Delineating components of emotion and its dysregulation in anxiety and mood psychopathology

Two studies sought to elucidate the components of emotion and its dysregulation and examine their role in both the overlap and distinctness of the symptoms of 3 highly comorbid anxiety and mood disorders (i.e., generalized anxiety disorder, major depression, and social anxiety disorder). In Study 1, exploratory factor analyses demonstrated that 4 factors--heightened intensity of emotions, poor understanding of emotions, negative reactivity to emotions, and maladaptive management of emotions--best reflected the structure of 4 commonly used measures of emotion function and dysregulation. In Study 2, a separate sample provided support for this 4-factor model of emotion dysregulation. Poor understanding, negative reactivity, and maladaptive management were found to relate to a latent factor of emotion dysregulation. In contrast, heightened intensity of emotions was better characterized separately, suggesting it may relate more strongly to dispositional emotion generation or emotionality. Finally, the 4 components demonstrated both common and specific relationships to self-reported symptoms of generalized anxiety disorder, major depression, and social anxiety disorder.     

Child maltreatment types and risk behaviors: Associations with attachment style and emotion regulation dimensions

Child maltreatment is a robust psychosocial risk factor linked to the development of a wide range of risk behaviors among young adults. Adult attachment style and emotion dysregulation are two potential mechanisms through which maltreatment leads to risk behaviors. Yet, less is known about the specificity of the relations among different maltreatment types, attachment styles, emotion regulation strategies, and risk behaviors. The present study examined the relations among various forms of maltreatment and risk behaviors (e.g., substance use; risky sex) among 361 undergraduate students and tested whether attachment styles and emotion dysregulation might underlie these relations. Emotional, and sexual but not verbal abuse (although verbal abuse was directly related to alcohol use), were related to anxious and avoidant attachment styles, emotion dysregulation, and a variety of risk behaviors. Among the emotion regulation dimensions, impulsivity showed the strongest indirect effect from child maltreatment to risk behaviors. Results support a cross-sectional link between child maltreatment and risk behavior outcomes via attachment styles and emotion regulation. Implications for treatment and prevention of these risk behaviors in young adults are discussed.     

The Role of Emotion Dysregulation in the Links Between Sibling Victimization and Internalizing Symptoms in Middle Childhood

Despite sibling victimization being a relatively common occurrence, there is a dearth of research examining the outcomes associated with this interpersonal stressor, including internalizing symptoms. The current study sought to advance the literature by longitudinally examining the links from sibling victimization to depression and anxiety symptoms while also considering peer victimization in a sample of elementary school-age youth (51.8% boys, M age?=?8.72) who were initially in 3rd and 4th grade. Further, emotion dysregulation was examined as a mediator of these associations. Youth provided self-reports at three separate time points approximately 6 months apart. Path analysis models indicated that emotion dysregulation mediated the association between sibling, but not peer, victimization and increased depression symptoms. However, neither sibling nor peer victimization were associated with anxiety symptoms over time. Results suggest the importance of attending to sibling victimization for the prevention of emotion dysregulation difficulties and ultimately early symptoms of depression. Youth assessments need to include questions about both sibling and peer victimization, and sibling victimization needs to be included as a target of prevention and intervention for subsequent internalizing difficulties.

     

Postnatal maternal symptoms of depression and child emotion dysregulation: The mediation role of infant EEG alpha asymmetry

In a community-based sample of 104 infants and their mothers, we hypothesized a pathway from postnatal maternal symptoms of depression to child emotion dysregulation, and tested at 6 months of age the mediation role of alpha asymmetry at frontal and parietal sites. We recorded infant resting-state EEG at 6 months of age. Child emotion dysregulation was measured at 24 months by the Child Behavior Checklist Dysregulation Profile derived from the CBCL 1½-5. Maternal depression symptoms were scored 6 months after the delivery by the Anxious/Depressed scale of the Adult Self-Report. We used structural equation modeling to test the mediation model from maternal depression symptoms to child emotion dysregulation mediated by frontal and parietal alpha asymmetry. The mediation model provided an excellent fit to the data [χ2(3) = 3.088, p = .378; RMSEA = .017, CFI = .1.00; SRMR = 0.040] and explained 23.3% of the variance in child emotion dysregulation. The indirect path via parietal alpha asymmetry was significant (β = .065; SE = .033; 95% CI = .001–.139; p = .048), i.e. greater levels of maternal depression symptoms predicted left parietal alpha asymmetry, which predicted higher levels of child emotion dysregulation. The direct effect, i.e. the pathway linking maternal depression symptoms and child emotion dysregulation above and beyond the indirect effects, was also significant. We found evidence for a partial mediation role of left parietal alpha asymmetry in a longitudinal pathway from postnatal maternal symptoms of depression to child emotion dysregulation, providing support for left parietal asymmetry as an index of biological vulnerability to emotion dysregulation in the first years of life.     

Emotion Dysregulation and Emotional Impulsivity among Adults with Attention-Deficit/Hyperactivity Disorder: Results of a Preliminary Study

Recent reviews argue that emotion dysregulation is an important feature of attention-deficit/hyperactivity disorder (ADHD) and involves a failure to inhibit negative emotions that leads to negative affectively-driven impulsive behavior (i.e., emotional impulsivity). The goal of the current study was to assess (a) whether emotion dysregulation and emotional impulsivity was higher in a group of adults diagnosed with ADHD and (b) if the relationship between core ADHD symptoms (i.e., inattention and hyperactivity-impulsivity) and emotional impulsivity is mediated by emotion dysregulation symptoms. A group of adults with (n?=?18) and without (n?=?23) ADHD completed measures of core ADHD symptoms, emotion dysregulation, and emotional impulsivity. A series of one-way analyses of covariance indicated significant between-group differences in emotion dysregulation and emotional impulsivity when current depression and oppositional defiant disorder ratings were covaried. In addition, the relationship between ADHD symptoms and emotional impulsivity was mediated by emotion dysregulation symptoms. These findings suggest that emotion dysregulation and emotional impulsivity are higher in adults diagnosed with ADHD and that emotion dysregulation symptoms have predictive value beyond core ADHD symptoms.     

Visceral sensitivity as a mediator of outcome in the treatment of irritable bowel syndrome

Patients with irritable bowel syndrome (IBS) experience anxiety about visceral sensations, leading to avoidance behaviors and hypervigilance that maintain IBS symptoms. The current study used data from a clinical trial that compared a treatment aimed at reducing anxiety about visceral sensations (interoceptive exposure; IE) to an attention control (AC) and a CBT-based stress-management treatment (SM) to examine whether changes in visceral sensitivity mediated IBS symptom and quality of life outcomes. Data from participants who completed one of the three treatments (N = 76) were subjected to mediation analyses. Visceral sensitivity mediated treatment outcomes across all outcome measures and across all treatment groups, with no differences between IE and the other treatment groups. This finding suggests that psychosocial treatments for IBS may work by decreasing visceral sensitivity, and the degree to which visceral sensitivity is decreased is related to outcome, suggesting IE may be the preferable treatment option.     

Sex differences in the indirect effects of cognitive processes on anxiety through emotion regulation difficulties

Drawing on a gender roles theory of emotion regulation, we examined the specific facets of emotion regulation difficulties through which higher-order cognitive abilities may be related to anxiety. Participants (N = 225) completed self-report measures of emotion regulation difficulties and anxiety, and were administered neuropsychological tests assessing abstract reasoning and inhibition. PROCESS (Hayes, 2012) was used to estimate the direct and indirect effects of both inhibition and abstract reasoning on anxiety symptoms, with six dimensions of emotion regulation difficulties serving as multiple mediators operating in parallel. Results suggest that the relation between higher-order cognitive abilities and anxiety operate through distinct, sex-dependent emotion dysregulation mechanisms. For females, higher levels of inhibition and abstract thinking were associated with poorer clarity of emotions, which in turn, was associated with higher levels of anxiety symptoms. As such, over-attentiveness to, or over-analysis of, emotions may be particularly detrimental among females who have relatively higher abstract reasoning abilities. For males, higher inhibition was associated with greater perceived effectiveness in regulating negative emotions, which in turn, was associated with lower levels of anxiety symptoms. This finding suggests that mood regulation expectancies may be particularly important in understanding the pathogenesis of anxiety in males.     

Equanimity to Excess: Inhibiting the Expression of Negative Emotion is Associated with Depression Symptoms in Girls

Emotion dysregulation is often invoked as an important construct for understanding risk for psychopathology, but specificity of domains of emotion regulation in clinically relevant research is often lacking. In the present study Gross’ (2001) model of emotion regulation is used to generate hypotheses regarding the relative contribution of two specific types of deficits in emotion regulation, inhibited and disinhibited expression of negative emotion, to individual differences in depressive symptoms in preadolescent girls. A sample of 232 9-year-old girls was recruited from a community based study. Depression symptoms were assessed via diagnostic interview. The mother and interviewer rated the girl’s level of impairment. Questionnaires and observations were used to assess inhibited and disinhibited expression of negative emotion. Differences in inhibited expression of negative emotion typically explained more variance in depressive symptoms and impairment across informants than did disinhibited expression of negative emotion. Although disinhibited expression of negative emotion is associated with depression and impairment, inhibited expression appeared to be a necessary ingredient, suggesting that inhibited expression may be a particularly relevant deficit in emotion regulation in the development of depression in females.     

Associations of ethnic discrimination with symptoms of anxiety and depression among Hispanic emerging adults: a moderated mediation model

Background and Objectives: Emerging adulthood is often marked with elevated symptoms of anxiety and depression. Hispanic emerging adults may face cultural stressors such as ethnic discrimination that further increase levels of anxiety and depression symptoms. The study aims were to examine if (a) self-esteem mediated effects of ethnic discrimination on symptoms of anxiety and depression, and (b) if gender moderated the indirect effects of discrimination. Design: The study design was cross-sectional self-report. Method: Two moderated mediation models were tested, with 1084 Hispanic emerging adults (ages 18–25) enrolled in institutions of post-secondary in the United States. Results: Results indicated that (a) higher ethnic discrimination was associated with higher anxiety symptoms (β?=?.05, p?=?.04), higher depression symptoms (β?=?.06, p?=?.02), and lower self-esteem (β?=??.30, p?Conclusions: Findings suggest that the mediating effects of self-esteem linking ethnic discrimination with symptoms of anxiety and depression vary between genders.     

Reactivity to Exclusion Prospectively Predicts Social Anxiety Symptoms in Young Adults

Peer victimization leads to negative outcomes such as increased anxiety and depression. The prospective relationship between peer victimization and social anxiety in children and adolescents is well established, and adults with social anxiety disorder (SAD) are more likely than individuals with other anxiety disorders to report a history of teasing. However, a crucial bridge between these findings (peer victimization in young adults) is missing. We manipulated perceptions of peer exclusion in a young adult sample (N = 108) using the Cyberball Ostracism Task. Reactivity to exclusion prospectively predicted social anxiety symptoms at a 2-month follow-up, whereas self-reported teasing during high school and current relational victimization did not. This research suggests that reactions to peer victimization may be a worthwhile target for clinical interventions in young adults. Targeting how young adults react to stressful social interactions such as exclusion may help prevent the development of SAD. Future research should test if reactivity to exclusion plays a role in the relationship between other disorders (e.g., depression) and peer victimization.     

Internalizing Symptoms in Female Adolescents: Associations with Emotional Awareness and Emotion Regulation

The transition into adolescence involves a number of changes that for many adolescents result in increased negative affect and internalizing symptoms, especially for females. In the current study we examined the direct and indirect effects of emotional awareness on internalizing symptoms by exploring the extent to which certain emotion regulation strategies influence this relationship. Participants were 123 female adolescents aged 13–16 years (M = 14.51 years) who completed measures of emotional awareness, emotion regulation (emotional reappraisal and expressive suppression), and symptoms of depression and social anxiety. Two multiple indirect effect models were conducted including both reappraisal and suppression (one for each of the dependent variables, depression and social anxiety) via the bootstrapping method. Results found that reappraisal accounted for the effect of emotional awareness on depressive symptoms but suppression accounted for the effect of emotional awareness on social anxiety symptoms. Results suggest that emotion regulation strategies play an important role in determining depressive and social anxiety symptoms and are associated with an adolescent’s level of emotional awareness.     

Affirmative Dialectical Behavior Therapy Skills Training With Sexual Minority Veterans

Minority stress theory posits that unique stressors create an invalidating environment, which places sexual minority individuals at increased risk for psychiatric morbidity. Sexual minority veterans’ experience of minority stressors results in elevated levels of emotion dysregulation, anxiety, depression, and suicidality. Clinical interventions designed to address minority stress and treat emotional dysregulation and related disorders among sexual minority veterans are warranted. Professional guidelines recommend the adaptation of evidence-based treatments to address the unique features of sexual minority and veteran mental health. Dialectical Behavior Therapy (DBT) is a treatment for emotion dysregulation and related problems that addresses an invalidating environment, which is an appropriate framework for sexual minorities. The current research adapts the Emotion Regulation module of DBT Skills Training. This adaptation highlights minority stress as part of the invalidating environment and adds new teaching points to address the unique features of sexual minority mental health to create Affirmative DBT Skills Training. Six sexual minority veterans completed Affirmative DBT Skills Training meeting on a weekly basis for 10 consecutive weeks. Before and after treatment, participants completed measures of emotion regulation, anxiety, and depression as well as assessments of minority stress processes. Affirmative DBT Skills Training was well received in this sample. Results suggest that the intervention was effective in decreasing emotion dysregulation and symptoms of depression. These findings suggest Affirmative DBT Skills Training is a promising treatment, although more research is warranted, particularly given the small sample size and lack of a control group.     

Anxiety and Related Disorders and Concealment in Sexual Minority Young Adults

Sexual minorities face greater exposure to discrimination and rejection than heterosexuals. Given these threats, sexual minorities may engage in sexual orientation concealment in order to avoid danger. This social stigma and minority stress places sexual minorities at risk for anxiety and related disorders. Given that three fourths of anxiety disorder onset occurs before the age of 24, the current study investigated the symptoms of generalized anxiety disorder, social phobia, panic disorder, posttraumatic stress disorder, and depression in sexual minority young adults relative to their heterosexual peers. Secondarily, the study investigated sexual orientation concealment as a predictor of anxiety and related disorders. A sample of 157 sexual minority and 157 heterosexual young adults matched on age and gender completed self-report measures of the aforementioned disorders, and indicated their level of sexual orientation concealment. Results revealed that sexual minority young adults reported greater symptoms relative to heterosexuals across all outcome measures. There were no interactions between sexual minority status and gender, however, women had higher symptoms across all disorders. Sexual minority young women appeared to be at the most risk for clinical levels of anxiety and related disorders. In addition, concealment of sexual orientation significantly predicted symptoms of social phobia. Implications are offered for the cognitive and behavioral treatment of anxiety and related disorders in this population.     

Facets of mindfulness mediate behavioral inhibition systems and emotion dysregulation

Behavioral motivation is regulated through the behavioral inhibition system (BIS) and the behavioral approach system (BAS), which underlie responses to emotional stimuli and are thought to influence emotion dysregulation. Research shows that mindfulness may increase the efficacy of emotion regulation among those with psychological symptoms, but the relationships between behavioral motivation and mindfulness have been only minimally explored. This study examines relationships between behavioral motivation systems and emotion dysregulation as mediated by mindfulness facets. Mediation was tested in a sample of 246 college students (M_age = 19.28, 61.8% female, 81.3% Caucasian) using a multiple mediator bootstrapping method. Results revealed an indirect relationship between BIS sensitivity and increased emotion dysregulation through underutilization of three distinct mindfulness skills: act with awareness, non-judging, and non-reactivity. Mindfulness facets did not mediate relationships between BAS sensitivity and emotion dysregulation, though BAS Reward Responsiveness directly predicted increased emotion dysregulation while BAS Drive was marginally associated with decreased emotion dysregulation. Findings delineate specific relationships between BIS/BAS, mindfulness skills, and emotion dysregulation while suggesting mindfulness training may be useful for BIS sensitive individuals.     

Interactions between emotion regulation strategies and affective style: Implications for trait anxiety versus depressed mood

Affective style reflecting approach and inhibition is thought to be associated in distinct ways with anxious versus depressed mood; relatively few studies, however, consider how the interaction between affective style and the strategies individuals use to regulate mood and emotion might influence these associations. Sixty-seven non-disordered adults self-reported on their use of two emotion regulation strategies (cognitive reappraisal and expressive suppression), behavioral approach (BAS) and behavioral inhibition sensitivity (BIS) dimensions of affective style, and anxious and depressed mood (trait anxiety and symptoms of depression). Trait anxiety versus depressed mood was associated with unique interactive patterns of emotion regulation and affective style: enhanced use of reappraisal was linked to less depressed mood in those reporting low BAS, whereas high suppression was linked to greater trait anxiety in those reporting low BIS. The implications of findings for typical emotional processes and for clinical disorders and interventions are discussed.     

父母情绪调节困难对流动儿童对立违抗症状的影响:亲子冲突解决方式和儿童情绪调节的作用

本研究以来自北京10所小学的369名有对立违抗(Oppositional Defiant Disorder, ODD)症状的流动儿童及父母、349名无ODD症状的对照组流动儿童及父母为被试进行了问卷施测,探究了父母情绪调节困难对流动儿童对立违抗症状的影响,并进一步探讨了亲子冲突解决方式和儿童情绪调节(情绪调节与情绪消极和不稳)在其中所起的作用。经过分析发现:(1)ODD症状流动儿童的父母情绪调节、亲子冲突解决方式、儿童情绪调节显著差于对照组儿童;(2)总体上,父母情绪调节困难、亲子冲突解决方式和儿童ODD症状之间两两相关显著,而儿童情绪调节与这几个变量相关不显著;(3)父母情绪调节困难能显著正向预测流动儿童ODD症状,并进一步通过亲子冲突解决方式对流动儿童ODD症状产生影响;(4)儿童情绪调节(儿童情绪调节与儿童情绪消极和不稳)仅在父母情绪调节困难对儿童ODD症状的直接影响中起着显著的调节作用,对亲子冲突解决方式所起的中介作用并无调节作用。在对有ODD症状的流动儿童进行干预时,不仅要培养儿童自身的情绪调节能力,也应提升父母的情绪调节能力并改善亲子冲突解决方式。     

Trajectory of change in anxiety sensitivity in relation to anxiety,depression, and quality of life among persons living with HIV/AIDS following transdiagnostic cognitive-behavioral therapy

ABSTRACT

Persons living with HIV/AIDS (PLHIV) disproportionately suffer from anxiety and depressive symptoms and disorders. Although past work has examined the efficacy of cognitive-behavioral therapy (CBT) for depression, and to a lesser extent anxiety, among PLHIV, little is known regarding potential mechanisms underlying improvement in anxiety/depression among this group. Anxiety sensitivity is a well-established risk/maintenance factor for anxiety and depressive disorders and is hypothesized to play an important role in maintaining anxiety among PLHIV. Past work has identified anxiety sensitivity as a mechanism of action underlying changes in various anxiety domains yet it is unknown whether changes in anxiety sensitivity relate to changes in anxiety symptoms among PLHIV undergoing transdiagnostic CBT for anxiety. The current study sought to examine treatment-related changes in anxiety sensitivity and how the trajectory of change relates to anxiety and depressive symptoms as well as overall quality of life. Individuals (n = 35) with HIV/AIDS and elevated anxiety symptoms received CBT for anxiety. Results indicated that reductions in anxiety sensitivity were significantly related to changes in anxiety, depression, and quality of life. Together, these data suggest that changes in anxiety sensitivity are significantly related to changes in anxiety/depression and quality of life among PLHIV seeking treatment.     

A Unified,Transdiagnostic Treatment for Adolescents With Chronic Pain and Comorbid Anxiety and Depression

Chronic pain disorders represent a significant public health concern, particularly for children and adolescents. High rates of comorbid anxiety and unipolar mood disorders often complicate psychological interventions for chronic pain. Unified treatment approaches, based on emotion regulation skills, are applicable to a broad range of emotional disorders and suggest the possibility of extending these interventions to chronic pain and pain-related dysfunction. This case report describes the use of a unified protocol for treatment of an adolescent boy with chronic daily headache and social anxiety and an adolescent girl with whole body pain and depression. Following weekly, 50-minute individual treatment sessions, the boy demonstrated notable improvement in emotional symptoms, emotion regulation skills, somatization, and functional disability. The girl showed some improvement on measures of anxiety and depression, although there appeared to be a worsening of pain symptoms and somatization. However, both patients demonstrated improvement over follow-up. This case study illustrates the potential utility of a unified treatment approach targeting pain and emotional symptoms from an emotion regulation perspective in an adolescent population.     

Angry rumination moderates the association between perceived ethnic discrimination and risky behaviors

Perceived ethnic discrimination (PED) is associated with increased engagement in risky behaviors in ethnic minority emerging adults. Risky behaviors may reflect efforts to cope with emotional distress like depression or anxiety resulting from PED, particularly for individuals with poor emotion regulation skills. We hypothesized that the association between PED and risky behaviors would be particularly strong for emerging adults with tendencies for angry rumination. We further hypothesized that increased depressive and anxious symptoms would mediate the effect of the PED-rumination interaction on risky behaviors. In this survey study, 155 ethnic minority college students completed measures of PED, depressive and anxiety symptoms, trait angry rumination, and risky behaviors. Analyses revealed that angry rumination moderated the association between PED and greater risky behaviors. Depressive and anxiety symptoms did not mediate this effect. Although cross-sectional, these findings suggest that individuals with poor coping skills may be especially likely to respond to stressors such as PED by engaging in risky behaviors. Implications include using rumination-focused interventions in order to prevent engagement in risky behaviors in ethnic minority emerging adults.     

Multi-domain Models of Risk Factors for Depression and Anxiety Symptoms in Preschoolers: Evidence for Common and Specific Factors

Relatively few studies have examined multiple pathways by which risk factors from different domains are related to symptoms of anxiety and depression in young children; even fewer have assessed risks for these symptoms specifically, rather than for internalizing symptoms in general. We examined a theoretically- and empirically-based model of variables associated with these symptom types in a diverse community sample of 796 4-year-olds (391 boys, 405 girls) that included factors from the following domains: contextual (SES, stress and family conflict); parent characteristics (parental depression); parenting (support/engagement, hostility and scaffolding); and child characteristics including negative affect (NA) effortful control (EC) sensory regulation (SR), inhibitory control (IC) and attachment. We also compared the models to determine which variables contribute to a common correlates of symptoms of anxiety or depression, and which correlates differentiate between those symptom types. In the best-fitting model for these symptom types (a) SES, stress and conflict had indirect effects on both symptom types via long-chain paths; (b) caregiver depression had direct effects and indirect ones (mediated through parenting and child effortful control) on both symptom types; (c) parenting had direct and indirect effects (via temperament and SR); and temperament had direct effects on both symptom types. These data provide evidence of common risk factors, as well as indicate some specific pathways/mediators for the different symptom types. EC was related to anxiety, but not depression symptoms, suggesting that strategies to improve child EC may be particularly effective for treatment of anxiety symptoms in young children.