Reducing the Meta-Emotional Problem Decreases Physiological Fear Response during Exposure in Phobics

Emotion dynamics of clients with test anxiety before and after an imagery-based treatment

BACKGROUND AND OBJECTIVES

Imagery-based techniques have become a promising means in the treatment of test anxiety (TA). Although previous studies have demonstrated the effectiveness of imagery-based treatment, not all clients seem to benefit from it. The present study compares clients' pre- as well as post-treatment emotion dynamics between responders and non-responders. Furthermore, it examines treatment-related changes in emotion dynamics in both subgroups.

METHODS

The results are based on 44 clients suffering from TA who underwent a six-session imagery-based treatment and include Ecological Momentary Assessment (EMA). Emotions were assessed with the Profile of Mood States four times a day over the course of two weeks before and after the treatment. Temporal networks were computed to index emotion dynamics.

RESULTS

Pre-treatment emotion dynamics differed between responders and non-responders. Similarly, post-treatment emotion dynamics differed as well between both groups. Some changes were also observed between pre-treatment and post-treatment networks: for responders, fatigue no longer predicted anger, and depression predicted itself; for non-responders, calmness predicted fatigue, anger, depression, contentment, and anxiety. In addition, fatigue no longer predicted itself and anxiety predicted vigor.

LIMITATIONS

The investigation is marked by several limitations: a liberal inclusion threshold of at least a 50% response to EMA prompts, and a relatively homogenous sample.

CONCLUSION

These results provide first evidence for the idea that emotion dynamics may be associated with response to treatment for TA. Furthermore, effective imagery-based treatments may be tied to changes within these dynamics.

Depression in the Mirror: Depression Severity and Its Link to Negative Judgments of Symptoms

Background and Objectives: Depressive states represent a normal and physiological response to the experience of loss. However, it is possible to identify some elements that allow distinguishing physiological depressive states from pathological ones. Over the years, research has confirmed that a stable tendency to negative self-evaluation is a transdiagnostic factor that triggers and amplifies dysfunctional emotional reactivity, thus contributing to the shift from normal to pathological reaction. In this sense, the secondary problem, or meta-emotional problem, referring to the negative evaluation of one's depressive state and the consequent dysfunctional attempts to solve it, seems to play an important role. The aim of the present study is to investigate how dysfunctional beliefs and the evaluations of depressive symptoms (meta-emotional problems) are related to depression severity. Methods: We asked to a community sample to focus on the depressive symptoms they regard as most distressful and evaluate them through specific questionnaires. One-hundred and eighty nine participants were asked to complete a set of questionnaires: (1) the Meta-Emotional Problem Questionnaire; (2) the Center for Epidemiologic Studies Depression Scale; (3) the Beck Depression Inventory; (4) the Dysfunctional Attitude Scale-24 in order to investigate the relation between dysfunctional beliefs, meta-emotional problems, and depressive symptoms severity. Results: Our results show that higher levels of depression are associated both to more pervasive dysfunctional attitudes and increased evaluation of meta-emotional problem. In addition, we conduct a regression analysis to disentangle the impact of the two different measures of depressive symptoms (i.e., BDI-II and CES-D) with two explanatory variables (dysfunctional attitudes and meta-emotional problem). Results show that meta-emotional problem remains a significant and robust predictor of the severity of depressive symptomatology, while dysfunctional beliefs has a rather weak and non-significant relation with the criterion. In other words, meta-emotional problem consistently explains the higher variance of depressive symptoms than dysfunctional beliefs. In conclusion, our study shows a clear link between meta-emotional problem and depression severity. This is relevant for clinical practice, as it highlights the importance of specifically targeting beliefs about the depressive condition in cognitive-behavioral treatment of depression, since they represent crucial factors maintaining depressive symptomatologies.

The emergency reaction questionnaire - First steps towards a new method

During emergencies, people are more or less capable of performing adequately. Knowledge about human behavior while facing emergencies has become more significant nowadays. This knowledge can help improving our already present defensive responses and natural coping mechanisms when facing imminent dangers, natural disasters, and catastrophes. A new method is here offered to explore the core points of this topic. The Emergency Reaction Questionnaire (ERQ), is proposed for predicting one's reaction and behaviour in an emergency. First, a large item pool was created based on interviews with people facing emergencies on a weekly basis and related literature. The factor structure, reliability and validity were assessed on a large sample of lay people (N = 1115, 440 males) and specific groups of firefighters and people doing extreme sports (N = 85, all males). Participants were Caucasian with an age range of 18-70. We also used measures of anxiety, depression, and sensation seeking, behavioral inhibition and activation and coping in stressful situations. The ERQ was proved to be reliable and consistent in time and having sound psychometric properties both on the community and special samples. Results show that psychometric properties are satisfying; the test has excellent validity ratings. Consequently, the ERQ can be used in future research effectively and facilitate a better understanding of how people react in a highly dangerous situation. Future directions in the utilization of the new method are discussed.

Synchronous change in subjective and physiological reactivity during flight as an indicator of treatment outcome for aviophobia: A longitudinal study with 3-year follow-up

BACKGROUND AND OBJECTIVES

Emotion can be seen as the organizing process that coordinates response systems to deal effectively with challenges and opportunities. Synchronous change in subjective and physiological reactivity is regarded as an indication of this organizing process. Synchrony is expected to increase with the intensity of emotional stimuli. Conversely, adaptive emotional functioning could be indicated by progressive synchrony upon increasing demands, and the magnitude of synchrony could be an indication of progress during therapy.

METHODS

We examined whether synchronous change in subjective and physiological reactivity over repeated exposures increased from watching a flight video through simulated flight to actual flight, and whether the magnitude of synchronous change predicted favourable short- and long-term treatment outcome within a group of 77 aviophobic participants during CBT.

RESULTS

Results did not show a relationship between the intensity of the phobic stimuli and the magnitude of synchronous change in subjective and physiological reactivity. Moreover, synchronous change across both response systems did not predict treatment outcome.

LIMITATIONS

By design this study had no control group. Additional treatment or life events between end of treatment and 3-year follow-up were not assessed.

CONCLUSION

The results provide only weak support for the functionalistic view that successful treatment of anxiety disorders is indicated by synchronous change in reactivity across emotional response systems. The relationship between these systems is likely to be affected by many intervening variables including higher order cognitive processes.

Biosignals to Detect the Imbalance of Explicit and Implicit Affect in Dementia: A Pilot Study

BACKGROUND

We assessed implicit and explicit emotion in older patients with dementia using biosignals.

METHODS

Fifty patients with dementia and 34 healthy individuals watched 3 videos that aimed to elicit various emotional responses. Electroencephalogram and heart rate variability were recorded.

RESULTS

Patients with dementia experienced less fun and more fear than controls. The high frequency (HF) from the baseline in response to funny stimulation as well as HF from neutral to fear stimulation in the dementia group increased further than in the control group. The slow wave (SW)-fast wave (FW) ratio from neutral to funny stimulation in the control group increased further than in the dementia group. The SW-FW from neutral to fear stimulation was further decreased in the dementia group than in the control group.

CONCLUSIONS

Although patients with dementia were more sensitive to implicit affect, they showed more enhanced imbalance between positive and negative affect in explicit affect assessment.

Rescripting Memory, Redefining the Self: A Meta-Emotional Perspective on the Hypothesized Mechanism(s) of Imagery Rescripting

Imagery Rescripting (ImRs) is a therapeutic technique that aims to reduce the distress associated with negative memories of early aversive experiences. It consists of prompting patients to rescript the autobiographical memory in line with their unmet needs. In recent years, ImRs was found effective in reducing symptoms of disorders such as depression, social phobia, obsessive-compulsive disorder, post-traumatic stress disorder, and personality disorders. However, the cognitive mechanisms underlying such broad effectiveness are currently an object of debate. Empirical evidence has shown that ImRs reduces the negative self-belief derived from aversive memories in different types of mental disorders. However, existing accounts are not very accurate in explaining how this change in self-belief occurs and therefore why ImRs is effective across psychopathologies. We propose that ImRs changes the semantic self-representation encapsulated in the aversive memory by reducing the meta-emotional problem (i.e., perceiving a negative emotion as problematic and unacceptable). Empirical evidence implicates the meta-emotional problem or “secondary problem” in the maintenance of different disorders and has shown that treating it leads to symptoms reduction. Here we hypothesize that: (i) ImRs as a stand-alone treatment may lead to a reduction of symptoms; negative self-belief and the meta-emotional problem; and (ii) the reduction of the meta-emotional problem might mediate the relation between symptoms and negative self-belief reduction. To test our hypothesis, we present an experimental procedure that could be used in future studies. We conclude discussing the existing theoretical frameworks that attempt to unravel the mechanisms that play a role in ImRs.

Identifying Patterns in Complex Field Data

Abstract. Ambulatory assessment methods are well suited to examine how patients with panic disorder and agoraphobia (PD/A) undertake situational exposure. But under complex field conditions of a complex treatment protocol, the variability of data can be so high that conventional analytic approaches based on group averages inadequately describe individual variability. To understand how fear responses change throughout exposure, we aimed to demonstrate the incremental value of sorting HR responses (an index of fear) prior to applying averaging procedures. As part of their panic treatment, 85 patients with PD/A completed a total of 233 bus exposure exercises. Heart rate (HR), global positioning system (GPS) location, and self-report data were collected. Patients were randomized to one of two active treatment conditions (standard exposure or fear-augmented exposure) and completed multiple exposures in four consecutive exposure sessions. We used latent class cluster analysis (CA) to cluster heart rate (HR) responses collected at the start of bus exposure exercises (5 min long, centered on bus boarding). Intra-individual patterns of assignment across exposure repetitions were examined to explore the relative influence of individual and situational factors on HR responses. The association between response types and panic disorder symptoms was determined by examining how clusters were related to self-reported anxiety, concordance between HR and self-report measures, and bodily symptom tolerance. These analyses were contrasted with a conventional analysis based on averages across experimental conditions. HR responses were sorted according to form and level criteria and yielded nine clusters, seven of which were interpretable. Cluster assignment was not stable across sessions or treatment condition. Clusters characterized by a low absolute HR level that slowly decayed corresponded with low self-reported anxiety and greater self-rated tolerance of bodily symptoms. Inconsistent individual factors influenced HR responses less than situational factors. Applying clustering can help to extend the conventional analysis of highly variable data collected in the field. We discuss the merits of this approach and reasons for the non-stereotypical pattern of cluster assignment across exposures.