation training (E-TRAIN) that will be added to CBT. This study aims to evaluate the effectiveness of E-TRAIN + CBT compared to CBT alone on depressive and anxiety outcomes among adolescents with depressive and/or anxiety disorder.

METHODS

In this multicenter two-arm randomized controlled trial with parallel group design, we aim to include 138 adolescents, aged 13-19 years, referred for treatment and diagnosed with depressive and/or anxiety disorder. Participants will be allocated to either CBT or CBT + E-TRAIN. Assessments will take place at baseline, and at 3 (T1), 6 (T2) and 12 (T3) months after baseline. We will conduct multi-informant assessments: the adolescent, a parent/caregiver, and the CBT therapist will be asked to fill in questionnaires. The continuous primary outcome measure is self-reported depressive and anxiety symptoms at six months after baseline, measured with the RCADS25. Secondary outcome measures include anxiety or depression diagnosis based on a semi-structured clinical interview, emotion (dys) regulation, and parent-report measures of anxiety, depression and emotion (dys) regulation.

DISCUSSION

This study is the first randomized controlled trial to examine the additional value of a guided internet-based emotion regulation training to regular CBT in adolescents with depressive and/or anxiety disorders. If this intervention is effective, it can be implemented in mental health care and improve treatment for these young people.

TRIAL REGISTRATION

Registered on June 23, 2021 in The Netherlands Trial Register (NL9564). Retrospectively registered. Recruitment started in May 2021 and is ongoing.

The interplay between expressive suppression, emotional self-efficacy and internalizing behavior in middle adolescence

Background

Maladaptive emotion regulation strategies are predictive of negative outcomes in adolescence which, in turn, may impact on later well-being.

Objective

The current study aimed at testing the moderating role of emotional self-efficacy on the relation between expressive suppression and the engagement in internalizing behavior, controlling for gender effect.

Method

A total of 526 adolescents (Mage = 14.7 years, age range = 14–17 years) filled out self-report questionnaires evaluating expressive suppression, emotional regulatory self-efficacy, and internalizing behavior, respectively.

Results

Suppressors with lower positive emotion self-efficacy were more likely to engage in internalizing behavior than suppressors with higher positive emotion self-efficacy.

Conclusions

Despite several limitations, the study provided preliminary insights on the role played by emotional self-efficacy in the relation between expressive suppression and internalizing behavior in middle adolescence.

A Mini-Review of Pharmacological and Psychosocial Interventions for Reducing Irritability Among Youth With ADHD

Approximately a third of children and adolescents with attention-deficit/hyperactivity disorder (ADHD) experience significant irritability; despite this, no study has reviewed whether interventions for youth with ADHD can improve irritability. This mini review sought to address this gap in the literature by discussing existing pharmacological and psychosocial interventions for irritability among children and adolescents with ADHD. A literature search was conducted in April 2021, with a total of 12 intervention articles identified (six pharmacological, one psychosocial, five combined). Studies were excluded if they did not involve an intervention, a measure of irritability, or the population was not youth with ADHD. Of these articles, two were with an ADHD only sample; seven included ADHD with comorbid disruptive behavior, disruptive mood dysregulation disorder (DMDD), or severe mood dysregulation (SMD); and three included ADHD with comorbid autism spectrum disorder (ASD). Findings suggest that central nervous system stimulants used alone or in combination with behavior therapy are effective at reducing irritability in youth with ADHD only or comorbid ADHD and DMDD/SMD. Less evidence was found for the efficacy of guanfacine and atomoxetine for youth with ADHD only or comorbid ADHD and ASD. Parent training alone or in combination with atomoxetine was found to be effective at reducing irritability in youth with comorbid ADHD and ASD. Future research assessing the efficacy of other psychosocial interventions, particularly cognitive behavioral therapy is necessary, as are randomized trials assessing intervention sequencing and intensity among youth with ADHD. Researchers are advised to utilize well-validated measures of irritability in future research.