How do you choose and how well does it work?: the selection and effectiveness of emotion regulation strategies and their relationship with borderline personality disorder feature severity

There is little research examining whether the selection of emotion regulation strategies is compromised among individuals characterised by emotion dysregulation. In a sample of 149 undergraduates, we examined the selection and effectiveness of 2 emotion regulation strategies (reappraisal or distraction) in response to emotionally evocative stimuli, and their relationship with emotion dysregulation, measured by borderline personality disorder (BPD) feature severity. Stimulus intensity and self-reported negative emotional intensity were also compared as predictors of strategy selection. Results indicated that self-reported negative emotional intensity was a stronger predictor of strategy selection than stimulus intensity, and participants generally selected reappraisal over distraction. However, increases in self-reported negative emotional intensity was associated with an increased likelihood of choosing distraction, particularly among individuals higher in BPD features. In general, distraction exhibited less effectiveness than reappraisal, and higher BPD features did not differentially impact such effectiveness. Our findings indicate that individuals higher in emotion dysregulation prefer to use distraction as self-reported negative emotional intensity increases, a strategy which, overall, may not be as effective as reappraisal. Selection, rather than effectiveness of emotion regulation strategy might be a key feature of individuals characterised by emotion dysregulation.     

Reciprocal within-day associations between incidental affect and exercise: An EMA study

Previous research suggests that how people feel throughout the course of a day (i.e. incidental affect) is predictive of exercise behaviour. A mostly separate literature suggests that exercise can lead to more positive incidental affect.

Objective: This study examines the potential reciprocal effects of incidental affect and exercise behaviour within the same day.

Design: Fifty-nine low-active (exercise <60 min/week), overweight (BMI: 25.0–39.9) adults (ages 18–65) participated in a six-month print-based exercise promotion programme.

Main outcome measures: Ecological momentary assessment was used to record self-reported exercise sessions in real time and incidental affective valence (feeling good/bad) as assessed by the 11-point Feeling Scale at random times throughout the day.

Results: Use of a within-subjects cross-lagged, autoregressive model showed that participants were more likely to exercise on days when they experienced more positive incidental affect earlier in the day (b = .58, SE = .10, p < .01), and participants were more likely to experience more positive incidental affect on days when they had exercised (b = .26, SE = .03, p < .01), with the former association significantly stronger than the latter (t = 23.54, p < .01).

Conclusion: The findings suggest a positive feedback loop whereby feeling good and exercising are reciprocally influential within the course of a day.     

Emotional distress and tobacco demand during the menstrual cycle in female smokers

Fluctuations in ovarian hormones over the menstrual cycle contribute to cigarette reward, however less is known about menstrual cycle influences on emotional distress in female smokers. We examined between-group differences in emotional distress (negative affectivity, emotion dysregulation, distress intolerance) and hypothetical cigarette purchasing (i.e. tobacco demand) among female smokers at three different menstrual stages. Women (n = 32) were non-treatment seeking daily smokers not on hormonal contraceptive, and were currently in their follicular (estradiol-dominant; n = 10), early-mid luteal (progesterone-dominant; n = 15), and late-luteal phase (decreasing progesterone/estradiol; n = 7). Effect sizes are reported given the small sample. Women in the late-luteal phase, relative to the follicular and early-mid luteal phases, reported higher levels of negative affectivity (d = 0.69), emotion dysregulation (d = 1.03), and distress intolerance (d = ?0.86). Compared to the early-mid luteal and late-luteal phases, women in the follicular phase reported the highest hypothetical cigarette consumption when cigarettes were free (d = 0.71) and made the largest maximum expenditures on cigarettes (d = 0.74). Findings offer preliminary evidence that the late-luteal phase is characterized by emotional distress, and the follicular phase is associated with elevated tobacco demand, which if replicated could implicate ovarian hormones in emotion-focused smoking.     

Testing social-cognitive mediators for objective estimates of physical activity from the Healthy Eating and Active Living for Diabetes in Primary Care Networks (HEALD-PCN) study

Objective: More evidence from prospective studies is needed to determine ‘if’ and ‘how’ social cognitive constructs mediate behaviour change. In a longitudinal study, we aimed to examine potential social cognitive mediators of objectively measured physical activity (PA) behaviour among people with type 2 diabetes (T2D) who participated in a six-month PA intervention. Methods: All participants from the proven effective Healthy Eating and Active Living for Diabetes in Primary Care Networks trial were included for this secondary analysis. Change in pedometer-derived daily step counts (baseline to six months) was the outcome of interest. Primary constructs of interest were from Social Cognitive Theory, however constructs from and Theory of Planned Behaviour were also tested in a mediating variable framework using a product-of-coefficients test. Results: The sample (N = 198) had a mean age of 59.5 (SD 8.3) years, haemoglobin A1c 6.8% (SD 1.1), 50% women, BMI 33.6 kg/m² (SD 6.5), systolic pressure 125.6 mmHg (SD 16.2) and average daily steps were 5879 (SD 3130). Daily pedometer-determined steps increased for the intervention group compared to usual care control at six-months (1481 [SD 2631] vs. 336 [SD 2712]; adjusted p = .002). There was a significant action theory test effect for ‘planning’ (A = .21, SE = .10, p = .037), and significant conceptual theory test results for ‘subjective norms’ (B = 657, SE = 312, p = .037) and ‘cons’ (B = ?664, SE = 270, p = .015). None of the constructs satisfied the criteria for mediation. Conclusions: We were unable to account for the effect of a pedometer-based PA intervention for people with T2D through our examination of mediators. Our findings are inconsistent with some literature concerning PA interventions in diabetes; this may be due to variability in measures used or in study populations.     

Effective regulation of affect: An action control perspective on emotion regulation

The present review adopts an action control perspective on emotion regulation, contextualising the gap between emotion control goals (e.g., I want to remain calm) and emotional outcomes (e.g., anger, anxiety, and aggression) in terms of the broader literature on goal pursuit. We propose that failure to effectively regulate emotions can result from difficulties with the self-regulatory tasks of (i) identifying the need to regulate, (ii) deciding whether and how to regulate, and (iii) enacting a regulation strategy. Next we review evidence that a technique traditionally associated with regulating behavioural goals (forming implementation intentions or “if-then” planning) can help to overcome these difficulties. Meta-analysis indicated that forming implementation intentions is effective in modifying emotional outcomes, with a large effect relative to no regulation instructions (k = 21, N = 1306 d ₊ = 0.91, 95% CI = 0.61 to 1.20) and a medium-sized effect relative to goal intention instructions (k = 29, N = 1208, d ₊ = 0.53, 95% CI = 0.42 to 0.65). Our conclusion is that research on emotion regulation might benefit from an action control perspective and the interventions that this perspective offers.     

An examination of the roles of trauma exposure and posttraumatic stress disorder on emotion regulation strategies of Operation Iraqi Freedom,Operation Enduring Freedom,and Operation New Dawn veterans

Theories of posttraumatic stress disorder (PTSD) implicate emotional processes, including difficulties utilizing adaptive emotion regulation strategies, as critical to the etiology and maintenance of PTSD. Operation Iraqi Freedom, Operation Enduring Freedom, and Operation New Dawn (OIF/OEF/OND) veterans report high levels of combat exposure and PTSD. We aimed to extend findings suggesting that emotion regulation difficulties are a function of PTSD, rather than combat trauma exposure or common comorbidities, to OIF/OEF/OND veterans, in order to inform models of PTSD risk and recovery that can be applied to returning veterans. We tested differences in emotion regulation, measured with the Difficulties in Emotion Regulation Scale and Emotion Regulation Questionnaire, among trauma-exposed veterans with (n = 24) or without PTSD (n = 22) and healthy civilian comparison participants (n = 27) using multivariate analyses of covariance, adjusting for major depressive disorder, anxiety disorders, and demographic variables (age, sex, and ethnicity). Veterans with PTSD reported more use of expressive suppression and more difficulties with emotion regulation than veterans without PTSD and healthy comparison participants. Groups did not differ on cognitive reappraisal. Findings suggest the key role of PTSD above and beyond trauma exposure, depression, and anxiety in specific aspects of emotion dysregulation among OIF/OEF/OND veterans. Interventions that help veterans expand and diversify their emotion regulation skills may serve as helpful adjunctive treatments for PTSD among OIF/OEF/OND veterans.     

Body mass index,inflammatory biomarkers and neurocognitive impairment in HIV-infected persons

To determine the relationships among body mass index (BMI), and HIV-associated neurocognitive impairment and the potential mediating effects of inflammatory cytokines. Among the HIV-infected individuals (N = 90) included in this study, obesity was associated with slower processing speed (β = ?.229, standard error (SE) = 2.15, p = .033), compared to participants with a normal BMI, after controlling for psychosocial and HIV clinical factors. Serum concentrations of the interleukin-16 (IL-16) cytokine were significantly associated with slowed processing speed (β = ?.235, SE = 1.62, p = .033) but did not mediate the relationship between obesity and processing speed These findings suggest that obesity may contribute to cognitive processing speed deficits in HIV-infected adults. Elevated concentrations of IL-16 are also associated with slowing, though the results suggest that obesity and IL-16 may exert independent effects.     

Prevalence of borderline personality disorder and its clinical correlates in Chinese patients with recent deliberate self-harm

This study examined the point prevalence of Borderline Personality Disorder (BPD) and its clinical correlates in patients with recent deliberate self-harm (DSH) in Hong Kong. A representative consecutive sample (n = 160) of patients with DSH referred to Prince of Wales Hospital from April 1, 2007 to March 31, 2008 was recruited. Their BPD status was determined according to the BPD subscale of the Chinese version of Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). The point prevalence of BPD was calculated. Subjects with and without BPD were compared in terms of demographic and clinical characteristics. Thirty out of 160 (18.8%) DSH patients were found to suffer from BPD. DSH patients with BPD were more likely to be female (p = .020), more often reported history of childhood physical (p = 0.043) and sexual abuse (p < 0.001), history of past DSH (p = 0.010), being younger at first DSH (p = 0.039), and more likely to suffer from current alcohol and substance use disorder (p = 0.043) and eating disorder (p = 0.040) than those without BPD. Being female, having history of childhood sexual abuse and current alcohol and substance use disorder were found to be independent predictors of BPD status by binary logistic regression.     

Executive functioning deficits in preschool children with Fetal Alcohol Spectrum Disorders

Executive function (EF) deficit is a hallmark of Fetal Alcohol Spectrum Disorders (FASD), but the vast majority of available evidence comes from school-age children and adolescents. Very little is known about EF during the critical developmental period prior to 6 years of age in FASD. We evaluated EF in 39 children with FASD (3.0–5.5 years) and a comparison group of 50 age-matched, nonexposed controls. Measures included the EF Scale for Early Childhood and a Delay of Gratification task. Compared to age-matched controls, preschool children with FASD had impairments on the EF Scale and showed more impulsivity on the Delay of Gratification task. To confirm the EF Scale finding, FASD group performance was compared to a separate normative dataset (N = 1,400). Those with FASD performed below normal (M = –0.57, SD = 0.92). Within the FASD group, IQ was correlated with the EF Scale (partial r = .60, p = .001) and Delay of Gratification (partial r = .58, p = .005). EF Scale performance did not differ significantly across levels of FASD severity (fetal alcohol syndrome [FAS], partial FAS, or alcohol-related neurobehavioral disorder [ARND]). However, compared to normative data, those with FAS had the largest deficits (M = –0.91 SD from the mean, SE = 0.23), followed by partial FAS (M = –0.66 SD from the mean, SE = 0.26), then ARND (M = –0.36 SD from the mean, SE = 0.20). These novel data show that EF deficits manifest well before the age of 6 years in children with FASD, that they occur across the spectrum, and that EF may be most impaired in children with more severe forms of FASD and/or lower IQs.     

Trait predictors of placebo responses in itch

This study investigated trait predictors of placebo responses in the context of inflammatory skin reactions. This was a randomized, cross-over, experimental study using a deceptive placebo protocol. A healthy sample of volunteers (N = 48) completed online personality measures, then attended two laboratory sessions in which short-term inflammatory skin reactions were induced. One was a control session and the other the ‘treatment’ session in which a placebo cream was administered with the suggestion of a reduced skin reaction. A placebo response was defined as smaller skin reactions in control vs. treatment sessions. The traits ego resiliency and neuroticism were selected as possible predictors of placebo responses. Traits were selected in consideration of the two-faceted transactional model of placebo responsiveness and in light of empirical and psychometric considerations ego resiliency emerged as a consistent predictor of placebo responses in itch (p < .05). This is the first study to identify trait predictors of placebo responses in inflammatory skin reactions. Ego resiliency may typify greater placebo responsiveness; however, this may only be in certain contexts. Matching treatment approaches to bio-behavioural response tendencies may be useful clinically if the placebo component of traditional treatments can be enhanced.     

Factors related to life satisfaction among urban African American adults receiving care at a publicly-funded sexual health clinic

Life satisfaction is linked to premature morbidity and mortality and it may be compromised for individuals living in economically-disadvantaged, urban neighborhoods. The present study explores how behavioral and social-environmental health factors are associated with life satisfaction among a sample of African American young adults. Participants (N = 307, M_age = 26.6 years, 53% male) were recruited from a publicly-funded clinic for a randomized controlled trial (RCT). Data from the baseline assessment of the RCT, which included measures of sleep, depression, anxiety, social support, alcohol and drug use problems, city stress, and life satisfaction, were used for the current study. Correlation analyses assessed bivariate associations between life satisfaction and the demographic and health-related factors. Linear regression using backward elimination determined the best fitting model of factors associated with life satisfaction. Backward elimination resulted in the following variables remaining as significantly associated with life satisfaction: age (b = ?2.40, p = .017), anxiety (b = ?5.32, p < .001), and social support (b = 2.89, p = .004). Feeling rested upon waking also remained in the best fitting model, although this association did not achieve statistical significance (p = .099). The results suggest that African American adults who are younger, less anxious, and report adequate social support are more likely to report satisfaction with life. These findings add to the literature aimed at examining health and social factors impacting the well-being of African Americans living in low-income, urban communities.     

Sleep Problems in Childhood and Borderline Personality Disorder Symptoms in Early Adolescence

Sleep disorders, such as insomnia and nightmares, are commonly associated with Borderline Personality Disorder (BPD) in adulthood. Whether nightmares and sleep-onset and maintenance problems predate BPD symptoms earlier in development is unknown. We addressed this gap in the literature using data from the Avon Longitudinal Study of Parents and Children (ALSPAC). Participants included 6050 adolescents (51.4 % female) who completed the UK Childhood Interview for DSM-IV BPD at 11 to 12 years of age. Nightmares and sleep onset and maintenance problems were prospectively assessed via mother report when children were 2.5, 3.5, 4.8 and 6.8 years of age. Psychopathological (i.e., emotional temperament; psychiatric diagnoses; and emotional and behavioural problems) and psychosocial (i.e., abuse, maladaptive parenting, and family adversity) confounders were assessed via mother report. In logistic regressions, persistent nightmares (i.e., regular nightmares at 3 or more time-points) were significantly associated with BPD symptoms following adjustment for sleep onset and maintenance problems and all confounders (Adjusted Odds Ratio = 1.62; 95 % Confidence Interval = 1.12 to 2.32). Persistent sleep onset and maintenance problems were not significantly associated with BPD symptoms. In path analysis controlling for all associations between confounders, persistent nightmares independently predicted BPD symptoms (Probit co-efficient [β] = 0.08, p = 0.013). Emotional and behavioural problems significantly mediated the association between nightmares and BPD (β =0.016, p < 0.001), while nightmares significantly mediated associations between emotional temperament (β = 0.001, p = 0.018), abuse (β = 0.015, p = 0.018), maladaptive parenting (β = 0.002, p = 0.021) and subsequent BPD. These findings tentatively support that childhood nightmares may potentially increase the risk of BPD symptoms in early adolescence via a number of aetiological pathways. If replicated, the current findings could have important implications for early intervention, and assist clinicians in the identification of children at risk of developing BPD.     

Conscientiousness and adherence to the oral contraceptive pill: A prospective study

Objective: We assess the association between conscientiousness and adherence to the oral contraceptive pill (OCP), and examine if such a relationship is independent of a measure of prospective memory and a range of social cognitive variables.

Method: Data were collected from 150 OCP users at baseline, and 99 provided follow-up data four weeks later. Conscientiousness, a range of social cognitive predictors and prospective memory were assessed at baseline. OCP adherence was measured at baseline, and again at Time 2. Data were analysed using correlation and multiple linear regression.

Results: Higher conscientiousness was associated with higher overall OCP adherence in both cross-sectional (r = ?0.28, p < 0.01) and prospective analysis (r = ?0.34, p < 0.01). Conscientiousness predicted OCP adherence at Time 2, adjusting for OCP adherence at Time 1 (R² change = 0.02, p = 0.04). The association was reduced to non-significance when social cognitive predictors and prospective memory were included in the multivariable model. Prospective memory was an independent predictor of OCP adherence at Time 2.

Discussion: This is the first study to identify an association between conscientiousness and OCP adherence. The association is not independent from social cognitive predictors and prospective memory. Facet-level analysis of conscientiousness and formal mediation analyses are recommended in future replications.     

Impact of outpatient non-myeloablative haematopoietic stem cell transplantation in quality of life vs. conventional therapy

The role of outpatient hematopoietic stem cell transplantation (HSCT) as a therapeutic tool has been strengthened significantly because of the increasing number of patients undergoing this treatment. Due the very nature of this procedure, one of the aspects that should not be overlooked is the quality of life (QOL) of patients undergoing HSCT. Thus, one must consider not only health status after treatment, but also, the psychosocial implications for the patient. This is an observational, longitudinal, and prospective study to assess QOL in patients undergoing outpatient HSCT vs. similar patients receiving medical treatment (MxTx). By applying the COOP/WONKA charts on five occasions (pre-HSCT/initial, post-HSCT/first month, and at 3, 6, and 9 months), thirty-eight patients were analysed, 19 with HSCT and 19 with MxTx with no differences in age, gender or diagnosis. The initial survey found significant differences only in pain perception, which was higher in the HSCT group (p = .08); at the first month, there was a greater tendency for feelings of depression or anxiety in the HSCT group (p = .016), with more limitations in social (p = .003) and daily (p = .044) activities. From 3 months post-HSCT, the results were very similar. The differences persisted only in the area of social activities. Four patients developed graft-versus-host disease with no significant difference in the scores obtained compared to other transplant patients at 3, 6, and 9 months (p = .26) of follow-up.     

Overcoming procrastination: one-year follow-up and predictors of change in a randomized controlled trial of Internet-based cognitive behavior therapy

Procrastination is a common self-regulatory failure that can have a negative impact on well-being and performance. However, few clinical trials have been conducted, and no follow-up has ever been performed. The current study therefore aimed to provide evidence for the long-term benefits and investigate predictors of a positive treatment outcome among patients receiving Internet-based cognitive behavior therapy (ICBT). A total of 150 self-recruited participants were randomized to guided or unguided ICBT. Self-report measures of procrastination, depression, anxiety, and quality of life were distributed at pre-treatment assessment, post-treatment assessment, and one-year follow-up. Mixed effects models were used to investigate the long-term gains, and multiple linear regression for predictors of a positive treatment outcome, using the change score on the Irrational Procrastination Scale as the dependent variable. Intention-to-treat was implemented for all statistical analyses. Large within-group effect sizes for guided and unguided ICBT, Cohen’s d = .97–1.64, were found for self-report measures of procrastination, together with d = .56–.66 for depression and anxiety. Gains were maintained, and, in some cases, improved at follow-up. Guided and unguided ICBT did not differ from each other, mean differences ?.31–1.17, 95% CIs [?2.59–3.22], and none of the predictors were associated with a better result, bs ?1.45–1.61, 95% CIs [?3.14–4.26]. In sum, ICBT could be useful and beneficial in relation to managing procrastination, yielding great benefits up to one year after the treatment period has ended, with comparable results between guided and unguided ICBT.     

Sleep disturbance and emotion dysregulation as transdiagnostic processes in a comorbid sample

Sleep disturbance and emotion dysregulation have been identified as etiologic and maintaining factors for a range of psychopathology and separate literatures support their relationships to anxiety, depression, PTSD, and alcohol dependence (AD) symptom severity. Previous studies have examined these relationships in isolation, failing to account for the high rates of comorbidity among disorders. It is not yet known whether these processes uniquely predict symptom severity in each of these domains. Participants were 220 patients in residential substance abuse treatment, who had experienced a potentially traumatic event and exceeded screening cutoffs for probable PTSD and problematic alcohol use. Controlling for emotion dysregulation and the interrelationships among the outcome variables, insomnia was uniquely associated with anxiety (B = .27, p < .001), depression (B = .25, p < .001), PTSD (B = .22, p < .001), and AD (B = .17, p = .01) symptom severity. Similarly, controlling for insomnia, emotion dysregulation was uniquely associated with anxiety (B = .40, p < .001), depression (B = .47, p < .001), PTSD (B = .38, p < .001), and AD (B = .26, p < .001) symptom severity. Insomnia and emotion dysregulation appear to be transdiagnostic processes uniquely associated with symptom severity across a number of different domains and might be important treatment targets for individuals with PTSD and AD.     

Predictors of psychological outcomes in a longitudinal study of Latina breast cancer survivors

Objective: This study sought to investigate the unique contributions of socio-ecological, cultural and cancer treatment-related factors in predicting depressive symptoms and cancer-specific distress among Latinas. Design: Participants were 140 English or Spanish-speaking Latinas (M_age = 50.6) with non-metastatic breast cancer who were assessed within two years of diagnosis (Time 1) and three months later (Time 2).

Main Measures: Hierarchical regression analyses identified predictors of depressive symptoms and cancer-specific distress at Time 1 and 2.

Results: Most women scored above the clinical cut-offs for depressive symptoms and cancer-specific distress. After adjusting for socio-ecological factors, greater Latino enculturation, measured by Latino ethnic identity, was significantly associated with greater cancer-specific distress at Time 1 (β = .20, p < .05). A significant interaction (p < .01) revealed that among women high on Latino identity, lower English language use was associated with more cancer-specific distress than higher English language use. After adjusting for socio-ecological factors, greater satisfaction with surgical treatment predicted improved depressive symptoms and cancer-specific distress across time (β_s range from ?.31 to ?.18, p_s < .01).

Conclusions: Findings elucidate the complex relationship between culture and psychological outcomes in the breast cancer context and suggest that treatment satisfaction might be an important intervention target for Latinas.     

Trajectories of Suicidal Ideation among Adolescents Following Psychiatric Hospitalization

Suicidal ideation (SI) is a common presenting problem for psychiatric hospitalizations in adolescents and often persists following discharge. This study examines whether distinct trajectories of SI could be delineated following hospitalization and the risk factors most strongly related to these trajectories. Adolescents (N = 104; 76 females; 28 males) were followed for 6 months after discharge from inpatient or partial hospitalization. Semi-parametric group modeling identified SI trajectory group membership. In all, 33.7% of adolescents fell in a Subclinical SI group, 43.3% in a Declining SI group, and 23.1% in a Chronic SI group. Multinomial logistic regression was utilized to examine baseline predictors of group membership. Emotion dysregulation differentiated Chronic SI from Declining SI. In multivariate analyses, adolescents endorsing greater non-acceptance of emotional responses (OR =1.18) and more limited access to emotion regulation strategies (OR =1.12) were more likely to belong to the Chronic SI than Declining SI trajectory. Those in the Chronic SI group also had the greatest number of suicide attempts and hospitalizations in the 6 months post-discharge. These results suggest that clinicians should closely monitor and address emotion dysregulation when assessing suicide risk. Greater dysregulation may require more intensive services in order to have an effect on chronic SI.     

Dialectical Behavior Therapy: An Emotion-Focused Treatment for Borderline Personality Disorder

Dialectical Behavior Therapy (DBT) is a cognitive-behavioral treatment for borderline personality disorder (BPD) that is based on the theory that emotion dysregulation is the core feature of BPD. This article focuses on aspects of DBT theory and techniques that specifically address emotion. The dialectical and biosocial theories that underlie DBT are reviewed with an emphasis on how each relates to emotional experiencing in BPD. Selected treatment strategies that address emotion dysregulation and their hypothesized mechanisms of change are also described. Relevant research findings are incorporated throughout to provide an empirical foundation for the DBT theories and strategies that are discussed.     

The role of maladaptive anger in self-criticism: A quasi-experimental study on emotional processes

The present study examines the role of emotion in the self-critical process of individuals with anger problems. Self-criticism is a prevalent intra-personal feature which greatly impacts an individual’s emotion. So far, it is unclear, which emotions individuals with maladaptive anger experience when they work through their self-criticism. Using a quasi-experimental design, the present study compared n = 23 anger-prone under-graduate students to n = 22 controls on process indices of contempt, fear, shame, anger and global distress, as well as on their access to underlying need, as participants were working through personalized self-critical content. This was achieved using a single-session enactment from emotion-focused therapy, augmented with a standardized procedure for priming participants to focus on their unmet needs. Findings suggested that this work on self-criticism reduced for both groups distress, fear and shame, as well as increased assertive anger (McNemar tests significant at p = .05). More centrally, anger-prone individuals expressed more self-contempt (t(1, 44) = 3.65; p < .05), and they had more difficulty in accessing their underlying need (χ² = 5.35; p < .05), when compared to controls. These results have implications for clinical work with anger-prone individuals, and clarify key features in the use of enactment interventions when working towards emotional resolution. The present study also demonstrates the use of personalized stimuli in the context of clinically relevant quasi-experimental research on emotional processes.