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Xu J, Falkenstein MJ, Kuckertz JM. Feeling more confident to encounter negative emotions: The mediating role of distress tolerance on the relationship between self-efficacy and outcomes of exposure and response prevention for OCD. J Affect Disord 2024; 353:19-26. [PMID: 38423365 PMCID: PMC11059676 DOI: 10.1016/j.jad.2024.02.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/16/2024] [Accepted: 02/26/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND While exposure and response prevention (ERP) is the first-line treatment for obsessive-compulsive disorder (OCD), up to half of patients do not effectively respond. In an effort to better understand the mechanisms behind ERP, the inhibitory learning model emphasizes the roles of increasing perceived self-efficacy and distress tolerance. While self-efficacy and distress tolerance have separately been shown to predict OCD symptoms and treatment outcomes, no studies have assessed their joint effects in ERP. The current study examined distress tolerance as a mediator of the relationship between self-efficacy and ERP outcomes. METHODS Patients in an intensive ERP-based treatment program (N = 116) completed weekly self-report measures. RESULTS Over the course of treatment, as OCD symptoms reduced, self-efficacy and distress tolerance both significantly increased. Importantly, increases in self-efficacy and distress tolerance mediated each other in explaining symptom reduction, suggesting a possible bi-directional effect. LIMITATIONS The temporal relationship between changes in self-efficacy and distress tolerance is worthy of further investigation. In addition, the current sample had limited racial diversity and might not be representative of patients receiving lower levels of care. Findings merit replication to be ascertained of their reliability. CONCLUSIONS Findings suggest that during ERP, patients gain confidence in their abilities both to cope with general challenges and to withstand distress, potentially helping them engage with exposures and overcome initial fears. These findings provide support for the inhibitory learning model and highlight the mechanistic roles of self-efficacy and distress tolerance in ERP. Clinical implications to target both in treatment are discussed.
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Affiliation(s)
- Junjia Xu
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States of America
| | - Martha J Falkenstein
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States of America; Harvard Medical School, United States of America
| | - Jennie M Kuckertz
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States of America; Harvard Medical School, United States of America.
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2
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Bock RC, Baker LD, Kalantar EA, Berghoff CR, Stroman JC, Gratz KL, Tull MT. Clarifying relations of emotion regulation, emotional avoidance and anxiety symptoms in a community-based treatment-seeking sample. Psychol Psychother 2024. [PMID: 38411316 DOI: 10.1111/papt.12523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 01/13/2024] [Accepted: 02/08/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVES Anxiety is a global problem that is readily treatable with psychosocial interventions, though many individuals do not benefit following participation in extant treatment protocols. Accordingly, clarification of process-related variables that may be leveraged to enhance outcomes appears warranted. Emotion regulation (ER) is a robust correlate of anxiety symptoms and is often targeted in behavioural treatments applied to anxiety-related problems. Yet, some evidence suggests ER difficulties may be a proxy variable for emotional avoidance (EA). Clarifying the relative influence of ER and EA on anxiety symptom severity may improve specificity in targeting behavioural processes within psychosocial treatments designed to alleviate anxiety-related suffering. Accordingly, we examined relations of ER and EA to anxiety symptom severity after accounting for anxiety sensitivity and anxiolytic medication use in a community-based treatment-seeking sample. DESIGN A four-step hierarchical linear regression analysis of cross-sectional data provided by a community-based treatment-seeking sample. METHODS Totally, 120 participants (Mage = 39.18; Female = 58.3%) completed a questionnaire packet upon intake to an anxiety disorders clinic. RESULTS EA and ER were strongly correlated, and each accounted for significant variance over and above model covariates. EA was a dominant risk factor for anxiety symptom severity, as ER was not a significant predictor (p = .073) following the inclusion of EA in the model (p = .006). CONCLUSIONS EA appears to be a dominant risk factor, and ER a proxy risk factor, for anxiety symptom severity. EA may be an avenue for greater treatment specificity for those with anxiety symptoms.
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Affiliation(s)
- Rachel C Bock
- Department of Psychology, University of South Dakota, Vermillion, South Dakota, USA
| | - Lucas D Baker
- George E. Wahlen VA Medical Center, Salt Lake City, Utah, USA
| | - Emily A Kalantar
- Department of Psychology, University of South Dakota, Vermillion, South Dakota, USA
| | | | - Joel C Stroman
- Department of Psychology, University of South Dakota, Vermillion, South Dakota, USA
| | - Kim L Gratz
- Lyra Health, Burlingame, California, USA
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
| | - Matthew T Tull
- Lyra Health, Burlingame, California, USA
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
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3
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Cavicchioli M, Tobia V, Ogliari A. Emotion Regulation Strategies as Risk Factors for Developmental Psychopathology: a Meta-analytic Review of Longitudinal Studies based on Cross-lagged Correlations and Panel Models. Res Child Adolesc Psychopathol 2023; 51:295-315. [PMID: 36208360 DOI: 10.1007/s10802-022-00980-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 02/09/2023]
Abstract
Cross-sectional relationships between emotion regulation strategies (ERSs) and several psychopathological conditions among children and adolescents have been well-demonstrated. However, the longitudinal associations of ERSs on psychopathological manifestations during development remain unclear, especially considering their reciprocal influences over time. This meta-analytic review was based on a set of ERSs referring to a comprehensive evidence-based model of ER processes. Three hundred thirty-five studies were screened. The meta-analytic procedures were based on 60 studies (N = 20, 191; age: M [SD] = 10.27 [4.36]; years of follow-up: M [SD] = 2.23 [2.76]), which primarily assessed prospective associations between ERt1 and internalizing/externalizing psychopathology (PSY)t2. The cross-lagged correlations among these variables were also considered. Results showed: i) a small prospective association between ERt1 and PSY t2, which was independent of age and length of follow-up period. Adaptive and maladaptive domains of ER were significant moderators. Deficits in adaptive ER seemed more associated to externalizing PSY, whereas maladaptive ER was more associated to internalizing PSY; ii) cross-lagged correlations were comparable with ERt1 - PSY t2 associations. Nevertheless, the detrimental effects of PSY t1 on levels of adaptive ERt2 were larger than the protective effects of adaptive ERt1 on PSYt2. iii) When the other cross-lagged correlations were controlled for, the meta-analytic cross-lagged panel model demonstrated that maladaptive ERt1 was a significant predictor of PSYt2. ER processes should be considered transdiagnostic risk factors for psychopathology during development. Homotypic and heterotypic continuity of psychopathological conditions might reflect the stability or dynamic organization of adaptive and maladaptive ERSs over time.
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Huang PC, Hung CH, Chen GW, Cashin C, Griffiths MD, Yang WC, Wang HW, Lin CY, Ko NY. COVID-19-Related Self-Stigma, Post-Traumatic Stress Disorder, Insomnia, and Smartphone Addiction Among Frontline Government Workers with COVID-19 Pandemic Control Duties. Psychol Res Behav Manag 2022; 15:3069-3080. [PMID: 36281271 PMCID: PMC9587721 DOI: 10.2147/prbm.s383842] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/27/2022] [Indexed: 11/22/2022] Open
Abstract
Purpose The duties related to COVID-19 control and prevention may have caused psychological stress for the individuals in charge (eg, frontline government workers) and have reportedly led to mental health issues, such as insomnia and post-traumatic stress disorder (PTSD). However, the prevalence of these COVID-19-related disorders and their associated factors remain unclear. Therefore, the purpose of the present study was to investigate the prevalence rates of insomnia, PTSD, COVID-19-related self-stigma, and smartphone addiction, along with the identification of risk factors and protective factors for Taiwan frontline government workers with COVID-19 pandemic control duties. Methods The survey was carried out with 151 participants between September and October 2021. All participants completed the Fear of COVID-19 Scale (assessing fear of COVID-19), Self-Stigma Scale (assessing self-stigma during the COVID-19 pandemic), Smartphone Application-Based Addiction Scale (assessing the risk of smartphone addiction), Insomnia Severity Index (assessing insomnia), Impacts of Event Scale-6 (assessing PTSD), and a self-designed set of questions assessing trait resilience. Results The results showed that the prevalence rate was 31.1% for insomnia and 33.8% for PTSD. Furthermore, service duration (adjusted odds ratio [AOR] = 0.93; 95% confidence interval [CI] = 0.86, 0.999) and trait resilience (AOR = 0.19; 95% CI = 0.08, 0.46) were protective factors and fear of COVID-19 (AOR = 1.91; 95% CI = 1.02, 3.57) was a risk factor for insomnia. Fear of COVID-19 (AOR = 2.63; 95% CI = 1.35, 5.14), self-stigma (AOR = 3.62; 95% CI = 1.19, 11.02), and smartphone addiction (AOR = 1.09, 95% CI = 1.001, 1.19) were risk factors, and trait resilience was a protective factor (AOR = 0.58; 95% CI = 0.29, 1.17) for PTSD. Conclusion The findings demonstrated a high prevalence of insomnia and PTSD. Risk-reducing strategies and protective factor promotion strategies are recommended to help reduce the symptoms of insomnia and PTSD among Taiwan frontline government workers.
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Affiliation(s)
- Po-Ching Huang
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ching-Hsia Hung
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Guan-Wei Chen
- Department of Hydraulic and Ocean Engineering, College of Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Ciaran Cashin
- Department of Hydraulic and Ocean Engineering, College of Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Mark D Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK
| | - Wen-Chi Yang
- Division of Hematology and Medical Oncology, Department of Internal Medicine, E-DA Hospital, Kaohsiung, Taiwan,Faculty of School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Hsiao-Wen Wang
- Department of Hydraulic and Ocean Engineering, College of Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Correspondence: Chung-Ying Lin, Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, 1 University Rd, Tainan, 701, Taiwan, Tel +886 6-2353535 ext. 5106, Fax +886 6-2367981, Email
| | - Nai-Ying Ko
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Karekla M, Demosthenous G, Georgiou C, Konstantinou P, Trigiorgi A, Koushiou M, Panayiotou G, Gloster AT. Machine learning advances the classification and prediction of responding from psychophysiological reactions. Journal of Contextual Behavioral Science 2022; 26:36-43. [DOI: 10.1016/j.jcbs.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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6
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Tao Y, Liu X, Hou W, Niu H, Wang S, Ma Z, Bi D, Zhang L. The Mediating Role of Emotion Regulation Strategies in the Relationship Between Big Five Personality Traits and Anxiety and Depression Among Chinese Firefighters. Front Public Health 2022; 10:901686. [PMID: 35719646 PMCID: PMC9205204 DOI: 10.3389/fpubh.2022.901686] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 04/27/2022] [Indexed: 11/30/2022] Open
Abstract
Identification of protective factors to prevent firefighters' anxiety and depression is meaningful. We explored whether emotion-regulation strategies mediate the relationship between personality traits and anxiety and depression among Chinese firefighters. Approximately, 716 Chinese firefighters were recruited and completed the Emotion Regulation Questionnaire (ERQ), Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), and Big Five Inventory−2 (BFI-2) Scale. Results (N = 622) indicated that only negative emotionality traits could predict anxiety symptoms. Meanwhile, the multilevel mediation effect analyses showed that conscientiousness through cognitive reappraisal could reduce anxiety and depression symptoms in Chinese firefighters. Our findings clarify Chinese firefighters' underlying emotion-regulation process between personality traits and anxiety and depression. Implications, limitations, and future directions are discussed.
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Affiliation(s)
- Yanqiang Tao
- Faculty of Psychology, Beijing Key Laboratory of Applied Experimental Psychology, Beijing Normal University, Beijing, China
| | - Xiangping Liu
- Faculty of Psychology, Beijing Key Laboratory of Applied Experimental Psychology, Beijing Normal University, Beijing, China
| | - Wenxin Hou
- Faculty of Psychology, Beijing Key Laboratory of Applied Experimental Psychology, Beijing Normal University, Beijing, China
| | - Haiqun Niu
- School of Psychology, Nanjing Normal University, Nanjing, China
| | - Shujian Wang
- Faculty of Psychology, Beijing Key Laboratory of Applied Experimental Psychology, Beijing Normal University, Beijing, China
| | - Zijuan Ma
- School of Psychology, South China Normal University, Guangzhou, China
| | - Dan Bi
- Yichun 1st High School, Yichun, China
| | - Liang Zhang
- College of Education for the Future, Beijing Normal University at Zhuhai, Zhuhai, China
- Student Mental Health Education Center Northeast Agricultural University, Harbin, China
- *Correspondence: Liang Zhang
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7
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Slivjak ET, Pedersen EJ, Arch JJ. Evaluating the efficacy of common humanity-enhanced exposure for socially anxious young adults. J Anxiety Disord 2022; 87:102542. [PMID: 35151021 DOI: 10.1016/j.janxdis.2022.102542] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/30/2021] [Accepted: 01/26/2022] [Indexed: 12/18/2022]
Abstract
Despite some evidence of the benefits of self-compassion training among socially anxious individuals, little is known about whether enhancing self-compassion prior to exposure therapy increases initial exposure engagement. Additionally, manipulations have relied on broad definitions of self-compassion, rendering it difficult to distinguish the impact of individual components. This study employed three experiential exercises designed to enhance one facet of self-compassion-common humanity. Socially anxious undergraduates (N = 63) were randomized in groups to 1) common humanity-enhanced exposure (n = 32) or 2) exposure alone (n = 31). In the common humanity condition, participants wrote self-compassionately, shared fears, and completed a common humanity-focused lovingkindness meditation. All participants then completed a speech exposure in front of live judges followed by an optional second exposure. Within the common humanity condition, positive self-responding to the speech exposure increased (b = 0.30, p = .026). Common humanity participants also remained in the first exposure longer, relative to exposure alone (b = -30.92, p = .002). Participants rated exercises as at least moderately helpful, with sharing fears rated most helpful. In sum, a brief group-based multi-modal common humanity induction represents a promising approach to improving initial engagement with feared contexts among socially anxious individuals.
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Affiliation(s)
- Elizabeth T Slivjak
- University of Colorado Boulder, Department of Psychology and Neuroscience, Boulder, CO, USA
| | - Eric J Pedersen
- University of Colorado Boulder, Department of Psychology and Neuroscience, Boulder, CO, USA
| | - Joanna J Arch
- University of Colorado Boulder, Department of Psychology and Neuroscience, Boulder, CO, USA.
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8
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Byrne A, Kangas M. Emotion regulation and memory in response to a trauma analogue: An online experimental comparison of humor and acceptance. Journal of Contextual Behavioral Science 2022. [DOI: 10.1016/j.jcbs.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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9
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Chard I, van Zalk N. Virtual Reality Exposure Therapy for Treating Social Anxiety: A Scoping Review of Treatment Designs and Adaptation to Stuttering. Front Digit Health 2022; 4:842460. [PMID: 35281220 PMCID: PMC8913509 DOI: 10.3389/fdgth.2022.842460] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/28/2022] [Indexed: 12/16/2022] Open
Abstract
Virtual Reality Exposure Therapy (VRET) has been shown to be an effective technique for reducing social anxiety. People who stutter are at greater risk of developing heightened social anxiety. Cognitive behavior therapy protocols have shown promise in reducing social anxiety in people who stutter, but no studies have investigated VRET targeting social anxiety associated with stuttering. The aim of the current review is to provide an overview of VRET techniques used to treat social anxiety and insights into how these techniques might be adopted in the case of comorbid stuttering and social anxiety. Twelve studies were reviewed to understand key distinctions in VRET protocols used to treat social anxiety. Distinctions include exercises targeting public speaking vs. general social anxiety, computer-generated virtual environments vs. 360° video, and therapist guided vs. automated VRET. Based on the review findings, we propose how certain features could be applied in the case of stuttering. Virtual therapists, inhibitory learning techniques and integration into speech therapy may be suitable ways to tailor VRET. Regardless of these different techniques, VRET should consider the situations and cognitive-behavioral processes that underlie the experience of social anxiety amongst people who stutter.
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Affiliation(s)
- Ian Chard
- Design Psychology Lab, Dyson School of Design Engineering, Imperial College London, London, United Kingdom
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10
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Helland SS, Mellblom AV, Kjøbli J, Wentzel-Larsen T, Espenes K, Engell T, Kirkøen B. Elements in Mental Health Interventions Associated with Effects on Emotion Regulation in Adolescents: A Meta-Analysis. Adm Policy Ment Health 2022; 49:1004-1018. [PMID: 35987830 PMCID: PMC9392499 DOI: 10.1007/s10488-022-01213-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/23/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE Adolescence is a sensitive period for developing mental health problems. Interventions targeting emotion regulation have shown promising transdiagnostic effects for this group, but optimization efforts are called for. In the current study, we used an element-based approach to identify potentially active ingredients in interventions measuring emotion regulation, to guide further optimization. METHODS We coded practice elements in 30 studies based on a systematic review of mental health interventions measuring emotion regulation in adolescents (N = 2,389 participants, mean age 13-17 years). Using a three-level modeling approach, we then investigated the difference in effect on emotion regulation between studies of interventions with and without these practice elements. RESULTS We identified 75 practice elements and 15 element categories used in the included interventions. Results showed significantly stronger effects on emotion regulation when interventions included the practice elements Setting goals for treatment (difference in d = 0.40, 95% CI [0.09, 0.70], p = .012) and Psychoeducation about acceptance (difference in d = 0.58, 95% CI [0.09, 1.07], p = .021). Furthermore, a total of 11 elements and four overall categories were identified as potentially active ingredients, based on an effect size difference of > 0.20 between interventions with and without the elements. CONCLUSION The results can direct experimental research into the selection of practices that are most likely key to mechanisms of change in interventions addressing emotion regulation for adolescents. The challenge of measuring emotion regulation is discussed.
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Affiliation(s)
- Siri Saugestad Helland
- Regional Center for Child and Adolescent Mental Health (RBUP), Southern and Eastern Norway, Gullhaugveien 1-3, 0484 Oslo, Norway
| | - A. V. Mellblom
- Regional Center for Child and Adolescent Mental Health (RBUP), Southern and Eastern Norway, Gullhaugveien 1-3, 0484 Oslo, Norway
| | - J. Kjøbli
- Regional Center for Child and Adolescent Mental Health (RBUP), Southern and Eastern Norway, Gullhaugveien 1-3, 0484 Oslo, Norway ,Institute of Education, University of Oslo, Oslo, Norway
| | - T. Wentzel-Larsen
- Regional Center for Child and Adolescent Mental Health (RBUP), Southern and Eastern Norway, Gullhaugveien 1-3, 0484 Oslo, Norway ,Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - K. Espenes
- Regional Center for Child and Adolescent Mental Health (RBUP), Southern and Eastern Norway, Gullhaugveien 1-3, 0484 Oslo, Norway
| | - T. Engell
- Regional Center for Child and Adolescent Mental Health (RBUP), Southern and Eastern Norway, Gullhaugveien 1-3, 0484 Oslo, Norway
| | - B Kirkøen
- Regional Center for Child and Adolescent Mental Health (RBUP), Southern and Eastern Norway, Gullhaugveien 1-3, 0484 Oslo, Norway
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11
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Teng S, Wang M, Han B, Ma Y, Du H, Ji L, Sun X, Liu J, Lu Q, Jia L, Lu G. The relationship between post-traumatic stress and negative emotions in patients with breast cancer: the mediating role of emotion regulation. J Psychosoc Oncol 2021; 40:506-518. [PMID: 34392806 DOI: 10.1080/07347332.2021.1950885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE Negative emotions can adversely affect the treatment and recovery of breast cancer patients. Post-traumatic stress caused by cancer can increase the negative emotions of patients. This study assessed the relationship between post-traumatic stress and emotional regulation strategies, and the role of emotional regulation in the relationship between post-traumatic stress and negative emotions in breast cancer patients. DESIGN Cross-sectional questionnaire with sample of 214 Chinese women with breast cancer. METHODS Participants completed the Impact of Event Scale-Revised, Hospital Anxiety and Depression Scale, and Emotion Regulation Questionnaire. Correlation and mediation analyses were conducted to assess associations among the scores of these scales. FINDINGS Patients with low post-traumatic stress chose cognitive reappraisal strategies, while those with high post-traumatic stress chose expressive suppression strategies. Cognitive reappraisal had a significant negative predictive effect on negative emotions, while expressive suppression had a significant positive predictive effect on patient's negative emotions. CONCLUSIONS Cognitive reappraisal may reduce the impact of post-traumatic stress on negative emotions experienced by breast cancer patients. Implications for psychosocial providers or policy: Psychosocial workers in China should conduct cognitive reappraisal training for breast cancer patients with high negative emotions and severe post-traumatic stress. For Chinese breast cancer patients living in other regions, the local oncology social workers should take into account their cultural background and lack of expression, and encourage them to choose cognitive reappraisal strategies.
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Affiliation(s)
- Shuai Teng
- School of Public Health, Weifang Medical University, Weifang, China
| | - Miaomiao Wang
- School of Public Health, Weifang Medical University, Weifang, China
| | - Bingxue Han
- School of Psychology, Weifang Medical University, Weifang, China
| | - Yufeng Ma
- School of Psychology, Weifang Medical University, Weifang, China
| | - He Du
- School of Psychology, Weifang Medical University, Weifang, China
| | - Lili Ji
- School of Nursing, Weifang Medical University, Weifang, China
| | - Xianglian Sun
- Department of breast surgery, Weifang People's Hospital, Weifang, China
| | - Jinxia Liu
- Department of breast and thyroid surgery, Weifang Traditional Chinese Hospital, Weifang, China
| | - Qian Lu
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Liping Jia
- School of Psychology, Weifang Medical University, Weifang, China
| | - Guohua Lu
- School of Psychology, Weifang Medical University, Weifang, China
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12
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Bordieri MJ. Acceptance: A Research Overview and Application of This Core ACT Process in ABA. Behav Anal Pract 2021; 15:90-103. [DOI: 10.1007/s40617-021-00575-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2021] [Indexed: 10/20/2022] Open
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13
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Liverant GI, Gallagher MW, Arditte Hall KA, Rosebrock LE, Black SK, Kind S, Fava M, Kaplan GB, Kamholz BW, Pineles SL, Sloan DM. Suppression and acceptance in unipolar depression: Short-term and long-term effects on emotional responding. Br J Clin Psychol 2021; 61:1-17. [PMID: 34268773 DOI: 10.1111/bjc.12323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/12/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Transdiagnostic treatments increasingly include emotion regulation training focused on use of emotional suppression and acceptance. Despite the frequent use of these treatments in depression, little is known about the effects of these strategies in this population. DESIGN An experimental study. METHODS Eighty Veterans with unipolar depression participated in a study examining effects of these strategies on emotional responding (subjective, behavioural, and physiological). Physiological measures included: heart rate (HR), respiration (Resp), skin conductance (SC), and corrugator electromyography. On Day 1, participants were randomised to one of three conditions (acceptance, suppression, or control) and underwent an autobiographical sad mood induction. On Day 2, participants underwent a similar mood induction one week later. RESULTS The suppression group demonstrated reduced physiological reactivity (Resp and SC) on Day 1. However, the suppression group reported decreased positive affect on Day 2. CONCLUSIONS Results support short-term effectiveness and longer term costs from suppression use among depressed individuals. Findings may inform application of transdiagnostic emotion regulation treatments and suggest suppression functions differently in depressed versus other clinical populations.
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Affiliation(s)
| | | | | | | | - Shimrit K Black
- Boston University School of Medicine, Massachusetts, USA.,VA Boston Healthcare System, Massachusetts, USA
| | - Shelley Kind
- Department of Psychology, Suffolk University, Boston, Massachusetts, USA
| | - Maurizio Fava
- Harvard Medical School, Boston, Massachusetts, USA.,Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gary B Kaplan
- Boston University School of Medicine, Massachusetts, USA.,VA Boston Healthcare System, Massachusetts, USA
| | - Barbara W Kamholz
- Boston University School of Medicine, Massachusetts, USA.,VA Boston Healthcare System, Massachusetts, USA
| | - Suzanne L Pineles
- Boston University School of Medicine, Massachusetts, USA.,VA National Center for PTSD, Women's Health Sciences Division, Veterans Affairs Boston Healthcare System, Massachusetts, USA
| | - Denise M Sloan
- Boston University School of Medicine, Massachusetts, USA.,VA Boston Healthcare System, Massachusetts, USA.,VA National Center for PTSD, Boston, Massachusetts, USA
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14
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Lemos V, Valega M, Serppe M. Cognitive Emotional Regulation Questionnaire: a Factorial Validation Study in Spanish for Children (CERQ-k). Int J Psychol Res (Medellin) 2021; 14:61-81. [PMID: 35096357 PMCID: PMC8794326 DOI: 10.21500/20112084.5234] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/25/2021] [Accepted: 06/24/2021] [Indexed: 11/24/2022] Open
Abstract
Background: The cognitive regulation of emotions is a fundamental variable in socio-affective functioning, being an essential skill in childhood due to its relationship with multiple areas of social functioning. Although there is a version that allows evaluating this construct (CERQ-k), translated and adapted for Argentine children, the structural model found does not fully coincide with the model proposed by the authors of the original version of CERQ. Objective: To test, through Confirmatory Factor Analysis (CFA), the model obtained in the adapted version and compare it with that of the original version of the instrument. Method: From a non-probabilistic sample, 761 children between the ages of 9 and 12, from the provinces of Entre Ríos and Córdoba, participated in the study. Descriptive analyzes of the items, CFA, and reliability analysis were carried out. Results: The CFA indicated an adequate fit in both models, although the second-order model proved to be more parsimonious and with satisfactory fit and error indices. Conclusion: The CERQ-k version adapted to Argentina, whose structure has been confirmed in this study, allows a valid and reliable measure of the construct to evaluate the cognitive regulation of emotion in children aged 9 to 12 years.
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Affiliation(s)
- Viviana Lemos
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Centro Interdisciplinario de Investigaciones en Ciencias de la Salud y del Comportamiento (CIICSAC), Universidad Adventista del Plata (UAP), 25 de Mayo 99, (3103). Libertador San Martín, Entre Ríos, Argentina. Universidad Adventista del Plata Universidad Adventista del Plata Argentina
| | - Melissa Valega
- Facultad de Humanidades Educación y Ciencias Sociales, Universidad Adventista del Plata (UAP). Argentina. Universidad Adventista del Plata Universidad Adventista del Plata Argentina
| | - Mónica Serppe
- Facultad de Humanidades Educación y Ciencias Sociales, Universidad Adventista del Plata (UAP). Argentina. Universidad Adventista del Plata Universidad Adventista del Plata Argentina.,Universidad de la Cuenca del Plata, Instituto de Investigación Científica (IDIC). Argentina. Universidad de la Cuenca del Plata Universidad de la Cuenca del Plata Argentina
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Balderas J, Bistricky SL, Schield S, Short MB. Spontaneous and instructed emotion regulation in dysphoria: Effects on emotion experience and use of other emotion regulation strategies. Curr Psychol 2021. [DOI: 10.1007/s12144-021-01924-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Rezaeisharif A, Cheraghian H, Naeim M. Effectiveness of Acceptance and Commitment Therapy on Reducing Body Image Disorders in Adolescent Girls. Addictive Disorders & Their Treatment 2021; 20:336-341. [DOI: 10.1097/adt.0000000000000265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hebert ER, Flynn MK, Wilson KG, Kellum KK. Values intervention as an establishing operation for approach in the presence of aversive stimuli. Journal of Contextual Behavioral Science 2021. [DOI: 10.1016/j.jcbs.2021.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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18
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Doorley JD, Kashdan TB. Positive and Negative Emotion Regulation in College Athletes: A Preliminary Exploration of Daily Savoring, Acceptance, and Cognitive Reappraisal. Cognit Ther Res 2021; 45:598-613. [PMID: 33518842 PMCID: PMC7821841 DOI: 10.1007/s10608-020-10202-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Despite increasing interest in positive psychological states, we know little about how regulatory responses to positive (savoring) compared to negative events (e.g. acceptance, cognitive reappraisal) influence emotional functioning. Savoring may be particularly helpful for athletes who are often trained to attend more to negative (e.g. rectifying weaknesses) compared to positive stimuli (e.g. enjoying progress). METHODS Sixty-seven college athletes completed a two-week daily diary study. Using multi-level modeling, we first explored whether various regulatory responses to daily negative events predicted unique variance in daily emotions (i.e. happy, content, grateful, sad, angry, annoyed). Next, we tested whether savoring positive events strengthened the association between event intensity and positive daily emotions. Finally, we tested whether regulatory responses to positive compared to negative events had stronger moderating (buffering) effects on the association between daily negative event intensity and daily emotions. RESULTS Based on 836 daily observations, reappraising and accepting negative events were the only strategies that predicted unique variance in daily emotions. Savoring enhanced positive emotions related to positive events. Reappraising negative events buffered associations between negative event intensity and decreased daily gratitude, while savoring positive events buffered associations between negative event intensity and increased anger, annoyance, and average negative emotions. Accepting negative events had similar effects. CONCLUSIONS Savoring positive events may be an underappreciated strategy for helping athletes regulate emotions related to negative events. Since our sample predominantly identified as white and female, further research is needed to understand savoring use and effectiveness among the full, diverse spectrum of college athletes.
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Affiliation(s)
- James D. Doorley
- Department of Psychology, George Mason University, MS 3F5, 4400 University Dr, Fairfax, VA 22030 USA
| | - Todd B. Kashdan
- Department of Psychology, George Mason University, MS 3F5, 4400 University Dr, Fairfax, VA 22030 USA
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Chien JH, Colloca L, Korzeniewska A, Meeker TJ, Bienvenu OJ, Saffer MI, Lenz FA. Behavioral, Physiological and EEG Activities Associated with Conditioned Fear as Sensors for Fear and Anxiety. Sensors (Basel) 2020; 20:E6751. [PMID: 33255916 PMCID: PMC7728331 DOI: 10.3390/s20236751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/03/2020] [Accepted: 11/10/2020] [Indexed: 11/16/2022]
Abstract
Anxiety disorders impose substantial costs upon public health and productivity in the USA and worldwide. At present, these conditions are quantified by self-report questionnaires that only apply to behaviors that are accessible to consciousness, or by the timing of responses to fear- and anxiety-related words that are indirect since they do not produce fear, e.g., Dot Probe Test and emotional Stroop. We now review the conditioned responses (CRs) to fear produced by a neutral stimulus (conditioned stimulus CS+) when it cues a painful laser unconditioned stimulus (US). These CRs include autonomic (Skin Conductance Response) and ratings of the CS+ unpleasantness, ability to command attention, and the recognition of the association of CS+ with US (expectancy). These CRs are directly related to fear, and some measure behaviors that are minimally accessible to consciousness e.g., economic scales. Fear-related CRs include non-phase-locked phase changes in oscillatory EEG power defined by frequency and time post-stimulus over baseline, and changes in phase-locked visual and laser evoked responses both of which include late potentials reflecting attention or expectancy, like the P300, or contingent negative variation. Increases (ERS) and decreases (ERD) in oscillatory power post-stimulus may be generalizable given their consistency across healthy subjects. ERS and ERD are related to the ratings above as well as to anxious personalities and clinical anxiety and can resolve activity over short time intervals like those for some moods and emotions. These results could be incorporated into an objective instrumented test that measures EEG and CRs of autonomic activity and psychological ratings related to conditioned fear, some of which are subliminal. As in the case of instrumented tests of vigilance, these results could be useful for the direct, objective measurement of multiple aspects of the risk, diagnosis, and monitoring of therapies for anxiety disorders and anxious personalities.
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Affiliation(s)
- Jui-Hong Chien
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD 21287-7713, USA; (J.-H.C.); (T.J.M.); (M.I.S.)
| | - Luana Colloca
- Department of Pain Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, MD 21201-1595, USA;
- Department of Anesthesiology, School of Medicine, University of Maryland, Baltimore, MD 21201-1595, USA
| | - Anna Korzeniewska
- Department of Neurology, Johns Hopkins University, Baltimore, MD 21287-7713, USA;
| | - Timothy J. Meeker
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD 21287-7713, USA; (J.-H.C.); (T.J.M.); (M.I.S.)
| | - O. Joe Bienvenu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD 21287-7713, USA;
| | - Mark I. Saffer
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD 21287-7713, USA; (J.-H.C.); (T.J.M.); (M.I.S.)
| | - Fred A. Lenz
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD 21287-7713, USA; (J.-H.C.); (T.J.M.); (M.I.S.)
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Curreri AJ, Farchione TJ, Sauer-Zavala S, Barlow DH. Mindful Emotion Awareness Facilitates Engagement with Exposure Therapy: An Idiographic Exploration Using Single Case Experimental Design. Behav Modif 2020; 46:36-62. [PMID: 32752883 DOI: 10.1177/0145445520947662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Exposure therapy works through inhibitory learning, whereby patients are exposed to stimuli that elicit anxiety in order to establish safety associations. Mindful emotion awareness, or nonjudgmental and present-focused attention toward emotions, may facilitate engagement in exposures, which may in turn enhance therapeutic outcome. This study utilizes a single-case experimental design (n = 6) to investigate the effect of mindful emotion awareness training on the use of avoidant strategies during exposures, distress during exposures, overall mindfulness, experiential avoidance, and symptom reduction in a sample of participants with social anxiety disorder. Data were analyzed using a combination of visual inspection and quantitative effect size metrics commonly applied in single-case experimental designs. To further investigate the relationship between distress and avoidant strategy use, contemporaneous and cross-lagged correlations were run. Results highlight individual differences in responses to mindful emotion awareness training and exposure exercises. Given these individual differences, repeated assessment and monitoring over the course of treatment may help clinicians most effectively identify treatment skills that will be most helpful for individual patients.
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Affiliation(s)
- Andrew J Curreri
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Todd J Farchione
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | | | - David H Barlow
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
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Kay AA, Skarlicki DP. Cultivating a conflict-positive workplace: How mindfulness facilitates constructive conflict management. Organizational Behavior and Human Decision Processes 2020; 159:8-20. [DOI: 10.1016/j.obhdp.2020.02.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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22
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Haspert V, Wieser MJ, Pauli P, Reicherts P. Acceptance-Based Emotion Regulation Reduces Subjective and Physiological Pain Responses. Front Psychol 2020; 11:1514. [PMID: 32695054 PMCID: PMC7338768 DOI: 10.3389/fpsyg.2020.01514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/08/2020] [Indexed: 11/23/2022] Open
Abstract
Acceptance-based regulation of pain, which focuses on the allowing of pain and pain related thoughts and emotions, was found to modulate pain. However, results so far are inconsistent regarding different pain modalities and indices. Moreover, studies so far often lack a suitable control condition, focus on behavioral pain measures rather than physiological correlates, and often use between-subject designs, which potentially impede the evaluation of the effectiveness of the strategies. Therefore, we investigated whether acceptance-based strategies can reduce subjective and physiological markers of acute pain in comparison to a control condition in a within-subject design. To this end, participants (N = 30) completed 24 trials comprising 10 s of heat pain stimulation. Each trial started with a cue instructing participants to welcome and experience pain (acceptance trials) or to react to the pain as it is without employing any regulation strategies (control trials). In addition to pain intensity and unpleasantness ratings, heart rate (HR) and skin conductance (SC) were recorded. Results showed significantly decreased pain intensity and unpleasantness ratings for acceptance compared to control trials. Additionally, HR was significantly lower during acceptance compared to control trials, whereas SC revealed no significant differences. These results demonstrate the effectiveness of acceptance-based strategies in reducing subjective and physiological pain responses relative to a control condition, even after short training. Therefore, the systematic investigation of acceptance in different pain modalities in healthy and chronic pain patients is warranted.
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Affiliation(s)
- Valentina Haspert
- Department of Biological Psychology, Clinical Psychology, and Psychotherapy, Institute of Psychology, University of Würzburg, Würzburg, Germany
| | - Matthias J Wieser
- Department of Biological Psychology, Clinical Psychology, and Psychotherapy, Institute of Psychology, University of Würzburg, Würzburg, Germany.,Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Paul Pauli
- Department of Biological Psychology, Clinical Psychology, and Psychotherapy, Institute of Psychology, University of Würzburg, Würzburg, Germany.,Center of Mental Health (ZEP), University Hospital of Würzburg, Würzburg, Germany
| | - Philipp Reicherts
- Department of Biological Psychology, Clinical Psychology, and Psychotherapy, Institute of Psychology, University of Würzburg, Würzburg, Germany.,Department of Medical Psychology and Sociology, Medical Faculty, University of Augsburg, Augsburg, Germany
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Schanche E, Vøllestad J, Binder PE, Osnes B, Visted E, Svendsen JL, Sørensen L. Can clinical psychology students benefit from brief and intensive mindfulness training? Couns Psychother Res 2020; 20:311-324. [DOI: 10.1002/capr.12273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Abstract
Gambling in moderation is a socially acceptable behavior and over 60% of the Swedish population gambles every year. It has been seen that slot machines are one of the most addictive and problematic forms of gambling and contribute highly to an addictive behavior.
It is unclear why some individuals intensify their gambling behavior over time to extreme levels while others do not. Initial positive response of a drug or as in this case a gambling behavior, most likely influences the likelihood of continuing use in non-addicted individuals. Therefore, we wanted to investigate if recreational gamblers show an altered subjective response to an online gambling challenge, e.g. to casino gambling. The present study was designed to examine the subjective effects after an acute gambling challenge, in healthy recreational gamblers compared with non-gamblers. Eighty-two subjects participated in the study. They were challenged with an acute online slot machine gambling challenge and self-report questionnaires of mood and blood pressure were taken before and after gambling. The gamblers, and more specifically the high recreational gamblers, reported increased stimulative effects after the gambling challenge in comparison to the non-gamblers. Findings suggests that gamblers experience significantly higher arousal effects to an acute online slot machine challenge. This response may be a uniquely predictive behavior for increased risk of gambling addiction.
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Affiliation(s)
- L Miller
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Blå stråket 15, SU/Sahlgrenska, 413 45, Gothenburg, Sweden.
| | - A Söderpalm Gordh
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Blå stråket 15, SU/Sahlgrenska, 413 45, Gothenburg, Sweden.,Beroendekliniken, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden
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Abstract
Emotion dysregulation is often considered a core characteristic of individuals with borderline personality disorder (BPD). With the development and strength of a contemporary affective-science model that encompasses both healthy emotion regulation (ER) and emotion dysregulation, this model has increasingly been used to understand the affective experiences of people with BPD. In this meta-analysis and review, we systematically review six of the most commonly studied ER strategies and determine their relative endorsement in individuals with elevated symptoms of BPD compared to individuals with low symptoms of BPD and healthy controls, as well as to individuals with other mental disorders. Results from 93 unique studies and 213 different effect-size estimates indicated that symptoms of BPD were associated with less frequent use of ER strategies that would be considered more effective at reducing negative affect (i.e., cognitive reappraisal, problem solving, and acceptance) and more frequent use of ER strategies considered less effective at reducing negative affect (i.e., suppression, rumination, and avoidance). When compared to individuals with other mental disorders, people with BPD endorsed higher rates of rumination and avoidance, and lower rates of problem solving and acceptance. We also review important contributions from studies of ER in BPD that we were unable to incorporate into our meta-analysis. We conclude by discussing how the pattern of using ER strategies in BPD contributes to emotion dysregulation and also the potential reasons for this pattern, integrating both Gross's extended process model of ER and Linehan's updated theoretical account on the development of emotion dysregulation.
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Wojnarowska A, Kobylinska D, Lewczuk K. Acceptance as an Emotion Regulation Strategy in Experimental Psychological Research: What We Know and How We Can Improve That Knowledge. Front Psychol 2020; 11:242. [PMID: 32180748 PMCID: PMC7057396 DOI: 10.3389/fpsyg.2020.00242] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 02/03/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
| | | | - Karol Lewczuk
- Institute of Psychology, Cardinal Stefan Wyszynski University, Warsaw, Poland
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Abstract
PURPOSE OF REVIEW Diabetes self-management and diabetes distress are complex processes implicated in glycemic control and other health outcomes for youth with type 1 diabetes. Growing integration of medical and behavioral care provides opportunities for brief psychosocial interventions during routine diabetes care. This review focuses on interventions for self-management and diabetes distress that can be delivered alongside usual medical care or via a single-patient encounter. RECENT FINDINGS Recent research underscores the potential of brief interventions delivered by both medical providers and integrated behavioral health professionals, but little is known regarding the comparative effectiveness of different interventions or the factors that impact dissemination and implementation. This article asserts that brevity is critical to maximizing the reach, scalability, and impact of psychosocial interventions for youth with type 1 diabetes. The authors review existing evidence for brief interventions, describe several untested clinical strategies, and make recommendations for accelerating the translational study of brief interventions.
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Affiliation(s)
- Samantha A Barry-Menkhaus
- The Madison Clinic for Pediatric Diabetes and Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, USA
| | - David V Wagner
- Institute on Development & Disability, Department of Pediatrics, Oregon Health & Science University, 707 SW Gaines St., Portland, OR, 97239, USA
| | - Andrew R Riley
- Institute on Development & Disability, Department of Pediatrics, Oregon Health & Science University, 707 SW Gaines St., Portland, OR, 97239, USA.
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Hayes SC, Law S, Malady M, Zhu Z, Bai X. The centrality of sense of self in psychological flexibility processes: What the neurobiological and psychological correlates of psychedelics suggest. Journal of Contextual Behavioral Science 2020. [DOI: 10.1016/j.jcbs.2019.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Montero-Marin J, Garcia-Campayo J, Pérez-Yus MC, Zabaleta-Del-Olmo E, Cuijpers P. Meditation techniques v. relaxation therapies when treating anxiety: a meta-analytic review. Psychol Med 2019; 49:2118-2133. [PMID: 31322102 DOI: 10.1017/s0033291719001600] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
To what extent meditation techniques (which incorporate practices to regulate attention, construct individual values, or deconstruct self-related assumptions), are more or less effective than relaxation therapy in the treatment of anxiety, is not clear. The aim of this study was to examine the effectiveness of meditation compared to relaxation in reducing anxiety. A systematic review from PubMed, Embase, PsycInfo and the Cochrane Central was conducted. A meta-analysis of 14 RCTs (n = 862 participants suffering from anxiety disorders or high trait anxiety) was performed. Effect sizes (ESs) were determined by Hedges' g. Heterogeneity, risk of publication bias, quality of studies/interventions, and researcher allegiance, were evaluated. Meditation techniques incorporated attentional elements, and five of them also added constructive practices. No studies were found using deconstructive exercises. The overall ES was g = -0.23 [95% confidence interval (CI) -0.40 to -0.07], favouring meditation (number needed to treat = 7.74). Heterogeneity was low (I2 = 2; 95% CI 0 to 56). There was no evidence of publication bias, but few studies and interventions were of high quality, and allegiance might be moderating results. Meditation seems to be a bit more effective than relaxation in the treatment of anxiety, and it might also remain more effective at 12-month follow-up. However, more research using the full spectrum of meditation practices to treat different anxiety disorders, including independent studies to avoid researcher allegiance, is needed if we are to have a precise idea of the potential of these techniques compared to relaxation therapy.
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Affiliation(s)
- Jesus Montero-Marin
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain
| | - Javier Garcia-Campayo
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain
- Miguel Servet University Hospital, University of Zaragoza, Zaragoza, Spain
- Aragon Institute of Health Research, Zaragoza, Spain
| | - Mari Cruz Pérez-Yus
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain
- Aragon Institute of Health Research, Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Edurne Zabaleta-Del-Olmo
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Pim Cuijpers
- Department of Psychology, VU University, Amsterdam, The Netherlands
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Abstract
OBJECTIVE Mindfulness has been found to be associated with less adverse stress response. However, little is known about how mindfulness modulates stress response in the real daily life. The current study investigated the relation between daily stress and negative emotions, and explored a mediational link via perceived loss of control, and moderation by dispositional mindfulness, to better understand this association. DESIGN A total of 95 college students were recruited to complete a questionnaire and to report on their stress, perceived loss of control and negative emotions in daily life. MAIN OUTCOME MEASURES Mindful Attention Awareness Scale (MAAS) was used to assess dispositional mindfulness. Stress, perceived loss of control and negative emotions were assessed by ambulatory assessment. RESULTS Stress was positively related with negative emotions at within-person level. Perceived loss of control mediated the relationship between stress and negative emotions. Furthermore, participants with higher levels of dispositional mindfulness showed an attenuated association between stress and anger, and also attenuated associations between perceived loss of control, and anger and fatigue at within-person level. CONCLUSION These findings point to perceived loss of control as an important key factor in daily stress effects. Dispositional mindfulness appears to have beneficial effects in that it attenuates the impact of daily stressors on individuals' wellbeing. Clinical implications and limitations are discussed.
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Affiliation(s)
- Yuanyuan An
- a School of Psychology , Nanjing Normal University , Nanjing , People's Republic of China
| | - Dominik Schoebi
- b Department of Psychology , University of Fribourg , Fribourg , Switzerland
| | - Wei Xu
- a School of Psychology , Nanjing Normal University , Nanjing , People's Republic of China
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Borlimi R, Benetka G, Brighetti G, Caselli G, Caletti E, Redaelli CA, Ruggiero GM, Sarracino D, Sassaroli S. An Investigation of Sequencing Effects in Combining Cognitive Questioning and Mindful Acceptance. J Rat-Emo Cognitive-Behav Ther 2019; 37:284-98. [DOI: 10.1007/s10942-018-0312-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Ji M, Yang C, Li Y, Xu Q, He R. The influence of trait mindfulness on incident involvement among Chinese airline pilots: The role of risk perception and flight experience. J Safety Res 2018; 66:161-168. [PMID: 30121102 DOI: 10.1016/j.jsr.2018.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/24/2018] [Accepted: 07/11/2018] [Indexed: 06/08/2023]
Abstract
Introduction The primary objective of this study is to investigate the relationships between trait mindfulness, risk perception, flight experience, and incident involvement among Chinese airline pilots. Method The study used a sample consisting of 295 commercial airline pilots from China Southern Airlines Ltd. Results The results show that trait mindfulness has a direct and negative effect on airline pilots' incident involvement, and an indirect effect on incident involvement through influencing risk perception. Flight experience was also found to strengthen the negative and direct effect of trait mindfulness on incident involvement. Practical applications The practical implications of the study include recommendations as to injury prevention efforts in incident involvement. Future research directions are also discussed.
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Affiliation(s)
- Ming Ji
- School of Psychology, Shaanxi Normal University, Xi'an, Shaanxi 710062, China; Shaanxi Provincial Key Laboratory of Behavior and Cognitive Neuroscience, Xi'an, Shaanxi 710062, China.
| | - Can Yang
- School of Psychology, Shaanxi Normal University, Xi'an, Shaanxi 710062, China; Shaanxi Provincial Key Laboratory of Behavior and Cognitive Neuroscience, Xi'an, Shaanxi 710062, China.
| | - Ying Li
- School of Psychology, Shaanxi Normal University, Xi'an, Shaanxi 710062, China; Shaanxi Provincial Key Laboratory of Behavior and Cognitive Neuroscience, Xi'an, Shaanxi 710062, China.
| | - Quan Xu
- School of Psychology, Shaanxi Normal University, Xi'an, Shaanxi 710062, China; Shaanxi Provincial Key Laboratory of Behavior and Cognitive Neuroscience, Xi'an, Shaanxi 710062, China.
| | - Rong He
- School of Psychology, Shaanxi Normal University, Xi'an, Shaanxi 710062, China; Shaanxi Provincial Key Laboratory of Behavior and Cognitive Neuroscience, Xi'an, Shaanxi 710062, China
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Quinlan E, Deane FP, Crowe T. Pilot of an acceptance and commitment therapy and schema group intervention for mental health carer's interpersonal problems. Journal of Contextual Behavioral Science 2018. [DOI: 10.1016/j.jcbs.2018.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Lennarz HK, Hollenstein T, Lichtwarck-Aschoff A, Kuntsche E, Granic I. Emotion regulation in action: Use, selection, and success of emotion regulation in adolescents' daily lives. Int J Behav Dev 2018; 43:1-11. [PMID: 30613118 PMCID: PMC6305959 DOI: 10.1177/0165025418755540] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Successful emotion regulation (ER) is a central aspect of psychosocial functioning and mental health and is thought to improve and be refined in adolescence. Past research on ER has mainly focused on one-time measurements of habitual ER. Linking regulatory strategies to emotions in daily lives is key to understanding adolescents’ emotional lives. Using an Experience Sampling Method with 78 adolescents (Mage = 13.91, SDage = .95, 66% girls), we investigated the use, selection, and success in down-regulating negative emotions of eight ER strategies across 44 assessments. Acceptance was the strategy employed most often followed by problem-solving, rumination, distraction, avoidance, reappraisal, social support, and suppression. Interestingly, negativity of the event influenced the use of ER strategies: With low intensity negative emotions, acceptance was more likely to be used, and with high intensity negative emotions, suppression, problem-solving, distraction, avoidance, social support, and rumination were more likely to be used. With regard to success, multilevel models revealed that problem-solving, reappraisal, and acceptance were more successful in down-regulating negative emotions than rumination. Further, among girls, no relations between the momentary use of ER strategies and depressive symptoms was found. Among boys, a negative relation between acceptance and depressive symptoms emerged. Results from this study suggest that there is a reciprocal relationship between the intensity of negative emotions and ER strategies and that gender differences may exist. Taken together, this study showed which ER strategies are used by a healthy adolescent sample, and these results are discussed with regard to their theoretical and practical importance.
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Affiliation(s)
- Hannah K Lennarz
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - Tom Hollenstein
- Psychology Department, Queen's University, Kingston, Ontario, Canada
| | | | - Emmanuel Kuntsche
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands.,Additction Info Switzerland, Research Institute, Lausanne, Switzerland
| | - Isabela Granic
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
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Daros AR, Guevara MA, Uliaszek AA, McMain SF, Ruocco AC. Cognitive Emotion Regulation Strategies in Borderline Personality Disorder: Diagnostic Comparisons and Associations with Potentially Harmful Behaviors. Psychopathology 2018; 51:83-95. [PMID: 29566390 DOI: 10.1159/000487008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 01/13/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although difficulties in emotion regulation (ER) are considered a core feature of borderline personality disorder (BPD), the specific strategies that individuals with BPD most commonly use, their diagnostic specificity, and their associations with harmful behaviors have not been firmly established. SAMPLING AND METHODS Individuals with BPD (n = 30), mixed anxiety and/or depressive disorders (MAD; n = 30), and healthy controls (HC; n = 32) completed questionnaires assessing both cognitive ER strategies (e.g., cognitive reappraisal) and potentially harmful behaviors that individuals might use to regulate their emotions (e.g., self-injury). RESULTS BPD subjects endorsed more maladaptive cognitive ER strategies and fewer adaptive strategies compared to HC. Compared to MAD subjects, BPD individuals endorsed more maladaptive cognitive ER strategies, but only when those with subthreshold symptoms in the MAD group were excluded. BPD also endorsed engaging in potentially harmful behaviors more often than both HC and MAD. Discriminant analysis revealed that MAD endorsed lower rates of problem-solving and cognitive reappraisal compared to both HC and BPD. Higher maladaptive and lower adaptive ER strategies were associated with higher rates of potentially harmful behaviors, although the specific strategies differed for MAD versus BPD. CONCLUSIONS BPD and MAD endorse cognitive ER strategies with a comparable frequency, although BPD subjects engage in potentially harmful behaviors more often. Subthreshold BPD symptoms may also affect rates of ER strategy use in individuals with other mental disorders.
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Affiliation(s)
- Alexander R Daros
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Mylann A Guevara
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Amanda A Uliaszek
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Shelley F McMain
- Clinical Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Anthony C Ruocco
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
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Affiliation(s)
- Justyna Kucharska
- School of Psychotherapy and Psychology, Regent’s University London, London, UK
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Reid AM, Garner LE, Van Kirk N, Gironda C, Krompinger JW, Brennan BP, Mathes BM, Monaghan SC, Tifft ED, André MC, Cattie J, Crosby JM, Elias JA. How willing are you? Willingness as a predictor of change during treatment of adults with obsessive-compulsive disorder. Depress Anxiety 2017; 34:1057-1064. [PMID: 28715850 DOI: 10.1002/da.22672] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 05/10/2017] [Accepted: 05/12/2017] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Exposure and response prevention (ERP) is an effective treatment for individuals with obsessive-compulsive disorder (OCD), yet a substantial number of individuals with OCD do not fully respond to this intervention. Based on emerging experimental and clinical research on acceptance, this study sought to explore whether willingness to experience unpleasant thoughts, emotions, and bodily sensations during ERP was associated with improved treatment response. METHODS Two hundred eighty-eight adults with OCD receiving residential ERP provided self-rated willingness and other exposure-related variables during each daily coached ERP session. Obsessive-compulsive and depressive symptom severity was assessed every week. Multilevel modeling was used to study the impact of willingness on treatment outcome during the first 6 weeks of residential care. RESULTS Data indicated that individuals with higher willingness during ERP reported faster symptom reduction during residential treatment, even when controlling for length of stay, psychopharmacological intervention, depression, adherence, and rituals performed during ERP. These results appear to have both statistical and clinical significance. CONCLUSIONS Willingness to fully experience unpleasant and unwanted thoughts, emotions, and bodily sensations during exposures appears to be a marker of successful exposure therapy in adults with OCD. Future research should examine how willingness may enhance extinction learning during ERP.
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Affiliation(s)
- Adam M Reid
- OCD Institute for Children and Adolescents, McLean Hospital, Middleborough, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Lauryn E Garner
- Office of Clinical Assessment and Research, OCD Institute, McLean Hospital, Middleborough, MA, USA
| | - Nathaniel Van Kirk
- Office of Clinical Assessment and Research, OCD Institute, McLean Hospital, Middleborough, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | | | - Jason W Krompinger
- Office of Clinical Assessment and Research, OCD Institute, McLean Hospital, Middleborough, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Brian P Brennan
- Office of Clinical Assessment and Research, OCD Institute, McLean Hospital, Middleborough, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Brittany M Mathes
- Department of Psychology, Florida State University, Tallahassee, MA, USA
| | - Sadie Cole Monaghan
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,Behavioral Health Partial Program, McLean Hospital, Middleborough, MA, USA
| | - Eric D Tifft
- Office of Clinical Assessment and Research, OCD Institute, McLean Hospital, Middleborough, MA, USA
| | - Marie-Christine André
- Department of Psychology, Suffolk University, Boston, MA, USA.,Boston Children's Hospital, Boston, MA, USA
| | - Jordan Cattie
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, GA, USA
| | - Jesse M Crosby
- Office of Clinical Assessment and Research, OCD Institute, McLean Hospital, Middleborough, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Jason A Elias
- Office of Clinical Assessment and Research, OCD Institute, McLean Hospital, Middleborough, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Diedrich A, Burger J, Kirchner M, Berking M. Adaptive emotion regulation mediates the relationship between self-compassion and depression in individuals with unipolar depression. Psychol Psychother 2017; 90:247-263. [PMID: 27743450 DOI: 10.1111/papt.12107] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 08/11/2016] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To identify the mechanisms involved in the association between self-compassion and depression, we examined whether adaptive emotion regulation would mediate the relationship between self-compassion and depression in individuals with unipolar depression. Furthermore, we explored which specific emotion regulation skills would be most important in this relationship. DESIGN AND METHOD Sixty-nine individuals with unipolar depression were assessed with the Self-Compassion Scale and the Emotion Regulation Skills Questionnaire at baseline and with the Beck Depression Inventory-II 1 week later. RESULTS The results showed that successful application of emotion regulation skills mediates the association between self-compassion and depression. Among eight specific emotion regulation skills, only the ability to tolerate negative emotions was identified as a significant mediator in the self-compassion-depression relationship. CONCLUSIONS These findings provide preliminary evidence that systematically fostering self-compassion might help depressed individuals cope with their symptoms by enhancing their abilities to tolerate undesired emotions. PRACTITIONER POINTS Systematically fostering self-compassion through specific compassion-focused interventions might facilitate a reduction in depressive symptoms by improving the person's emotion regulation abilities, especially by improving his or her ability to tolerate negative emotions. Hence, compassion-focused interventions might be particularly promising in depressed patients with a tendency to avoid negative emotions and deficits in tolerating them.
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Affiliation(s)
- Alice Diedrich
- Department of Psychiatry and Psychotherapy, University of Munich (LMU), Germany
| | - Julian Burger
- Department of Clinical Psychology and Psychotherapy, University of Mainz, Germany
| | | | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, University of Erlangen-Nuremberg, Germany
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Paz R, Zvielli A, Goldstein P, Bernstein A. Brief mindfulness training de-couples the anxiogenic effects of distress intolerance on reactivity to and recovery from stress among deprived smokers. Behav Res Ther 2017. [DOI: 10.1016/j.brat.2017.05.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Cochrane A, Barnes-Holmes D, Barnes-Holmes Y. The Perceived-Threat Behavioral Approach Test (PT-BAT): Measuring Avoidance in High-, Mid-, and Low-Spider-Fearful Participants. Psychol Rec 2017. [DOI: 10.1007/bf03395639] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Gird S, Zettle RD. Differential Response to a Dysphoric Mood Induction Procedure as a Function of Level of Experiential Avoidance. Psychol Rec 2009; 59:537-50. [DOI: 10.1007/bf03395680] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Breuninger C, Sláma DM, Krämer M, Schmitz J, Tuschen-Caffier B. Psychophysiological Reactivity, Interoception and Emotion Regulation in Patients with Agoraphobia During Virtual Reality Anxiety Induction. Cogn Ther Res 2016. [DOI: 10.1007/s10608-016-9814-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kunze AE, Lancee J, Morina N, Kindt M, Arntz A. Efficacy and mechanisms of imagery rescripting and imaginal exposure for nightmares: study protocol for a randomized controlled trial. Trials 2016; 17:469. [PMID: 27671748 PMCID: PMC5037644 DOI: 10.1186/s13063-016-1570-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 05/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recurrent nightmares can effectively be treated with cognitive-behavioral techniques such as imagery rehearsal therapy, which involves imagery rescripting (IR) of nightmares, and imaginal exposure (IE) therapy. However, the underlying mechanisms of these treatments remain largely unknown. To investigate this, we identified a number of variables that might mediate the therapeutic effect of rescripting-based and/or exposure-based therapies. Also, to control for the possible confounding influence of (other) treatment components, we designed two stripped-down treatment protocols, which primarily consist of either (1) rescripting of, or (2) exposure to, the nightmare content. In a randomized controlled trial, we aim to investigate the therapeutic efficacy of these stripped-down IR and IE treatments, and explore their working mechanisms. METHOD Three weekly sessions of either IR or IE will be compared to a waiting-list control group. Ninety participants suffering from nightmare disorder will be included and randomly allocated to one of the three groups. The primary clinical outcome measures are nightmare frequency and distress caused by nightmares. Secondary clinical outcome measures include sleep complaints, dysfunctional beliefs about nightmares, and posttraumatic stress symptom severity. Outcomes will be assessed weekly from week 1 (pre-assessment) to week 5 (post-assessment). Online follow-up assessments will take place at 3 and 6 months after post-assessment. In order to investigate temporal relationships between mediators and outcome, we will measure the proposed mediators of the treatment effect 1 day after each outcome assessment (but not after the follow-ups). Mediators include nightmare distress and valence, mastery of the nightmare content, predictability, controllability, and tolerability of emotions elicited by nightmares, as well as sleep quality. DISCUSSION The proposed trial allows us to investigate the efficacy of IR and IE as intervention techniques for the treatment of nightmares, and to explore mediators of their respective therapeutic effects. The results may advance our understanding of nightmare therapies by identifying possible mechanisms of psychological treatments for chronic nightmares. Moreover, the results of the proposed study might provide useful knowledge about the working mechanism of rescripting-based and exposure-based treatments in general. TRIAL REGISTRATION Netherlands Trial Register ( NTR4951 ), registered on 14 December 2014.
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Affiliation(s)
- Anna E Kunze
- University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WS, Amsterdam, Netherlands. .,LMU Munich, Leopoldstraße 13, 80802, Munich, Germany.
| | - Jaap Lancee
- University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WS, Amsterdam, Netherlands
| | - Nexhmedin Morina
- University of Münster, Fliednerstraße 21, 48149, Münster, Germany
| | - Merel Kindt
- University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WS, Amsterdam, Netherlands.,Amsterdam Brain and Cognition, Nieuwe Achtergracht 129, 1018 WS, Amsterdam, Netherlands
| | - Arnoud Arntz
- University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WS, Amsterdam, Netherlands
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Abstract
Despite the demonstrated efficacy of cognitive-behavior therapy (CBT) for social anxiety disorder (SAD), many individuals do not respond to treatment or demonstrate residual symptoms and impairment posttreatment. Preliminary evidence indicates that acceptance-based approaches (e.g., acceptance and commitment therapy; ACT) can be helpful for a variety of disorders and emphasize exposure-based strategies and processes. Nineteen individuals diagnosed with SAD participated in a 12-week program integrating exposure therapy and ACT. Results revealed no changes across a 4-week baseline control period. From pretreatment to follow-up, significant improvements occurred in social anxiety symptoms and quality of life, yielding large effect size gains. Significant changes also were found in ACT-consistent process measures, and earlier changes in experiential avoidance predicted later changes in symptom severity. Results suggest the acceptability and potential efficacy of ACT for SAD and highlight the need for future research examining both the efficacy and mechanisms of change of acceptance-based programs for SAD.
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Affiliation(s)
- Kristy L Dalrymple
- Brown Medical School and Rhode Island Hospital, Providence, RI 02905, USA.
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48
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Plate AJ, Aldao A, Quintero JM, Mennin DS. Interactions Between Reappraisal and Emotional Nonacceptance in Psychopathology: Examining Disability and Depression Symptoms in Generalized Anxiety Disorder. Cogn Ther Res 2016; 40:733-46. [DOI: 10.1007/s10608-016-9793-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Diedrich A, Hofmann SG, Cuijpers P, Berking M. Self-compassion enhances the efficacy of explicit cognitive reappraisal as an emotion regulation strategy in individuals with major depressive disorder. Behav Res Ther 2016; 82:1-10. [DOI: 10.1016/j.brat.2016.04.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 04/18/2016] [Accepted: 04/20/2016] [Indexed: 12/28/2022]
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Schneider RL, Arch JJ, Landy LN, Hankin BL. The Longitudinal Effect of Emotion Regulation Strategies on Anxiety Levels in Children and Adolescents. J Clin Child Adolesc Psychol 2016; 47:978-991. [PMID: 27254420 DOI: 10.1080/15374416.2016.1157757] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
There is growing evidence linking emotion dysregulation to anxiety. However, few studies have examined this relationship longitudinally or developmentally. Additionally, no studies have specifically examined the predictive relevance of the emotion regulation skills taught in mindfulness- and acceptance-based therapies. We explore whether specific emotion regulation processes differentially predict specific anxiety symptoms over time among children and adolescents. METHODS Initial emotion non-awareness, nonacceptance, and difficulties with goal-directed behavior were assessed in a community sample (n = 312, age range = 8-16, mean age = 11.68, 59% female, 69% Caucasian). Social anxiety, separation anxiety, and physical anxiety symptoms were assessed every 3 months for 3 years. Hierarchical linear modeling was used to examine the concurrent and longitudinal effects of emotion dysregulation assessed at baseline or 18 months on anxiety. RESULTS After controlling for depression, age, and gender, all three processes concurrently predicted physical and social anxiety, and all but nonacceptance predicted separation anxiety. Only difficulties with goal-directed behavior, however, predicted longitudinal change in separation anxiety over time with covariates. Additionally, emotion non-awareness and difficulties with goal-directed behavior predicted subsequent changes in social anxiety. CONCLUSIONS Emotion dysregulation may serve as a potential risk factor for the development of anxiety symptoms among youth. It may be beneficial to target reductions in maladaptive strategies in prevention or intervention work.
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Affiliation(s)
- Rebecca L Schneider
- b Department of Psychology and Neuroscience , University of Colorado Boulder
| | - Joanna J Arch
- b Department of Psychology and Neuroscience , University of Colorado Boulder
| | - Lauren N Landy
- b Department of Psychology and Neuroscience , University of Colorado Boulder
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