Factor Structure of the Difficulties in Emotion Regulation Scale (DERS) in Adult Outpatients Receiving Dialectical Behavior Therapy (DBT)

The Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer in Journal of Psychopathology and Behavioral Assessment, 26, 41–54, 2004) is a widely used measure of emotion regulation, however, few studies have examined the scale’s psychometric properties in clinical samples. The current study examined the latent factor structure of the scale, in addition to other psychometric properties, in a naturalistic sample of adult outpatients (n = 344) receiving dialectical behavior therapy (DBT). A number of models were fitted, including a bifactor model, which has not previously been examined with the DERS, but which may be more appropriate for addressing the study’s two primary aims. These aims were to: (1) investigate some of the prior concerns raised about the Awareness subscale items; and (2) evaluate the appropriateness of using DERS total vs. subscale scores. Results indicated that a modified bifactor model which excluded the Awareness items from the general factor fit the data best. Additional findings suggested that the DERS total score (excluding Awareness items) was reliable and had good criterion-related validity in this sample. However, the findings related to the DERS subscales were mixed. This study extends prior research on the DERS by demonstrating the utility of the scale with individuals receiving DBT for problems with emotion regulation, as well as by clarifying some of the prior questions about the scale’s latent structure.     

The Difficulties in Emotion Regulation Scale: Factor Structure and Association with Nonsuicidal Self-Injury in Adolescent Inpatients

Research suggests that difficulties in emotion regulation are an important correlate of nonsuicidal self-injury (NSSI) in adults. Research examining this link in adolescents is limited by the lack of comprehensive instruments to assess difficulties in emotion regulation. Against this background, the aims of the current study were to (a) confirm the six-factor structure of the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, Journal of Psychopathology and Behavioral Assessment, 23(4), 253?C263, 2004) in a sample of adolescent inpatients (N?=?218); (b) explore the relation between different aspects of emotion dysregulation and lifetime NSSI while controlling for psychopathology and sex; and (c) assess the clinical utility of the DERS in detecting lifetime NSSI status. Fit indices obtained through Confirmatory Factor Analysis indicated that the six-factor structure of the DERS fit the data adequately and that most items loaded strongly on their respective latent factor. All six latent factors were significantly correlated with each other, with the exception of lack of emotional awareness and difficulties engaging in goal-directed behavioral when distressed. Regression analyses revealed that only the limited access to emotion regulation strategies subscale accounted for a significant portion of the variance in NSSI when controlling for other aspects of emotion dysregulation, sex, and psychopathology. Receiver Operating Characteristic analysis indicated that the DERS limited access to emotion regulation strategies subscale score has moderate diagnostic accuracy in detecting the presence of NSSI. The optimal cut-off score was 21.5 when detecting NSSI among inpatient adolescents. Results provide further support for the relation between emotion regulation difficulties and NSSI. The DERS appears to be a useful measure of detecting NSSI in clinical samples of adolescents.     

Validation of a Brief Version of the Difficulties in Emotion Regulation Scale (DERS-18) in Five Samples

The field of affective clinical science has expanded dramatically over the past several decades (Rottenberg and Gross 2003; Tracy et al. 2014). An important part of this research is understanding emotion regulation and dysregulation, in particular, how individuals differ in their ability to identify, accept, and manage their emotional experiences. One of the most common and widely cited measures of emotion dysregulation is the Difficulties with Emotion Regulation Scale (DERS; Gratz and Roemer 2004), which has been extensively used to facilitate understanding of how emotion dysregulation is associated with psychiatric symptoms, other emotion-related constructs, and treatment progress. While this scale has contributed greatly to our understanding of emotion regulation problems, its length makes its inclusion in brief study protocols difficult, limiting its utility and increasing participant burden. In order to address this issue, we developed a short form version of the DERS (DERS-18) composed of the strongest items from each of the measure’s six subscales from the original DERS publication (Gratz and Roemer 2004), and then validated this measure in five datasets that vary in age and sample type. Our results demonstrate that an 18-item short-form of the DERS exhibits a similar structure as the original 36-item DERS, demonstrates excellent reliability and validity, and performs similarly to the original DERS despite comprising half the items. The DERS-18 has the potential to improve and expand emotion regulation assessment while reducing demands on research participants.     

Multidimensional Assessment of Emotion Regulation and Dysregulation: Development, Factor Structure, and Initial Validation of the Difficulties in Emotion Regulation Scale

Given recent attention to emotion regulation as a potentially unifying function of diverse symptom presentations, there is a need for comprehensive measures that adequately assess difficulties in emotion regulation among adults. This paper (a) proposes an integrative conceptualization of emotion regulation as involving not just the modulation of emotional arousal, but also the awareness, understanding, and acceptance of emotions, and the ability to act in desired ways regardless of emotional state; and (b) begins to explore the factor structure and psychometric properties of a new measure, the Difficulties in Emotion Regulation Scale (DERS). Two samples of undergraduate students completed questionnaire packets. Preliminary findings suggest that the DERS has high internal consistency, good test–retest reliability, and adequate construct and predictive validity. An erratum to this article is available at .     

Development and Validation of a Brief Version of the Difficulties in Emotion Regulation Scale: The DERS-16

The Difficulties in Emotion Regulation Scale (DERS) is a widely-used, theoretically-driven, and psychometrically-sound self-report measure of emotion regulation difficulties. However, at 36-items, the DERS may be challenging to administer in some situations or settings (e.g., in the course of patient care or large-scale epidemiological studies). Consequently, there is a need for a briefer version of the DERS. The goal of the present studies was to develop and evaluate a 16-item version of the DERS – the DERS-16. The reliability and validity of the DERS-16 were examined in a clinical sample (N = 96) and two large community samples (Ns = 102 and 482). The validity of the DERS-16 was evaluated comparing the relative strength of the association of the two versions of the DERS with measures of emotion regulation and related constructs, psychopathology, and clinically-relevant behaviors theorized to stem from emotion regulation deficits. Results demonstrate that the DERS-16 has retained excellent internal consistency, good test-retest reliability, and good convergent and discriminant validity. Further, the DERS-16 showed minimal differences in its convergent and discriminant validity with relevant measures when compared to the original DERS. In conclusion, the DERS-16 offers a valid and brief method for the assessment of overall emotion regulation difficulties.     

Facets of Emotion Regulation and Emotional Disorder Symptom Dimensions: Differential Associations and Incremental Validity in a Large Clinical Sample

A growing literature suggests robust associations between dimensions of emotion regulation and emotional disorder psychopathology. However, limited research has investigated associations of emotion regulation dimensions across several emotional disorders (transdiagnostic associations), or the incremental validity of emotion regulation versus the higher-order construct of neuroticism. The current study used exploratory structural equation modeling and a large clinical sample (N = 1,138) to: (a) develop a multidimensional emotion regulation measurement model, (b) evaluate the differential associations between latent emotion regulation dimensions and five latent emotional disorder symptom dimensions (social anxiety, depression, agoraphobia/panic, obsessions/compulsions, generalized worry), and (c) determine the incremental contribution of emotion regulation in predicting symptom dimensions beyond neuroticism. The best-fitting measurement model of emotion regulation included four dimensions: Problematic Responses, Poor Recognition/Clarity, Negative Thinking, and Emotional Inhibition/Suppression. Although many zero-order associations between the four latent emotion regulation dimensions and five latent symptom dimensions were significant, few associations remained significant in a structural regression model that included neuroticism. Specifically, Negative Thinking and Problematic Responses incrementally predicted depression symptoms, while Emotional Inhibition/Suppression predicted both social anxiety and depression symptoms. Associations between neuroticism and the emotional disorder dimensions were similar regardless of whether the emotion regulation dimensions were held constant. These results suggest that self-reported emotion regulation dimensions are associated with the severity and expression of a range of emotional disorder symptoms, but that some emotion regulation dimensions have limited incremental validity after accounting for general emotional reactivity. Studies of emotion regulation should assess neuroticism as a key covariate.     

Addressing Psychometric Limitations of the Difficulties in Emotion Regulation Scale Through Item Modification

Through its frequent use, a pattern has emerged showing psychometric limitations of the Difficulties in Emotion Regulation Scale (DERS; Gratz &; Roemer, 2004 Gratz, K. L., &; Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment, 26, 41–54.[Crossref], [Web of Science ®] , [Google Scholar]). This 3-part study sought to (a) determine whether these limitations are due to a method effect by rewording all reverse-coded items in a straightforward manner and submitting them to exploratory factor analysis (EFA), and (b) examine the tenability of an adaptation of the original measure. EFA results from Study 1 (N = 743) supported retention of 29 modified items across 5 factors. Consistent with the original theoretical underpinnings of the DERS, Awareness and Clarity items loaded on the same factor. In Study 2 (N = 738), confirmatory factor analysis (CFA) was used to examine the factor structure of the pool of items identified in Study 1. All of the modified subscales clustered strongly with one another and evidenced large loadings on a higher-order emotion regulation construct. These results were replicated in Study 3 (N = 918). Results from Study 3 also provided support for the reliability and validity of scores on the modified version of the DERS (i.e., internal consistency, convergent and criterion-related validity). These findings provide psychometric support for a modified version of the DERS.     

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.     

The Greek Version of the Difficulties in Emotion Regulation Scale: Testing the Factor Structure, Reliability and Validity in an Adult Community Sample

We examined the factor structure, reliability, convergent and criterion validity of the Greek version of the Difficulties in Emotion Regulation Scale (DERS) using data from a community lifespan sample. Exploratory and confirmatory factor analyses revealed a clear six-factor structure consistent with the factor structure evidenced in English-speaking samples. The results also demonstrated adequate classical psychometric properties in terms of internal consistency and test-retest reliability. The scale branches demonstrated convergent and concurrent validity with personality, emotion intelligence abilities and coping strategies. The importance of using culturally validated dimensional measures of emotion regulation is discussed.     

Pathological personality facets and emotion (dys)regulation in gambling disorder

A number of researches showed high prevalence of personality disorders among addicted gamblers. However, there are still few studies investigating the role of pathological personality facets in Gambling Disorder (GD). Moreover, the nature of the relationship between GD and pathological personality is not clear. We administered to a group of addicted gamblers (N = 79) and a group of healthy participants (N = 101) a battery of self-report questionnaires encompassing the South Oaks Gambling Screen (SOGS), The Personality Inventory for DSM-V (PID-5), the Difficulties in Emotion Regulation Scale (DERS) and the Emotion Regulation Questionnaire (ERQ). Analyses of variance showed that addicted gamblers, compared to healthy participants, scored higher on most of the subscales of the DERS, on the Suppression Dimension of the ERQ and on the five main domains of the PID-5 whereas they obtained lower scores on the Reappraisal subscale of the ERQ. Moreover, multiple regression analyses indicated that some specific facets of pathological personality, emotion dysregulation and lack of cognitive reappraisal, significantly predict GD's severity. Finally, emotion dysregulation levels and lack of cognitive reappraisal partially mediated the relationship between these and GD's severity. Our results confirmed the central roles played by both pathological personality and deficit in emotion regulation capacities in GD. Specifically, Impulsivity, Lack of Perseverance and Suspiciousness may be important predictors of GD severity. Moreover, emotion dysregulation and lack of adaptive emotion regulation strategies partially explained such relationship. As such, training for emotion regulation abilities appears strategically useful in the treatment of addicted gamblers with pathological personality traits.     

Mothers’ self-reported emotion dysregulation: A potentially valid method in the field of infant mental health

In the current study, we evaluated the extent to which mothers reported emotion dysregulation on the Difficulties with Emotion Regulation Questionnaire (DERS) (a) converged with physiological indices of emotion dysregulation while parenting, (b) correlated with maternal sensitivity, and (c) predicted infant attachment disorganization and behavior problems in a sample of 259 mothers and their infants. When infants were 6 months old, mothers’ physiological arousal and regulation were measured during parenting tasks and mothers completed the DERS. Maternal sensitivity was observed during distress-eliciting tasks when infants were 6 and 14 months old. Infant attachment disorganization was assessed during the Strange Situation when infants were 14 months old and mothers reported on infants’ behavior problems when infants were 27 months old. Mothers who reported greater emotion regulation difficulties were more physiologically dysregulated during stressful parenting tasks and also showed lower levels of maternal sensitivity at 6 months. Mother-reported dysregulation predicted higher likelihood of infant attachment disorganization and more behavior problems. Results suggest that the DERS is a valid measure of maternal emotional dysregulation and may be a useful tool for future research and intervention efforts aimed toward promoting positive parenting and early child adjustment.     

Specificity of cognitive emotion regulation strategies: A transdiagnostic examination

Despite growing interest in the role of regulatory processes in clinical disorders, it is not clear whether certain cognitive emotion regulation strategies play a more central role in psychopathology than others. Similarly, little is known about whether these strategies have effects transdiagnostically. We examined the relationship between four cognitive emotion regulation strategies (rumination, thought suppression, reappraisal, and problem-solving) and symptoms of three psychopathologies (depression, anxiety, and eating disorders) in an undergraduate sample (N = 252). Maladaptive strategies (rumination, suppression), compared to adaptive strategies (reappraisal, problem-solving), were more strongly associated with psychopathology and loaded more highly on a latent factor of cognitive emotion regulation. In addition, this latent factor of cognitive emotion regulation was significantly associated with symptoms of all three disorders. Overall, these results suggest that the use of maladaptive strategies might play a more central role in psychopathology than the non-use of adaptive strategies and provide support of a transdiagnostic view of cognitive emotion regulation.     

Emotion Regulation Difficulties During and After Partial Hospitalization Treatment Across Eating Disorders

Emotion regulation deficits are associated with eating disorder (ED) symptoms, regardless of eating disorder diagnosis. Thus, recent treatment approaches for EDs, such as dialectical behavior therapy (DBT), have focused on teaching patients skills to better regulate emotions. The present study examined changes in emotion regulation among adult patients with EDs during DBT-oriented partial hospital treatment, and at follow-up (M[SD] = 309.58[144.59] days from discharge). Exploratory analyses examined associations between changes in emotion regulation and ED symptoms. Patients with anorexia nervosa, restricting (AN-R, n = 77), and binge-eating/purging subtype (AN-BP, n = 46), or bulimia nervosa (BN, n = 118) completed the Difficulties in Emotion Regulation Scale (DERS) at admission, discharge, and follow-up. Patients with BN demonstrated significant improvements across all facets of emotion dysregulation from admission to discharge and maintained improvements at follow-up. Although patients with AN-BP demonstrated statistically significant improvements on overall emotion regulation, impulsivity, and acceptance, awareness, and clarity of emotions, from admission to discharge, these improvements were not significant at follow-up. Patients with AN-R demonstrated statistically significant improvements on overall emotion dysregulation from treatment admission to discharge. Changes in emotion regulation were moderately correlated with changes in ED symptoms over time. Results support different trajectories of emotion regulation symptom change in DBT-oriented partial hospital treatment across ED diagnoses, with patients with BN demonstrating the most consistent significant improvements.     

Yoga-integrated psychotherapy for emotion dysregulation: A pilot study

Aims & Objectives

Yoga has been evidenced as beneficial for physical and mental health. This study sought to pilot the acceptability and feasibility of a yoga-integrated psychotherapy (YiP) intervention, aimed at alleviating difficulties in emotion regulation. A further aim was to explore the perceived effectiveness of YiP in alleviating depression, anxiety and improving well-being.

Methods

Seven participants who scored significantly on the Difficulties in Emotion Dysregulation Scale (DERS) took part in a psychological assessment session followed by six weekly one hr therapy sessions. Participants completed self-report measures in each session to quantify the effects of each YiP session on emotion regulation, well-being, depression and anxiety. Following seven sessions, five participants completed qualitative follow-up interviews to explore subjective experiences of YiP and any perceived impacts.

Findings

An ANOVA that contained data from seven participants who completed all six sessions revealed that DERS scores were significantly lower, and well-being scores were significantly higher, at both mid and end-points than at baseline. Thematic analysis of qualitative interviews identified five themes: “YiP assists the client's psychological and emotional processing,” “YiP improves insight and focus,” “YiP is culturally sensitive,” “the body facilitates regulation and resilience” and “YiP is acceptable & impactful.”

Conclusion

The study presents promising findings for the integration of yoga into psychotherapeutic practice and indicates that YiP may have beneficial effects on emotion regulation and psychological well-being. Future research should use randomised controlled methodologies to examine the ability of YiP to alleviate a wide range of affective symptoms using a larger sample of participants.     

A Psychometric Evaluation of the Revised Parental Emotion Regulation Inventory

Despite significant research on parental emotion, parents’ regulation of their own emotions during discipline encounters is an understudied topic. Progress in this area of inquiry would be enhanced by the development of valid measures of emotion regulation. The present article describes an evaluation of such a measure, the revised Parental Emotion Regulation Inventory (PERI2). Mothers of 2-year-old children (N?=?232) completed the PERI2, additional questionnaire measures, and a parent-child observation during home visits. The present findings support the factorial and concurrent validity of the PERI2’s suppression (e.g., concealing negative emotion), capitulation (e.g., giving into aversive child behavior to reduce negative emotion) and escape (e.g., walking away mid discipline encounter to reduce negative emotion) factors. Suppression, capitulation, and escape were distinct but interrelated emotion regulatory behaviors that were associated with such factors as harsh parenting, lax discipline, parental maladjustment, and child physical aggression. In contrast, the psychometric adequacy of the reappraisal factor (e.g., thinking differently about the child’s behavior to reduce negative emotion) was not supported. The results support the future use of the PERI2, minus the reappraisal factor’s items.     

An Investigation of the Relationships among Negative Affect, Difficulties in Emotion Regulation, and Features of Borderline Personality Disorder

This study investigated the indirect effects of problematic emotion regulation on features of Borderline Personality Disorder (BPD) when accounting for negative affect in 456 participants from two distinct geographic regions. Participants completed the Affect Intensity Measure (AIM), Difficulties in Emotion Regulation Scale (DERS), the Emotion Regulation Questionnaire (ERQ), and the Borderline Symptom List (BSL). Results from this study supported a model in which there were significant indirect effects of both a lack of emotional clarity and limited access to emotion regulation strategies on features of BPD when accounting for negative affective intensity. Results also supported a second model in which there were significant indirect effects of both limited access to emotion regulation strategies and difficulties engaging in goal-directed behavior on features of BPD when accounting for negative affective reactivity. The results highlight important inter-relationships among features of BPD, difficulties regulating emotions, and negative affective intensity and reactivity.     

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.     

Differences in Emotion Regulation Difficulties Across Types of Eating Disorders During Adolescence

Emotion regulation appears to play a key role in eating disorders. However, prior attempts to associate specific emotion regulation abilities with specific types of eating disorders resulted in inconsistent findings. Moreover, far less is known about emotion regulation in eating disorders during adolescence, a critical period of emotional development. The current study addresses this gap, comparing emotion regulation characteristics between adolescents with restrictive types of eating disorders and those with binge eating or purging types of eating disorders. Ninety-eight adolescents with eating disorders (49 with restrictive and 49 with binge eating/purging eating disorders) completed a set of questionnaires including the Difficulties in Emotion Regulation Scale (DERS). The results revealed that binge eating/purging types of eating disorders were associated with greater difficulties in a variety of emotion regulation dimensions including impulse control, goal-directed behavior and access to effective emotion regulation strategies. Awareness and clarity of emotions were also worse in the binge eating/purging types of eating disorders, but this difference did not remain when comorbid psychopathology measures were controlled for. Moreover, the emotion regulation profile of adolescents with anorexia nervosa-binging/purging type was more similar to that of adolescents with bulimia nervosa than to that of adolescents with anorexia nervosa-restrictive type. While both restrictive and binge eating/purging eating disorders have been associated with emotion regulation difficulties, the current study shows that the presence of binge eating or purging episodes is linked with greater severity of emotion regulation deficits among adolescents with eating disorders.     

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.     

Emotion regulation mediates relationships between mindfulness facets and aggression dimensions

Recent years have witnessed an increase of research on socio-affective factors that can explain individual differences in aggressive tendencies across community and offender populations. Specifically, mindfulness and emotion regulation have emerged as important factors, which could also constitute important prevention and treatment targets. Yet, recent studies have advanced the possibility that mindfulness may also have a “dark” side, being associated with increased levels of aggression-related variables, especially when accounting for the variance associated with emotion regulation. The present study sought to elucidate relationships among mindfulness, emotion regulation, and aggression dimensions (i.e., verbal and physical aggression, anger, and hostility) across violent offender (N = 397) and community (N = 324) samples. Results revealed expected associations between both mindfulness and emotion regulation and aggression dimensions, such that greater impairments in mindfulness and emotion regulation were related to increased levels of aggression across samples. Further, analyses of indirect effects revealed that a latent emotion dysregulation factor accounted for (i.e., mediated) relationships between mindfulness facets and aggression dimensions in both samples. Previously reported positive associations between the residual variance in mindfulness scales (i.e., controlling for emotion regulation) and aggression-related variables were not replicated in the current samples. Taken together, findings suggest that mindfulness and emotion regulation have unequivocal relations with lower levels of aggression, and should therefore be considered as relevant targets for prevention and treatment programs aimed at reducing aggressive tendencies.