Developmental trajectories of anger and sadness dysregulation in childhood differentially predict later borderline symptoms

Difficulties with emotion regulation are integral to borderline personality disorder (BPD) and its hypothesized developmental pathway. Here, we prospectively assess trajectories of emotion processing across childhood, how BPD symptoms impact these trajectories, and whether developmental changes are transdiagnostic or specific to BPD, as major depressive (MDD) and conduct disorders (CD) are also characterized by emotion regulation difficulties. This study included 187 children enriched for those with early symptoms of depression and disruptive behaviors from a longitudinal study. We created multilevel models of multiple components of emotional processing from mean ages 9.05 to 18.55 years, and assessed the effect of late adolescent BPD, MDD, and CD symptoms on these trajectories. Linear trajectories of coping with sadness and anger, and quadratic trajectories of dysregulated expressions of sadness and anger were transdiagnostic, but also exhibited independent relationships with BPD symptoms. Only inhibition of sadness was related to BPD symptoms. The quadratic trajectories of poor emotional awareness and emotional reluctance were also independently related to BPD. Findings support examining separable components of emotion processing across development as potential precursors to BPD, underscoring the importance of understanding these trajectories as not only a marker of potential risk but also potential targets for prevention and intervention.

Multidimensional schizotypy and embodied emotions

Background

Disembodiment and socio-emotional deficits are core features of the schizophrenia spectrum from the prodromal stages to chronic illness. A recent study documented anomalous emotional embodiment in individuals with schizophrenia. Although bodily self disturbances have been shown to precede and predict psychosis onset in at-risk populations, the etiology of anomalous emotional embodiment remains largely unexplored. The present study investigated bodily maps of emotions in relation to schizotypy to extend our understanding of embodied emotions in the schizophrenia spectrum.

Methods

A total of 419 participants (312 female; 19.50 ± 1.22 years) completed a topographical body mapping task where they reported patterns of embodiment experienced in the context of eleven different emotions and a neutral state (EmBODY). Embodied emotions were investigated in relation to multidimensional schizotypy.

Results

Individuals with elevated negative schizotypy experienced embodied emotions with higher intensity (r = 0.16, p = 0.003) but lower clarity (i.e., endorsing activation and deactivation in the same bodily location; β = -0.28, 95% CI [-0.54, -0.03], Z = 2.25, p=0.02) and endorsed more incongruent bodily sensations of emotions (i.e., reporting bodily activation in the context of a low-arousal emotion, r = 0.12, p = 0.05; reporting bodily deactivation in the context of high-arousal emotions, r = 0.13, p = 0.02). In line with the anomalous emotional embodiment documented in individuals with schizophrenia, some of these differences were particularly notable for low-arousal emotions.

Discussion

These results reveal negative schizotypy as a significant correlate of differences in emotional embodiment. More work is needed to link these differences to the anomalous bodily sensations of emotions documented in schizophrenia and assess their functional impact.

A meta-analytic investigation of grey matter differences in anorexia nervosa and autism spectrum disorder

Recent research reports Anorexia Nervosa (AN) to be highly dependent upon neurobiological function. Some behaviours, particularly concerning food selectivity are found in populations with both Autism Spectrum Disorder (ASD) and AN, and there is a proportionally elevated number of anorexic patients exhibiting symptoms of ASD. We performed a systematic review of structural MRI literature with the aim of identifying common structural neural correlates common to both AN and ASD. Across 46 ASD publications, a meta‐analysis of volumetric differences between ASD and healthy controls revealed no consistently affected brain regions. Meta‐analysis of 23 AN publications revealed increased volume within the orbitofrontal cortex and medial temporal lobe, and adult‐only AN literature revealed differences within the genu of the anterior cingulate cortex. The changes are consistent with alterations in flexible reward‐related learning and episodic memory reported in neuropsychological studies. There was no structural overlap between ASD and AN. Findings suggest no consistent neuroanatomical abnormality associated with ASD, and evidence is lacking to suggest that reported behavioural similarities between those with AN and ASD are due to neuroanatomical structural similarities.

Findings related to neuroanatomical structure in AN/ASD demonstrate overlap and require revisiting.

Meta‐analytic findings show structural increase/decrease versus healthy controls (LPFC/MTL/OFC) in AN, but no clusters found in ASD.

The neuroanatomy associated with ASD is inconsistent, but findings in AN reflect condition‐related impairment in executive function and sociocognitive behaviours.

Electrodermal Response to Mirror Exposure in Relation to Subjective Emotional Responses, Emotional Competences and Affectivity in Adolescent Girls With Restrictive Anorexia and Healthy Controls

Objective: Body image disturbances and the attendant negative emotions are two of the major clinical symptoms of eating disorders. The objective of the present experimental study was to shed more light on the degree of association or dissociation between the physiological and emotional response to mirror exposure in patients with restrictive mental anorexia, and on the relationships between the physiological response and characteristics connected with emotional processing. Materials and Methods: Thirty adolescent girls with the restrictive type of anorexia and thirty matched healthy controls underwent bilateral measurement of skin conductance (SC) during rest, neutral stimulus exposure, and mirror exposure, and completed a set of measures focused on emotion regulation competencies, affectivity, and eating disorder pathology. Results: Compared to healthy controls, girls with restrictive anorexia rated mirror exposure as a subjectively more distressful experience. Differences in skin conductance response (SCR) were not significant; however, variance in SCR was substantially greater in the group of anorexia patients as compared to healthy controls. The overall skin conductance level (SCL) was lower in anorexia patients. Increase in SCR during mirror exposure, as opposed to exposure to neutral stimuli, was positively related to the tendency to experience negative emotions, interoceptive sensitivity, body dissatisfaction and suppression, but not to other symptoms of eating pathology or emotional awareness. A post hoc analysis suggested that physiological reactivity might be associated with interoceptive sensitivity to mirror exposure especially in anorectic patients. Conclusion: The study seems to demonstrate some degree of dissociation between psychophysiological reactivity and subjective response to body exposure in patients with restrictive anorexia. Factors affecting differences in psychophysiological responsiveness to body exposure in anorectic patients require further exploration.

Anxiety in Older Adolescents at the Time of COVID-19

Corona Virus Disease-19 (COVID-19) is a catastrophic health risk, with psychological, emotional, social, and relational implications. From the early stages of the virus spread, the elderly population was identified as the most vulnerable, and health authorities have rightly focused on this frailer population. Conversely, less attention was given to the emotional and psychological dimensions of children and adolescents. Moreover, even though they were the subjects whose lives and health were at low risk, they, nevertheless, had to face a reality full of anxiety, fears, and uncertainties. The current study investigated the state of anxiety and emotional awareness in a sample of healthy older adolescents, 84 females and 64 males, aged 17 to 19, during the pandemic lockdown, using the Self-Rating Anxiety Scale and the Italian Emotion Awareness Questionnaire. An unexpected anxious phenomenology was found, affecting anxiety and the ideo-affective domain, while somatic symptomatology appeared to be less severe. The highest anxiety symptoms were breathing difficulties. These findings supported the hypothesis that the COVID-19 pandemic may be a risk condition for an increased state of anxiety in older adolescents and suggested the need to provide (1) an effective, empathic communication system with direct participation of older adolescents, (2) a psychological counseling service for the stress management of adolescents.

"My child will actually say 'I am upset' … Before all they would do was scream": Teaching parents emotion validation in a social care setting

BACKGROUND

Emotion validation by parents has positive outcomes for children's emotional development, particularly in vulnerable families, but there is a lack of research on supporting health workers to teach emotion validation to parents whose children are open to early help and children's social services. There is also a theoretical debate about how best to conceptualize emotion validation and why it is beneficial to children. The purpose of the study was to test the feasibility of teaching emotion validation skills to parents and family workers in a social care setting and to examine the effects of such teaching on children's emotion awareness and emotion regulation.

METHODS

This small scale qualitative feasibility study involved 11 parents (with children aged 2-5 years) who were receiving early help social services and five family workers. All parents took part in a 4-week course teaching emotionally validating parenting: either in a group class (six parents) or one-one delivery at home via a family worker (five parents). Effects on parents, children, and family workers were assessed using semi-structured interviews.

RESULTS

Six themes were identified in qualitative analysis: (1) parent became more validating, (2) parent's own vulnerability affected their ability to use the skills, (3) child became more aware of emotions, (4) child became calmer and more accepting of negative emotions, (5) child transferred emotion validation to others, and (6) family workers incorporated emotion validation techniques into their professional practice.

CONCLUSION

Results demonstrated the feasibility of teaching emotional validation skills to parents via both delivery methods, with positive outcomes reported for parents and children and positive impact reported on family worker practice. Qualitative analysis suggested that parental acceptance of child's negative emotions may be linked with greater self-awareness of negative emotions in the child.

Affect Intensity Moderates the Association of Emotional Clarity with Emotion Regulation and Depressive Symptoms in Unselected and Treatment-Seeking Samples

Depression is associated with subjective difficulties identifying one's emotions, known as low emotional clarity, but the mediators and moderators of this relationship are not well understood. We hypothesized that the role of emotional clarity in emotion regulation and, in turn, depression depends on individual differences in negative affect intensity. In Study 1, conducted in an unselected sample (N=119), low emotional clarity more strongly predicted depression symptoms among individuals higher in affect intensity. In Study 2, conducted in a clinically diagnosed, treatment-seeking sample (N=245), we examined whether affect intensity moderated an indirect path of clarity through emotion regulation strategy use that has emerged in previous work. When affect intensity was very low, emotional clarity did not predict reappraisal, and when affect intensity was very high, emotional clarity did not predict non-acceptance or experiential avoidance. By contrast, rumination mediated associations of emotional clarity with depressive symptoms regardless of affect intensity. Findings support a process model of low emotional clarity in depression that integrates (1) emotion regulatory mediators and (2) moderation by negative affect intensity. Trait differences in affect intensity may determine whether and how emotional clarity and regulation processes factor into mood psychopathology.

Assessing Empathy across Childhood and Adolescence: Validation of the Empathy Questionnaire for Children and Adolescents (EmQue-CA)

Empathy plays a crucial role in healthy social functioning and in maintaining positive social relationships. In this study, 1250 children and adolescents (10-15 year olds) completed the newly developed Empathy Questionnaire for Children and Adolescents (EmQue-CA) that was tested on reliability, construct validity, convergent validity, and concurrent validity. The EmQue-CA aims to assess empathy using the following scales: affective empathy, cognitive empathy, and intention to comfort. A Principal Components Analysis, which was directly tested with a Confirmatory Factor Analysis, confirmed the proposed three-factor model resulting in 14 final items. Reliability analyses demonstrated high internal consistency of the scales. Furthermore, the scales showed high convergent validity, as they were positively correlated with related scales of the Interpersonal Reactivity Index (Davis, 1983). With regard to concurrent validity, higher empathy was related to more attention to others' emotions, higher friendship quality, less focus on own affective state, and lower levels of bullying behavior. Taken together, we show that the EmQue-CA is a reliable and valid instrument to measure empathy in typically developing children and adolescents aged 10 and older.

The impact of emotion awareness and regulation on social functioning in individuals at clinical high risk for psychosis

BACKGROUND

Social functioning (SF) difficulties are ubiquitous among individuals at clinical high risk for psychosis (CHR), but it is not yet clear why. One possibility is suggested by the observation that effective SF requires adaptive emotion awareness and regulation. Previous reports have documented deficits in emotion awareness and regulation in individuals with schizophrenia, and have shown that such deficits predicted SF. However, it is unknown whether these deficits are present prior to the onset of psychosis or whether they are linked to SF in CHR individuals.

METHOD

We conducted a cross-sectional comparison of emotion awareness and regulation in 54 individuals at CHR, 87 with schizophrenia and 50 healthy controls (HC). Then, within the CHR group, we examined links between emotion awareness, emotion regulation and SF as indexed by the Global Functioning Scale: Social (Cornblatt et al. 2007).

RESULTS

Group comparisons indicated significant differences between HC and the two clinical groups in their ability to identify and describe feelings, as well as the use of suppression and reappraisal emotion-regulation strategies. Specifically, the CHR and schizophrenia groups displayed comparable deficits in all domains of emotion awareness and emotion regulation. A hierarchical multiple regression analysis indicated that difficulties describing feelings accounted for 23.2% of the SF variance.

CONCLUSIONS

The results indicate that CHR individuals display substantial emotion awareness and emotion-regulation deficits, at severity comparable with those observed in individuals with schizophrenia. Such deficits, in particular difficulties describing feelings, predate the onset of psychosis and contribute significantly to poor SF in this population.

Tuned In Emotion Regulation Program Using Music Listening: Effectiveness for Adolescents in Educational Settings

This paper presents an effectiveness study of Tuned In, a novel emotion regulation intervention that uses participant selected music to evoke emotions in session and teaches participants emotional awareness and regulation skills. The group program content is informed by a two dimensional model of emotion (arousal, valence), along with music psychology theories about how music evokes emotional responses. The program has been evaluated in two samples of adolescents: 41 "at risk" adolescents (76% males; M age = 14.8 years) attending an educational re-engagement program and 216 students (100% females; M age = 13.6 years) attending a mainstream secondary school. Results showed significant pre- to post-program improvements in measures of emotion awareness, identification, and regulation (p < 0.01 to p = 0.06 in the smaller "at risk" sample and all p < 0.001 in the mainstream school sample). Participant ratings of engagement and likelihood of using the strategies learned in the program were high. Tuned In shows promise as a brief emotion regulation intervention for adolescents, and these findings extend an earlier study with young adults. Tuned In is a-theoretical in regard to psychotherapeutic approach and could be integrated with other program components as required.

Empathy in adolescence: Relations with emotion awareness and social roles

In this study, we aimed at gaining a better understanding of the individual differences contributing to feelings of empathy in adolescents. Therefore, we examined the extent to which emotion awareness (e.g., recognizing and appreciating one's own and the emotions of others) and a tendency for certain social roles (e.g., helping or teasing peers when being bullied) are related to adolescents' levels of empathy. The sample was comprised of 182 adolescents aged between 11 and 16. Empathy and emotion awareness were assessed using self-report measures. Peer reports were used to indicate adolescents' different social roles: Bullying, defending the victim, and outsider behaviour. Outcomes demonstrated that evaluating one's own and the emotions of others, and more defending nominations were associated with both affective and cognitive empathy, whereas aspects of emotion awareness which are linked with internalizing symptoms were related to empathic distress, suggesting maladaptive emotion appraisal. Furthermore, outsider behaviour was associated with empathic distress, emphasizing a self-focused orientation. In contrast, more bullying was negatively associated with cognitive empathy. Overall, these outcomes demonstrate that, besides social roles, emotion awareness is an important factor for adaptive empathic reactions, whereas emotion dysregulation might cause distress when witnessing the negative feelings of others.

The role of emotion awareness and mood: somatic complaints and social adjustment in late childhood

Emotion awareness is a key concept related to different child adjustment outcomes. This relationship, influenced by mood, has been found in the preadolescent and adolescent population for somatic complaints. However, little is known in the case of younger children and when other adjustment outcomes are included. The objective of this work is to analyze the contribution of emotion awareness and mood upon different adjustment outcomes (somatic complaints, maladjustment, and peer sociometric status), in children aged 8-12 years old. Self-reported questionnaires and peer-nomination scales were administered to 1423 children (mean age = 9.8 years old). Results support the influence of emotion awareness reinforced by mood, not only upon somatic complaints, but also upon new indicators of personal and social maladjustment, within an age bracket that has not been considered previously. These results stress the importance of emotional abilities and the corresponding affective moods in children's daily life.

Emotional blunting following left basal ganglia stroke: the role of depression and fronto-limbic functional alterations

Disorders of the basal ganglia (BG) alter perception and experience of emotions. Left hemisphere BG (LBG) stroke is also associated with depression. The interplay between depression and alterations in emotional processing following LBG stroke was examined. Evoked affective responses to emotion-laden pictorial stimuli were compared among LBG stroke and healthy participants and participants with stroke damage in brain regions not including the LBG selected to equate depression severity (measured using the Hamilton Depression Scale) with LBG damage participants. Brain activity {[O(15)]water positron emission tomography, PET} was measured in LBG stroke relative to healthy participants to identify changes in regions associated with emotion processing and depression. LBG stroke subjects reported less intense emotions compared with healthy, but not stroke comparison participants. Depression negatively correlated with emotional experience for positive and negative emotions. In response to positive stimuli, LBG subjects exhibited higher activity in amygdala, anterior cingulate, dorsal prefrontal cortex, and insula compared to healthy volunteers. In response to negative stimuli, LBG subjects demonstrated lower activity in right frontal-polar region and fusiform gyrus. Higher baseline activity in amygdala and ventral and mesial prefrontal cortex and lower activity in left dorsal lateral prefrontal cortex were associated with higher depression scores. LBG stroke led to blunted emotions, and brain activity alterations accounting for reduced affective experience, awareness and depression. Depression and fronto-limbic activity changes may contribute to emotional blunting following LBG stroke.

Deficits in emotional awareness in schizophrenia and their relationship with other measures of functioning

Conscious awareness of emotion is adaptive and its disruption in schizophrenia can impact social functioning. This study assessed levels of emotional awareness for self and others in social scenarios (Levels of Emotional Awareness Scale) in 21 individuals with schizophrenia spectrum disorders (SSD) and 20 healthy individuals. Individuals with SSD had lower levels of emotional awareness for others in complex social scenarios, but not simple social scenarios; no difference was found in emotional awareness for self. Higher levels of emotional awareness were associated with better quality of life in patients. Patients also reported higher social anhedonia. Healthy individuals' higher levels of emotional awareness for self were associated with lower anhedonia, but this relationship was not found in SSD patients. Individuals with schizophrenia have particular difficulty anticipating others' emotional responses in complex social situations. Further, this deficit is independent of anhedonia in SSD patients, indicating a systemic disruption in the integration of emotional processing.