Emotion Regulation of Events Central to Identity and Their Relationship With Concurrent and Prospective Depressive Symptoms

Dispositional emotion regulation is related to the severity and maintenance of depressive symptoms. However, whether emotion regulation specific to an event highly central for an individual’s identity is predictive of depressive symptoms has not been examined. Nonclinical participants (N = 220) reported the extent to which they employed a selection of emotion regulation strategies when recalling low- and high-centrality events. Dispositional emotion regulation and depressive symptoms were also assessed. A 7-week follow-up was conducted. High-centrality events were associated with more emotion regulation efforts. Greater brooding and expressive suppression in relation to high-centrality memories predicted concurrent depressive symptoms after controlling for event valence and dispostional emotion regulation. Effects were absent for low-centrality memories. Emotion regulation in response to high-centrality memories did not predict depressive symptoms at follow-up beyond baseline depressive symptoms. Overall, the findings showed that maladaptive emotion regulation in response to memories of high-centrality events is important for explaining depressive symptomatology.     

Emotion Dysregulation Mediates the Relationship Between Child Maltreatment and Non-Suicidal Self-Injury

One risk factor for non-suicidal self-injury (NSSI) in adolescents is exposure to traumatic experiences, particularly child maltreatment. However, the mechanisms through which childhood maltreatment predicts NSSI are largely unknown. Emotion dysregulation (ED) is likely an important mechanism in this relationship. Therefore, this study examined the relationship between childhood maltreatment, ED, and NSSI in a sample of adolescent inpatients (n = 53). Results demonstrated that child physical and emotional maltreatment, but not child sexual abuse, was significantly associated with NSSI frequency. More specifically, ED mediated the relationship between child physical and emotional maltreatment and NSSI frequency. Findings support the importance of ED as a mediating factor in the relationship between childhood maltreatment and NSSI behaviors and highlight the need for teaching emotion regulation skills to youth affected by trauma.     

Gender differences in the role of alexithymia and emotional expressivity in disordered eating

Disordered eating habits such as binge-eating, purging, and extreme diet restriction have been linked to a variety of deficits in emotion regulation. Two such aspects of emotion regulation are alexithymia and emotional expressivity, although much of the research is limited to females. This study examines associations between these aspects of emotion regulation and symptoms of bulimia nervosa (BN) in men and women. Participants were 201 female and male undergraduates who completed self-report measures of emotion regulation and BN symptoms. Consistent with prior research, results indicate that alexithymia predicted BN symptoms in females, but not in the presence of emotional expressivity, which proved to be the only unique predictor of BN symptoms. In the male sample, alexithymia predicted BN symptoms over and above emotional expressivity. These findings suggest that BN symptoms in males may partly be explained by one facet of emotion regulation, but they also highlight important gender differences in disordered eating. Future research should further examine the role of emotion regulation in eating pathology in males.     

The Mediational Role of Effortful Control and Emotional Dysregulation in the Link Between Maternal Responsiveness and Turkish Preschoolers' Social Competency and Externalizing Symptoms

This cross‐sectional study relied on circumscribed measures of emotion regulation and dysregulation to examine their role in mediating the associations of maternal responsiveness and effortful control with social competency and externalizing symptoms. We examined those associations in an understudied cultural context, Turkey, with 118 preschoolers. Emotion regulation and dysregulation showed differential associations with broad indices of self‐regulation such that emotion dysregulation predicted both low social competency and high externalizing symptoms but emotion regulation was only associated with high social competency. Effortful control was unrelated to emotion regulation but was associated with lower levels of emotion dysregulation. Effortful control had both direct and mediated associations with externalizing and social competency (mediated by lower emotion dysregulation). Findings also showed that maternal responsiveness was associated with better social competency and lower externalizing. Those associations were both singly (through effortful control) and doubly mediated (through effortful control and lower emotion dysregulation), similar to US samples. The study contributes to a better understanding of the factors and mechanisms that speak to children's self‐regulation. Copyright © 2013 John Wiley & Sons, Ltd.     

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.     

Emotion dysregulation and adolescent psychopathology: a prospective study

Background

Emotion regulation deficits have been consistently linked to psychopathology in cross-sectional studies. However, the direction of the relationship between emotion regulation and psychopathology is unclear. This study examined the longitudinal and reciprocal relationships between emotion regulation deficits and psychopathology in adolescents.

Methods

Emotion dysregulation and symptomatology (depression, anxiety, aggressive behavior, and eating pathology) were assessed in a large, diverse sample of adolescents (N = 1065) at two time points separated by seven months. Structural equation modeling was used to examine the longitudinal and reciprocal relationships between emotion dysregulation and symptoms of psychopathology.

Results

The three distinct emotion processes examined here (emotional understanding, dysregulated expression of sadness and anger, and ruminative responses to distress) formed a unitary latent emotion dysregulation factor. Emotion dysregulation predicted increases in anxiety symptoms, aggressive behavior, and eating pathology after controlling for baseline symptoms but did not predict depressive symptoms. In contrast, none of the four types of psychopathology predicted increases in emotion dysregulation after controlling for baseline emotion dysregulation.

Conclusions

Emotion dysregulation appears to be an important transdiagnostic factor that increases risk for a wide range of psychopathology outcomes in adolescence. These results suggest targets for preventive interventions during this developmental period of risk.     

Changes in defensiveness and in affective distress following inpatient treatment of eating disorders: Rorschach comprehensive system and self-report measures

Conceptualizing eating disorders (EDs) as forming a coping mechanism against facing psychic pain, in this study, we examined the contribution of weight stabilization and ED behaviors to psychological outcomes of affective distress, defensiveness, and contact with inner/external reality among 2 subgroups of adolescent inpatients with (a) "restricting type" anorexia (AN-R) and (b) bingeing/purging type EDs (B/P). We administered Rorschach Comprehensive System (CS; Exner, 2003) and self-report measures at acute admission and on discharge. Data indicated that in both subgroups, stabilization of weight and disordered eating behaviors was accompanied by reduced explicit (self-reported) affective distress, yet by elevated implicit affective distress (D, SumShd). Subgroups' different Rorschach change trends indicated different dynamic processes in defensive style and contact with inner/external reality.     

Intolerance of Uncertainty and Eating Disorder Symptoms Over the Course of Intensive Treatment

There is a critical need to identify processes that may influence outcome in existing treatments for eating disorders (EDs). Intolerance of uncertainty (IU), which refers to excessive distress regarding uncertain situations, is a well-established feature of anxiety disorders. Emerging work suggests that IU decreases over the course of cognitive-behavioral treatments and may relate to better treatment outcomes. As some literature has suggested IU may functionally maintain ED symptoms, testing whether changes in IU over treatment relate to outcome may result in the identification of novel treatment targets. This study aimed to build upon past work documenting links between IU and ED symptoms by exploring changes in IU over treatment and links between early change in IU (1-month) and discharge symptoms. Participants (N = 274) receiving partial hospitalization treatment completed the Eating Pathology Symptoms Inventory and Intolerance of Uncertainty Scale at admission, 1-month post-admission, and discharge. Results suggested that IU significantly reduced from admission to discharge and that reductions in IU scores from admission to 1-month related to cognitive restraint, dietary restriction, and body image at discharge. However, this pattern did not hold for exercise, binge eating, or purging. Altogether, these results replicate past work supporting IU as a common feature across ED diagnoses and provide initial data suggesting that targeting IU early in treatment may enhance treatment outcomes.     

Self-Acceptance Group Therapy: A Transdiagnostic,Cognitive-Behavioral Treatment for Shame

Shame has broad importance to psychological problems. However, few interventions specifically address shame, and most of these have been designed to target shame in the context of particular disorders. Self-Acceptance Group Therapy (SAGT) was developed as a transdiagnostic shame-focused treatment, based on a cognitive-behavioral framework. SAGT is an 8-week treatment that involves psychoeducation and training in the use of cognitive and behavioral shame regulation and support-building skills in order to promote self-acceptance. After describing SAGT, the study presented used an open trial design to examine the utility of SAGT for addressing shame, self-acceptance, quality of life, and relevant psychological problems (e.g., depression, social anxiety). Twenty-four outpatients with elevated shame were assessed at pretreatment, posttreatment, and 1-month follow-up. By post-treatment, results revealed significant improvements in self-acceptance, shame, and borderline personality disorder (BPD) symptoms among treatment completers (n = 18), with all of these improvements maintained at follow-up. Additionally, significant improvements in quality of life, emotion dysregulation, depression, loneliness, and stress were observed at follow-up. Results provide preliminary support for SAGT’s utility in the treatment of shame and related pathology among diverse outpatients.     

A Pilot Open Trial of a Digital Mindfulness-Based Intervention for Anorexia Nervosa

Anorexia nervosa (AN) is a chronic and debilitating psychiatric disorder. Unfortunately, current treatments are lacking, with only 30-50% of individuals with AN recovering after treatment. We developed a beta-version of a digital mindfulness-based intervention for AN called Mindful Courage-Beta, which includes: (a) one foundational multimedia module; (b) 10 daily meditation mini-modules; (c) emphasis on a core skill set called the BOAT (Breathe, Observe, Accept, Take a Moment); and (d) brief phone coaching for both technical and motivational support. In this open trial, we aimed to evaluate (1) acceptability and feasibility; (2) intervention skill use and its association with state mindfulness in daily life; and (3) pre-to-post changes in target mechanisms and outcomes. Eighteen individuals with past-year AN or past-year atypical AN completed Mindful Courage-Beta over 2 weeks. Participants completed measures of acceptability, trait mindfulness, emotion regulation, eating disorder symptoms, and body dissatisfaction. Participants also completed ecological momentary assessment of skill use and state mindfulness. Acceptability ratings were good (ease-of-use: 8.2/10, helpfulness: 7.6/10). Adherence was excellent (100% completion for foundational module and 96% for mini-modules). Use of the BOAT in daily life was high (1.8 times/day) and was significantly associated with higher state mindfulness at the within-person level. We also found significant, large improvements in the target mechanisms of trait mindfulness (d = .96) and emotion regulation (d = .76), as well as significant, small-medium to medium-large reductions in eating disorder symptoms (ds = .36–.67) and body dissatisfaction (d = .60). Changes in trait mindfulness and emotion regulation had medium-large size correlations with changes in global ED symptoms and body dissatisfaction (rs = .43 – .56). Mindful Courage-Beta appears to be promising and further research on a longer, refined version is warranted.     

Are emotion regulation difficulties a moderator in the relationship between dating abuse and body investment in eating disorders?

IntroductionIt is well known that eating disorders (EDs) are related to intimacy difficulties and to previous adverse experiences; however, little is known about dating abuse and how this kind of abuse is related to the different facets of body investment and emotion regulation difficulties in EDs. This study aimed to evaluate the presence of dating abuse in ED outpatients and to evaluate the moderating role of difficulties in emotion regulation in the relationship between dating abuse and the different facets of body investment.MethodSixty-four ED outpatients (95.3% females; aged from 15 to 30 years) completed self-report measures regarding dating abuse, body investment, difficulties in emotion regulation, and ED symptoms.ResultsApproximately 89% of ED outpatients identified a current or past dating relationship. Of those, 51 (89.5%) reported at least one episode of dating abuse perpetration, and 52 (91.2%) reported at least one episode of dating abuse victimization. Emotional abuse was the most reported type of dating abuse. High levels of dating abuse were related to elevated body care in participants with more difficulties in emotion regulation. The remaining models, incorporating the other facets of body investment, did not show significant moderating effects.DiscussionA substantial number of ED outpatients reported dating abuse. Pending longitudinal replication, body care may be used as a strategy to deal with dating abuse in the absence of more adaptive emotion regulation strategies.     

The Relationship Between Perceived Parenting Style and Emotion Regulation Abilities in Adulthood

Emotion regulation abilities are very important for psychological and social wellbeing during the whole course of life. By contrast, emotion dysregulation is a significant risk factor for several psychological disorders. According to developmental research, an optimal parenting style, described as warmth and affectionate, promotes the development of an adequate emotion regulation in children and adolescents. However, little research has examined the relationship between parenting style and emotion regulation in adulthood. In the present study, we tested the relationship between perceived experiences with parents, in terms of parental care and parental overprotection, during childhood, and emotion regulation abilities in a sample of adults. One hundred participants completed the Parental Bonding Instruments, the Emotion Regulation Questionnaire, and the Difficulties in Emotion Regulation Scale. Hierarchical multiple regression analyses revealed that perceived parental care was more related to emotion regulation abilities than perceived parental overprotection. In particular, perceived paternal care was strictly linked to several difficulties in emotion regulation. By contrast, perceived maternal care was negatively associated with the use of maladaptive emotion regulation strategies, and a specific emotion dysregulation dimension, that is lack of emotional awareness. In summary, perceived parental care seemed to have a key role to protect individuals from emotion dysregulation. These results demonstrate that parenting styles still exert their influence on emotion regulation abilities also in adulthood. Limitations and directions for future research are discussed.     

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.     

Combined Emotional Socialization Training and Family Accommodation Modification: Impact on Emotional Regulation and Anxiety Symptoms in Anxious Children

Past studies show that emotional socialization and family accommodation are involved in children's anxiety, but research has yet to investigate whether targeting emotional socialization training (EST), family accommodation modification (FAM), or EST and FAM in tandem can reduce anxiety in children. The purpose of this study was to evaluate the efficacy of a combination of EST and FAM on improving emotion regulation (ER) and reducing anxiety symptoms in anxious children. The sample consisted of 80 children with an anxiety disorder (M_age = 6.7, SD = 0.1) and their mothers. Mothers were randomly assigned to an EST (n = 17), FAM (n = 16), Combined (n = 17), or a waitlist control (WLC) (n = 16) groups. Mothers completed The Emotion Regulation Checklist (ERC) and Spence Children’s Anxiety Scale (SCAS) at pre-test, post-test, and at 6-month of follow-up. The results showed that the EST, FAM, and Combined groups were more effective than WLC in improving ER and reducing anxiety severity at post-test and follow-up. Among the intervention groups, children in the combined group showed greater reductions in the severity of anxiety symptoms and emotion dysregulation than the other two groups. Assisting parents to use strategies that encourage healthy emotion regulation and decrease family accommodation might help reduce the severity of children's anxiety symptoms.     

Eating Disorder Symptom and Fear Change Trajectories During Imaginal Exposure Therapy: A Slope Network Analysis

Eating disorders (EDs) are characterized by fears related to food, body image, and social evaluation. Exposure-based interventions hold promise for targeting a range of ED fears and reducing ED psychopathology. We investigated change mechanisms and optimal fear targets in imaginal exposure therapy for EDs using a novel approach to network analysis. Individuals with an ED (N = 143) completed up to four online imaginal exposure sessions. Participants reported ED symptoms and fears at pretreatment, posttreatment, and 6-month follow-up. We constructed networks of symptoms (Model 1), fears (Model 2), and combined symptoms and fears (Model 3). Change trajectory networks from the slopes of symptoms/fears across timepoints were estimated to identify how change in specific ED symptoms/fears related to change in other ED symptoms/fears. The most central changing symptoms and fears were feeling fat, fear of weight gain, guilt about one’s weight/shape, and feared concerns about consequences of eating. In Model 3, change in ED fears bridged to change in desire to lose weight, desiring a flat stomach, following food rules, concern about eating with others, and guilt. As slope networks present averages of symptom/fear change slopes over the course of imaginal exposure therapy, further studies are needed to examine causal relationships between symptom changes and heterogeneity of change trajectories. Fears of weight gain and consequences of eating may be optimal targets for ED exposure therapy, as changes in these fears were associated with maximal change in ED pathology. Slope networks may elucidate change mechanisms for EDs and other psychiatric illnesses.     

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。     

Assessing Emotion Regulation in Social Anxiety Disorder: The Emotion Regulation Interview

Social anxiety disorder (SAD) is thought to involve emotional hyper-reactivity and emotion dysregulation. However, the precise nature of the emotion dysregulation in SAD has not been well characterized. In the present study, the Emotion Regulation Interview (ERI) was developed to quantify the frequency and self-efficacy of five emotion regulation strategies specified by Gross’s (Review of General Psychology 2: 271–299, 1998) process model of emotion regulation. Forty-eight individuals with SAD and 33 healthy controls (HCs) were interviewed about responses during (a) a laboratory speech task and (b) two recent social anxiety-evoking situations. Individuals with SAD reported greater use of avoidance and expressive suppression than HCs, as well as lesser self-efficacy in implementing cognitive reappraisal and expressive suppression. These regulation deficits were not accounted for by differences in emotional reactivity. These findings highlight specific emotion regulation deficits in SAD, and support the idea that the Emotion Regulation Interview may be usefully applied to other clinical disorders.     

The Difficulties in Emotion Regulation Scale Short Form (DERS-SF): Validation and Replication in Adolescent and Adult Samples

Emotion dysregulation often emerges early in development and is a core feature of many psychological conditions. The Difficulties in Emotion Regulation Scale (DERS) is a well validated and widely used self-report measure for assessing emotion regulation problems among adolescents and adults. The DERS has six subscales with five to eight items each (36 total), suggesting multiple questions may assess similar underlying constructs. In an effort to reduce respondent burden and streamline this widely-used instrument, we created a short-form version of the DERS (DERS-SF) using confirmatory factor analysis on data from three adolescent (n?=?257) and two adult samples (n?=?797). Scores on the DERS-SF yielded similar correlation patterns relative to the full measure, ranging from .90 to .98 and reflecting 81–96 % shared variance. This instrument maintains the excellent psychometric properties and retains the total and subscale scores of the original measure with half the items.     

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.     

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.