Internet-based emotion regulation training aimed at reducing violent revictimization and depressive symptoms in victimized depressed patients: Results of a randomized controlled trial

BACKGROUND

Depressed patients who have become victim of violence are prone to revictimization. However, no evidence-based interventions aimed at reducing revictimization in this group exist.

METHODS

This multicenter randomized controlled trial evaluated the effectiveness of an internet-based emotion regulation training (iERT) added to TAU in reducing revictimization, emotion dysregulation, and depressive symptoms in recently victimized, depressed patients compared to TAU alone. Adult outpatients (N = 153) with a depressive disorder who had experienced threat, physical assault, or sexual assault within the previous three years were randomly allocated to TAU+iERT (n = 74) or TAU (n = 79). TAU involved psychotherapy (mainly cognitive behavioral therapy [77.8 %]). iERT comprised six guided online sessions focused on the acquisition of adaptive emotion regulation skills. The primary outcome measure was the number of revictimization incidents at 12 months after baseline, measured with the Safety Monitor. Analyses were performed according to the intention-to-treat principle.

RESULTS

Both groups showed a large decrease in victimization incidents. Mixed-model negative binomial regression analyses showed that TAU+iERT was not effective in reducing revictimization compared to TAU (IRR = 0.97; 95%CI = 0.64,1.46; p = .886). Linear mixed-model analyses demonstrated that TAU+iERT yielded a larger reduction of emotion dysregulation (B = -7.217; p = .046; Cohens d = 0.33), but not depressive symptoms (B = -1.041; p = .607) than TAU.

LIMITATIONS

The study was underpowered to detect small treatment effects. Additionally, uptake of iERT was quite low.

CONCLUSIONS

Although TAU+iERT resulted in a larger decrease of emotion dysregulation than TAU alone, it was not effective in reducing revictimization and depressive symptoms. Patients' revictimization risk substantially decreased during psychotherapy.

Do deficits in subjective stress recovery predict subsequent stress sensitivity and symptoms in schizophrenia spectrum disorders?

High levels of stress play a crucial role in the development of psychotic symptoms, such as paranoia, and may stem in part from recovery deficits after stress exposure. However, it remains unclear whether deficient recovery causes a build-up of heightened stress levels that increases stress sensitivity and symptoms when exposed to another stressor. To test this, we investigated the effect of subjective stress recovery on the response to a subsequent stressor and paranoia. We applied two consecutive runs of the same combined physical and cognitive stressor separated by a recovery phase of 60 min in individuals with schizophrenia spectrum disorders (n = 49). We repeatedly assessed self-reported stress, negative affect, heart rate, heart rate variability, salivary cortisol, and paranoia. Recovery of self-reported stress was defined as the geometric mean of the percentage changes of self-reported stress during recovery after the first stressor, and was regressed on the response to the second stressor controlling for self-reported stress during the first stressor. Lower subjective stress recovery predicted higher levels of self-reported stress, negative affect, and paranoia in response to the second stressor. The subjective stress recovery was not predictive of the physiological stress response (heart rate, heart rate variability, or salivary cortisol). Taken together, the findings indicate that recovery deficits could contribute to high levels of self-reported stress, negative affect, and paranoia in schizophrenia spectrum disorders and that the improvement of stress recovery could be a promising approach for interventions.

The Future of Emotion Regulation Research: Broadening Our Field of View

Over the past few decades, emotion regulation research has matured into a vibrant and rapidly growing field (in 2022 alone, more than 30 thousand papers were published on emotion regulation). Taking stock of our progress, we ask "What does the future hold?" In this manuscript, we offer a roadmap for the next generation of research on emotion regulation. We begin by painting a picture of the field's journey so far. We then outline a forward-looking agenda for broadening our field of view along three key dimensions: (1) increasing our resolution to see how regulatory strategies are flexibly and dynamically translated into tactics; (2) widening our viewing angle to embrace interpersonal emotion regulation; and (3) extending the timescale of emotion regulation research to examine how regulatory efforts are fine-tuned across the regulatory cycle and in the context of a broader range of affective experiences. In doing so, we highlight empirical studies that exemplify these three areas of focus and discuss the opportunities that lie before us. We close by offering a set of concrete practical and methodological recommendations for how the field can accomplish the goals we have outlined.

Affect Across the Wake-Sleep Cycle

Affective scientists traditionally have focused on periods of active wakefulness when people are responding to external stimuli or engaging in specific tasks. However, we live much of our lives immersed in experiences not related to the current environment or tasks at hand-mind-wandering (or daydreaming) during wakefulness and dreaming during sleep. Despite being disconnected from the immediate environment, our brains still generate affect during such periods. Yet, research on stimulus-independent affect has remained largely separate from affective science. Here, we suggest that one key future direction for affective science will be to expand our field of view by integrating the wealth of findings from research on mind-wandering, sleep, and dreaming to provide a more comprehensive account of affect across the wake-sleep cycle. In developing our argument, we address two key issues: affect variation across the wake-sleep cycle, and the benefits of expanding the study of affect across the full wake-sleep cycle. In considering these issues, we highlight the methodological and clinical implications for affective science.

The Role of Hedonic Goal Pursuit in Self-Control and Self-Regulation: Is Pleasure the Problem or Part of the Solution?

This paper examines the role of hedonic goal pursuit in self-control and self-regulation. We argue that not all pursuit of immediate pleasure is problematic and that successful hedonic goal pursuit can be beneficial for long-term goal pursuit and for achieving positive self-regulatory outcomes, such as health and well-being. The following two key questions for future research are discussed: How can people's positive affective experiences during hedonic goal pursuit be enhanced, and how exactly do those affective experiences contribute to self-regulatory outcomes? We also call for an intercultural perspective linking hedonic goal pursuit to self-regulatory outcomes at different levels. We suggest that understanding the cognitive, motivational, and affective mechanisms at play can help individuals reap the benefits of successful hedonic goal pursuit. Considering those potential benefits, hedonic goal pursuit should be studied more systematically. To achieve this, we argue for a stronger integration of affective science and self-control research.

Investigating measurement invariance of the Emotion Regulation Questionnaire-8 (ERQ-8) across 29 countries

The widely used Emotion Regulation Questionnaire (ERQ) measures the habitual use of cognitive reappraisal and expressive suppression. Recently, a more economical 8-item version of the ERQ was proposed that showed good model fit. We assessed whether the latent constructs of the ERQ-8 are generalizable across different countries and cultures. To this end, we used data from the COVIDiSTRESS survey and investigated measurement invariance of the ERQ-8 in a large sample that included 11,288 individuals from 29 countries with diverse cultural backgrounds. Our analyses revealed configural and metric invariance of the ERQ-8 in 14 countries. The results suggest that emotion regulation strategies may not readily converge across all cultures. This underscores the importance of testing measurement invariance before interpreting observed differences and similarities between countries.

Supplementary information

The online version contains supplementary material available at 10.1007/s12144-022-04220-6.

Long-term efficacy of exercise across diagnostically heterogenous mental disorders and the mediating role of affect regulation skills

BACKGROUND

Exercise interventions are efficacious in reducing disorder-specific symptoms in various mental disorders. However, little is known about long-term transdiagnostic efficacy of exercise across heterogenous mental disorders and the potential mechanisms underlying treatment effects.

METHODS

Physically inactive outpatients, with depressive disorders, anxiety disorders, insomnia or attention deficit hyperactivity disorder were randomized to a standardized 12-week exercise intervention, combining moderate exercise with behavior change techniques (BCTs) (n = 38), or a passive control group (n = 36). Primary outcome was global symptom severity (Symptom Checklist-90, SCL-90-R) and secondary outcomes were self-reported exercise (Physical Activity, Exercise, and Sport Questionnaire), exercise-specific affect regulation (Physical Activity-related Health Competence Questionnaire) and depression (SCL-90-R) assessed at baseline (T1), post-treatment (T2) and one year after post-treatment (T3). Intention-to-treat analyses were conducted using linear mixed models and structural equations modeling.

RESULTS

From T1 to T3, the intervention group significantly improved on global symptom severity (d = -0.43, p = .031), depression among a depressed subsample (d = -0.62, p = .014), exercise (d = 0.45, p = .011) and exercise-specific affect regulation (d = 0.44, p = .028) relative to the control group. The intervention group was more likely to reveal clinically significant changes from T1 to T3 (p = .033). Increases in exercise-specific affect regulation mediated intervention effects on global symptom severity (ß = -0.28, p = .037) and clinically significant changes (ß = -0.24, p = .042).

CONCLUSIONS

The exercise intervention showed long-term efficacy among a diagnostically heterogeneous outpatient sample and led to long-lasting exercise behavior change. Long-term increases in exercise-specific affect regulation within exercise interventions seem to be essential for long-lasting symptom reduction.

Right brain-to-right brain psychotherapy: recent scientific and clinical advances

This article overviews my recent acceptance of a Lifetime Achievement Award from Sapienza University of Rome, in which I discussed three decades of my work on the right brain in development, psychopathogenesis, and psychotherapy. In the following, I offer current brain laterality and hemispheric asymmetry research indicating that right brain emotional and relational processes operate beneath conscious awareness not only in early human development, but over the lifespan. I discuss recent interdisciplinary studies on the central role of ultrarapid right brain-to-right brain intersubjective communications of face, voice, and gesture and the implicit regulation of emotion in nonverbal attachment dynamics. Special emphasis is on the fundamental psychobiological process of interpersonal synchrony, and on the evolutionary mechanism of attachment, the interactive regulation of biological synchrony within and between organisms. I then present some clinical applications, suggesting that effective therapeutic work with "primitive" nonverbal emotional attachment dynamics focuses not on conscious verbal insight but on the formation of an unconscious emotion-communicating and regulating bond within the therapeutic relationship. Lastly, I review recent hyperscanning research of the patient's and therapist's brains during a face-to-face, emotionally focused psychotherapy session that supports the right brain-to-right brain communication model. I end suggesting that the right brain is dominant in both short-term symptom-reducing and long-term growth-promoting deep psychotherapy.

Affect regulation as a moderator of intentions for breast cancer chemoprevention

Women at high risk for breast cancer (BC) may consider chemoprevention for risk reduction, but uptake is low. This study examined the role of affect regulation (the attempt to alter or control one's emotions) in decision-making about BC chemoprevention. A cross-sectional, single group design was used. High-risk women (N = 81) were surveyed. Moderation analyses specified cancer-specific distress as the independent variable, affect regulation (cognitive reappraisal or expressive suppression) as the moderator, and chemoprevention intentions (yes = 1, unsure = 0, no = -1) as the dependent variable. Cognitive reappraisal significantly moderated the relationship between cancer-specific distress and chemoprevention intentions (p = 0.03), but expressive suppression did not (p = 0.31). For the 44% of participants who were highest on reappraisal, higher cancer-specific distress was associated with greater intentions for chemoprevention. For the remaining 56%, there was no relationship between cancer-specific distress and chemoprevention intentions. Cognitive reappraisal may play an important role in decisions regarding uptake of chemoprevention.

Subtyping youngsters with obesity: A theory-based cluster analysis

Psychological mechanisms play a crucial role in explaining weight gain. Aim of the present study was to identify subtypes in youngsters with obesity in line with these mechanisms. Defining homogeneous clusters within this heterogeneous group provides relevant information for personalized treatments. Data were collected in N = 572 participants (51% boys, aged 7-19) with extreme obesity (%BMI M = 187.8; SD = 30.9) recruited in an inpatient treatment centre. Based on psychological models of overweight/obesity, the Affect Regulation Model, the Reward Deficiency Model and The Dual Pathway Model, cluster variables were selected assessing emotional eating, reward reactivity and regulative capacities. Youngsters reported on emotional eating (DEBQ Emotional Eating) and reward sensitivity (BAS), while parents reported on children's regulative Executive Functions (BRIEF). Characteristics of the different clusters were examined concerning weight variables (pre and post treatment) and variables indexing problematic eating (DEBQ External Eating, Ch-EDE), affect regulation (FEEL-KJ) and depressive symptoms (CDI). Hierarchical cluster analyses supported the presence of three clusters, further evaluated by K-means cluster analyses. The cluster solutions differed according to age and sex (boys 7-13, boys 14-19, girls 7-13, girls 14-19). In all four age and gender subsamples, an "Emotional Eating" cluster displaying a vulnerable profile (high depression, maladaptive emotion regulation, problematic eating) and a "Reward Deficiency" cluster displaying a more resilient profile were detected. In girls 7-13, a "Weak Executive Functioning" indicative of insufficient self-regulative capacities, showed moderate to high emotional problems and problematic eating. In the other subgroups, the "Mean Level Functioning" cluster also showed elevated emotional problems and problematic eating. Given that different clusters can be identified, and given that these clusters have different profiles on emotional problems and problematic eating, subtyping youngsters with severe obesity is indicated, setting the stage for personalized treatments.

Affect regulation in psychoanalytic treatments of patients with a borderline personality disorder–psychoanalysis and psychodynamic psychotherapy–a comparison

BACKGROUND

A recent meta-analysis has confirmed that the effects of psychotherapy on patients with borderline personality disorders (BPD) are still insufficiently understood. Evidence of differences between different types of therapies has been questioned.

AIM

To study repetitive interaction patterns in patients with BPD undergoing either psychoanalysis or psychodynamic therapy.

METHODS

Psychoanalysis (PSA) or psychodynamic psychotherapy (PDT) was administered to 10 patients each, the two groups were matched. Therapy regimens were applied according to care as usual/manualized including quality control and supervision as usual. Randomization to one of the groups was done after baseline assessment. During classical PSA (n = 10) and PDT (n = 10), semiannually, recordings (audio or video) of five consecutive therapy sessions were taken over three years for an ex-post analysis. The patients' characteristics, such as affect parameters [Affect regulation and experience Q-sort (AREQ)], quality of object relations (quality of object relations scale) and personality traits [Shedler-Westen Assessment Procedure (SWAP-200)] were analyzed retrospectively by independent raters. Therapeutic action (psychotherapy process Q-sort) and affective (re)actions of the patients (AREQ) were then analyzed in relation to changes found in the patients' characteristics.

RESULTS

During the first year of therapy (PSA: n = 10; PDT: n = 9), the therapeutic method PSA was associated with significant improvements in the variable "SWAP Borderline", while in PDT change was not significantly different to baseline (PSA: P = 0.04; PDT: P = 0.33). Long-term results and follow up was available for seven participants in PSA and for five in PDT after three years; change in SWAP borderline for the whole sample was not significant at this time point when confronting to baseline (P = 0.545). However, differences between PSA and PDT were significant when analyzing the “mean change” in the SWAP Borderline variable after one year of therapy (P = 0.024): PSA led to slightly increased BPD symptoms, while PDT to a decrease; for the long run, variance of observed change was higher in PSA than in PDT (SD_PSA ± 9.29 vs SD_PDT ± 7.94). Our assumption that transference interpretations, closely followed by affective changes in the patient, could be useful modes of interaction was reproducible in our findings, especially when looking at the descriptive findings in the long-term data. The analysis of repetitive interaction structures demonstrated a very specific "time-lag" between therapeutic intervention and a corresponding increase in positive affect in successful therapy cases.

CONCLUSION

Exploring the change processes in the patients' characteristics and linking these changes to specific treatment strategies is of clinical importance when starting treatment and for its long-term progress.

Individual differences in perceived sleep quality do not predict negative affect reactivity or regulation

Do people who have low-quality sleep tend to have more negative affect? This question is of great public interest, and many would assume the answer is "yes." However, previous findings have been mixed, possibly due to differing measures of sleep and affect, or to a failure to separately examine negative affect reactivity and regulation. Across two studies, we assessed adults' perceived sleep quality for at least two weeks and tested their negative affect reactivity and regulation in response to unpleasant pictures (Study 1) or painful thermal stimulation (Study 2) using both self-report and physiological measures. The relationships between perceived sleep quality, on the one hand, and negative affect reactivity and regulation, on the other, were non-significant. Furthermore, a Bayesian approach unanimously favored the null hypothesis. These results suggest that individual differences in perceived sleep quality may not predict negative affect reactivity or regulation across adult individuals.

Differentiating reactivity and regulation: Evidence for a role of prefrontal asymmetry in affect regulation

Prefrontal asymmetry (PFA) has originally been referred to as "affective style" and is said to be associated with an individual's personality. Therefore, previous research has focused on finding a link between PFA and trait variables associated with affective processing, such as the behavioral activation and inhibition systems (BAS/BIS). However, recent evidence suggests that PFA might be involved in regulatory processes rather than initial affective reactions. Here, we investigated if failure-related action orientation (AOF), as a personality variable reflecting the ability to disengage from negative experiences, is related to PFA. Forty-seven participants completed two trait questionnaires to assess BAS/BIS and AOF, followed by 8 min of resting EEG measurement. Results showed that higher AOF scores predicted a higher relative left-hemispheric PFA when BAS/BIS was controlled for. The findings suggest that a suppression effect might account for the inconsistencies in the literature regarding the association between PFA and BAS/BIS.

Loss-related mental states impair executive functions in a context of sadness

Stress and anxiety have been shown to temporally impair executive functions, but the role of other emotions, such as sadness, has been inconclusive. Moreover, the role of affect regulation in this relationship has not been extensively studied. The present research investigated whether certain types of mental states (mental output resulting from the use of affect regulation within a specific context or with respect to a specific material or theme) relative to the context of loss would predict impairment of executive functions. Participants were randomly assigned to read either a loss-related newspaper article inducing sadness or a neutral newspaper article. Results showed that low mental states relative to loss (maladaptive affect regulation) predicted impairment of executive functions following an induction of sadness, but not following the neutral induction. Conversely, high mental states (adaptive affect regulation) were not predictive of impairment of executive functions in both the sadness and neutral condition. These findings have implications for the boundaries within which emotion can disrupt high-order cognitive processes.

Emotion regulation in pediatric bipolar disorder: A meta-analysis of published studies

BACKGROUND

Emotion regulation is a relatively recent topic in psychiatry, and has only recently begun to be tested across Pediatric Bipolar Disorder (PBD). To date, no meta-analysis has investigated the presence of emotion regulation deficits in PBD patients.

OBJECTIVES

The aim of this study is to understand where the literature stands on this topic, as well as how different researchers are measuring and grasping the concept of emotion regulation in pediatric bipolar disorders.

METHODS

A systematic search of trials using the terms ("Pediatric Bipolar Disorder") AND ("Emotion Regulation" OR "Affect Regulation" OR "Mood Lability" OR "Mood Instability" OR "Irritability") was conducted using PubMed, Google Scholar, ResearchGate, Web of Science and Psych Info databases. Of the initial 366 articles identified, 8 met eligibility criteria for the meta-analysis and were included in this study.

RESULTS

There is a statistically significant difference in Accuracy in Emotion Regulation tasks, with a tendency for lower accuracy in PBD patients; however, both groups did not differ statistically regarding Response Time.

CONCLUSION

Our data suggests that PBD patients do present emotion regulation deficits, particularly regarding facial emotion recognition and affective language interference tasks mediated by cognitive assignments. These results have important implications in developing novel psychotherapeutic interventions for this population.

Linking psychophysiological adaptation, emotion regulation, and subjective stress to the occurrence of paranoia in daily life

As stress is relevant to the formation of paranoia, maladaptive behavioral and physiological stress regulation is discussed as a crucial indicator of vulnerability. This is supported by research linking psychosis to the tendency to make less use of functional and more use of dysfunctional emotion regulation strategies (ER) and with a lower vagally-mediated heart rate variability (HRV). However, it remains unclear whether ER serves as a mediator between resting-state HRV on the one hand and subjective stress levels and paranoia on the other and whether this is specific to paranoia as compared to depression. We used an experience sampling method during seven days to repeatedly assess the experience of stress, usage of ER strategies, paranoia und depression (9/day) in a sample with subclinical positive symptoms (N = 32). Resting-state HRV was measured during a 5min interval in the laboratory. Data was analyzed by multi-level models. Higher resting-state HRV was predictive of lower stress-levels and of using more functional ER strategies (reappraisal, acceptance) in daily life, but did not predict the use of dysfunctional strategies (rumination, suppression) or paranoia. The association between resting-state HRV and stress was mediated by the usage of functional ER. Less functional and more dysfunctional ER were linked to higher levels of stress, paranoia and depression. Our study highlights that deficits in ER represent a link between psychophysiological and phenomenological aspects of paranoia but also of depression. This encourages to further investigate transdiagnostic prevention and therapy programs aiming to improve ER and to increase HRV.

The relevance of being hypnotic in addressing trauma in children across settings

Clinical hypnosis has proven effective in the treatment of trauma, not just for adults but for children as well. Given the prevalence of children with trauma and the trauma-related dysregulation evident in school settings, promotion of emotional regulation skills and access to emotional management tools are necessary. Trauma-informed care is on the rise in both medical and academic settings. Some schools are even employing hypnotic-like methods such as meditation with substantial success to address symptoms of dysregulation. Given the suggestibility of children without formal inductions and the ease of which hypnotic-like interventions can be employed, this article will explore how the art of "being hypnotic" and the use of hypnotic language is, and can, be used in various settings, not to treat trauma, but to foster affect regulation, reduce observable distress, improve self-confidence, and promote resilience.

Randomized comparison of W.A.R.A. (Wiring Affect with ReAttach) versus distraction: A pilot study assessing the efficacy of an ultrafast transdiagnostic intervention

BACKGROUND

Generally, neuropsychiatric patients share different symptoms across nosological categories, such as, amongst other, psychological distress, mood alterations, anxiety, and self-regulation disturbances.ReAttach is a novel psychological intervention with its key elements being external affect and arousal regulation, stimulation of multiple sensory processing, conceptualization, affective mentalization, and associative memory processing. ReAttach has been hypothesized to be effective in reducing symptom severity in different psychiatric conditions. Given the limited information currently available, the present study aimed to investigate the effect of main ReAttach elements called "Wiring Affect with ReAttach" (W.A.R.A.) on negative affect (N.A.), and to compare it with "Distraction," another well-established affect-regulating strategy.

METHODS

We used a single-blind, randomized controlled crossover equivalence design to compare the efficacy on N.A. regulation of W.A.R.A. versus Distraction in 101 patients with different neuropsychiatric disorders.

RESULTS

The results showed a significant difference (p < 0.001) in response to W.A.R.A. vs. Distraction, with W.A.R.A. being significantly more effective in regulating N.A., with a large effect size (dRMpooled = 2.38) and a high probability (95%) of success.

LIMITATIONS

The heterogeneity of the study population makes generalization and clear recommendations for specific patient groups difficult. The Numeric Rating Scale might have prevented detection of increased N.A. when the baseline scores were high. More in-depth research is needed to explore the W.A.R.A. technique and the extent of confounding variables such as the placebo effect.

CONCLUSIONS

The findings suggest that W.A.R.A. may be an effective, accessible, and brief intervention reducing negative affect. Although premature, these first results are encouraging.

Heart Rate Variability, Cortisol and Attention Focus During Shamatha Quiescence Meditation

Cardiac vagal tone can be seen as a stable marker for the ability to sustain attention and regulate emotion, two factors associated with the quality of meditation. In this study, heart rate variability (HRV) has been monitored in different forms of Shamatha quiescence meditation: three breath meditations, Settling the Mind in its natural state, Awareness of Awareness, Loving-kindness and Tonglen. Establish and test a practical means of monitoring neurobiological effects of meditation. Over 6 weeks, two experimental groups practiced Shamatha meditation on a daily basis (n = 20). HRV patterns and cortisol tests were monitored at three measuring points during these weeks, and an attention focus test was performed at the start and after 6 weeks. Six weeks of regular practice in Shamatha meditation were associated with HRV indices suggesting improvements in the homeostatic regulation of the autonomic nervous system (ANS) in 85% of the HRV recordings (tachogram and frequency specter) of all 20 subjects. Further, a substantial decrease in cortisol levels was also noted. The attention focus test showed a significant increase of 18.7% in sustained attention, moving from medium to high attention focus, with a significant result of t(20) = - 8.764 and p < 0.001. Participants reported positive subjective changes in attention focus, sense of happiness and calmness and increased abilities in emotional regulation and attunement. Six weeks of regular practice in Shamatha meditation contributes to a substantial increase of attention focus and a decrease in stress levels evidenced in changes in diurnal cortisol measures. HRV biofeedback shows that the sympathetic nervous system is counterbalanced by increased vagal tone, and autonomic balance is enhanced by all Shamatha meditations, not only breath meditations, but also mind meditations: Settling the Mind in its natural state, Awareness of Awareness, Loving-kindness and Tonglen. Although these results are promising, further research is recommended with HRV biofeedback instruments to report statistical analysis and to understand unique HRV patterns in Shamatha mind meditation.

Music-Based Affect Regulation and Unhealthy Music Use Explain Coping Strategies in Adults with Mental Health Conditions

While people can use music for affect enhancement and self-regulation, there is a dearth of empirical inquiry investigating if music-based affect self-regulatory factors explain coping strategies in adults with mental health conditions (MHC). Due to the relevance of coping strategies for illness management and recovery, the purpose of this study was to explore music-based affect regulation, healthy and unhealthy music use, and coping strategies in adults with MHC on an acute care unit via correlational and multiple regression analyses. Participants (N = 128) completed the Brief Music in Mood Regulation Scale, the Healthy-Unhealthy Music Scale, and the Brief COPE. Correlational and multiple regression analyses were conducted to determine if music-based affect regulation factors were related to and explained coping strategies. There were numerous significant relationships between music-based affect regulation factors, healthy and unhealthy music use, and coping strategies. Regression results indicated that discharge explained humor, mental work explained positive framing, revival explained positive reframing and acceptance, strong sensation explained acceptance and planning, and entertainment explained denial. Unhealthy music use explained denial and behavioral disengagement. Healthy music use did not significantly explain any coping strategy. Practitioners might consider including education specific to music-based affect regulation to augment the likelihood of recovery.

Attachment insecurity accounts for the relationship between maternal and paternal maltreatment and adolescent health

OBJECTIVES

Maltreatment is linked with poor health outcomes. Attachment and affect regulation may mitigate the long-term impact of these adverse experiences on health outcomes. Little is known about the relative impact of maternal versus paternal maltreatment and interparental violence (IPV) on general health status of female and male youth.

METHOD

The present study examined the impact of exposure to maternal and paternal emotional and physical maltreatment, neglect, IPV, and cumulative maltreatment exposure in adolescence on general physical health problems reported five years later. High-risk youth (N = 179; Mage = 15.34, SD = 1.53; 46.4% female) self-reported maltreatment experiences, attachment insecurity, and affect dysregulation at Time 1; and affect dysregulation and physical health five years later at Time 2.

RESULTS

Attachment insecurity accounted for the effect of maternal and paternal emotional maltreatment, and maternal and paternal cumulative maltreatment exposure, on physical health. Additionally, attachment insecurity accounted for the effect of paternal neglect on physical health. Further sex differences were found with regard to maltreatment type and are discussed.

CONCLUSION

Both maternal and paternal maltreatment in adolescence predicted poor general health five years later via attachment insecurity. Youth who lack a secure attachment with their parents are most vulnerable to these impacts.

The extended nervous system: affect regulation, somatic and social change processes associated with mindful parenting

BACKGROUND

A theoretical model of mindful parenting has the potential to succinctly summarise its various change processes. The primary aim of this study was to investigate some of the change processes associated with mindful parenting, namely, the affect regulation, somatic and social change processes. A secondary aim was to verify whether clinical insights are consistent with the change processes identified in a systematic review of mindful parenting.

METHOD

Interpretative Phenomenological Analysis (IPA) was used to analyse semi-structured interviews with four Australian clinicians delivering Mindful Parenting (MP) programs. The clinicians had extensive personal meditation practice. This qualitative study is part of a mixed methods study, which commenced with a quantitative systematic review.

RESULTS

Six higher-order themes identified as change processes included reflective functioning, attachment, cognitive, affective, somatic and social change processes.

CONCLUSION

The anchor is a new theoretical model summarising the change processes associated with mindful parenting. The mother portrayed as the extended nervous system for the infant is a neologism that also has not been previously mentioned in the literature. Given the limitations with the small sample and potential bias with interpretation, the anchor is a starting point to developing a theoretical model of mindful parenting. Future research with larger sample sizes and objective measures is needed to confirm whether the anchor is a reasonable summary of the change processes.

Circulating endocannabinoids and affect regulation in human subjects

The endocannabinoid (EC) system influences a wide variety of neurobiological processes including affect and emotionality as well as other neuropsychiatric functions. In this study we examined the relationship of circulating endocannabinoids [anandamide (AEA) and 2-arachidonoylglycerol (2-AG)] with affect and emotionality in 175 individuals with (n = 115) and without (n = 60) mood, anxiety, and/or personality disorders. Circulating AEA levels displayed a modest, though statistically significant, inverse relationship with a composite measure of affect regulation (β = - 0.264, p = 0.009), due to its relationship with affect intensity (β = - 0.225, p = 0.021) across all study participants. Neither AEA nor 2-AG level differed as a function of any syndromal/personality disorder and neither correlated significantly with state depression or state anxiety scores. These data suggest that circulating levels endocannabinoids may play a role in emotionality across individuals regardless of defined psychiatric disorder.

Affective startle modulation in young people with first-presentation borderline personality disorder

This study investigated psychophysiological and subjective emotional responses to an affective startle modulation paradigm in first-presentation borderline personality disorder (BPD). Twenty BPD and 20 healthy control participants, aged 15-24 years, viewed a set of standardized pictures with pleasant, neutral, or unpleasant valence, and were instructed to either "maintain" or "suppress" their emotional response to the stimuli. Despite showing markedly higher levels of baseline distress on self-report questionnaires, BPD participants had significantly lower skin conductance responses and showed an absence of the fear potentiated startle response during early picture processing. Both groups showed similar startle responses later in picture processing, and when instructed to "maintain" or "suppress" their emotions. BPD participants were hypo-responsive to aversive stimuli during early processing, and did not react with more intense emotional responses to affective stimuli or show a diminished ability to regulate their responses. These results might be consistent with the finding that hypersensitivity of emotional response in BPD is specific to stimuli with themes of particular relevance to this disorder, such as rejection and abandonment.

Social cognition and aggression in methamphetamine dependence with and without a history of psychosis

In substance use and psychotic disorders, socially problematic behaviours, such as high aggression may, in part, be explained by deficits in social cognition skills, like the detection of emotions or intentions in others. The aim of this study was to assess the magnitude of social cognition impairment and its association with aggression in individuals with methamphetamine (MA) dependence, methamphetamine-associated psychosis (MAP), and healthy controls (CTRL). A total of 20 MAP participants, 21 MA-dependent participants without psychosis, and 21 CTRL participants performed a facial morphing emotion recognition task (ERT) across four basic emotions (anger, fear, happiness and sadness) and the reading the mind in the eyes task (RMET), and completed the aggression questionnaire. Both MA-dependent groups showed impairment in social cognition in terms of lower RMET scores relative to CTRL participants (MA; p = .047; MAP: p < .001). Additionally, performance decrements were significantly greater in MAP (p = .040), compared to MA-dependent participants. While deficits in recognising emotional expressions were restricted to anger in the MA group (p = .020), a generalized impairment across all four emotions was observed in MAP (all p ≤ .001). Additionally, both patient groups demonstrated higher levels of aggression than CTRLs, yet no association was found with social cognition. This study supported the notion of deficits in recognising facial emotional expressions and inferring mental states of others in MA dependence, with additional impairments in MAP. Failure to detect an association between social cognitive impairment and aggressive behaviour may implicate independent disturbances of the two phenomena in MA dependence.

Self-compassion is more effective than acceptance and reappraisal in decreasing depressed mood in currently and formerly depressed individuals

BACKGROUND

Self-compassion has recently been discussed as an effective affect regulation strategy for reducing negative affective states. The primary aim of the current study was to compare the efficacy of self-compassion to the more established strategies of acceptance and reappraisal.

METHODS

For this purpose, we induced depressed mood in formerly, currently and never depressed individuals (n=30 each) at four different time-points. Participants were instructed to regulate their emotions after each mood induction by either waiting, employing self-compassion, accepting their emotions or reappraising the situation. Level of depressed mood was assessed before and after each mood induction and regulation phase.

RESULTS

Across groups, decreases in depressed mood were greater in the self-compassion compared to the waiting and acceptance conditions. In recovered and never depressed participants, self-compassion was also more effective than reappraisal.

LIMITATIONS

Our results rely solely on self-report data.

CONCLUSIONS

Our finding that self-compassion is superior to acceptance and equally or more effective than reappraisal encourages future research on how self-compassion interventions can be used to enhance the efficacy and stability of current depression treatments.

Do personality traits related to affect regulation predict other tobacco product use among young adult non-daily smokers?

INTRODUCTION

Understanding factors that influence non-cigarette tobacco use is important given these products' prevalence and health risks. The goal of this study was to test the hypothesis that personality traits related to affect regulation would be associated with greater frequency of other tobacco product (OTP) use in a sample of young adult non-daily smokers.

METHODS

Participants (n=518, 51% male) aged 18-24 were non-daily cigarette smokers recruited from the community for a longitudinal study of tobacco use. Personality characteristics (impulsivity, anhedonia, and negative affectivity) were measured at baseline, and participants reported recent tobacco use at baseline and 3, 6, and 9months later. Assessments were conducted online or via mobile phone.

RESULTS

Across the 4 assessments, 33-52% of participants reported recent OTP use, with frequency of use decreasing over time. Longitudinal negative binomial regression models indicated that greater sensation seeking and lack of premeditation were associated with more frequent OTP use (ps<0.05). These effects were consistent over time.

CONCLUSIONS

Findings suggest that young adult non-daily cigarette smokers with greater propensity for immediately rewarding behaviors may use OTPs more frequently. Young, non-daily cigarette smokers with high levels of sensation seeking and/or lack of premeditation may be at increased risk for harms related to OTP use and may benefit from prevention and cessation strategies that specifically address affect.

Elevated rate of alcohol consumption in borderline personality disorder patients in daily life

RATIONALE

Borderline personality disorder (BPD) is highly associated with alcohol use disorder, but little is known about how BPD individuals consume alcohol or the immediate effects of their consumption. There is therefore a need for research investigating drinking behavior in BPD.

OBJECTIVES

The current study examined rate of alcohol consumption in BPD (N = 54) and community individuals (COM; N = 59) within ecologically valid drinking episodes. We hypothesized that rate of consumption would be elevated in BPD individuals. We further hypothesized that rate of consumption would be positively associated with subjective stimulation, but not sedation, and that stimulation would be associated with increased positive affect (PA) and reduced negative affect (NA).

METHODS

Ambulatory assessment was used to assess rate of consumption, subjective alcohol response, and affect in the moment (N _observations = 3444). Rate of consumption was defined as change in estimated blood alcohol concentration (eBAC) relative to drinking episode start. Multilevel modeling was used to test hypotheses.

RESULTS

As hypothesized, BPD individuals demonstrated a faster increase in eBAC than COM individuals. Rate of consumption was associated with subjective stimulation, but not sedation, in both groups. Stimulation was associated with increased PA in both groups and reduced NA in the BPD group.

CONCLUSIONS

BPD individuals consumed alcohol more rapidly than COM individuals. Faster consumption may serve as a means for BPD individuals to maximize the rewarding pharmacological effects of alcohol and to increase positive and reduce negative affect.

Targeting couple and parent-child coercion to improve health behaviors

This phase of the NIH Science of Behavior Change program emphasizes an "experimental medicine approach to behavior change," that seeks to identify targets related to stress reactivity, self-regulation, and social processes for maximal effects on multiple health outcomes. Within this framework, our project focuses on interpersonal processes associated with health: coercive couple and parent-child conflict. Diabetes and poor oral health portend pain, distress, expense, loss of productivity, and even mortality. They share overlapping medical regimens, are driven by overlapping proximal health behaviors, and affect a wide developmental span, from early childhood to late adulthood. Coercive couple and parent-child conflict constitute potent and destructive influences on a wide range of adult and child health outcomes. Such interaction patterns give rise to disturbed environmental stress reactivity (e.g., disrupted sympathetic nervous and parasympathetic nervous systems) and a wide range of adverse health outcomes in children and adults, including dental caries, obesity, and diabetes-related metabolic markers. In this work, we seek to identify/develop/validate assays assessing coercion, identify/develop and test brief interventions to reduce coercion, and test whether changes in coercion trigger changes in health behaviors.

The Youth Mental Health Risk and Resilience Study (YouR-Study)

BACKGROUND

The transition from adolescence to adulthood is associated with the emergence of psychosis and other mental health problems, highlighting the importance of this developmental period for the understanding of developing psychopathology and individual differences in risk and resilience. The Youth Mental Health Risk and Resilience Study (YouR-Study) aims to identify neurobiological mechanisms and predictors of psychosis-risk with a state-of-the-art neuroimaging approach (Magnetoencephalography, Magnetic Resonance Spectroscopy, Magnetic Resonance Imaging) in combination with core psychological processes, such as affect regulation and attachment, that have been implicated in the development and maintenance of severe mental health problems.

METHODS/DESIGN

One hundred participants meeting clinical high-risk criteria (CHR) for psychosis through the Comprehensive Assessment of At-Risk Mental State and Schizophrenia Proneness Instrument, Adult Version, in the age range from 16 to 35 years of age will be recruited. Mental-state monitoring up to a total of 2 years will be implemented to detect transition to psychosis. In addition, a sample of n = 40 help-seeking participants will be recruited who do not meet CHR-criteria, a group of n = 50 healthy control participants and a sample of n = 25 patients with first-episode psychosis. MEG-activity will be obtained during auditory and visual tasks to examine neural oscillations and event-related fields. In addition, we will obtain estimates of GABA and Glutamate levels through Magnetic Resonance Spectroscopy (MRS) to examine relationships between neural synchrony and excitatory-inhibition (E/I) balance parameters. Neuroimaging will be complemented by detailed neuropsychological assessments as well as psychological measures investigating the impact of childhood abuse, attachment experiences and affect regulation.

DISCUSSION

The YouR-study could potentially provide important insights into the neurobiological mechanisms that confer risk for psychosis as well as biomarkers for early diagnosis of severe mental health problems. Moreover, we expect novel data related to the contribution of affect regulation and attachment-processes in the development of mental health problems, leading to an integrative model of early stage psychosis and the factors underlying risk and resilience of emerging psychopathology.

Behavioral evidence of emotion dysregulation in binge eaters

Binge eating is the most common disordered eating symptom and can lead to the development of obesity. Previous self-report research has supported the hypothesis that individuals who binge eat report greater levels of general emotion dysregulation, which may facilitate binge-eating behavior. However, to date, no study has experimentally tested the relation between binge eating history and in-vivo emotion dysregulation. To do this, a sample of female college students who either endorsed binge eating (n = 40) or denied the presence of any eating pathology (n = 47) completed the Difficulties with Emotion Regulation Scale (DERS) and a behavioral distress tolerance task (the Paced Auditory Serial Addition Task-Computer: PASAT-C) known to induce negative affect and distress. The binge eating group was 2.96 times more likely to quit the PASAT-C early (χ² = 5.04, p = 0.025) and reported greater irritability (F(1,84) = 7.09 p = 0.009) and frustration (F(1,84) = 5.00, p = 0.028) after completing the PASAT-C than controls, controlling for initial levels of these emotions. Furthermore, across the entire sample, quitting early was associated with greater emotion dysregulation on the DERS (r_pb = 0.342, p < 0.01). This study is the first to demonstrate that individuals who binge eat show in-vivo emotional dysregulation on a laboratory task. Future studies should examine the PASAT-C to determine its potential clinical utility for individuals with or at risk of developing binge eating.

An experimental analysis of the affect regulation model of binge eating

There is research suggesting that binge eating may serve an affect regulation function. However, experimental evidence supporting this model in adults is sparse and studies have been mixed regarding whether negative affect impacts objective energy intake. This study examined the impact of a real-time interpersonal stressor on laboratory test meal intake between individuals endorsing recent objective binge eating (≥1×/week) and those denying disordered eating. Generalized linear modeling was used to compare individuals with recent binge eating (BE group; n = 52) to those denying recent eating pathology (HC group; n = 51) on test meal intake following a stressor (stressful condition) or neutral stimulus (non-stressful condition). Moderated mediation analyses were used to examine whether negative affect mediated the impact of condition on intake differently between BE and HC groups. The BE group did not have significantly higher energy intake than the HC group in the stressful verses non-stressful condition. However, the BE group was more likely to engage in extreme intake (i.e., over- or under-consumption) than the HC group in the stressful versus non-stressful condition (p = 0.02). Changes in negative affect did not significantly mediate the relationship between condition and intake extremes for the BE group. The results indicate that both over- and under-consumption are triggered by stress among individuals with recent binge eating. Continued research investigating both binge eating and restriction as a means of affect regulation in binge-eating samples is encouraged.

Personality differences in the susceptibility to stress-eating: The influence of emotional control and impulsivity

PURPOSE

Stress has been associated with deviations from typical eating patterns, with respect to both food choice and overall caloric intake. Both increases and decreases in dietary intake have been previously noted in response to stress. The purpose of the present study was to determine whether the affect regulation strategies of emotional control and impulsivity predict susceptibility to eating in response to stress. Specifically, it was anticipated that emotional suppression would predict decreases in caloric intake, whereas impulsivity would predict increases in caloric intake, in response to a stressor.

METHOD

Participants were randomly assigned to view either a video designed to elicit stress or a control video. Food was provided during the video and the amount and type of food consumed was measured.

RESULTS

Participants' nutritional intake was greater in the stress condition than in the control condition. One aspect of affect regulation, impulsivity, moderated this relationship, with a tendency for greater impulsivity to be associated with greater caloric intake in the stress condition. The degree of negative affect that participants experienced in the stress condition predicted food choice and overall caloric intake. Both emotional control and impulsivity moderated the relationship between negative affect and both food choice and caloric intake in the stress condition.

DISCUSSION

The present study highlights the importance of considering the personality attributes of both impulsivity and emotional suppression in understanding stress eating.

Parental Flooding During Conflict: A Psychometric Evaluation of a New Scale

Parents who are overwhelmed by the intensity and aversive nature of child negative affect - those who are experiencing flooding - may be less likely to react effectively and instead may focus on escaping the aversive situation, disciplining either overly permissively or punitively to escape quickly from child negative affect. However, there are no validated self-report measures of the degree to which parents experience flooding, impeding the exploration of these relations. Thus, we created and evaluated the Parent Flooding scale (PFS), assessing the extent to which parents believe their children's negative affect during parent-child conflicts is unexpected, overwhelming and distressing. We studied its factorial validity, reliability, and concurrent validity in a community sample of 453 couples with 3- to 7-year-old children (51.9 % girls) recruited via random digit dialing. Confirmatory factor analyses indicated a one-factor solution with excellent internal consistency. Test-retest stability over an average of 5.6 months was high. Concurrent validity was suggested by the associations of flooding with parents' aggression toward their children, overreactive and lax discipline, parenting satisfaction, and parents' anger, as well as with child externalizing behavior and negative affect. Incrementally concurrent validity analyses indicated that flooding was a unique predictor of mothers' and fathers' overreactive discipline and fathers' parent-child aggression and lax discipline, over and above the contributions of parents' anger and children's negative affect. The present results support the psychometric validity of the PFS.

[Well-being, quality of life and affect regulation in Portuguese adolescents]

Objetivos

El objetivo de este trabajo es explorar la regulación emocional, calidad de vida y bienestar subjetivo en la adolescencia, considerando diferencias individuales y familiares en función del sexo, la edad y la escolaridad de los progenitores. También se pretende analizar la relación entre las variables estudiadas.

Diseño

Estudio cuantitativo descriptivo-comparativo, transversal.

Emplazamiento

Institutos de Portugal.

Participantes

Muestra por conveniencia de 2 escuelas al Norte de Portugal. Criterios de inclusión: adolescentes (entre 12 y 18 años) de los cursos obligatorios y sin ninguna dificultad especial (sea necesidad educativa especial o dificultad de aprendizaje diagnosticada). Muestra total 619, muestra válida 602.

Mediciones principales

Índice de bienestar personal, Cuestionario de salud SF-8 (calidad de vida) y el Cuestionario de estilos de regulación afectiva.

Resultados

El bienestar no presenta diferencias entre sexos, la percepción de salud suele ser mejor en los chicos y la regulación afectiva en las chicas. En relación con la edad se encuentran correlaciones negativas principalmente con las variables del cuestionario de salud. Aparecen diferencias significativas en función del nivel de escolarización de los padres. Las mayores correlaciones aparecen entre las variables de los cuestionarios de bienestar y el de salud.

Conclusiones

La influencia del nivel educativo de los padres y la edad tienen un papel diferenciador, especialmente en bienestar y calidad de vida. Desde una perspectiva de promoción del bienestar en la adolescencia hay que destacar el potencial de la percepción de salud y algunas estrategias de regulación emocional en intervenciones y estrategias de educación para la salud.

Adolescent brain development and depression: A case for the importance of connectivity of the anterior cingulate cortex

We propose that structural and functional connectivity of the anterior cingulate cortex (ACC) represents a critical component of adolescent developmental psychopathology. We hypothesize that connectivity of the ACC, a hub for integrating cognitive, affective, and social information to guide self-regulation across domains, supports adaptive development of self-regulation during adolescence and that, conversely, disrupted maturation of ACC connectivity contributes to the development of depression. To integrate findings on typical development, we report results of a meta-analysis of diffusion imaging findings of typical adolescent development of the cingulum and anterior thalamic radiations, the tracts most relevant to ACC connectivity, and provide a critical review of the literature on ACC functional connectivity. Finally, we review the evidence for altered structural and functional connectivity in adolescents with depression. Although the evidence for our claim is persuasive, a more comprehensive understanding of the ACC's role depends upon future investigations with sophisticated modeling of networks, prospective and longitudinal designs, and examination of structure-function associations.

A daily process examination of episode-specific drinking to cope motivation among college students

OBJECTIVE

Theory suggests that state- and trait-like factors should interact in predicting drinking to cope (DTC) motivation, yet no research to date has demonstrated this at the drinking episode level of analysis. Thus, we examined whether daily variation in positive and negative affect and avoidance and active coping were associated with DTC motivation during discrete drinking episodes and whether these associations were moderated by tension-reduction expectancies and other person-level risk factors.

METHODS

Using a secure website, 722 college student drinkers completed a one-time survey regarding their tension reduction expectancies and then reported daily for 30 days on their affect, coping strategies, drinking behaviors and motives for drinking.

RESULTS

Individuals reported higher levels of DTC motivation on days when negative affect and avoidance coping were high and positive affect was low. We found only little support for the predicted interactive effects among the day- and person-level predictors.

CONCLUSION

Our results support the state and trait conceptualizations of DTC motivation and provide evidence for the antecedent roles of proximal levels of daily affect and avoidance coping. Our inconsistent results for interaction effects including day-level antecedents raise the possibility that some of these synergistic processes might not generalize across level of analysis.

It's not what you expect: feedback negativity is independent of reward expectation and affective responsivity in a non-probabilistic task

ERP studies commonly utilize gambling-based reinforcement tasks to elicit feedback negativity (FN) responses. This study used a pattern learning task in order to limit gambling-related fallacious reasoning and possible affective responses to gambling, while investigating relationships between the FN components between high and low reward expectation conditions. Eighteen undergraduates completed measures of reinforcement sensitivity, trait and state affect, and psychophysiological recording. The pattern learning task elicited a FN component for both high and low win expectancy conditions, which was found to be independent of reward expectation and showed little relationship with task and personality variables. We also observed a P3 component, which showed sensitivity to outcome expectancy variation and relationships to measures of anxiety, appetitive motivation, and cortical asymmetry, although these varied by electrode location and expectancy condition. Findings suggest that the FN reflected a binary reward-related signal, with little relationship to reward expectation found in previous studies, in the absence of positive affective responses.

Investigating the association between parental reflective functioning and distress tolerance in motherhood

Parental reflective functioning, referring to the capacity of a parent to consider their child's mental states as they relate to their behavior, may support sensitive and adaptive parenting. We investigated the relationship between parental reflective functioning and tolerance of distress in a sample of recent mothers (N=59). Participants completed self-report measures of parental reflective functioning and distress tolerance, as well as two behavioral distress tolerance tasks. We also examined blood pressure and heart rate during the laboratory session. Mothers reporting more difficulty in recognizing and understanding their child's mental states displayed decreased tolerance of distress on our behavioral and self-report measures. Further, we found evidence of a relationship between these measures and assessments of peripheral physiology. These findings are discussed in the context of reflective functioning and distress tolerance in parenthood, and their implications for parenting interventions.

Response Styles to Positive Affect and Depression: Concurrent and Prospective Associations in a Community Sample

We examined the concurrent and prospective relations between response styles to positive affect and depression in a community sample. Participants (n = 345) completed self-report measures of current and past depressive episodes, depressive symptoms, anhedonia, and responses to positive affect (including dampening and positive rumination) at two time points, with a 5-month interval. Higher levels of dampening responses to positive affect were related to higher concurrent levels of depressive symptoms. The tendency to positively ruminate on positive affect was negatively related to concurrent anhedonic symptoms. When controlling for current depressive symptomatology, formerly depressed individuals had a higher tendency to dampen positive affect than never-depressed controls, and did not differ from a currently depressed group. Dampening responses did not predict depressive symptoms prospectively, but lower levels of (self-focused) positive rumination did predict higher levels of future anhedonic symptoms. Results indicate that not only currently but also formerly depressed individuals engage in dysfunctional (dampening) strategies in response to positive affect. It is possible that currently as well as formerly depressed individuals might benefit from interventions that are directed at the remediation of disturbed regulation of positive affect. However, our prospective results make clear that more research is needed to examine the precise conditions under which dampening would be a detrimental (and positive rumination a beneficial) response style in the course of depression.

Dimensions of emotion dysregulation in anorexia nervosa and bulimia nervosa: A conceptual review of the empirical literature

Several existing conceptual models and psychological interventions address or emphasize the role of emotion dysregulation in eating disorders. The current article uses Gratz and Roemer's (2004) multidimensional model of emotion regulation and dysregulation as a clinically relevant framework to review the extant literature on emotion dysregulation in anorexia nervosa (AN) and bulimia nervosa (BN). Specifically, the dimensions reviewed include: (1) the flexible use of adaptive and situationally appropriate strategies to modulate the duration and/or intensity of emotional responses, (2) the ability to successfully inhibit impulsive behavior and maintain goal-directed behavior in the context of emotional distress, (3) awareness, clarity, and acceptance of emotional states, and (4) the willingness to experience emotional distress in the pursuit of meaningful activities. The current review suggests that both AN and BN are characterized by broad emotion regulation deficits, with difficulties in emotion regulation across the four dimensions found to characterize both AN and BN, although a small number of more specific difficulties may distinguish the two disorders. The review concludes with a discussion of the clinical implications of the findings, as well as a summary of limitations of the existing empirical literature and suggestions for future research.

Risk factors for alcoholism in the Oklahoma Family Health Patterns project: impact of early life adversity and family history on affect regulation and personality

AIM

This study examined the impact of early lifetime adversity (ELA) on affect regulation and personality in persons with family history (FH+) and without (FH-) a family history of alcoholism. We examined the impact of early life adversity in healthy young adults, 18-30 years of age enrolled in a long-term study on risk for alcohol and other substance abuse.

METHODS

ELA was assessed by a composite score of low socioeconomic status and personal experience of physical or sexual abuse and/or separation from parents before age 16, resulting in a score of 0, 1-2, or >3 adverse events. Unstable affect regulation and personality variables were obtained via self-report measures.

RESULTS

Higher ELA scores were seen in FH+ (χ(2)=109.2, p<0.0001) and in women (χ(2)=17.82, p=0.0019). Although higher ELA predicted less emotional stability and more behavioral undercontrol, further analysis including both FH and ELA showed that FH+ persons are prone to poor affect regulation, negative moods, and have risky drinking and drug abuse tendencies independent of ELA level. ELA predicts reduced stress reactivity and poorer cognitive control over impulsive behaviors as shown elsewhere.

CONCLUSIONS

The present work shows that FH+ have poor mood regulation and antisocial characteristics. The greater prevalence of ELA in FH+ persons indicates that life experience and FH+ work in tandem to result in risky patterns of alcohol and drug experimentation to elevate risk for alcoholism. Further studies of genetic and environmental contributions to alcoholism are called for.

Familiality of mood repair responses among youth with and without histories of depression

Affect regulation skills develop in the context of the family environment, wherein youths are influenced by their parents', and possibly their siblings', regulatory responses and styles. Regulatory responses to sadness (mood repair) that exacerbate or prolong dysphoria (maladaptive mood repair) may represent one way in which depression is transmitted within families. We examined self-reported adaptive and maladaptive mood repair responses across cognitive, social and behavioural domains in Hungarian 11- to 19-year-old youth and their parents. Offspring included 214 probands with a history of childhood-onset depressive disorder, 200 never depressed siblings and 161 control peers. Probands reported the most problematic mood repair responses, with siblings reporting more modest differences from controls. Mood repair responses of parents and their offspring, as well as within sib-pairs, were related, although results differed as a function of the regulatory response domain. Results demonstrate familiality of maladaptive and adaptive mood repair responses in multiple samples. These familial associations suggest that relationships with parents and siblings within families may impact the development of affect regulation in youth.

The interactive role of distress tolerance and eating expectancies in bulimic symptoms among substance abusers

Difficulties tolerating distress and the expectancy that eating will relieve negative affect have been linked with bulimic symptoms, which commonly co-occur with other forms of psychopathology characterized by emotion dysregulation (e.g., substance abuse). Indeed, problems with emotional functioning may be of particular relevance to bulimic symptoms in at-risk populations with heightened emotion dysregulation (such as substance use disorder patients). This study examined the interactive role of two emotion-related constructs (distress tolerance and the expectancy that eating relieves negative affect) in relation to bulimic symptoms among patients (N=93) recruited from a residential substance abuse treatment facility. Participants completed the Bulimia Test-Revised, the Positive and Negative Affect Schedule, the Distress Tolerance Scale, and the Eating Expectancy Inventory. A hierarchical multiple regression analysis was conducted to examine the main effects and interaction of distress tolerance and negative affect eating expectancies in relation to bulimic symptoms, controlling for participant gender and overall negative affect. Significant main effects were found for both distress tolerance and negative affect eating expectancies, and these two constructs were found to significantly interact in the prediction of bulimic symptoms. Interventions that address these constructs may be useful in treating those with bulimic symptoms, as well as those with co-occurring bulimic symptoms and substance use disorders.

Functions, lifetime frequency, and variety of methods of non-suicidal self-injury among college students

Borderline Personality Disorder (BPD) and intrapersonal functions of non-suicidal self-injury (NSSI) have both been found to have strong relationships with NSSI. The present study examines their role in the lifetime frequency and variety of NSSI methods, taken as indicators of severity of NSSI. We hypothesized that intrapersonal functions would explain frequency and variety of NSSI beyond the effects of interpersonal functions. Further we hypothesized that intrapersonal functions would moderate the effect of BPD characteristics on frequency of NSSI. College students (n=52) who endorsed at least one lifetime act of NSSI completed self-report measures and semi-structured interviews about NSSI behaviors, frequency, variety and functions, and BPD symptoms. Results supported the hypotheses that intrapersonal functions play a role in the lifetime frequency and variety of NSSI behaviors in addition to that of interpersonal functions, but did not support the role of intrapersonal functions as a moderator. Findings are discussed in terms of relative importance of all factors involved in explaining severity of NSSI, measured as lifetime frequency and variety.

Considering an affect regulation framework for examining the association between body dissatisfaction and positive body image in Black older adolescent females: does body mass index matter?

The present study provided an initial evaluation of an affect regulation model describing the association between body dissatisfaction and two contemporary measures of positive body image among 247 Black college-bound older adolescent females. We further tested whether possessing a higher body mass index (BMI) would strengthen these associations. Self-reported height and weight were used to calculate BMI. Respondents also completed a culturally-sensitive figure rating scale along with assessments of body appreciation and body image flexibility. Results indicated a robust positive association between the two measures of positive body image; BMI was the strongest predictor of both body appreciation and body image flexibility with body size discrepancy (current minus ideal) contributing incremental variance to both models tested. Implications for improving our understanding of the association between positive and negative body image and bolstering positive body image to promote health-protective behaviors among Black young women at this developmental juncture are discussed.

Shame aversion and maladaptive eating-related attitudes and behaviors

Consistent with affect regulation models of eating-related psychopathology, prior research indicates that trait-like shame and state self-conscious emotion are associated with maladaptive eating-related attitudes/behaviors. The present investigation extended past research on shame and maladaptive eating-related attitudes/behaviors by examining the role of shame aversion - the perception of shame as an especially unwanted and painful emotion - in these attitudes/behaviors over and above shame-proneness, general distress, and experiential avoidance. In 488 female undergraduates, shame aversion was positively associated with dieting, self-perceptions of body shape, awareness of food content, and food preoccupation even after taking into account other possible explanatory variables. Additionally, shame aversion moderated shame-proneness' associations with dieting, awareness of food content, and food preoccupation, such that shame-proneness was positively associated with these attitudes/behaviors only when shame aversion was high. Future directions for research and clinical implications of the present findings are discussed.

Caloric vestibular stimulation modulates affective control and mood

BACKGROUND

Clinical evidence suggests a link between vestibular dysfunctions and mood disorders. No study has yet investigated mood and affective control during vestibular stimulation in healthy participants.

OBJECTIVE

We predicted a modulating effect of caloric vestibular stimulation (CVS) on affective control measured in an affective Go/NoGo task (AGN).

METHODS

Thirty-two participants performed an AGN task while they were exposed to cold left or right ear CVS (20 °C) and sham stimulation (37 °C). In each block, either positive or negative pictures (taken from the International Affective Picture System) were defined as targets. Participants had to respond to targets (Go), and withhold responses to distractors (NoGo).

RESULTS

The sensitivity index d' (hits - false alarms) was used to measure affective control. Affective control improved during right ear CVS when viewing positive stimuli (P = .005), but decreased during left ear CVS when compared to sham stimulation (P = .009). CVS had a similar effect on positive mood ratings (Positive and Negative Affect Schedule). Positive mood ratings decreased during left ear CVS when compared to sham stimulation, but there was no effect after right ear CVS.

DISCUSSION

The results suggest that CVS, depending on side of stimulation, has a modulating effect on mood and affective control. The results complement previous findings in manic patients and provide new evidence for the clinical potential of CVS.

Individual differences in positivity offset and negativity bias: Gender-specific associations with two serotonin receptor genes

Individual differences in the evaluation of affective stimuli, such as the positivity offset and negativity bias may have a biological basis. We tested whether two SNPs (HTR2A; 102T>C and HTR1A; 1019C>G) related to serotonin receptor function, a biological pathway associated with affective regulation, were differentially related to positivity offset and negativity bias for males and females. Participants were 109 cigarette smokers who rated a series of affective stimuli to assess reactions to positive and negative pictures. Gender × genotype interactions were found for both SNPs. Males with the 102T allele showed a greater positivity offset than males with the 102C allele. For females, in contrast, the 1019C allele was associated with a greater positivity offset than the 1019G allele, whereas the 102T allele was associated with a greater negativity bias than the 102C allele. Identifying how gender differences may moderate the effect of serotonin receptor genes on affective information processing may provide insight into their role in guiding behavior and regulating affect.

Affect regulation training (ART) for alcohol use disorders: development of a novel intervention for negative affect drinkers

Although negative affect is a common precipitant of alcohol relapse, there are few interventions for alcohol dependence that specifically target negative affect. In this stage 1a/1b treatment development study, several affect regulation strategies (e.g., mindfulness, prolonged exposure, distress tolerance) were combined to create a new treatment supplement called affect regulation training (ART), which could be added to enhance cognitive-behavioral therapy (CBT) for alcohol dependence. A draft therapy manual was given to therapists and treatment experts before being administered to several patients who also provided input. After two rounds of manual development (stage 1a), a pilot randomized clinical trial (N=77) of alcohol-dependent outpatients who reported drinking often in negative affect situations was conducted (stage 1b). Participants received 12-weekly, 90-minute sessions of either CBT for alcohol dependence plus ART (CBT+ART) or CBT plus a healthy lifestyles control condition (CBT+HLS). Baseline, end-of-treatment, and 3- and 6-month posttreatment interviews were conducted. For both treatment conditions, participant ratings of treatment satisfaction were high, with CBT+ART rated significantly higher. Drinking outcome results indicated greater reductions in alcohol use for CBT+ART when compared to CBT+HLS, with moderate effect sizes for percent days abstinent, drinks per day, drinks per drinking day, and percent heavy drinking days. Overall, findings support further research on affect regulation interventions for negative affect drinkers.