The Importance of Being Flexible

Understanding the role of regulatory flexibility and context sensitivity in preventing burnout in a palliative home care team

Although burnout syndrome has been investigated in depth, studies specifically focused on palliative home care are still limited. Moreover, there is still a lack of evidence regarding the interplay between emotional flexibility and sensitivity to context in preventing burnout in home care settings. For these reasons, the aims of this study were to examine burnout symptoms among practitioners specializing in palliative home care and to investigate the role of regulatory flexibility and sensitivity to context in understanding burnout. An exploratory cross-sectional design was adopted. A convenience sample (n = 65) of Italian specialist palliative care practitioners participated in this study. Participants were recruited between February and April 2019 from two palliative home care services that predominantly cared for end-of-life cancer patients. The Italian version of the Maslach Burnout Inventory (MBI), the Flexible Regulation of Emotional Expression (FREE) scale (a measure of emotional flexibility), and the Context Sensitivity Index (CSI) (a measure of sensitivity to context) were administered. Analyses of variance were conducted using the three MBI factors as dependent variables and profession as an independent variable. Subsequently, three identical analyses of covariance were conducted with age, work experience, flexibility and sensitivity to context as covariates. The results showed a low burnout risk for all three of the MBI factors, and there were no gender differences. An ANOVA revealed a significant effect of profession type and age on the emotional exhaustion factor of the MBI, and an ANCOVA indicated that these effects persisted after covariates were accounted for. The results also showed a significant effect of the FREE score on emotional exhaustion. These findings can help explain the differential contributions of profession type and age to the burnout symptoms investigated. In addition, the emotional flexibility component, as an aspect of resilience, represents a significant and specific factor of emotional exhaustion. Interventions to prevent burnout must consider these relationships.

The Masking of Mourning: Social Disconnection After Bereavement and Its Role in Psychological Distress

Social support has been shown to facilitate adaptation after bereavement in some studies but not others. A felt sense of social disconnection may act as a barrier to the utilization of social support, perhaps explaining these discrepancies. Factorial and psychometric validity of the Oxford Grief-Social Disconnection Scale (OG-SD) was tested in a bereaved sample (N = 676). A three-factor solution (negative interpretation of others’ reactions to grief expression, altered social self, and safety in solitude) fit the data best and demonstrated excellent psychometric validity. A second three-wave longitudinal sample (N = 275) recruited 0 to 6 months following loss and followed up 6 and 12 months later completed measures of prolonged grief disorder, posttraumatic stress disorder, depression, and the OG-SD at each time point. High levels of baseline social disconnection were associated with concurrently high psychological distress. The extent to which social disconnection declined over time predicted resolution of psychological distress.

Do Coping Strategies Differentially Mediate the Relationship Between Emotional Closeness and Complicated Grief and Depression?

Although complicated grief (CG) following the death of a loved one has traditionally been viewed as avoidance-driven, recent research implicates approach behavior. Researchers have investigated how coping styles predict CG; however, emotional closeness remains unexamined. This study investigated the differential relationship of approach- and avoidance-focused coping on CG and depressive symptoms. Bereaved adults ( n = 340) completed questionnaires about their loss, coping styles, CG, and depression. Results suggest that approach-, but not avoidance-, focused coping mediates the relationship of emotional closeness on CG, while emotional closeness of the relationship had no direct impact on depressive symptoms. This suggests closeness of the relationship plays a unique role in CG.

Emotion Regulation Flexibility

Abstract. Emotion regulation (ER) flexibility, defined as shifting regulatory efforts based on contextual demands, has been proposed as central to well-being. However, it remains an elusive construct to capture. In this article, we highlight the promise and challenges of using ambulatory assessment to examine ER flexibility. We consider difficulties in assessing relevant contextual features and ER dynamics using ecological momentary assessment (EMA). The solutions offered include drawing on existing taxonomies of situational characteristics and ER strategies, adopting methods that passively track contextual features and enhance reliability, and leveraging the advantages of various sampling schemes based on target ER dynamics. Studying ER flexibility in vivo, as it naturally unfolds in daily life, is crucial for a comprehensive understanding of the contextual, dynamic nature of ER. Further work is needed developing theories to guide research on how and why specific aspects of the context might call for shifts in regulatory efforts.

Psychological Flexibility in Depression Relapse Prevention: Processes of Change and Positive Mental Health in Group-Based ACT for Residual Symptoms

Relapse rates following a depressive episode are high, with limited treatments available aimed at reducing such risk. Acceptance and commitment therapy (ACT) is a cognitive-behavioral approach that has gained increased empirical support in treatment of depression, and thus represents an alternative in relapse prevention. Psychological flexibility (PF) plays an important role in mental health according to the model on which ACT is based. This study aimed to investigate the role of PF and its subprocesses in reducing residual symptoms of depression and in improving positive mental health following an 8-week group-based ACT treatment. Adult participants (75.7% female) with a history of depression, but currently exhibiting residual symptoms (N = 106) completed measures before and after intervention, and at 6 and 12-month follow-up. A growth curve model showed that positive mental health increased over 12-months. Multilevel mediation modeling revealed that PF significantly mediated these changes as well as the reduction of depressive symptoms, and that processes of acceptance, cognitive defusion, values and committed action, in turn, mediated increased PF.

Increased Amygdala Activations during the Emotional Experience of Death-Related Pictures in Complicated Grief: An fMRI Study

Complicated grief (CG) is associated with alterations in various components of emotional processing. The main aim of this study was to identify brain activations in individuals diagnosed with CG while they were observing positive, negative, and death-related pictures. The participants included 19 individuals with CG and 19 healthy non-bereaved (NB) individuals. Functional magnetic resonance imaging (fMRI) scans were obtained during an emotional experience task. The perception of death-related pictures differed between the CG group and the NB group, with a greater activation in the former of the amygdala, putamen, hypothalamus, middle frontal gyrus, and anterior cingulate cortex. Amygdala and putamen activations were significantly correlated with Texas Revised Inventory of Grief scores in the CG group, suggesting that the higher level of grief in this group was associated with a greater activation in both brain areas while watching death-related pictures. A significant interaction between image type and group was observed in the amygdala, midbrain, periaqueductal gray, cerebellum, and hippocampus, largely driven by the greater activation of these areas in the CG group when watching death-related pictures and the lower activation when watching positive-valence pictures. In this study, individuals with CG showed significantly distinct brain activations in response to different emotional images.

Cognitive flexibility and persistent post-surgical pain: the FLEXCAPP prospective observational study

BACKGROUND

Impaired performance on tasks assessing executive function has been linked to chronic pain. We hypothesised that poor performance on tests assessing the ability to adjust thinking in response to changing environmental stimuli (cognitive flexibility) would be associated with persistent post-surgical pain.

METHODS

We conducted a single-centre prospective observational study in two perioperative cohorts: patients undergoing total knee arthroplasty or noncardiac chest surgical procedures. The co-primary outcome measures compared preoperative performance on the Trail Making Test and the colour-word matching Stroop test between patients who developed persistent post-surgical pain and those who did not. Secondary outcome measures included the associations between these test scores and pain severity at 6 months.

RESULTS

Of 300 participants enrolled, 198 provided 6 month follow-up data. There were no significant differences in preoperative Trail Making Test B minus A times (33 vs 34 s; P=0.59) or Stroop interference T-scores (47th vs 48th percentile; P=0.50) between patients with and without persistent post-surgical pain (primary outcome). Of those who reported persistent post-surgical pain, poorer baseline performance on the colour-word matching Stroop test was associated with higher pain scores at 6 months in both knee arthroplasty (r=-0.32; P=0.04) and chest (r=-0.44; P=0.02) surgeries (secondary outcome).

CONCLUSIONS

Preoperative cognitive flexibility test performance was not predictive of overall persistent post-surgical pain incidence 6 months after surgery. However, poor performance on the colour-word matching Stroop test was independently associated with more severe persistent post-surgical pain in both cohorts.

CLINICAL TRIAL REGISTRATION

NCT02579538.

Benefits of Implicit Regulation of Instructed Fear: Evidence From Neuroimaging and Functional Connectivity

Instructed fear, which denotes fearful emotions learned from others' verbal instructions, is an important form of fear acquisition in humans. Maladaptive instructed fear produces detrimental effects on health, but little is known about performing an efficient regulation of instructed fear and its underlying neural substrates. To address this question, 26 subjects performed an instructed fear task where emotional experiences and functional neuroimages were recorded during watching, explicit regulation (calmness imagination), and implicit regulation (calmness priming) conditions. Results indicated that implicit regulation decreased activity in the left amygdala and left insula for instructed fear; however, these effects were absent in explicit regulation. The implementation of implicit regulation did not increase activity in the frontoparietal control regions, while explicit regulation increased dorsolateral prefrontal cortex activity. Furthermore, implicit regulation increased functional connectivity between the right amygdala and right fusiform gyrus, and decreased functional connectivity between the right medial temporal gyrus and left inferior frontal gyrus, which are key nodes of memory retrieval and cognitive control networks, respectively. These findings suggest a favourable effect of implicit regulation on instructed fear, which is subserved by less involvement of control-related brain mechanisms.

Emotion Regulation Flexibility in Generalized Anxiety Disorder

Background

People differ in their affective styles, which refers to habitual use of emotion regulation (ER) strategies. Previous research has shown that mental health is associated with an individual's adaptive flexibility of emotion regulation strategies rather than any one particular ER strategy.

Methods

The present study employed a person-centered approach using latent profile analyses to distinguish patients with generalized anxiety disorder based on their responses on an affective styles measure.

Results

Results of the latent profile analysis supported a three-class solution. Class 1 (26% of participants) identified individuals with the lowest scores of each affective style; class 2 (10%) included individuals with the highest scores of each style; and class 3 (64%) consisted of individuals who scored in the mid-range of each affective style. Greater ER flexibility was associated with better emotional functioning and quality of life.

Conclusions

Patients with GAD differ in ER flexibility. The vast majority of patients appear to have only moderate or low ER flexibility. Those individuals with high ER flexibility show a greater quality of life and less emotional distress.

Age differences in emotion regulation strategy use, variability, and flexibility: An experience sampling approach

Life span developmental theories suggest that as individuals age, they accumulate knowledge about how to deploy emotion regulation (ER) strategies effectively and learn how to match their ER strategy use with changes in situational demands. Using an event-contingent experience sampling design wherein 150 adults Age 18 to 89 years reported on 64,213 social interactions (M = 427.41, SD = 145.66) during 9 weeks of daily life, this study examines (a) age-related differences in individuals' usual ER strategy use (reappraisal, suppression) during everyday social interactions, (b) age-related differences in how much individuals' use of these two strategies varies across social situations-ER variability, and (c) age-related differences in the extent to which ER strategy use covaries with relational (close vs. nonclose others) and emotional (happy, sad) contextual features of those social situations-ER flexibility. In line with a small body of prior work, usual ER strategy use did not differ across adulthood and ER variability was lower at older ages. Results from multilevel models of intraindividual covariation suggested that individuals flexibly matched their ER strategy implementation to changes in emotional context-especially when interacting with close others. The results also provided evidence that the intraindividual covariation between relational context and use of suppression was weaker at older ages. Beyond these specific findings, this study demonstrated the utility of experience sampling designs, event-contingent reports, and the measurement/modeling of intraindividual variation and covariation for study of emotional development across the life span. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Mediating role of cognitive biases, resilience and depressive symptoms in the relationship between childhood trauma and psychotic-like experiences in young adults

OBJECTIVES

The present study aimed to test a hypothetical model where causally linked and ordered cognitive biases, resilience and depressive symptoms serve as mediators of the relationship between early traumatic life events and psychotic-like experiences (PLEs) in the general population of young adults.

METHODS

Two thousand six hundred and fourteen people (1673 females) took part in the online survey. Participants completed self-report questionnaires measuring exposure to early traumatic life events, PLEs, cognitive biases, resilience and depressive symptoms. Correlation and multiple mediation analyses were performed.

RESULTS

All three mediators turned out to be significantly correlated with early trauma, PLEs and with each other. Mediational analysis demonstrated that hypothesized model of causally linked mediators was significant (P ≤ .001) and accounted for 33% (P < .001) of the explained variance in PLEs in comparison to 11% (P ≤ .001) without mediators.

CONCLUSIONS

First, our results provide evidence for significant associations between early traumatic life events, cognitive biases, depressive symptoms, psychological resilience and PLEs. Second, they indicate significant indirect effects of early trauma exposure on PLEs through a path consisted of cognitive biases, psychological resilience and depressive symptoms that suggest a possible importance of interventions bolstering resilience in young people in order to minimize the severity of depressive and psychotic psychopathology.

Commemoration of disruptive events: a scoping review about posttraumatic stress reactions and related factors

Collective commemoration in response to war or disaster is widespread across time and cultures. It is assumed to support those affected by the disruptive event to cope with their experiences. However, the actual relationship between commemoration and mental health outcomes is complicated and evidence of healing effects remains elusive. By applying a scoping review approach, this article maps empirical studies that focus on commemoration from a psychological perspective. Within five electronic databases, 415 unique articles were identified, of which 26 met the predetermined inclusion criteria, i.e. presenting empirical data on the subject of war or large-scale violence and commemoration in relation to posttraumatic stress (PTS) and grief reactions. The data were extracted and analysed according to the five steps of a systematic scoping review. Results varied, with both negative and positive effects of commemoration on PTS and grief reactions being reported. Based on these findings we propose an evidence-informed model that distinguishes different aspects influencing the linkage between commemoration and PTS and grief reactions. The following aspects are distinguished: contextual factors, including political and cultural context, individual characteristics and facilitating mechanism, including expression, recognition, support, meaning-making and personal memories. The proposed model needs to be tested and validated by further quantitative research. This will allow social workers and policy makers to make well-informed decisions about commemorative events that may benefit fractured communities as well as individuals.

A round peg in a square hole: strategy-situation fit of intra- and interpersonal emotion regulation strategies and controllability

Although the importance of contextual factors is often recognised, research on emotion regulation strategies (ERS) has mainly focused so far on the effectiveness of ERS across situations. In the present research, we tested the strategy-situation fit hypothesis, which does not assume general effectiveness of ERS but instead stresses the importance of the congruency between ERS and the contexts in which they are used. Using a longitudinal Ambulatory Assessment dataset (N = 138), we found that controllability of a situation positively moderated the effectiveness of interpersonal ERS, such that, e.g. providing feedback to others was significantly associated with less positive feelings but only in less controllable situations. Intrapersonal ERS were negatively moderated by controllability, such that downplaying a negative situation was associated with less negative feelings in less controllable situations. Finally, favouring interpersonal over intrapersonal ERS was also positively moderated by controllability, demonstrating the situational fit of ERS in daily life.

Post-traumatic stress disorder symptom severity attenuates bi-directional associations between negative affect and avoidant coping: A daily diary study

INTRODUCTION

Avoidant coping plays an important role in the maintenance of post-traumatic stress disorder (PTSD). However, existing investigations have been limited in their assessment of coping as a static process - despite evidence that the coping strategies individuals use to manage stressors vary across time and contexts. Further, research has relied on cross-sectional designs, precluding determination of the directionality of the negative affect-avoidant coping association. The current study addresses these limitations by using a daily diary method to examine the moderating role of PTSD symptom severity on reciprocal relations between negative affect and avoidant coping.

METHODS

Participants were 1,188 trauma-exposed adults (M age = 19.2, 56% female, 79% White) who provided daily diary data for 30 days via online surveys. Multi-level models were tested to evaluate the moderating role of PTSD symptom severity in the daily relations between negative affect and avoidant coping during the 30-day period.

RESULTS

Levels of daytime negative affect were assoicated with use of evening avoidant coping. Use of evening avoidant coping were associated with levels of next-day daytime negative affect. PTSD symptom severity moderated these relations. For individuals with more (vs. less) severe PTSD symptoms, the association of negative affect to avoidant coping was weaker and the association of avoidant coping to negative affect was stronger.

LIMITATIONS

Findings must be interpreted in light of limitations, including self-report measures and assessment of a alcohol using sample of college students.

DISCUSSION

These findings advance our understanding of the negative affect-avoidant coping association among trauma-exposed individuals.

Attachment and emotion regulation: A person-centred examination and relations with coping with rejection, friendship closeness, and emotional adjustment

Guided by attachment theory of emotion regulation (ER), the current study utilized a person-centred approach to identify clusters of individuals that differed in their attachment representations and ER, and further examined individual differences in socio-emotional functioning based on these profiles. Participants included 658 emerging adults (M = 19.9, SD = 2.7, 65.5% female) who completed surveys measuring responses to rejection, friendship closeness, and emotional maladjustment. Five clusters were identified: secure regulated (19%), disorganized unregulated (21%), anxious unregulated (16%), emotive (21%), and avoidant suppressor (22%). Each group displayed unique patterns, with the secure regulated group reporting significantly less withdrawal, retribution, rumination, and emotional maladjustment, and the disorganized unregulated group reporting the poorest functioning across all indicators. Significant cluster × sex effects were also found for friendship closeness. These findings suggest the importance of considering attachment and ER, and implications for attachment theory and development are discussed. Statement of contribution What is already known on this subject? Insecure attachment representations are a significant risk factor for poorer outcomes across development. Hyperactivating and deactivating strategies are maladaptive responses to coping with emotional threat. These strategies are an extension of the internal working model and positive correlates of poorer functioning. What does this study add? Previous studies have over-relied on variable-centred approaches to replicate findings of attachment theory. A person-centred approach allowing for the joint consideration of patterns of both attachment and ER strategies. The identification of five novel profiles revealing unique differences in three important domains of functioning.

Protective Buffering and Individual and Relational Adjustment Following Hematopoietic Stem Cell Transplantation: A Dyadic Daily-Diary Study

Background

Supportive communication (e.g., protective buffering, PB) may impact individual and relational adjustment in patients following hematopoietic stem cell transplantation (HSCT) and their caregivers. Previous studies revealed that PB (i.e., hiding one’s concerns and denying one’s worries) has mixed effects, namely it is beneficial, costly or unrelated to dyadic adjustment. This study aimed to verify these findings by addressing some unresolved issues, i.e., examining (1) both individual and relational as well as both positive and negative indicators of adjustment, (2) the effect of within-dyad congruence (i.e., complementarity/similarity) in PB, and (3) within-dyad causal associations between PB and adjustment.

Methods

Two hundred patients (following first autologous or allogeneic HSCT) and their caregivers independently completed measures of daily PB, relationship satisfaction, relationship stress, and positive affect (PA) and negative affect (NA) for 28 consecutive evenings after discharge of patients.

Findings

For both patients and caregivers, the results showed a same-day association between daily PB and individual (positive and negative) and relational (positive and negative) adjustment indicators showing the advantage of PB. In terms of the dyad congruence, complementarity (one partner high and the other low) in daily PB was related to higher same-day relationship satisfaction for both patients and caregivers and lower same-day relationship stress in caregivers. The benefits from similarity (both patient and caregiver high or low in PB) had delayed effects, although only in patients. As far as the causal associations were concerned, day-to-day changes in PB preceded changes in daily adjustment. In caregivers, reverse causality was found, i.e., changes in adjustment predicted next-day changes in support.

Discussion

Contrary to previous studies, daily PB has a rather beneficial effect in dyads following HSCT. Patients seemed to have benefited the most from the similarity in daily PB fluctuation, while caregivers profited from complementarity. Causal associations between PB and adjustment within-dyad were also different. The findings may add to a better understanding of PB-adjustment relationship in dyads facing HSCT.

Adaptive and maladaptive emotion processing and regulation, and the case of alexithymia

In this conceptual review, we discuss models of emotion and its regulation and identify a spectrum of processes that characterise adaptive adjustment to the affective environment. We describe a dynamic-phasic model of emotion processing and regulation, focusing on five stages: anticipation, response, recovery, habituation and rest as part of a cascade of responses to emotional challenges, as these become progressively expected, proximal, chronic or repeated. We argue for the need to investigate beyond simple reactivity to emotional stimuli, in order to understand mental and physical health conditions where emotional dysregulation plays a role. We propose that a hallmark of an effective and adaptive emotion regulation system is its flexibility, in the service of life goals and values. Consistent with McEwen's model (1998, Stress, adaptation, and disease: Allostasis and allostatic load. Annals of the New York Academy of Sciences, 840(1), 33-44), inflexible emotion regulation can lead to increased allostatic load, from frequent stress, inadequate reactivity, failed shutdown and habituation, which may result in physical and mental illness. Alexithymia exemplifies inflexible emotion regulation, with dysfunctions potentially across all stages of emotion processing, both psychologically and physiologically. These maladaptive processes and their consequence on allostatic load potentially explain the association between alexithymia and physical and mental illness.

The late positive potential as a neurocognitive index of emotion regulatory flexibility

A growing body of research has examined regulatory flexibility as the ability to dynamically modulate emotional expression and experience (Bonanno & Burton, 2013). The late positive potential (LPP), an event-related potential reflecting processing of emotionally-evocative stimuli, is sensitive to emotion regulation (ER) or the psychological processes that underlie the experience, expression, and management of emotions. However, few studies have used the LPP to index regulatory flexibility or tested its association with self-reported emotional well-being and ER. The results of the current study showed that regulatory flexibility indexed via the LPP was associated with self-reported use of specific ER strategies. Further, greater regulatory flexibility measured as the full LPP regulatory range (indexed following prompts to enhance and suppress emotional responses to stimuli) was specifically and uniquely associated with greater self-reported coping flexibility. Findings provide preliminary support for this neurocognitive approach to conceptualizing and assessing regulatory flexibility.

Exercise Counteracts the Cardiotoxicity of Psychosocial Stress

Physical inactivity and psychosocial stress are prevalent in residents of the United States. The purpose of this article is to review the interaction between these 2 conditions and examine the effects of exercise on stress and cardiovascular (CV) health. A query of scientific references between 1974 to 2018 was performed using the PubMed search engine accessing the MEDLINE database using the search terms psychosocial stress, CV disease (CVD), physical activity, exercise, cardiac rehabilitation, and team sports. Psychosocial stress is a strong independent risk factor for adverse CV events. Conversely, people who experience CV events subsequently have drastically elevated rates of new-onset mental health disorders, including depression and anxiety. Psychosocial stress and CVD often trigger self-reinforcing feedback loops that can worsen mental health and cardiac prognosis. Exercise predictably improves CV health and prognosis and also is effective at lowering levels of psychosocial stress. Group exercise in particular seems to provide social support while at the same time boosting fitness levels and, thus, may be the single most important intervention for patients with concomitant CVD and emotional stress. Collaborative physical activity, such as group exercise, team sports, interactive physical play, and cardiac rehabilitation programs, have the potential to improve mental health and CV prognosis.

Using automated computer vision and machine learning to code facial expressions of affect and arousal: Implications for emotion dysregulation research

As early as infancy, caregivers' facial expressions shape children's behaviors, help them regulate their emotions, and encourage or dissuade their interpersonal agency. In childhood and adolescence, proficiencies in producing and decoding facial expressions promote social competence, whereas deficiencies characterize several forms of psychopathology. To date, however, studying facial expressions has been hampered by the labor-intensive, time-consuming nature of human coding. We describe a partial solution: automated facial expression coding (AFEC), which combines computer vision and machine learning to code facial expressions in real time. Although AFEC cannot capture the full complexity of human emotion, it codes positive affect, negative affect, and arousal-core Research Domain Criteria constructs-as accurately as humans, and it characterizes emotion dysregulation with greater specificity than other objective measures such as autonomic responding. We provide an example in which we use AFEC to evaluate emotion dynamics in mother-daughter dyads engaged in conflict. Among other findings, AFEC (a) shows convergent validity with a validated human coding scheme, (b) distinguishes among risk groups, and (c) detects developmental increases in positive dyadic affect correspondence as teen daughters age. Although more research is needed to realize the full potential of AFEC, findings demonstrate its current utility in research on emotion dysregulation.

Broadening Our Field of View: The Role of Emotion Polyregulation

The field of emotion regulation has developed rapidly, and a number of emotion regulatory strategies have been identified. To date, empirical attention has focused on contrasting specific regulation strategies to determine their unique profile of consequences. However, it is becoming clear that people commonly pursue multiple regulation approaches within any given emotional episode (e.g., pursuing different regulation goals, strategies, or tactics). We refer to the concurrent or sequential use of multiple approaches to regulate emotions within a single emotion episode as polyregulation. Here, we extend existing theoretical frameworks of emotion regulation to consider polyregulation. We then pose several core questions to summarize and inspire research on polyregulation, thereby improving our understanding of emotion regulation as it unfolds in everyday life.

Heterogeneity of the Anxiety-Related Attention Bias: A Review and Working Model for Future Research

The anxiety-related attention bias (AB) has been studied for several decades as a clinically-relevant output of the dynamic and complex threat detection-response system. Despite research enthusiasm for the construct of AB, current theories and measurement approaches cannot adequately account for the growing body of mixed, contradictory, and null findings. Drawing on clinical, neuroscience, and animal models, we argue that the apparent complexity and contradictions in the empirical literature can be attributed to the field's failure to clearly conceptualize AB heterogeneity and the dearth of studies in AB that consider additional cognitive mechanisms in anxiety, particularly disruptions in threat-safety discrimination and cognitive control. We review existing research and propose a working model of AB heterogeneity positing that AB may be best conceptualized as multiple subtypes of dysregulated processing of and attention to threat anchored in individual differences in threat-safety discrimination and cognitive control. We review evidence for this working model and discuss how it can be used to advance knowledge of AB mechanisms and inform personalized prevention and intervention approaches.

Understanding Emotion Inflexibility in Risk for Affective Disease: Integrating Current Research and Finding a Path Forward

Emotion-related disorders (e.g., depression, anxiety, stress, eating, substance and some personality disorders) include some of the most common, burdensome, and costly diseases worldwide. Central to many, if not all of these disorders, may be patterns of rigid or inflexible emotion responses. Indeed, theorists point to emotion in-flexibility as a potential cause or maintaining factor in emotion-related diseases. Despite the increasing prominence of emotion inflexibility in theories of affective disease, a comprehensive review of the developing empirical literature has not yet been conducted. Accordingly, this review will examine the three dominant lines of inquiry assessing emotion flexibility. These include: (1) the capacity to use and vary deliberate emotion regulation strategies, (2) the context sensitivity of spontaneous emotional responses, and (3) flexibility in the appraisal of emotional events and experiences. Moreover, current evidence suggests that each of these three lines of research may converge to suggest the interplay of two key biological dimensions in emotion inflexibility, threat sensitivity, and cognitive control, known to be impaired in patients with affective disorders. In short, this developing body of work suggests a path by which future research could explicate and even exploit the ties between emotion inflexibility and affective disease, contributing to the development of improved models of risk, assessment, and intervention, with broad implications for psychological health.

Cognitive Behavioral Treatment for Acute Posttrauma Distress: A Randomized, Controlled Proof-of-Concept Study Among Hospitalized Adults With Burns

OBJECTIVE

(1) To evaluate the feasibility of conducting a randomized controlled trial (RCT) of the Safety, Meaning, Activation and Resilience Training (SMART) intervention vs nondirective supportive psychotherapy (NDSP) in an acutely hospitalized adult survivor of burn injury sample; and (2) to assess the preliminary effect of SMART on acute stress disorder (ASD), posttraumatic stress disorder (PTSD), and major depressive disorder (MDD) symptom reduction as secondary prevention.

DESIGN

Proof-of-concept, parallel group RCT design.

SETTING

Regional burn center.

PARTICIPANTS

Acutely injured, hospitalized adult survivors of burn injury (N=50) were randomly assigned to SMART (n=28) or nondirective supportive psychotherapy (n=22). Due to dropout and missing data, final sample size was 40, SMART (n=21) and nondirective supportive psychotherapy (n=19).

INTERVENTIONS

SMART is a manualized, 4-session cognitive behavioral therapy-based psychological intervention targeting ASD, PTSD, and MDD symptoms. NDSP is a manualized, 4-session protocol.

MAIN OUTCOME MEASURES

Davidson Trauma Scale ([DTS]; diagnostic proxy for ASD and PTSD; clinical cutoff=40, with higher score=higher severity) and the Patient Health Questionnaire-9 ([PHQ-9]; diagnostic proxy for MDD; clinical cutoff=10, with higher score=higher severity) at pretreatment, immediate posttreatment, and 1 month posttreatment.

RESULTS

At baseline, median DTS scores and PHQ-9 scores were above clinical cutoffs and did not differ across groups. At 1 week and 1 month posttreatment, median DTS and PHQ-9 scores were beneath clinical cutoffs in the SMART group; scores remained above clinical cutoffs in the NDSP group at these time points.

CONCLUSIONS

It is feasible to conduct an RCT of SMART in hospitalized adult survivors of burn injury. SMART has the potential to yield clinically significant outcomes. Additional studies are needed to replicate and extend these findings.

Using computer-vision and machine learning to automate facial coding of positive and negative affect intensity

Facial expressions are fundamental to interpersonal communication, including social interaction, and allow people of different ages, cultures, and languages to quickly and reliably convey emotional information. Historically, facial expression research has followed from discrete emotion theories, which posit a limited number of distinct affective states that are represented with specific patterns of facial action. Much less work has focused on dimensional features of emotion, particularly positive and negative affect intensity. This is likely, in part, because achieving inter-rater reliability for facial action and affect intensity ratings is painstaking and labor-intensive. We use computer-vision and machine learning (CVML) to identify patterns of facial actions in 4,648 video recordings of 125 human participants, which show strong correspondences to positive and negative affect intensity ratings obtained from highly trained coders. Our results show that CVML can both (1) determine the importance of different facial actions that human coders use to derive positive and negative affective ratings when combined with interpretable machine learning methods, and (2) efficiently automate positive and negative affect intensity coding on large facial expression databases. Further, we show that CVML can be applied to individual human judges to infer which facial actions they use to generate perceptual emotion ratings from facial expressions.

Flexible Emotion Regulation: How Situational Demands and Individual Differences Influence the Effectiveness of Regulatory Strategies

The number of studies and theoretical contributions on emotion regulation has grown rapidly. In this article we describe the concept of flexible emotion regulation. We argue that the effectiveness of specific emotion regulation strategies depends on the interaction of the features of a situation and personality characteristics of the individual regulating his/her emotions. We review a few recent theoretical contributions and studies that have attempted to capture some aspects of the flexibility of emotion regulation rather than distinguish between overly adaptive and maladaptive strategies. Moreover, we discuss potential personality determinants of effectiveness of particular regulatory strategies. We claim that further studies should address the interaction of situational and dispositional factors in shaping the effectiveness of particular emotion regulation strategies. So far, situational and personality determinants have been studied rather separately.

Contextual factors influence the selection of specific and broad types of emotion regulation strategies

An emerging focus in the emotion regulation (ER) literature is to consider the importance of context for people's ER strategy choice, given that ER responses that adapt to situational demands have been found to be highly beneficial. However, it remains unclear what (and in what way) contextual factors impact people's ER strategy selections. Also, only a limited number of ER strategies have been extensively studied and little is known about people's selection of broad ER strategy categories (we focus on covert vs. overt ER strategies based on Aldao & Dixon-Gordon's [2014] conceptualization). In the current study, 203 participants were recruited from Amazon Mechanical Turk to imagine experiencing either positive or negative emotion in various contextual settings (location: home, social, vs. professional setting × social context: alone vs. with others) and to identify from 16 ER strategies the ones that they would in general deem applicable for each context. Results showed that the aforementioned factors, in various ways, uniquely or interactively predicted the selection of specific and broad ER strategies. Furthermore, personality (neuroticism and extraversion) also influenced participants' ER strategy selection. Overall, this study underscores the importance of including diverse strategies and considering context in the study of ER strategy choices.

School-related subjective well-being promotes subsequent adaptability, achievement, and positive behavioural conduct

BACKGROUND

Previous studies have shown that subjective well-being and adaptability are linked to adaptive educational outcomes, including higher achievement and lower anxiety. It is not presently clear, however, how school-related subjective well-being and adaptability are related, or predict behavioural outcomes such as student conduct.

AIM

The aim of the present study was to test a bidirectional model of school-related subjective well-being and adaptability, and how they relate to achievement and behavioural conduct.

METHOD

Data were collected from 539 Year 12 students over four waves. Achievement and behavioural conduct were measured in the first wave of data collection (T₁ ), school-related subjective well-being and adaptability at the second and third waves (T₂ and T₃ ), and achievement and behavioural conduct again in the fourth wave of data collection (T₄ ).

RESULTS

A structural equation model showed that T₂ school-related subjective well-being predicted higher T₃ adaptability, but not vice versa. T₃ school-related subjective well-being predicted greater T₄ achievement and positive behavioural conduct, and T₃ adaptability predicted greater T₄ positive behavioural conduct.

CONCLUSION

School-related subjective well-being promotes adaptability, achievement, and positive behavioural conduct, and adaptability is also related to positive behavioural conduct. Attempts to foster well-being and adaptability could show educational gains for students.

The role of coping in the relationship between stressful life events and quality of life in persons with cancer

OBJECTIVE

Stressful life events (SLEs) impact the quality of life (QOL) of cancer patients. This study investigated the mediation of the relationship between SLEs and QOL (Model 1: Emotional-EQOL and Model 2: Physical/Functional-PFQOL by three types of coping: Action/Planning, Support/Advise-Seeking, and Disengagement/Denial). Design and Main Measures: 662 persons with cancer completed a Stressful Life Events Checklist, the Brief COPE scale, the FACT Emotional, Physical, and Functional Scales, and the Physical Impact Scale of the Sickness Impact Profile.

RESULTS

SLEs were positively associated with Action/Planning (Model 1: B = 0.195, 95% CI = [0.089, 0.304]; Model 2: B = 0.192, 95% CI = [0.086, 0.289]) and Disengagement/Denial (Model 1: B = 0.394, 95% CI = [0.281, 0.513]; Model 2: B = .392, 95% CI = [0.285, 0.508]) but not Support/Advice-Seeking; however, only Disengagement/Denial was related to Emotional-QOL (Model 1: B = -0.659, 95% CI = [-0.848, -0.498]) and Physical/Functional-QOL (Model 2: B = -1.460, 95% CI = [-1.856, -1.069]). Thus, only Disengagement/Denial mediated the relationship between SLEs and QOL.

CONCLUSIONS

The results indicated that SLEs represent a class of events for which there may be only one dominant coping response, disengagement. SLEs may not be controllable or predictable and reduce capacity for active coping with serious illness. However, SLEs may be detected at any point in the cancer trajectory so that supportive services might be provided.

Concurrent and Lagged Relations between Emotion Regulation and Affect in Adolescents' Daily Life

A better understanding of emotion regulation (ER) within daily life is a growing focus of research. This study evaluated the average use of two ER strategies (cognitive reappraisal and expressive suppression) and concurrent and lagged relationships between these two ER strategies and affect (positive and negative affect) in the daily lives of adolescents. We also investigated the role of the same strategies at the trait level on these within-person relationships. Thirty-three adolescents provided 1,258 reports of their daily life by using the Experience Sampling Method for one week. Regarding the relative use of ER strategies, cognitive reappraisal (M = 2.87, SD = 1.58) was used more often than expressive suppression (M = 2.42, SD = 1.21). While the use of both strategies was positively correlated when evaluated in daily life (p = .01), the same did not occur at the trait level (p = .37). Multilevel analysis found that ER strategies were concurrently related to affect (p &lt; .01), with the exception of cognitive reappraisal-positive affect relationship (p = .11). However, cognitive reappraisal predicted higher positive affect at the subsequent sampling moment ( β = 0.07, p = .03). The concurrent associations between cognitive reappraisal and negative affect vary as function of the use of this strategy at the trait level (β = 0.05, p = .02). Our findings highlighted the complex associations between daily ER strategies and affect of a normative sample of adolescents.

The Context Sensitivity Index (CSI): Measuring the Ability to Identify the Presence and Absence of Stressor Context Cues

The ability to accurately perceive cues to contextual demands across different situations has been identified as a crucial component of successful self-regulation. However, previous attempts to measure context sensitivity have suffered from serious methodological limitations, most notably the possibility that respondents may not possess sufficient knowledge of their own abilities, the confounding of perception of context with response to context, the use of only one or two contextual variations, and the failure to consider the abilities to both accurately detect contextual cues and accurately determine cue absence. This article reports a new, easy-to-administer scenario-based questionnaire measure, the Context Sensitivity Index (CSI), that addressed each of these limitations. The 20-item CSI was iteratively developed and normed using data from five studies to create separate indices to capture sensitivity to the presence of contextual cues (Cue Presence index) and to the relative absence of cues (Cue Absence index). We validated these indices against measures of flexibility, psychopathology, and other scales. Results are discussed in terms of the CSI's implications, limitations, and future applications.

Dialectical Behavior Therapy Skills Training in Alcohol Dependence Treatment: Findings Based on an Open Trial

BACKGROUND

Dialectical behavior therapy (DBT) has demonstrated efficacy in treating disorders such as alcohol dependence that are characterized by emotional dysregulation. Preliminary evidence has revealed the feasibility of DBT skills training (ST) as a stand-alone treatment for such disorders. Although emotional dysregulation plays a significant role in alcohol dependence, there are no previous reports of using DBT-ST to treat it.

OBJECTIVES

The aim of this study was to evaluate the duration of abstinence and changes in emotional regulation in a 3-month DBT-ST program for alcohol-dependent patients and to look for relations between abstinence and emotional regulation.

METHODS

We administered the Difficulties in Emotion Regulation Scale (DERS) and used urine toxicology screening to monitor alcohol/substance intake among the 244 subjects admitted to the program.

RESULTS

Among the 157 patients who completed the treatment, 73.2% were abstinent at the end of the program, and their emotional regulation improved. Improvement was independent of the initial severity of both alcohol use and emotional dysregulation. For substance use outcomes, we found a partial mediation role of improved emotional regulation.

CONCLUSIONS

This is the first open trial to show improved alcohol-related behavior and emotional regulation in alcohol-dependent patients treated with DBT-ST and to posit a partial but significant relation between improved emotional regulation and alcohol use outcomes. In the treatment of alcohol dependence, emotional regulation may be a relevant factor for therapists to consider.

A double-edged sword? Sub-types of psychological flexibility are associated with distinct psychiatric disorders

INTRODUCTION

Psychological flexibility is associated with both better and worse health outcomes. The objective of this study was to differentiate two types of psychological flexibility - affective instability and interpersonal flexibility - and to estimate associations with psychiatric disorders.

METHOD

Study participants were drawn from a large outpatient psychiatric sample that completed standard assessment batteries at an academic hospital (N = 1,358, 55.5% males, mean age=43.87, SD=16.57).

RESULTS

Less interpersonal flexibility was associated with depressive diagnoses. Greater affective instability was associated with bipolar disorder and was negatively associated with psychotic disorders, but showed no association with depressive disorders.

CONCLUSION

Differing degrees of flexibility and instability in emotional and interpersonal domains may be uniquely associated with specific classes of psychological disorders.

Have a look around: the effect of physical environments on risk behaviour in work-related versus non-work related decision-making tasks

Due to ubiquitous computing, knowledge workers do not only work in typical work-associated environments (e.g. the office) but also wherever it best suits their schedule or preferences (e.g. the park). In two experiments using laboratory and field methods, we compared decision making in work and non-work environments. We hypothesised that participants make riskier work-related decisions when in work-associated environments and riskier non-work-related decisions in non-work-associated environments. Therefore, if environment (work vs. non-work) and decision-making task (work-related vs. non-work-related) are incongruent, then risk-taking should be lower, as the decision maker might feel the situation is unusual or inappropriate. Although results do not reveal that work-associated environments generally encourage riskier work-related decisions (and likewise for non-work), we found environmental effects on decision making when including mood as a moderator. Practitioner summary: Mobile workers are required to make decisions in various environments. We assumed that decisions are more risky when they are made in a fitting environment (e.g. work-related decisions in work environments). Results of the two experiments (laboratory and field) only show an environmental effect when mood is included as a moderator.