Emotion malleability beliefs, emotion regulation, and psychopathology: Integrating affective and clinical science

How I think about how I feel: Personal beliefs about emotion prospectively predict suicide-related outcomes and depression symptoms

One transdiagnostic process that may be critical to depression and suicidal ideation is beliefs about the nature of one's own emotions, both concurrently and longitudinally. In a sample of community adults (n = 143), we assessed personal emotion beliefs about the degree to which one's own emotions are malleable, unique, and last a long time. There were significant associations between stronger views that one's own emotions were fixed, unique to you, and had a longer duration and higher clinical symptom severity, including higher levels of current suicidal ideation, and less adaptive emotion regulation. Mediation analyses using longitudinal data clarified that the differential engagement in emotion regulation, specifically rumination, represented the link tying specific personal emotion beliefs to clinical symptoms and that, in certain cases, the opposite pathway is also significant - differences in clinical symptoms mediated the relationship between specific personal emotion beliefs and emotion regulation (rumination) longitudinally. Additionally, personal emotion beliefs varied based on depression status, as determined using a semi-structured clinical interview. For example, individuals meeting current criteria for Major Depressive Disorder (MDD) held stronger views that their emotions were unique to them compared to individuals with remitted MDD or no history of MDD. The current study's findings highlight the important role of specific personal emotion beliefs in clinical symptoms concurrently and longitudinally and mechanisms in these relationships. These results could guide future research on interventions to promote more adaptive beliefs about emotion to improve clinical outcomes.

Predictive utility of emotional regulation abilities for assessing cognitive improvement in depression

OBJECTIVE

To construct a predictive model for the improvement of cognitive function in patients with depressive disorder treated with SNRIs, based on emotional regulation abilities, and to provide personalized treatment for depressed patients.

METHODS

Clinical data from 170 patients with depressive disorder treated with SNRIs at Tongji Hospital, Shanghai, from December 2017 to May 2023 were collected. Based on whether the MoCA-B total score at 3-6 months post-treatment was at least 2 points higher than at baseline, patients were divided into the cognitive function improved group (n = 80) and the cognitive function not improved group (n = 90). Stepwise logistic regression and LASSO regression were used to select predictive factors, and logistic regression analysis was applied to construct predictive models solely based on emotional regulation abilities, combined with executive functions and HAMD scores. The models were further validated through Bootstrap internal validation, calibration curve plotting, and C-index calculation, and a comparison between the two models was performed.

RESULTS

An ER model with an area under the ROC curve of 0.817was established using four emotional regulation ability indicators: the valence of reappraised images, the arousal of negative images, the arousal of neutral images, and the success of reappraisal (arousal). Internal validation using Bootstrap showed a C index of 0.817, and clinical decision curves indicated that this model has a significant net benefit with a probability of improved cognitive function ranging from about 20 to 85%. Additionally, an EREH model including emotional regulation ability, executive function, and HAMD score as predictors was constructed using Lasso and logistic regression methods. This model reached an area under the ROC curve of 0.859and clinical decision curves showed high net benefits with probabilities of improved cognitive function ranging from 10 to 100%. The calibration curves of both models coincided well with the actual curves, with the latter having a higher AUC and significant statistical differences between the two models.

CONCLUSION

This study suggests that emotional regulation ability may serve as a predictor for the improvement of cognitive functions in patients with depression depressive disorder treated with SNRIs. However, it is important to note that there may be other factors not covered or included in this study.The predictive model that includes executive functions and HAMD scores offers better differentiation and consistency and is more feasible in clinical practice.

Associations Between Parents' Cognitions About Child Anxiety and Emotion Dysregulation in Clinically Anxious Children: The Unique Contribution of Fathers

This study examined the influence of parental cognition, including attitudes, beliefs, and understanding of anxiety, on emotion dysregulation in children with anxiety disorder. A total of 47 clinically anxious children (6-17 years old) and their parents were involved in the current study. The mothers and fathers separately completed a self-reported questionnaire assessing their attitudes, beliefs, and understanding of their children's anxiety, while the children completed a self-report questionnaire assessing emotion dysregulation. Pearson correlation and hierarchical regression analyses were used for data analysis. The results indicated that only fathers' higher levels of unhelpful attitudes, beliefs, and understanding of anxiety were positively and significantly associated with greater emotion regulation (ER) difficulties in anxious children. Furthermore, fathers' unhelpful cognitions regarding anxiety uniquely predicted their children's emotion regulation difficulties. These findings highlight the importance of including fathers in preventive and therapeutic interventions in promoting ER abilities in children with anxiety disorder.

Dimensions of Emotion Regulation as Mediators of the Relationship Between Emotion Controllability Beliefs With Stress and Well-Being

Although beliefs about the extent to which emotions are amenable versus immutable to control (i.e., implicit theories of emotion) have been linked to various mental health indices, mediators of this relationship remain unclear. This study extends prior research by examining dimensions of emotion regulation (ER) difficulties as parallel mediators in the relationship between emotion controllability beliefs and stress and well-being among university students (n = 483). Higher emotion controllability beliefs were found to be associated with fewer difficulties in emotional clarity, emotional acceptance, effective ER strategy access, impulse control, and goal-directed behaviour. Moreover, the relationship between emotion controllability beliefs and stress and well-being was mediated by emotional clarity and strategy access. Results implicate difficulties understanding one's own emotions and accessing effective ER strategies as key mechanisms through which lower emotion controllability beliefs may be associated with higher stress and lower well-being. Conversely, better emotional clarity and greater access to effective ER strategies may explain why higher emotion controllability beliefs are associated with better mental health. The present study provides support for the role of implicit theories of emotion in clarifying patterns of adaptive versus maladaptive emotional responding, and sheds light on the cognitive processes underlying individual differences in emotion regulation and mental health. Furthermore, findings offer novel insight regarding the specific emotion regulatory mechanisms through which emotion controllability beliefs may be associated with mental health.

Emotion Regulation Frequency and Self-Efficacy: Differential Associations with Affective Symptoms

Successful emotion regulation is a critical component of mental health, and difficulties with emotion regulation have been associated with a wide range of disorders, including anxiety and depressive disorders. However, although much is known about commonly used forms of emotion regulation such as cognitive reappraisal and expressive suppression, the relative contribution of two important facets of emotion regulation-frequency and self-efficacy-is not yet clearly established. To address this issue, we conducted two studies. Study 1 employed a community sample (cross-sectional N = 431; 4- to 5-month longitudinal N = 182). Study 2 employed a clinical sample (cross-sectional N = 132). Both assessed emotion regulation frequency and self-efficacy, as well as affective outcomes (anxiety and depressive symptoms). Findings indicated cognitive reappraisal self-efficacy appears to be a relevant variable understanding negative affect outcomes, cross-sectionally, longitudinally and in the clinical sample. Our findings support the process model of emotion regulation in affective symptomatology. Implications for theory and treatment are discussed.

Emotion malleability beliefs matter in emotion regulation: a comprehensive review and meta-analysis

Individuals' beliefs about the malleability of emotions have been theorised to play a role in their psychological distress by influencing emotion regulation processes, such as the use of emotion regulation strategies. We conducted a meta-analysis to test this idea across studies with a focus on the relationships between emotion malleability beliefs and five distinct emotion regulation strategies: cognitive reappraisal, suppression, avoidance, rumination, and acceptance. Further, using two-stage meta-analytic structural equation modelling (TSSEM), we examined whether the emotion regulation strategies mediate the cross-sectional relationship between emotion malleability beliefs and psychological distress across studies. Thirty-seven studies were included in the meta-analyses and 55 cross-sectional studies were included in the TSSEM. Results demonstrated that, across studies, emotion malleability beliefs were significantly associated with greater use of putatively helpful strategies (particularly with cognitive reappraisal) and less use of putatively unhelpful strategies (particularly with avoidance). The use of cognitive reappraisal and avoidance partially mediated the relationship between emotion malleability beliefs and psychological distress. These results highlight the importance of considering beliefs about the malleability of emotions in the context of emotion regulation. These findings suggest the potential role of emotion malleability beliefs in interventions for individuals with emotion regulation-related difficulties and psychological distress.

Effects of a Parent-Child Single-Session Growth Mindset Intervention on Adolescent Depression and Anxiety Symptoms: Protocol of a 3-Arm Waitlist Randomized Controlled Trial

BACKGROUND

Depression and anxiety are common mental health problems among adolescents worldwide. Extant research has found that intelligence, emotion, and failure-is-debilitating beliefs (fixed mindsets) are closely related to more depression and anxiety symptoms, hopelessness, and suicidality. Recent research also points to the importance of parental mindset, which can strongly influence children's affect, behavior, and mental health. However, the effects of parent-child mindset interventions on a child's internalizing problems have not yet been empirically examined. As recent evidence has shown the promise of single-session interventions in reducing and preventing youth internalizing problems, this study develops and examines a parent and child single-session intervention on mindsets of intelligence, failure, and emotion (PC-SMILE) to tackle depression and anxiety in young people.

OBJECTIVE

Using a 3-arm randomized controlled trial, this study will examine the effectiveness of PC-SMILE in reducing depression and anxiety symptoms among children. We hypothesize that compared to the waitlist control group, the PC-SMILE group and child single-session intervention on mindsets of intelligence, failure, and emotion (C-SMILE) group will significantly improve child depression and anxiety (primary outcome) and significantly improve secondary outcomes, including children's academic self-efficacy, hopelessness, psychological well-being, and parent-child interactions and relationships, and the PC-SMILE is more effective than the C-SMILE.

METHODS

A total of 549 parent-child dyads will be recruited from 8 secondary schools and randomly assigned to either the PC-SMILE intervention group, the C-SMILE intervention group, or the no-intervention waitlist control group. The 45-minute interventions include parent-version and child-version. Both parents and students in the PC-SMILE group receive the intervention. Students in C-SMILE group receive intervention and their parents will receive intervention after all follow-up ends. Students in 3 groups will be assessed at 3 time points, baseline before intervention, 2 weeks post intervention, and 3 months post intervention, and parents will be assessed in baseline and 3-month follow-up. The intention-to-treat principle and linear-regression-based maximum likelihood multilevel models will be used for data analysis.

RESULTS

Recruitment started in September 2023. The first cohort of data collection is expected to begin in May 2024 and the second cohort will begin in September 2024. The final wave of data is expected to be collected by the end of the first quarter of 2025. The results are expected to demonstrate improved anxiety and depression among students assigned to the intervention condition, as well as the secondary outcomes compared to those in the control group. The efficacy and effectiveness of the intervention will be discussed.

CONCLUSIONS

This study is the first attempt to develop a web-based single-session intervention for students and their parents to enhance their well-being in Hong Kong and beyond, which potentially contributes to providing evidence-based recommendations for the implementation of brief digital parent-child interventions.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/63220.

Modeling the associations between emotion regulation, suicide crisis syndrome and suicidal behavior: Results in community and clinical samples

BACKGROUND

Emotion Regulation (ER) and Suicide Crisis Syndrome (SCS) are psychological processes involved in suicide. Within ER, both the use of rumination and dysfunctional emotion beliefs are associated with suicide. SCS, a pre-suicidal mental state involving cognitive and affective dysregulation, is related to short-term suicide risk.

AIMS

Here, we first examined associations between ER (beliefs about the uncontrollability of emotions and rumination), SCS and suicide behavior, and second, we test a multistep model in which ER factors are linked to suicide behavior through SCS.

MATERIALS & METHODS

We conducted two cross-sectional studies to address this issue by self-reports. Study 1 used a community sample (N = 421). Study 2 used a clinical sample (N = 70).

RESULTS

Results from both studies showed that beliefs about the uncontrollability of emotions and rumination were associated with higher levels of SCS symptoms and suicide behavior, and that SCS was associated with suicide behavior. In addition, path analyses showed that uncontrollability beliefs were linked to rumination, which in turn was associated with SCS, and this variable mediated the association between ER factors and suicide ideation (in both community and clinical samples) and suicide attempts (in the community sample).

DISCUSSION

As we expected, in both samples, uncontrollability of emotions and rumination were positively related with SCS and suicide behavior.

CONCLUSION

We emphasize the importance of addressing uncontrollability beliefs and rumination in suicide prevention.

Childhood maltreatment and Internet addiction among Chinese adolescents: A moderated mediation model

Although childhood maltreatment has been suggested to play an important role in developing Internet addiction among adolescents, little is known about the mediating and moderating mechanisms underlying this association. The present study investigated (a) the mediating role of maladaptive cognitive emotion regulation strategy (MCERS) in the association between childhood maltreatment and Internet addiction, and (b) the moderating role of peer support in the relationship between childhood maltreatment and Internet addiction. A sample of 4163 Chinese adolescents (50.3 % females, Mage = 14.25, SD = 1.53) were recruited. The moderated mediation model showed that MCERS mediated the relationship between childhood maltreatment and Internet addiction. Furthermore, the mediating process was moderated by peer support. Interestingly, peer support can protect adolescents from being affected by higher levels of MCERS while it displays limited protective effect when adolescents suffered from higher levels of childhood maltreatment. These findings indicate that reducing the MCERS and enhancing peer support can contribute to the alleviation of negative influences of childhood maltreatment on Internet addiction.

Emotion beliefs: conceptual review and compendium

Laypeople hold richly divergent beliefs about emotion, and these beliefs are consequential. Specific forms of belief that have been investigated include the usefulness, contagiousness, duration, dependence upon intersubjective experience, cognitively mediated properties, malleability, and hindering properties of emotion, just to name a few. Progress in this emerging sub-field of research has been hampered by the lack of a widely accepted definition of emotion belief able to capture all of these dimensions. Correspondingly, there has been a proliferation of different terminologies, constructs, and measures. The present review aims to address these obstacles by defining emotion belief, and subsequently re-considering existing constructs and measures that align with this definition. The latter is presented in the form of a comprehensive compendium of 21 different constructs and associated self-report measures that assess varying components of one's beliefs about emotions in general and/or about their own emotions, and an additional 5 scales that were designed to measure one's beliefs about another's emotions. From the more unified conceptualization of emotion belief presented here, critical areas of future research are highlighted.

Single-session intervention on growth mindset on negative emotions for university student mental health (U-SIGMA): a protocol of two-armed randomized controlled trial

BACKGROUND

The university years are a developmentally crucial phase and a peak period for the onset of mental disorders. The beliefs about the changeability of negative emotion may play an important role in help-seeking. The brief digital growth mindset intervention is potentially scalable and acceptable to enhance adaptive coping and help-seeking for mental health needs in university students. We adapted the Single-session Intervention on Growth Mindset for adolescents (SIGMA) to be applied in university students (U-SIGMA). This protocol introduces a two-armed waitlist randomized controlled trial study to examine the effectiveness and acceptability of U-SIGMA in promoting help-seeking among university students in the Greater Bay Area.

METHODS

University students (N = 250, ages 18-25) from universities in the Greater Bay Area will be randomized to either the brief digital growth mindset intervention group or the waitlist control group. Participants will report on the mindsets of negative emotions, perceived control over anxiety, attitude toward help-seeking, physical activity, hopelessness, psychological well-being, depression, anxiety, and perceived stress at baseline and the 2-week and 8-week follow-ups through web-based surveys. A 30-min digital intervention will be implemented in the intervention group, with a pre- and post-intervention survey collecting intervention feedback, while the control group will receive the link for intervention after 8 weeks.

DISCUSSION

This protocol introduces the implementation plan of U-SIMGA in multi-cities of the Greater Bay Area. The findings are expected to help provide pioneer evidence for the effectiveness and acceptability of the brief digital intervention for university students in the Chinese context and beyond and contribute to the development of accessible and effective prevention and early intervention for university students' mental health.

TRIAL REGISTRATION

HKU Clinical Trials Registry: HKUCTR-3012; Registered 14 April 2023.  http://www.hkuctr.com/Study/Show/7a3ffbc0e03f4d1eac0525450fc5187e .

The association between emotion malleability beliefs and severe psychological distress stratified by sex, age, and presence of any psychiatric disorders

Background

Recent studies have shown an association between psychological distress and emotion malleability beliefs, meaning mindsets about whether one's emotions are fixed or changeable. However, most studies have not examined the association between these beliefs and sociodemographic factors.

Methods

A nationwide cross-sectional Internet survey of residents of Japan aged 15-79 years was conducted using sampling weights for national estimates to investigate the association between emotion malleability beliefs and sociodemographic factors and between fixed beliefs and severe psychological distress (SPD). SPD was defined as a Kessler 6 Scale score of ≥13. Adjusted odds ratios for SPD were calculated considering potential confounders. Further analyses were stratified by sex, age and presence of any psychiatric disorder.

Results

The analysis included 23,142 participants (female, 48.64%). Fixed beliefs were associated with female sex, age < 45 years, and presence of psychiatric disorders. These beliefs were associated with SPD, and additional analysis showed stronger associations with SPD among female respondents, respondents aged 45-59 years, and those aged ≥60 years.

Conclusion

Results indicate that female sex, age < 45 years, and current mental disorders were associated with fixed emotion malleability beliefs. Associations between fixed emotion malleability beliefs and SPD were particularly strong among female respondents and people aged ≥45 years compared with the general population. Our study extends the association between emotion malleability beliefs and psychological health to the general population. Future studies should explore mechanisms underlying individual differences in emotion beliefs.

How do fundamental emotion beliefs affect the rapid emotional processing? An ERP study

Beliefs about whether emotions are good or bad, controllable or uncontrollable are two fundamental emotion beliefs. Studies have confirmed the link between the two beliefs and emotional responses, but how emotion beliefs affect the process from emotional stimulus perception to emotion generation and automatic regulation is unclear. Answering this question helps to understand the role of emotion beliefs in emotional dysfunction and dysregulation and can provide a basis for effective emotion regulation. Therefore, the current study used event-related potential (ERP) measures to examine the time course and neural mechanisms by which emotional beliefs influence the processing of emotional pictures. One hundred participants were divided into four groups (25 per group) according to controllable or uncontrollable beliefs about emotions and good or bad beliefs about negative emotions, and viewed emotional negative and neutral pictures. Results showed that P2 was more positive in participants with emotion controllable vs. uncontrollable belief. The early posterior negativity (EPN) was more negative for unpleasant than neutral images in participants with emotion good and controllable beliefs as well as with bad and uncontrollable beliefs. On late positive potential (LPP), middle LPP (500-1000ms) was more positive in emotion good vs. bad belief holders and the late LPP (1000-2000 ms) was more positive for negative than neutral images in emotion uncontrollable belief holders. The findings suggest that fundamental emotion beliefs can affect individuals' early attention and late meaning evaluation towards unpleasant stimuli. Furthermore, they provide insight into altered beliefs about emotion in people with emotion dysfunction or dysregulation.

Framing depression as a functional signal, not a disease: Rationale and initial randomized controlled trial

Depression is often framed as a disease or dysfunctional syndrome, yet this framing has unintended negative consequences including increased stigma. Here, we consider an alternative messaging framework - that depression serves an adaptive function. We describe the historical development of popular messages about depression and draw from the fields of evolutionary psychiatry and social cognition to describe the alternative framework that depression is a "signal" that serves a purpose. We then present data from a pre-registered, online randomized-controlled study in which participants with self-reported depression histories viewed a series of videos that explained depression as a "disease like any other" with known biopsychosocial risk factors (BPS condition), or as a signal that serves an adaptive function (Signal condition). In the entire sample (N = 877), three of the six hypotheses were supported: The Signal condition led to less self-stigma, greater offset efficacy, and more adaptive beliefs about depression. Exploratory analyses revealed these Signal effects were stronger among females (N = 553), who also showed a greater growth mindset of depression after the Signal explanation. Results suggest that framing depression as an adaptive signal can benefit patients and avoid harmful consequences of popular etiological presentations. We conclude that alternative framings of depression are worthy of further study.

Emotion Controllability Beliefs and Young People's Anxiety and Depression Symptoms: A Systematic Review

Emotion regulation is a powerful predictor of youth mental health and a crucial ingredient of interventions. A growing body of evidence indicates that the beliefs individuals hold about the extent to which emotions are controllable (emotion controllability beliefs) influence both the degree and the ways in which they regulate emotions. A systematic review was conducted that investigated the associations between emotion controllability beliefs and youth anxiety and depression symptoms. The search identified 21 peer-reviewed publications that met the inclusion criteria. Believing that emotions are relatively controllable was associated with fewer anxiety and depression symptoms, in part because these beliefs were associated with more frequent use of adaptive emotion regulation strategies. These findings support theoretical models linking emotion controllability beliefs with anxiety and depression symptoms via emotion regulation strategies that target emotional experience, like reappraisal. Taken together, the review findings demonstrate that emotion controllability beliefs matter for youth mental health. Understanding emotion controllability beliefs is of prime importance for basic science and practice, as it will advance understanding of mental health and provide additional targets for managing symptoms of anxiety and depression in young people.

Lay perspectives on emotion: past, present, and future research directions

Empirical research has demonstrated that individuals vary widely in how they view their emotions. We call the viewpoints that individuals have towards their emotions emotion perspectives. While many subdisciplines of psychology, such as social psychology and clinical psychology, have studied this topic, research thus far can be siloed, despite overlap in terms and constructs. The goal of the current special issue and this introduction is to describe the state of research on emotion perspectives, highlight common themes in streams of emotion perspective research, and present future directions for investigation. The first portion of this introduction to the special issue provides a basic review of emotion perspective research, spotlighting topics such as emotion beliefs, emotion mindsets, lay theories of emotion, and attitudes toward emotion. The second portion of the introduction presents themes that cut across papers in the special issue, with a discussion of future research directions throughout. The goal of this introduction and special issue is to serve as a guide for greater integration in emotion perspective research and to provide a roadmap for emotion perspective research moving forward.

Individual differences in social power: Links with beliefs about emotion and emotion regulation

OBJECTIVE

People differ in how they regulate their emotions, and how they do so is guided by their beliefs about emotion. We propose that social power-one's perceived influence over others-relates to one's beliefs about emotion and to emotion regulation. More powerful people are characterized as authentic and uninhibited, which should translate to the belief that one should not have to control one's emotions and, in turn, less suppression and more acceptance. More powerful people are also characterized as self-efficacious and confident, which should translate to the belief that one can control one's emotions and, in turn, more reappraisal and acceptance.

METHOD

Two preregistered studies using four samples (Ntotal  = 1286) tested these hypotheses using cross-sectional and longitudinal surveys as well as diaries.

RESULTS

In Study 1, power related to beliefs about emotion and emotion regulation in hypothesized ways. Study 2 also largely supported the hypotheses: The belief that one should not have to control one's emotions accounted for the links between power and suppression and acceptance, whereas the belief that one can control one's emotions accounted for the link between power and reappraisal.

CONCLUSION

Power and emotion regulation are interconnected, in part because of their links with beliefs about emotions.

Risk and protective factors in suicidal behaviour among young people in Hong Kong: A comparison study between children and adolescents✰

Suicide is the leading cause of death among young people worldwide. Few studies examined the factors of childhood suicidality and compared them with adolescent suicidality to meet their age-specific needs. We examined the similarities and differences in risk and protective factors of children and adolescent suicidality in Hong Kong. A school-based survey with 541 students in grades 4-6 and 3,061 students in grades 7-11 from 15 schools was conducted. We measured the demographic, familial, school, mental health, and psychological factors of suicidality. Hierarchical binary logistic regressions were performed to examine the association between correlates and child and youth suicidality, and the interaction effects of these factors and school-age groups. Approximately 17.51% and 7.84% of secondary school respondents and 15.76% and 8.17% of primary school respondents reported suicidal ideation and attempt, respectively. Common correlates for suicidal ideation were depression, bullying, loneliness, self-compassion, and growth mindset, while those for suicide attempt were depression and bullying. Secondary school respondents with higher life satisfaction reported less suicidal ideation, while primary school respondents with higher self-control reported fewer suicide attempts. In conclusion, we recommended recognizing the factors of suicidal ideation and attempt in children and adolescents to tailor preventive strategies in a culturally sensitive manner.

Emotion malleability beliefs influence emotion regulation and emotion recovery among individuals with depressive symptoms

Despite the centrality of emotion regulation in psychiatric disorders such as depression, there is a lack of experimental studies examining the psychological factors that influence emotion regulation in individuals with depressive symptoms. Participants with current depressive symptoms were randomly assigned to an experimental manipulation promoting more malleable emotion beliefs or the control condition. Participants underwent a negative emotion induction and reported on their affect and emotion regulation during the induction. Individuals who received the experimental manipulation reported greater cognitive reappraisal and greater emotion recovery. Experimental manipulations that can enhance emotion regulation and emotion recovery possess significant promise as a preliminary step in developing brief interventions that can overcome formal barriers to care.

A Pilot Study of a Tablet-Based Emotion Regulation Intervention for Early Adolescents

OBJECTIVE

This study examined the feasibility, acceptability, and preliminary outcomes of internet-based Talking About Risk and Adolescent Choices (iTRAC), a tablet intervention designed to promote emotion regulation (ER) skills among middle schoolers as a strategy for reducing risk behaviors.

METHODS

Adolescents (12-14 years) were recruited from 3 urban US schools for advisory groups (n = 15), acceptability testing (n = 11), and pilot testing (n = 85). Youth advisory boards and expert panels tailored content, resulting in an animated intervention of instructional videos, games, and activities designed to teach ER strategies to young adolescents. Eighty-five adolescents were randomized to the 4-module digital iTRAC intervention or a wait-list control group. Adolescents and 1 parent completed baseline and 3-month follow-up questionnaires examining ER attitudes and behaviors; adolescents also completed behavioral tasks related to distress tolerance.

RESULTS

Among those randomized to iTRAC, 88% completed all modules. Moderate effect sizes ( d ≥ 0.36) were found from baseline to follow-up on adolescents' beliefs in the controllability of emotions, awareness of emotions, self-efficacy for managing emotions, perceived access to ER strategies, and use of ER strategies. Parent measures of adolescent regulation showed mixed results.

CONCLUSION

A digital intervention to enhance ER skills for youth in early adolescence was feasible and demonstrated promising indicators of impact on emotional competence. Increasing adolescents' awareness of and access to ER strategies could reduce decisions driven by transient emotions, which in turn may reduce engagement in risk behaviors and resultant negative health outcomes. This brief tablet-based intervention has the potential to be self-administered and used to increase emotional competency.

What matters for adolescent suicidality: Depressive symptoms or fixed mindsets? Examination of cross-sectional and longitudinal associations between fixed mindsets and suicidal ideation

BACKGROUND

Fixed mindsets or beliefs about the non-malleability of self-attributes are linked to a wide range of negative psychological outcomes. Its association with suicidal ideation (SI) among young people has not been explored.

OBJECTIVES

To examine the association of fixed mindsets of depression, anxiety, and stress and SI; and its mediating role underlying the association between depression and SI.

METHODS

A sample of 1393 adolescents (M_age  = 13.04, SD = 0.85, 640 boys) from 11 middle schools voluntarily participated in a two-wave longitudinal study before and during the COVID-19 pandemic with a 9-month interval.

RESULTS

Both depressive symptoms and fixed mindsets were positively and significantly associated with concurrent and future suicidality, after controlling for demographic and socioeconomic status and previous SI. Participants with stronger fixed mindsets were more likely to have SI than those with only depressive symptoms. Also, fixed mindsets mediated the association between depressive symptoms and SI in both cross-sectional and longitudinal models.

CONCLUSION

The current study provides empirical evidence of the effects of fixed mindsets and SI and the mediating role of fixed mindset between depressive symptoms and SI among young people. Interventions to foster a growth mindset may enhance hope and reduce suicidality among adolescents.

Reliability and validity of the Chinese version of the Brief Emotion and Regulation Beliefs Scale in Chinese nursing students

Background

Nursing students are experiencing complex learning environments and will experience complex work environments in future clinical work, which lead to emotional problems easily. However, one’s beliefs about controlling their emotions portend a series of vital psychological outcomes. So, it is especially important to search for suitable tools to assess the emotion and regulation beliefs of nursing students and give timely intervention to improve their physical and mental health. This study aimed to translate the American version of the Emotion and Regulation Beliefs Scale (ERBS) into Chinese, revise the original scale and form a simplified version, and assess the reliability and validity of the brief Chinese version in nursing students.

Methods

The study adopted a cross-sectional design and the multistage sampling design. The ERBS was translated into Chinese, and the reliability and validity of the Chinese version were tested in 980 nursing students.

Results

The content validity index was 0.920. Exploratory factor analysis supported a three-factor model for the Chinese version of Brief-ERBS, and confirmatory factor analysis indicated that the model fit the Brief-ERBS well. Furthermore, the three-factors model was obtained by using exploratory factor analysis, explaining 51.023% variance, and the communalities of the items ranged from 0.359 to 0.680. With modified confirmatory factor analysis, the fit indices were chi-square/degree of freedom (CMIN/DF) = 4.092, goodness of fit index (GFI) = 0.949, adjusted goodness of fit index (AGFI) = 0.927, comparative fit index (CFI) = 0.913, incremental fit index (IFI) = 0.914, Tucker Lewis index (TLI) = 0.908, root-mean-square error of approximation (RMSEA) = 0.061. The two-tailed independent samples t-test showed the scores of the top (50%) and low (50%) groups reached the level of significance (P < 0.001). A highly positive correlation between the Brief-ERBS total score and the ERBS total score was found (r = 0.972, P < 0.01). The Cronbach’s α coefficient of the scale was 0.798, the split-half reliability coefficient was 0.784, and the retest coefficient was 0.879.

Conclusion

The Chinese version of Brief-ERBS has good reliability and validity, and may be used for the beliefs about emotional management in Chinese nursing students.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-022-00992-1.

Emotion Appraisals and Coping with Secrets

Secrecy is both common and consequential. Recent work suggests that personal experiences with secrets (i.e., mind-wandering to them outside of concealment contexts), rather than concealment (within conversations), can explain the harms of secrecy. Recent work has also demonstrated that secrecy is associated with emotions that center on self-evaluation-shame and guilt. These emotions may help explain the harms of secrecy and provide a point of intervention to improve coping with secrecy. Four studies with 800 participants keeping over 10,500 secrets found that shame surrounding a secret is associated with lower perceived coping efficacy and reduced well-being. Moreover, shifting appraisals away from shame improved perceptions of efficacy in coping with secrets, which was linked with higher well-being. These studies suggest that emotions surrounding secrets can harm well-being and highlight avenues for intervention.

It’s all about beliefs: Believing emotions are uncontrollable is linked to symptoms of anxiety and depression through cognitive reappraisal and expressive suppression

The aim of this study was to examine the link between personal beliefs about emotion controllability and symptoms of anxiety and depression, with a particular focus on the mediating role of emotion regulation. To date, there has been little research examining the mediating role of cognitive reappraisal or expressive suppression in the link between beliefs about emotion controllability and symptoms of anxiety. Online questionnaires measuring emotion regulation, beliefs about emotion controllability, and depression and anxiety, were completed by 1227 participants (n = 336 males; Mage = 25.3, SD = 10.1; range = 16 to 83 years). The results indicated that perceived control over one’s own emotions predicted better psychological health (fewer symptoms of anxiety and depression). This link between beliefs about emotion controllability and psychological heath was partially mediated by cognitive reappraisal and expressive suppression, with cognitive reappraisal predicting a reduction in clinical symptoms and expressive suppression predicting an increase in clinical symptoms. These findings suggest that individuals’ beliefs about emotion controllability, leads to the use of certain emotion regulation strategies which in turn, have important consequences for psychological health.

Trait boldness and emotion regulation: An event-related potential investigation

The present study sought to extend knowledge of the role of boldness, a transdiagnostic bipolar trait dimension involving low sensitivity to threat, in emotional reactivity and regulation using physiological and report-based measures. One prior study found that boldness was associated with reduced late positive potential (LPP) while passively viewing aversive images, but not during emotion regulation; a disconnect between LPP and self-reported reactivity was also observed. Here, participants (N = 63) completed an emotion regulation task in which they either passively viewed or effortfully up- or downregulated their emotional reactivity to pleasant, unpleasant, and neutral pictures while EEG activity was recorded; they later retrospectively rated the success of their regulation efforts. ANOVAs examining the interactive effects of regulation instruction and boldness on LPP amplitude revealed that lower boldness (higher trait fearfulness) was associated with paradoxical increases in LPP to threat photos during instructed downregulation, relative to passive viewing, along with lower reported regulation success on these trials. Unexpectedly, similar LPP effects were observed for affective images overall, and especially nurturance photos. Although subject to certain limitations, these results suggest that individual differences in boldness play a role not only in general reactivity to aversive stimuli, as evidenced by prior work, but in the ability to effortfully downregulate emotional response.

Psychometric properties of the Mindsets of Depression, Anxiety, and Stress Scale (MDASS) in Chinese young adults and adolescents

AIM

Mindset has been found to be closely related to mental health symptoms. Yet no scale for the Mindsets of Depression, Anxiety, and Stress (MDASS) has been validated. This study developed a 12-item MDASS with four items in each domain and examined its psychometric properties among young adults and adolescents.

METHODS

Young adults (Study 1: N = 1735, aged 18-25) and adolescents (Study 2, N = 1648, aged 9-16) completed socio-demographics information, MDASS (unidirectional items in Study 1 and bi-directional items in Study 2), and mental health symptoms measures. Both samples were randomly divided into two equal sub-samples, one for exploratory factor analysis (EFA) to identify the factor structure, the other for confirmatory factor analysis (CFA) to assess the goodness-of-fit of EFA models. Spearman correlations were used to assess the convergent validity of MDASS with measures of depression, anxiety, and stress.

RESULTS

In Study 1, EFA yielded a three-factor model with underlying factors of fixed mindsets on depression, anxiety, and stress; CFA revealed a good goodness-of-fit (CFI and TFI >0.95; RMSEA and SRMR <0.08). In Study 2 with reversed items, EFA and CFA yielded a complex model structure. Fixed mindsets were positively correlated with depression, anxiety, and stress symptoms (all absolute correlations >0.3) in both studies.

CONCLUSION

MDASS is a reliable scale with clear factor structure to measure mindsets of negative emotions among early adults. MDASS is suggested to use only fixed-mindset statements. The MDASS are highly associated with symptoms of depression, anxiety, and stress.

Physical activity, smoking, alcohol consumption and depressive symptoms among young, early mature and late mature people: A cross-sectional study of 76,223 in China

OBJECTIVES

The purpose of this study was to screen for depressive symptoms in a large sample of Chinese population, and explore the effects of demographic and lifestyle factors on depressive symptoms based on the brain maturity.

METHOD

Adults from 8 health management centers in 6 provinces completed an online health self-report questionnaire. Finally, a total of 76,223 valid questionnaires were collected.

RESULT

A total of 76,223 participants were included in this study, including 44,167 (57.9%) males and 32,056 (42.1%) females. The percentage of clinically relevant depressive symptoms among young, early mature and late mature participants was 13.5%, 18.5% and 27.3%, respectively. Among young participants, being female was a risk factor for depressive symptoms, while having a bachelor's or graduate degree, being married, smoking, and moderate alcohol consumption were protective factors. And among early mature participants, female, married and other marital status, BMI of 24-27.9 were risk factors, post-graduate education or above, smoking, moderate alcohol consumption and meeting exercise standard were protective factors. Among late mature participants, Compared with junior high school, all other degrees were protective factors, as was meeting physical activity standards, excessive alcohol consumption was a risk factor.

CONCLUSION

This study analyzed the association among young, early mature and late mature participants respectively, and proposed strategies for improving healthy lifestyle of Chinese people. Our findings support the need for individualized recommendations to improve mental health based on brain maturity.

Increasing Love Feelings, Marital Satisfaction, and Motivated Attention to the Spouse

Abstract. Love typically decreases over time, sometimes leading to divorces. We tested whether positively reappraising the spouse and/or up-regulating positive emotions unrelated to the spouse increases infatuation with and attachment to the spouse, marital satisfaction, and motivated attention to the spouse as measured by the late positive potential (LPP). Married individuals completed a regulation task in which they viewed spouse, pleasant, and neutral pictures without regulation prompt as well as spouse and pleasant pictures that were preceded by regulation prompts. Event-related potentials were recorded, and self-reported infatuation, attachment, and marital satisfaction were assessed. Viewing spouse pictures increased infatuation, attachment, and marital satisfaction compared to viewing pleasant or neutral pictures in the no regulation condition. Thinking about positive aspects of the spouse and increasing positive emotions unrelated to the spouse did not increase infatuation, attachment, and marital satisfaction any further. Motivated attention, measured by the LPP amplitude, was greatest to spouse pictures, intermediate to pleasant pictures, and minimal to neutral pictures. Although the typical up-regulation effect on the LPP amplitude was observed for pleasant pictures, positively reappraising the spouse did not increase the LPP amplitude and hence motivated attention to the spouse any further. This study indicates that looking at spouse pictures increases love and marital satisfaction, which is not due to increased positive emotions unrelated to the spouse. Looking at spouse pictures is an easy strategy that could be used to stabilize marriages in which the main problem is the decline of love feelings over time.

Borderline Personality Traits and Emotion Regulation Strategies in Adolescents: The Role of Implicit Theories

Borderline Personality Disorder (BPD) is associated with emotion dysregulation. The emotion regulation strategies people adopt may depend on one's belief about emotion as either fixed or changeable (termed "implicit theory"). We test this experimentally by modifying beliefs about emotions using virtual reality (VR). A sample of 29 adolescents (ages 14-17 years) were recruited from two adolescent inpatient units for an uncontrolled pilot trial of a new brief intervention. We measured BPD traits, beliefs about emotion, treatment preference, cognitive reappraisal and rumination, before the VR game and 14-31 days later. Adolescents with higher levels of BPD traits endorsed fixed beliefs of emotion and reported higher levels of rumination and lower levels of cognitive reappraisal. After a one-time message delivered via VR, adolescents evidenced an increase in belief that their emotions were changeable. These findings suggest beliefs about emotions may have an important role in interventions for adolescents with BPD traits.

The Relationship between Beliefs about Emotions and Emotion Regulation: A Systematic Review

Emotion regulation is a known predictor for psychopathology and a target for treatment. A growing body of literature has examined the role of beliefs about emotions (BEs) in the emotion regulation process, yet the relationship between the two has yet to be systematically evaluated. A systematic review was conducted across five databases and 22 studies that assessed the relationship between BEs and emotion regulation were identified. The findings generally revealed a positive relationship between beliefs about the controllability and goodness of emotions and emotion regulation. There was strong evidence that beliefs about controllability were consistently associated with ‘active’ emotion regulatory strategies. This outcome has important implications for targeting change in therapy. However, further investigation is needed to establish consistent patterns regarding beliefs about the goodness of emotion and emotion regulation using longitudinal designs.

Mental Health Problems Due to Social Isolation During the COVID-19 Pandemic in a Mexican Population

Introduction: Social isolation due to the COVID-19 pandemic has been identified as a risk factor of several mental disorders. Therefore, the present work aimed to evaluate the effect of social isolation experienced during the COVID-19 pandemic on the mental health of a Mexican population. Materials and Methods: A cross-sectional online survey was conducted in individuals of 18 years of age and over. The questioner was structured to identify onset or worsening of psychiatric symptoms due to social isolation by COVID-19. The survey included changes in eating habits, changes in personal hygiene habits, the starting the use or increased the use of psychoactive substances, symptoms of depression or post-traumatic stress. Results: A total of 1,011 individuals were included in the analysis. The majority were women (68.84%). Changes in eating habits were reported in 38.51% of the participants, 67.80% reported having their physical self-perception distorted or having started a low-calorie diet. Regarding symptoms of depression, 46.10% participants indicated to have at least one depressive symptom, and 4.46% reported suicidal ideation during social isolation. Interestingly, 6.09% of individuals reported that they used to have depressive symptoms prior the COVID-19 pandemic and those symptoms decreased due to social isolation. Additionally, 2.27% of individuals presented symptoms of post-traumatic stress due to the possibility of getting COVID-19. Conclusions: In this work we identified how social isolation has impacted the mental health of the Mexican population. We observed that practically all the symptoms evaluated were affected during isolation, such as personal hygiene and eating habits. Depression and suicidal ideation were the ones that increased the most in the general population, while in individuals who had symptoms of depression before isolation, these symptoms decreased during social isolation.

An In Situ, Child-Led Intervention to Promote Emotion Regulation Competence in Middle Childhood: Protocol for an Exploratory Randomized Controlled Trial

BACKGROUND

Emotion regulation is a key transdiagnostic risk factor for a range of psychopathologies, making it a prime target for both prevention and treatment interventions in childhood. Existing interventions predominantly rely on workshops or in-person therapy-based approaches, limiting the ability to promote emotion regulation competence for children in everyday settings and at scale. Purrble is a newly developed, inexpensive, socially assistive robot-in the form of an interactive plush toy-that uses haptic feedback to support in-the-moment emotion regulation. It is accessible to children as needed in their daily lives, without the need for a priori training. Although qualitative data from previous studies show high engagement in situ and anecdotal evidence of the robot being incorporated into children's emotion regulation routines, there is no quantitative evidence of the intervention's impact on child outcomes.

OBJECTIVE

The aim of this study is to examine the efficacy of a new intervention model for child-led emotion regulation-Purrble-that can be deployed across prevention and treatment contexts.

METHODS

Overall, 134 children aged 8 to 10 years will be selected from an enriched nonclinical North American population; for inclusion, the cutoff for the parents' rating of child dysregulation will be ≥10 points in the total difficulties score on the Strengths and Difficulties Questionnaire. This cutoff was selected to obtain a measurable, but not necessarily clinical, level of the child's emotion regulatory difficulties. The selected families will be randomly assigned with .5 probability to receive either a Purrble or an active control (noninteractive plush toy). The primary outcome will be a daily ecological momentary assessment measure of child emotion regulation capability (as reported by parents) over a period of 4 weeks. Exploratory analyses will investigate the intervention impact on secondary outcomes of child emotion regulation, collected weekly over the same 4-week period, with follow-ups at 1 month and 6 months postdeployment. Quantitative data will be analyzed on an intent-to-treat basis. A proportion of families (approximately 30% of the sample) will be interviewed after deployment as part of the process analysis.

RESULTS

The study is funded by the UKRI Future Leaders Fellowship (MR/T041897/1) and an in-kind contribution from the Committee for Children. This study received ethical approval from the Pearl institutional review board (#18-CFC-101). Participant recruitment started in February 2021, with the 1-month deployment in April-May 2021. The results of this analysis will be published in 2022.

CONCLUSIONS

This study will be the first quantitative evaluation of the efficacy of an innovative, proof-of-concept intervention model for an in situ, child-led emotion regulation intervention. Insights into the trajectory of daily changes, complemented with weekly questionnaire batteries and postdeployment interviews, will result in an in-depth understanding of whether and how the hypothesized intervention logic model works, leading to further intervention optimization.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04810455; http://clinicaltrials.gov/ct2/show/NCT04810455.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/28914.

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.

Longitudinal associations between emotion malleability beliefs and avoidance in college students

Emotion malleability beliefs, or beliefs that emotions are changeable versus fixed, may be an important and modifiable determinant of emotion regulation strategy employment and psychological distress. The present study evaluated the prospective relationship between college students' emotion malleability beliefs, depression and anxiety symptom severity, cognitive and behavioural avoidance, social engagement, and cognitive reappraisal. Participants were college students (N = 177) who completed a battery of questionnaires at the beginning of the academic year and again at a 6-month follow-up. Linear regression analyses indicated that emotion malleability beliefs predicted anxiety and depression, although this effect was not found when controlling for baseline symptom severity. Increases in emotion malleability beliefs were associated with more cognitive reappraisal and less cognitive and behavioural avoidance at follow-up when controlling for baseline levels of each variable. To the extent that emotion malleability beliefs predicted less avoidance at follow-up, anxiety and depression symptom severity was lower. Results suggest that emotion malleability beliefs predict avoidance and related psychological outcomes across the academic year.

Association between gambling disorder and emotion (dys)regulation: A systematic review and meta-analysis

The aim of this systematic review and meta-analysis was to provide a comprehensive evaluation of the role of emotion (dys)regulation in gambling disorder (GD). PsycINFO, PsycARTICLES, MEDLINE, Scopus, Web of Science, and PubMed were systematically searched for articles published until November 3, 2020. Forty-nine studies were considered for the systematic review; of these, 38 comprising 5242 participants met the inclusion criteria for the meta-analysis. Associations were found between GD and specific emotion regulation (ER) deficits, namely (1) nonacceptance of negative emotional states, (2) difficulties in maintaining goal-directed behaviors when faced with intense emotional contexts, (3) lack of clarity about emotional states (poor emotional awareness), (4) low impulse control in reaction to negative emotional states, and (5) difficulties in accessing adaptive ER strategies. We furthermore found that GD is associated with a tendency for emotional suppression, which is known as a maladaptive ER strategy and linked with reduced mindfulness abilities. Additional moderator analyses were conducted regarding age, gender, type of instrument used to measure GD, clinical status of the samples, and quality of the studies. Overall, the data demonstrated consistent and significant associations between GD and ER. This systematic review and meta-analysis mostly supports the conceptualization of GD as an addictive disorder characterized by ER deficits and stresses the need to develop interventions in ER deficits that are tailored to the specificities of GD.

Incidence and Risk Factors of Moderate to Severe Postoperative Pain Following the Placement of Primary and Secondary Orbital Implants: A Prospective Observational Study

PURPOSE

To prospectively explore the incidence and risk factors of moderate to severe pain after primary and secondary orbital implantation following evisceration or enucleation surgery.

METHODS

One hundred eighteen patients under general anesthesia for orbital implantation were enrolled in this study. In 91 patients, primary orbital implantation followed evisceration, and in 27 patients, the implantation was secondary after previous evisceration or enucleation surgery. Medical interventions for all participants were followed by standardized surgical, anesthetic, and analgesic protocols. Postoperative pain (POP) intensity was quantified by an 11-point numerical rating scale within 72 hours after the surgery, numerical rating scale ≥4 was considered moderate to severe POP. Multivariate logistic regression was utilized to identify the risk factors related to the development of POP.

RESULTS

Thirty-five patients (29.7%) displayed moderate to severe POP, particularly within 6 to 24 hours after surgery, which peaked at 24 hours. Of these patients, 26 patients who were unable to tolerate the pain received additional doses of analgesics during in-hospital stay. Logistic regression model revealed that preoperative anxiety (odds ratios = 4.890; p = 0.002), congenital microphthalmia (odds ratios = 14.602; p = 0.038), and surgical time longer than 60 minutes (odds ratios = 5.586; p = 0.001) were significantly associated with moderate to severe POP after orbital implantation.

CONCLUSIONS

Orbital implantation after evisceration or enucleation surgery is likely to cause moderate to severe pain intensity in the early postoperative period. Preoperative anxiety, prolonged surgical time, and congenital microphthalmia were the risk factors.

Implicit Beliefs About Emotions in Youth: Associations With Temperamental Negative Emotionality and Depression

Introduction: Individual differences in beliefs about the controllability of emotions are associated with a range of psychosocial outcomes, including depressive symptoms. Less is known, however, about factors contributing to individual differences in these beliefs. The current study examined prospective associations between negative emotionality (NE) and implicit beliefs about emotions, as well as the indirect effect of NE on depressive symptoms through implicit beliefs about emotions.

Methods: In a sample of children and adolescents, NE was assessed at baseline, implicit beliefs about emotions were assessed 18 months later, and depressive symptoms were assessed at baseline and 36 months later.

Results: NE was associated with implicit beliefs about emotions, and an indirect effect of NE on depressive symptoms through implicit beliefs about emotions was observed.

Discussion: NE represents a salient dispositional vulnerability factor contributing to individual differences in implicit beliefs about emotions, with implications for the development of depressive symptoms in youth.

Higher Negative Self-Reference Level in Patients With Personality Disorders and Suicide Attempt(s) History During Biological Treatment for Major Depressive Disorder: Clinical Implications

Objective: The aim of the study was to identify clinical variables associated with changes in specific domains of self-reported depression during treatment by antidepressant and/or repetitive Transcranial Magnetic Stimulation (rTMS) in patients with Major Depressive Disorder (MDD).

Methods: Data from a trial involving 170 patients with MDD receiving either venlafaxine, rTMS or both were re-analyzed. Depressive symptoms were assessed each week during the 2 to 6 weeks of treatment with the 13-item Beck Depression Inventory (BDI₁₃). Associations between depression changes on BDI₁₃ domains (Negative Self-Reference, Sad Mood, and Performance Impairment), treatment arm, time, and clinical variables were tested in a mixed linear model.

Results: A significant decrease of self-reported depressive symptoms was observed over time. The main characteristics associated with persistent higher depressive symptomatology on Negative Self-Reference domain of the BDI₁₃ were personality disorders (+2.1 points), a past history of suicide attempt(s) (+1.7 points), age under 65 years old (+1.5 points), and female sex (+1.1 points).

Conclusions: Early cognitive intervention targeting specifically negative self-referencing process could be considered during pharmacological or rTMS treatment for patients with personality disorders and past history of suicide attempt(s).

Beliefs About Emotion Shift Dynamically Alongside Momentary Affect

This study examined if beliefs about emotion change across emotional contexts in daily life, and it investigated whether people with prominent features of borderline personality pathology experience greater shifts in emotion beliefs during emotional states. Undergraduate participants with (n = 49) and without borderline features (n = 50) completed a 1-week ecological momentary assessment study where they provided ratings of affect, nine different beliefs about emotion, and indicators of momentary self-efficacy. Results support the notion of beliefs as relatively schematic. However, most of the beliefs about emotion shifted with either positive or negative affect, and they predicted momentary self-efficacy for tolerating distress and exerting willpower. Those with borderline features experienced greater instability of beliefs, and borderline features moderated the relationships between affect and many beliefs. Results confirm that there are implications for emotion beliefs for people who struggle with emotion regulation and impulsivity (i.e., people with features of borderline personality).

Development and Validation of Nomogram Prediction Model for Postoperative Sleep Disturbance in Patients Undergoing Non-Cardiac Surgery: A Prospective Cohort Study

PURPOSE

To develop a risk prediction nomogram of postoperative sleep disturbance (PSD) in patients undergoing non-cardiac surgery.

PATIENTS AND METHODS

Data on 881 consecutive patients who underwent non-cardiac surgery at the Affiliated Hospital of Xuzhou Medical University between June 2020 and April 2021 were prospectively collected. Of these, we randomly divided 881 non-cardiac patients into two groups, training cohort (n = 617) and validation cohort (n = 264) at the ratio of 7:3. Characteristic variables were selected based on the data of training cohort through least absolute shrinkage and selection operator (LASSO) regression. Multivariate logistic regression was used to identify the independent risk factors associated with PSD that then were incorporated into the nomogram. The predictive performance of the nomogram was measured by concordance index (C index), receiver operating characteristic (ROC) curve, and calibration with 1000 bootstrap samples to decrease the over-fit bias.

RESULTS

PSD was found in 443 of 617 patients (71.8%) and 190 of 264 patients (72.0%) in the training and validation cohorts, respectively. The perioperative risk factors associated with PSD were female sex, anxiety, dissatisfaction of ward environment, absence of combined regional nerve block, postoperative nausea and vomiting (PONV), the longer duration stayed in post anesthesia care unit (PACU), the higher dose of midazolam and sufentanil, the higher postoperative numeric rating score for pain (NRS) score. Incorporating these 9 factors, the nomogram achieved good concordance indexes of 0.82 (95% confidence interval [CI], 0.78-0.85) and 0.80 (95% CI, 0.74-0.85) in predicting PSD in the training and validation cohorts, respectively, and obtained well-fitted calibration curves. The sensitivity and specificity (95% CIs) of the nomogram were calculated, resulting in sensitivity of 74.0% (70.0-78.2%) and 75.3% (68.4-81.7%) and specificity of 79.3% (72.5-85.2%) and 70.3% (58.4-80.7%) for the training and validation cohorts, respectively. Patients who had a nomogram score of less than 262 or 262 or greater were considered to have low or high risks of PSD presence, respectively.

CONCLUSION

The proposed nomogram achieved an optimal prediction of PSD in patients undergoing non-cardiac surgery. The risks for an individual patient to harbor PSD can be determined by this model, which can lead to a reasonable preventive and treatment measures.