Using the Ball-in-Bowl Metaphor to Outline an Integrative Framework for Understanding Dysregulated Emotion

Dysregulated emotion plays an important role for mental health problems. To elucidate the underlying mechanisms, researchers have focused on the domains of strategy-based emotion regulation, psychophysiological self-regulation, emotion evaluations, and resulting emotion dynamics. So far, these four domains have been looked at in relative isolation from each other, and their reciprocal influences and interactive effects have seldom been considered. This domain-specific focus constrains the progress the field is able to make. Here, we aim to pave the way towards more cross-domain, integrative research focused on understanding the raised reciprocal influences and interactive effects of strategy-based emotion-regulation, psychophysiological self-regulation, emotion evaluations, and emotion dynamics. To this aim, we first summarize for each of these domains the most influential theoretical models, the research questions they have stimulated, and their strengths and weaknesses for research and clinical practice. We then introduce the metaphor of a ball in a bowl that we use as a basis for outlining an integrative framework of dysregulated emotion. We illustrate how such a framework can inspire new research on the reciprocal influences and interactions between the different domains of dysregulated emotion and how it can help to theoretically explain a broader array of findings, such as the high levels of negative affect in clinical populations that have not been fully accounted for by deficits in strategy-based emotion regulation and the positive long-term consequences of accepting and tolerating emotions. Finally, we show how it can facilitate individualized emotion regulation interventions that are tailored to the specific regulatory impairments of the individual patient.

Alexithymia and Facial Mimicry in Response to Infant and Adult Affect-Expressive Faces

Facial mimicry is the automatic tendency to imitate facial expressions of emotions. Alexithymia is associated with a reduced facial mimicry ability to affect expressions of adults. There is evidence that the baby schema may influence this process. In this study it was tested experimentally whether facial mimicry of the alexithymic group (AG) is different from the control group (CG) in response to dynamic facial affect expressions of children and adults. A multi-method approach (20-point Toronto Alexithymia Scale and Toronto Structured Interview for Alexithymia) was used for assessing levels of alexithymia. From 3503 initial data sets, two groups of 38 high and low alexithymic individuals without relevant mental or physical diseases were matched regarding age, gender, and education. Facial mimicry was induced by presentation of naturalistic affect-expressive video sequences (fear, sadness, disgust, anger, and joy) taken from validated sets of faces from adults (Averaged Karolinska Directed Emotional Faces) and children (Picture-Set of Young Children's Affective Facial Expressions). The videos started with a neutral face and reached maximum affect expression within 2 s. The responses of the groups were measured by facial electromyographic activity (fEMG) of corrugator supercilii and zygomaticus major muscles. Differences in fEMG response (4000 ms) were tested in a variance analytical model. There was one significant main effect for the factor emotion and four interaction effects for the factors group × age, muscle × age, muscle × emotion, and for the triple interaction muscle × age × emotion. The participants of AG showed a decreased fEMG activity in response to the presented faces of adults compared to the CG but not for the faces of children. The affect-expressive faces of children induced enhanced zygomatic and reduced corrugator muscle activity in both groups. Despite existing deficits in the facial mimicry of alexithymic persons, affect-expressive faces of children seem to trigger a stronger positive emotional involvement even in the AG.

Eating Motives and Other Factors Predicting Emotional Overeating during COVID-19 in a Sample of Polish Adults

We hypothesised that the higher levels of emotion-related predictors (eating motive in the form of affect regulation and COVID-19-related stress) would be associated with higher emotional overeating, after accounting for the effects of demographic variables (gender and BMI) and other eating motives (visual- and attitude-related predictors: liking, pleasure, visual appeal; body- and health-related predictors: need and hunger, health, weight control). Participants (N = 868; Mage = 33.53 years, SD = 11.98) completed: the Eating Motivation Survey, the Emotional Overeating Questionnaire, a COVID-19-related stress measure and a socio-demographic survey. The final step of the regression with emotional overeating was significant; affect regulation and COVID-19-related stress were significantly related to emotional overeating (ΔF p < 0.001, Adj. ΔR2 = 0.13). During the COVID-19 pandemic, eating can, on the one hand, help to cope with the current difficult situation and the negative emotions associated with it; on the other hand, frequent use of this tendency can lead to rigid regulation of affect and use of this mechanism as the dominant mechanism. Therefore, limited social contact, related disruptions in daily activities and stress resulting from COVID-19 should generate appropriate interventions, not necessarily focusing only on emotional eating, but also on the resources of the individual. It is worth encouraging specialists to implement alternative methods of contact with their patients, e.g., online.

Emotion-related constructs engaged by mindfulness-based interventions: A systematic review and meta-analysis

OBJECTIVES

Mindfulness-based interventions (MBIs) have been widely implemented to improve self-regulation behaviors, often by targeting emotion-related constructs to facilitate change. Yet the degree to which MBIs engage specific measures of emotion-related constructs has not been systematically examined.

METHODS

Using advanced meta-analytic techniques, this review examines construct and measurement engagement in trials of adults that used standardized applications of the two most established MBIs: Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT), or modified variations of these interventions that met defined criteria.

RESULTS

Seventy-two studies (N=7,378) were included (MBSR k=47, MBCT k = 21, Modified k=4). MBIs led to significant improvement in emotion-related processing overall, compared to inactive controls (d=0.58; k =36), and in all constructs assessed: depression (d=0.66; k=26), anxiety (d =0.63; k=19), combined mental health (d =0.75; k=7 ) and stress (d =0.44; k=11). Reactions to pain, mood states, emotion regulation, and biological measures lacked sufficient data for analysis. MBIs did not outperform active controls in any analyses. Measurement tool and population-type did not moderate results, but MBI-type did, in that MBCT showed stronger effects than MBSR, although these effects were driven by a small number of studies.

CONCLUSIONS

This review is the first to examine the full scope of emotion-related measures relevant to self-regulation, to determine which measures are most influenced by MBCT/MBSR. Compared to extant reviews, which typically focused on MBI outcomes, this work examined mechanistic processes based on measurement domains and tools. While effect sizes were similar among measurement tools, this review also includes a descriptive evaluation of measures and points of caution, providing guidance to MBI researchers and clinicians for selection of emotion-related measurement tools.

The Efficacy of Music for Emotional Wellbeing During the COVID-19 Lockdown in Spain: An Analysis of Personal and Context-Related Variables

The strict lockdown experienced in Spain during March-June 2020 as a consequence of the COVID-19 crisis has led to strong negative emotions. Music can contribute to enhancing wellbeing, but the extent of this effect may be modulated by both personal and context-related variables. This study aimed to analyze the impact of the two types of variables on the perceived efficacy of musical behaviors to fulfill adults' emotional wellbeing-related goals during the lockdown established in Spain. Personal variables included age, gender, musical training, personality, resilience, and perception of music's importance. Contextual variables referred to living in a region with a high COVID-19 impact, perception of belonging to a risk group, being alone, having caring responsibilities during confinement, and amount of time of music listening as compared to prior to the crisis. The study was conducted retrospectively during August-December 2020, when the strict lockdown was over in Spain. An online survey was disseminated among the general population and groups of musicians, and the answers of 507 adults (from 18 years on, 73.9% females, 51.3% musically trained adults) were analyzed. Only personal, but not COVID-19 context-related variables, showed an impact on music's efficacy. The youngest age group of adults and those with musical training reported the highest efficacy of music for wellbeing enhancement, and music's importance was found to be the main significant predictor of music's perceived efficacy. Our findings suggest that the people who have been reported to be emotionally more vulnerable during the lockdown, due to either a strong impact on their daily lives or their lower resilience, perceive a higher benefit from musical behaviors. Being musically trained, even for a small number of years, also leads to a perception of higher efficacy of music for the achievement of emotional wellbeing goals. However, this effect is explained by the musically trained individuals' higher perception of music's importance. Although musical behaviors can be generally considered as important for wellbeing enhancement, our study highlights who are the potential individuals who could benefit the most from music-related activities for obtaining better levels of wellbeing, at least within the current context of the COVID-19 crisis.

The terror of the good: working the edge of experience

This paper considers the topic of the 'good' within the literature and in clinical work. Milder forms of the good which arise on the personal level generate defences against personal vulnerability. More powerful forms of the good, which the author calls the 'truly good', arise on an archetypal level and overwhelm the ego, generating fear, even terror. The 'truly good' invokes defences against the dissolution of an intact sense of self. In both mild and intense forms, the good will arise in every analysis, will challenge boundaries of both client and analyst, and touch the core of the analytic relationship. It demands acknowledgement. Within these two categories, the author identifies five forms of the good that may arise in containable and uncontainable intensities: beauty, intimacy, becoming, love, and encounters with the divine. Exploring encounters with the good in its various forms expands the range of tolerable human experience - one of the fundamental goals of analysis. Living the good, or at times suffering the truly good, furthers individuation as it enlarges access to experiences of profound meaning, including the divine or the numinous.

Remote W.A.R.A. Compared With Face-to-Face W.A.R.A.: A Pilot Study

BACKGROUND

Since the outbreak of the COVID-19 pandemic and its social restriction measures, online therapy is a life-saving possibility for patients with acute stress. Wiring Affect with ReAttach (W.A.R.A.) is a brief psychological intervention aiming to decrease negative affect, that can be offered online.

METHODS

We assessed the effect of remote W.A.R.A. on negative affect in 37 patients. Consequently, we compared the effect of remote W.A.R.A. versus face-to-face W.A.R.A on negative affect in a cross-sectional design.

RESULTS

W.A.R.A. remote therapy provoked a significant reduction of negative affect with a large effect size (d = 3.08, p < 0.001). However, the reduction on negative affect was smaller than with W.A.R.A. face-to-face. We found a substantial difference between W.A.R.A. remote therapy and W.A.R.A. face-to-face in decrease of negative affect (d = 1.36, p < 0.001).

LIMITATIONS

The major limitation of the pilot-study is the sample size of 37 patients. Besides, we designed a numeric rating scale for evaluating negative affect. We investigated the impact on negative affect by assessing "unpleasant feelings." This conceptualization of negative affect might still be a point of discussion.

CONCLUSION

The study's findings indicated that W.A.R.A. remote therapy significantly reduced negative affect, but to a lesser extent than W.A.R.A. face-to-face. Nevertheless, W.A.R.A. remote therapy might offer a fast relief, especially when personal contact is difficult.

Emotion Regulatory Strategies in Complicated Grief: A Systematic Review

Prolonged grief disorder, characterized by severe, persistent, and disabling grief, has recently been included in the International Classification of Diseases-11 (ICD-11). Emotional disturbances are central to such complicated grief responses. Accordingly, emotion regulation is assumed critical in the development, persistence, and treatment of complicated grief. Yet, a comprehensive review on this topic is lacking. We conducted a systematic review (PROSPERO: CRD42017076061) searching PsycInfo, Web of Science, and PubMed to identify quantitative research examining relationships between emotion regulation and complicated grief. Sixty-four studies on 7,715 bereaved people were identified, focusing on a variety of emotion regulation strategies (i.e., experiential avoidance, behavioral avoidance, expressive suppression, rumination, worry, problem solving, cognitive reappraisal, positive thought, and mindfulness). Our synthesis showed strong evidence that experiential avoidance and rumination play a role in the persistence of complicated grief. More generally, surveys support positive associations between putative maladaptive emotion regulation strategies and complicated grief, and negative associations between putative adaptive emotion regulation strategies and complicated grief. Laboratory research yielded mixed results. Emotion regulation is critical in complicated grief, and in particular experiential avoidance and rumination form important targets in complicated grief treatments. We advise expanding current knowledge, by employing more advanced, intensive data collection methods and experiments across diverse samples. Increasing knowledge in this domain will improve clinical practice.

Reduced Hedonic Tone and Emotion Dysregulation Predict Depressive Symptoms Severity during the COVID-19 Outbreak: An Observational Study on the Italian General Population

The COVID-19 pandemic has spiked stress-related symptoms worldwide. This study aims to assess depressive symptoms related to the early phase of the COVID-19 outbreak among the Italian general population and to analyze anhedonia and emotion dysregulation as potential predictors of depression severity. Through an online questionnaire, we collected sociodemographic and lockdown-related information; depressive symptoms, hedonic tone, and emotion dysregulation were assessed through the Beck Depression Inventory II, the Snaith-Hamilton Pleasure Scale, and the Difficulties in Emotion Regulation Scale, respectively. In our sample (n = 500), 122 individuals (24.4%) reported depressive symptoms during the COVID-19 outbreak. Individuals with and without depression differed in gender (X2 = 4.77, df = 1, p = 0.02) and age (X2 = 15.7, df = 4, p = 0.003). Among individuals presenting with depressive symptoms, those reporting close contact with confirmed cases of COVID-19 were at higher risk for severe depression (p = 0.026). Reduced hedonic tone (p = 0.014) and emotion dysregulation (p < 0.001) also predicted depression severity. To the best of our knowledge, these are among the earliest data that focus on the risk for depression among a sizeable sample of the Italian general population during the COVID-19 outbreak. Our results indicate emotion dysregulation and reduced hedonic tone as potential factors predicting COVID-19-related depression severity and provide insight into developing targeted intervention policies.

The Role of Exercise in Management of Mental Health Disorders: An Integrative Review

A large and growing body of evidence suggests that physical activity (PA) may hold therapeutic promise in the management of mental health disorders. Most evidence linking PA to mental health outcomes has focused on the effects of aerobic exercise training on depression, although a growing body of work supports the efficacy of both aerobic and resistance exercise paradigms in the treatment of anxiety and post-traumatic stress disorder. Despite abundant evidence linking PA and mental health, use of exercise training as a mental health treatment remains limited due to three important sources of uncertainty: (a) large individual differences in response to exercise treatment within multiple mental health domains; (b) the critical importance of sustained PA engagement, not always achieved, for therapeutic benefit; and (c) disagreement regarding the relative importance of putative therapeutic mechanisms. Our review of treatment data on exercise interventions and mental health outcomes focuses primarily on depression and anxiety within a health neuroscience framework. Within this conceptual framework, neurobiological and behavioral mechanisms may have additiveor synergistic influences on key cognitive and behavioral processes that influence mental health outcomes. We therefore highlight sources of treatment heterogeneity by integrating the critical influences of (a) neurobiological mechanisms enhancing neuroplasticity and (b) behavioral learning of self-regulatory skills. Understanding the interrelationships between dynamic neurobiological and behavioral mechanisms may help inform personalized mental health treatments and clarify why, and for whom, exercise improves mental health outcomes. The review concludes with recommendations for future studies leveraging individual differences to refine treatment approaches to optimize mental health benefits.

Short Bouts of Physical Activity Are Associated with Reduced Smoking Withdrawal Symptoms, but Perceptions of Intensity May Be the Key

The primary aim of this study was to assess the effectiveness of a short bout (10 min) of moderate-intensity exercise to reduce withdrawal symptomatology, craving and negative affect; while the secondary aim was to assess how the effectiveness of a short bout of moderate exercise can be modulated by the perception of intensity in physically active and low-activity smokers. Fifty low-activity and physically active smokers were recruited (24 male and 26 female) and randomized in three different conditions. Prescribed (objective) moderate intensity (OBJ) and perceived moderate intensity (PER), and passive waiting (PW). After the intervention (T3), smokers reported less desire to smoke in the PER (p < 0.001) and OBJ (p < 0.001) conditions, relative to the PW condition. At T3 smokers in the PER condition reported less negative affect than smokers in the PW condition relative to the baseline (T1) (p < 0.007). Further, smokers in the PER condition reported less negative affect than smokers in the PW condition (p < 0.048). Physically active (PA) smokers perceived less exertion than low-activity (LA) smokers, and the effects were stronger in the PER condition relative to OBJ. Generally, our results suggest that a short bout of moderate exercise helps both LA and PA smokers. These findings provided a novel insight into the psychological mechanisms that affect the efficacy of the exercise in smoking cessation and suggest that exercise should be tailored according to individual perception of intensity.

Childhood Trauma, Personality, and Substance Use Disorder: The Development of a Neuropsychoanalytic Addiction Model

BACKGROUND

While traditional psychoanalysis has been criticized as insufficient for the treatment of substance use disorder (SUD), recent progress in the field of neuropsychoanalysis has generated new and promising hypotheses regarding its etiology. However, empirical research applying this framework has been sparse.

AIM AND SCOPE

The present overview aims at developing and empirically validating a neuroscientifically informed psychodynamic framework regarding the etiology of SUD. For this purpose, this review provides a concise overview of the most relevant historical and contemporary psychoanalytic theories on SUD etiology. Furthermore, the original research summarized in this paper consists of three studies investigating connections between childhood trauma, primary emotions, personality structure and attachment, as well as their relation to SUD development and treatment.

CONCLUSIONS

The results highlight the empirical validity of the neuropsychoanalytic approach towards SUD etiology. In particular, the findings underscore the conceptualization of SUD as a disorder related to dysfunctional attachment and affect regulation abilities especially linked to increased SADNESS and ANGER dispositions, which mediated the relationship between SUD and traumatic childhood relationships. Based on these findings, a refined model of SUD etiology is proposed, which should be tested in future studies.

The momentary interplay of affect, attention bias, and expectancies as predictors of binge eating in the natural environment

OBJECTIVE

Affect regulation, eating expectancies, and attention toward food-related cues are interrelated constructs that have been implicated in the maintenance of binge eating. While these processes show considerable temporal variability, the momentary associations between these domains have not been elucidated. This study examined a model that posited momentary fluctuations in affect, eating expectancies, and attention bias (AB) would interact to predict subsequent binge eating.

METHOD

Forty women who endorsed recurrent binge eating completed a 10-day ecological momentary assessment protocol with ambulatory measures of AB (i.e., dot-probe task with palatable food and neutral cues) and self-report assessments of positive and negative affect, eating expectancies (i.e., the belief that eating would improve one's mood), and binge-eating symptoms.

RESULTS

Generalized linear mixed models indicated higher momentary AB toward palatable food was associated with increased risk of subsequent binge eating, and a two-way interaction showed that moments of higher eating expectancies and negative affect were associated with increased likelihood of subsequent binge eating. Also, a three-way interaction emerged, in that the association between eating expectancies and subsequent binge eating was strongest at lower levels of positive affect and higher AB.

DISCUSSION

Together, findings partially supported hypotheses and demonstrate meaningful within-person fluctuations in AB that precede binge eating. Further, results demonstrate that the momentary influence of eating expectancies on binge eating depends on both affective state and attentional processes.

Is physical exercise and dietary therapy a feasible alternative to cognitive behavior therapy in treatment of eating disorders? A randomized controlled trial of two group therapies

OBJECTIVE

To compare effects of physical exercise and dietary therapy (PED-t) to cognitive behavioral therapy (CBT) in treatment of bulimia nervosa (BN) and binge-eating disorder (BED).

METHOD

The active sample (18-40 years of age) consisted of 76 women in the PED-t condition and 73 in the CBT condition. Participants who chose not to initiate treatment immediately (n = 23) were put on a waiting list. Outcome measures were the eating disorder examination questionnaire (EDE-Q), Clinical Impairment Assessment (CIA), Satisfaction with Life Scale (SWLS), Beck Depression Inventory (BDI), and numbers in remission at posttreatment, and at 6-, 12-, and 24-months follow-up.

RESULTS

Both treatment conditions produced medium to strong significant improvements on all outcomes with long-term effect. The PED-t produced a faster improvement in EDE-Q and CIA, but these differences vanished at follow-ups. Only PED-t provided improvements in BDI, still with no between-group difference. Totally, 30-50% of participants responded favorable to treatments, with no statistical between-group difference.

DISCUSSION

Both treatments shared a focus on normalizing eating patterns, correcting basic self-regulatory processes and reducing idealized aesthetic evaluations of self-worth. The results point to the PED-t as an alternative to CBT for BN and BED, although results are limited due to compliance and dropout rates. Replications are needed by independent research groups as well as in more clinical settings.

Situation selection and cognitive conflict: explicit knowledge is necessary for conflict avoidance

Humans transform their environment in order to regulate their own affect. One way to do so is to avoid situations that come with negative rather than positive affect. This selection might not solely bear on expectations of full-blown emotions, but may also be invoked by anticipating the aversiveness of cognitive conflict, when a situation suggests competing behavioural responses. If cognitive conflict is indeed aversive, it may trigger affect regulation goals, which in turn influence choices of situations depending on the magnitude of conflict they contain. People should prefer actions that produce conflict-free situations to actions that produce conflicting situations. In three experiments, participants had to solve a Stroop task by freely choosing between response keys that were either associated with low-conflict or high-conflict in the subsequent trial. We find that people do not automatically prefer actions associated with conflict-free situations to actions that are associated with conflicting situations. They only do so, when they are explicitly informed about the contingency between action and congruency of an upcoming situation. This suggests that cognitive conflict, at least at the level of a standard conflict task as used here, is insufficient to invoke affect regulation processes.

Mental Health and Affect Regulation Impairment in Fetal Alcohol Spectrum Disorder (FASD): Results from the Canadian National FASD Database

AIMS

Individuals with fetal alcohol spectrum disorder (FASD) frequently have challenges with regulating emotional arousal, or affect regulation (AR), and experience high rates of mental health disorders. This study examined children and adults with FASD to investigate the relationship between AR impairment and several mental health problems and diagnoses.

METHODS

Data from the Canadian national FASD database was used for analysis. Seven mental health diagnoses, including attention-deficit/hyperactivity disorder, post-traumatic stress disorder, conduct disorder, attachment disorder, intellectual disability, and language disorder were examined. A history of suicidality was also examined. The prevalence of these mental health problems in individuals with and without AR impairment was compared.

RESULTS

Individuals with FASD and AR impairment were significantly more likely to be diagnosed with conduct disorder (OR 4.8), attachment disorder (OR 6.1), or post-traumatic stress disorder (OR 8.1) when compared to those without AR impairment. They were also more likely to have a history of suicidality (OR 8.6). AR impairment was most commonly found in those with greater overall neurodevelopmental impairment. Having AR impairment was associated with receiving a diagnosis of FASD at a later age, but was not related to gender, intellectual disability, or language disorder.

CONCLUSION

AR impairment is strongly related to several mental health diagnoses in those with FASD and presents some promising possibilities for targeted early intervention.

Cognitive Reappraisal Facilitates Decentering: A Longitudinal Cross-Lagged Analysis Study

Previous studies have suggested that cognitive reappraisal, which is an effective emotion regulation strategy, enhances decentering. On the other hand, other studies have implied the reverse in regard to this relationship: that decentering supports cognitive reappraisal. However, these possibilities have not yet been examined empirically. In the present study, we investigated the causal relationship between decentering and cognitive reappraisal by conducting two wave cross-lagged analysis. One hundred and thirty-eight Japanese university students responded to a questionnaire comprising measures of decentering and cognitive reappraisal tendency; the questionnaire was administered on two occasions, with an interval of 1 month. Cross-lagged analysis indicated the positive effect of cognitive reappraisal on decentering; however, the reverse possibility, that decentering influences cognitive reappraisal, was not significant. These results suggested that habitual use of cognitive reappraisal fosters decentering.

Opening the closed heart: affect-focused clinical work with the victims of early trauma

This paper begins with the understanding that early trauma leads to powerful dissociative defenses which injure the capacity to feel. It further explores ways to restore this capacity through body-centred attention to affect-in-the-moment in the psychoanalytic situation. Using the author's personal experience while in analysis as well as a case of severe early trauma, he demonstrates the consciousness-killing effect of primitive defenses and shows how body-sensitive techniques hold the promise of restoring the patient's sense of aliveness and hence, opening the unconscious to those affect-images that are the building blocks of the human imagination. A final section focuses on the neglect of feeling in Jungian psychology and suggests that the "creation of consciousness" which Jung described as his personal myth, is quintessentially a process of emotional transformation - of bringing unconscious suffering into consciousness - as feelings.

A Scientometric Review of Alexithymia: Mapping Thematic and Disciplinary Shifts in Half a Century of Research

The term "alexithymia" was introduced in the lexicon of psychiatry in the early '70s by Sifneos to outline the difficulties manifested by some patients in identifying and describing their own emotions. Since then, the construct has been broadened and partially modified. Today this describes a condition characterized by an altered emotional awareness which leads to difficulties in recognizing your own and others' emotions. In half a century, the volume of scientific products focusing on alexithymia has exceeded 5,000. Such an expansive knowledge domain poses a difficulty for those willing to understand how alexithymia research has developed. Scientometrics embodies a solution to this issue, employing computational, and visual analytic methods to uncover meaningful patterns within large bibliographical corpora. In this study, we used the CiteSpace software to examine a corpus of 4,930 publications on alexithymia ranging from 1980 to 2020 and their 100,251 references included in Web of Science. Document co-citation analysis was performed to highlight pivotal publications and major research areas on alexithymia, whereas journal co-citation analysis was conducted to find the related editorial venues and disciplinary communities. The analyses suggest that the construct of alexithymia experienced a gradual thematic and disciplinary shift. Although the first conceptualization of alexithymia came from psychoanalysis and psychosomatics, empirical research was pushed by the operationalization of the construct formulated at the end of the '80s. Specifically, the development of the Toronto Alexithymia Scale, currently the most used self-report instrument, seems to have encouraged both the entrance of new disciplines in the study of alexithymia (i.e., cognitive science and neuroscience) and an implicit redefinition of its conceptual nucleus. Overall, we discuss opportunities and limitations in the application of this bottom-up approach, which highlights trends in alexithymia research that were previously identified only through a qualitative, theory-driven approach.

A quest for self-soothing: A systematic case study into emotion-focused therapy with an emotionally avoidant client who committed sexual offenses

OBJECTIVE

The current study is part of a multiple case study that investigated the emotional change in individuals who have committed sexual offenses (ISOs). This case study highlights how one client used sex as a maladaptive coping strategy to suppress negative emotions.

METHOD

A mixed-methods design was used to track changes in the client's affect regulation (AR) during four phases, including a baseline (Phase A), treatment as usual (Phase B), treatment with an emotion-focused therapy (EFT) component added (Phase C), and follow up (Phase A).

RESULTS

The qualitative description with verbatim clinical vignettes, revealed deeper insight into some important steps and hindrances and the impact of specific EFT-interventions. Quantitative analysis of self-report and observational measures showed a significant improvement in the client's AR across different phases of treatment.

CONCLUSIONS

The study improves our knowledge of the emotional change in ISOs during treatment and illustrates some key interventions, steps, and hindrances.

Into the Wild, Out of the Woods: A Systematic Case Study on Facilitating Emotional Change

Cognitive and behavioral treatment programs for individuals who have committed sexual offenses (ISOs) have shown significant but small effect sizes. A growing body of research points toward the importance of difficulties in affect regulation (AR) as a risk factor for sexual recidivism. On this basis, it seems important to target difficulties in AR in treatment. The current systematic case study investigates the potential contribution of emotion-focused therapy (EFT) to changing problematic AR in ISOs. Kevin was a high-risk offender with a traumatic history who met the diagnostic criteria of pedophilic and borderline disorders, with serious AR difficulties. Self-report outcome measures, observation measures, and a biomarker were used to track changes in AR, psychological symptoms, and distress during baseline (Phase A); treatment as usual (Phase B); treatment with an EFT component added (Phase C); and follow-up (Phase A). Statistically significant change was found in AR, psychological symptoms, and distress during treatment (Phase B + C); however, it is not possible to attribute these changes causally to EFT. An examination of the qualitative process data provides deeper insights into how the client reacted to specific EFT interventions. Verbatim clinical vignettes are included to clarify key interventions, hindrances, and mechanisms of change. This study provides preliminary support for the role of therapy to facilitate emotional change in ISOs.

Mentalizing Self and Other and Affect Regulation Patterns in Anorexia and Depression

The study aimed to examine two constructs: general mentalizing processes and the specific component of affective mentalizing regarding self and others alongside the construct of affect regulation patterns in female adolescent and young adult inpatients with anorexia nervosa (AN; n = 41), depression (n = 20) and controls (n = 53). We further examined the predictive ability of affect regulation to eating-disorder (ED) symptoms beyond that of the mentalizing variables, and their potential role in mediating between mentalizing, depression and ED symptoms. We used tools assessing reflective functioning (RF), complex emotion recognition and theory of mind (ToM), alexithymia, affect regulation, depression, and ED symptoms. The AN and depression groups exhibited lower general mentalizing and higher alexithymia, emotional reactivity, and emotional cutoff patterns than controls, but showed no greater disturbance in ToM. The two clinical groups did not differ on any of these variables. Elevated mentalizing and adequate affect regulation patterns separately predicted lower severity of ED symptoms. Nonetheless, affect regulation did not add to the predictive value of mentalizing variables. Specifically, elevated alexithymia, and depressive symptomatology, but not RF, predicted greater ED symptomatology. Moreover, alexithymia directly accounted for elevated ED symptoms and also indirectly connected with ED symptoms via emotional hyperactivation and elevated depressive symptoms. These findings suggest that deficiencies in mentalization and affect regulation are not unique to AN, but may rather associated with psychopathology in general. Nonetheless, alexithymia and depression may increase ED-related symptomatology. Affect regulation deficiencies are mainly related with depressive symptoms and emotional hyperactivation is indirectly related with AN via the depressive symptoms.

Examining the role of therapists' empathy and clients' attachment styles on changes in clients' affect regulation and outcome in the treatment of depression

Objective: The purpose of this study was to test whether changes in clients' affect regulation capacity (AR) mediated the impact of therapists' empathy on outcome and whether this relationship was stronger for more insecurely than securely attached clients. Method: The data set included 66 clients, who had participated in 16 weeks of either CBT or EFT for depression. Clients' AR was assessed using an observer and a self-report measure. Results: Changes in AR significantly mediated the relationship between therapists' empathy and outcome for depression, dysfunctional attitudes and self-esteem but not interpersonal problems, and changes in AR were moderated by clients' insecure attachment styles. Conclusions: The findings provide support for therapists' empathy as an active ingredient of change contributing to changes in clients' affect regulation capacities and emphasize the importance of assessing clients' attachment styles so that therapists can be more responsive and effectively tailor their treatments to fit the needs of individual clients.

Mental illness and well-being: an affect regulation perspective

Mental health crucially depends upon affective states such as emotions, stress responses, impulses and moods. These states shape how we think, feel and behave. Often, they support adaptive functioning. At other times, however, they can become detrimental to mental health via maladaptive affect generation processes and/or maladaptive affect regulation processes. Here, we present an integrative framework for considering the role of affect generation and regulation in mental illness and well-being. Our model views affect generation as an iterative cycle of attending to, appraising and responding to situations. It views affect regulation as an iterative series of decisions aimed at altering affect generation. Affect regulation decisions include identifying what, if anything, should be changed about affect, selecting where to intervene in the affect generation cycle, choosing how to implement this intervention, and monitoring the regulation attempt to decide whether to maintain, switch or stop it. Difficulties with these decisions, often arising from biased inputs to them, can contribute to manifestations of mental illness such as clinical symptoms, syndromes and disorders. The model has a number of implications for clinical assessment and treatment. Specifically, it offers a common set of concepts for characterizing different affective states; it highlights interactions between affect generation and affect regulation; it identifies assessment and treatment targets among the component processes of affect regulation; and it is applicable to prevention and treatment of mental illness as well as to promotion and restoration of psychological well-being.

The Influence of Attachment Styles and Personality Organization on Emotional Functioning After Childhood Trauma

Background: Current literature suggests a tenuous link among childhood trauma, personality organization, adult attachment, and emotional functioning in various psychiatric disorders. However, empirical research focusing on the interaction of these concepts is sparse. Therefore, this study intends to investigate the influence of personality organization and attachment dimensions on the relationship between childhood maltreatment and emotional functioning in adult life. To assess emotional functioning, we adopted the Affective Neuroscience model of primary emotions, comprising SEEKING, FEAR, ANGER, SADNESS, CARE, and PLAY. Methods: The total sample consisted of 616 nonclinical adults (Age: M = 30; SD = 9.53; 61.9% female). Path analysis was applied to investigate interactions among childhood trauma, personality organization, adult attachment, and primary emotion dispositions. Results: The findings suggest that childhood trauma significantly predicted deficits in personality organization and insecure attachment (all p < 0.001). Furthermore, a reduced level of personality organization was significantly associated with increased ANGER (p < 0.001), whereas adult attachment substantially predicted primary emotion dispositions in general. Moreover, the results indicate significant mediational effects of personality organization and attachment dimensions on the relationship between childhood trauma and primary emotions (p < 0.01). The final model was able to explain 48% of the variance in SADNESS, 38% in PLAY, 35% in FEAR, 28% in CARE, 14% in ANGER, and 13% in SEEKING. Discussion: The findings contribute to the understanding of the relationship between childhood maltreatment and impaired emotional functioning in adult life. Furthermore, the importance of personality organization and attachment dimensions for emotion regulation is underlined. Consequently, the treatment of patients with childhood trauma should focus on facilitating the development of more secure attachment patterns and increased personality functioning to improve overall emotional functioning.