201
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Sex differences in the indirect effects of cognitive processes on anxiety through emotion regulation difficulties. PERSONALITY AND INDIVIDUAL DIFFERENCES 2015. [DOI: 10.1016/j.paid.2014.07.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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202
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Macatee RJ, Capron DW, Guthrie W, Schmidt NB, Cougle JR. Distress Tolerance and Pathological Worry: Tests of Incremental and Prospective Relationships. Behav Ther 2015; 46:449-62. [PMID: 26163710 DOI: 10.1016/j.beth.2015.03.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 03/04/2015] [Accepted: 03/11/2015] [Indexed: 11/19/2022]
Abstract
Pathological worry and generalized anxiety disorder (GAD) have been linked with low distress tolerance (DT), although questions remain including whether this association exists independent of depression and comorbidity, the directionality of the relationship between worry and DT, and DT's nonredundancy with other worry-relevant variables (i.e., emotional reactivity, stressful life events). Further, it is unclear whether DT is merely a correlate of excessive worry or acts as a risk factor for its development. Two independent studies were completed to evaluate these questions. In Study 1, DT was examined in patients with GAD and healthy controls. In Study 2, a nonclinical sample completed baseline measures of DT, negative affect, and worry, as well as daily assessments of these constructs and stressors for 1month. In Study 1, lower DT was associated with GAD diagnosis and greater worry symptoms independent of extent of comorbidity and depressive symptoms. In Study 2, lower baseline DT predicted unique variance in daily worry and increases in worry over time, whereas baseline worry did not predict daily DT or decreases in DT 1month later. Findings suggest that low DT plays a role in excessive worry independent of relevant covariates (i.e., comorbidity, emotional reactivity, stressful life events) and that this relationship is unidirectional. Further, preliminary evidence indicates that low DT may be an overall risk factor for the development of worry, particularly during periods of romantic stress, although further research and replication is required.
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203
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Berking M, Lukas CA. The Affect Regulation Training (ART): a transdiagnostic approach to the prevention and treatment of mental disorders. Curr Opin Psychol 2015. [DOI: 10.1016/j.copsyc.2015.02.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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204
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Krentzman AR, Higgins MM, Staller KM, Klatt ES. Alexithymia, emotional dysregulation, and recovery from alcoholism: therapeutic response to assessment of mood. QUALITATIVE HEALTH RESEARCH 2015; 25:794-805. [PMID: 25810468 PMCID: PMC4425592 DOI: 10.1177/1049732315577608] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study is a secondary analysis of a randomized controlled trial that tested the effects of a gratitude intervention on well-being in a sample of individuals in outpatient treatment for alcohol use disorder (AUD). Follow-up qualitative interviews unexpectedly revealed that participants found the Positive and Negative Affect Schedule (PANAS) to be helpful to their recovery in the ways that it asked them to identify and rate their emotions. Participant statements were purposively sampled and analyzed using grounded theory methods to produce a conceptual framework illustrating the process of mood identification and its sequelae. Evidence of existing alexithymia and emotional dysregulation, dominance of negative mood, and increasing ability to identify, accept, and regulate mood as part of recovery was found. Findings suggest that emotion regulation is a compelling topic for those in recovery from AUD, and may deserve a more prominent role in treatment.
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205
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Weiss NH, Williams DC, Connolly KM. A Preliminary Examination of Negative Affect, Emotion Dysregulation, and Risky Behaviors among Military Veterans in Residential Substance Abuse Treatment. ACTA ACUST UNITED AC 2015; 3:212-218. [PMID: 27088056 DOI: 10.1080/21635781.2015.1038405] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Substance use disorder (SUD) is highly prevalent among military populations and associated with a wide range of negative outcomes. The goal of the present study was to explicate the relations among negative affect, emotion dysregulation, and urges to engage in risky behaviors among military veterans in residential SUD treatment. Emotion dysregulation (overall and three dimensions: access to emotion regulation strategies, impulse control, and emotional awareness) mediated the relation between negative affect and urges to engage in risky behaviors. Findings highlight the potential utility of treatments targeting emotion dysregulation in reducing risky behaviors among military veterans with SUD.
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Affiliation(s)
- Nicole H Weiss
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06511, USA
| | - Daniel C Williams
- G. V. (Sonny) Montgomery VAMC, 1500 E. Woodrow Wilson Ave., Jackson, MS, 39216, USA. University of Mississippi Medical Center, 2500 N. State St., Jackson, MS, 39216, USA
| | - Kevin M Connolly
- G. V. (Sonny) Montgomery VAMC, 1500 E. Woodrow Wilson Ave., Jackson, MS, 39216, USA. University of Mississippi Medical Center, 2500 N. State St., Jackson, MS, 39216, USA
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206
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Eddie D, Vaschillo E, Vaschillo B, Lehrer P. Heart rate variability biofeedback: Theoretical basis, delivery, and its potential for the treatment of substance use disorders. ADDICTION RESEARCH & THEORY 2015; 23:266-272. [PMID: 28077937 PMCID: PMC5222529 DOI: 10.3109/16066359.2015.1011625] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Heart rate variability biofeedback (HRV BFB) is a biobehavioural clinical intervention that is gaining growing empirical support for the treatment of a number of psychological disorders, several of which are highly comorbid with substance use disorders (SUDs). The present article reviews the autonomic nervous system bases of two key processes implicated in the formation and maintenance of addictive pathology-affect dysregulation and craving-and asks if HRV BFB may be an effective intervention to ameliorate autonomic nervous system dysregulation in these processes, and as such, prove to be an effective intervention for SUDs. A detailed description of HRV BFB and its delivery is provided. Preliminary evidence suggests HRV BFB may be an effective addendum to current first-line SUD treatments, though no firm conclusions can be drawn at this time; more research is needed.
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Affiliation(s)
- David Eddie
- Center of Alcohol Studies, Rutgers, the State University of New Jersey, Piscataway, USA
| | - Evgeny Vaschillo
- Center of Alcohol Studies, Rutgers, the State University of New Jersey, Piscataway, USA
| | - Bronya Vaschillo
- Center of Alcohol Studies, Rutgers, the State University of New Jersey, Piscataway, USA
| | - Paul Lehrer
- Robert Wood Johnson Medical School, Rutgers, the State University of New Jersey, Piscataway, USA
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207
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Han JW, Han DH, Bolo N, Kim B, Kim BN, Renshaw PF. Differences in functional connectivity between alcohol dependence and internet gaming disorder. Addict Behav 2015; 41:12-9. [PMID: 25282597 DOI: 10.1016/j.addbeh.2014.09.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 08/27/2014] [Accepted: 09/03/2014] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Internet gaming disorder (IGD) and alcohol dependence (AD) have been reported to share clinical characteristics including craving and over-engagement despite negative consequences. However, there are also clinical factors that differ between individuals with IGD and those with AD in terms of chemical intoxication, prevalence age, and visual and auditory stimulation. METHODS We assessed brain functional connectivity within the prefrontal, striatum, and temporal lobe in 15 patients with IGD and in 16 patients with AD. Symptoms of depression, anxiety, and the attention deficit hyperactivity disorder were assessed in patients with IGD and in patients with AD. RESULTS Both AD and IGD subjects have positive functional connectivity between the dorsolateral prefrontal cortex (DLPFC), cingulate, and cerebellum. In addition, both groups have negative functional connectivity between the DLPFC and the orbitofrontal cortex. However, the AD subjects have positive functional connectivity between the DLPFC, temporal lobe and striatal areas while IGD subjects have negative functional connectivity between the DLPFC, temporal lobe and striatal areas. CONCLUSIONS AD and IGD subjects may share deficits in executive function, including problems with self-control and adaptive responding. However, the negative connectivity between the DLPFC and the striatal areas in IGD subjects, different from the connectivity observed in AD subjects, may be due to the earlier prevalence age, different comorbid diseases as well as visual and auditory stimulation.
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Affiliation(s)
- Ji Won Han
- Department of Psychiatry, Chung Ang University Hospital, Seoul, South Korea
| | - Doug Hyun Han
- Department of Psychiatry, Chung Ang University Hospital, Seoul, South Korea.
| | - Nicolas Bolo
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, MA, USA
| | - BoAh Kim
- Department of Psychiatry, Seoul National Hospital, Seoul, South Korea
| | - Boong Nyun Kim
- Department of Psychiatry, Seoul National Hospital, Seoul, South Korea
| | - Perry F Renshaw
- The Brain Institute, The University of Utah, Salt Lake City, UT, USA
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208
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Tripp JC, McDevitt-Murphy ME, Avery ML, Bracken KL. PTSD Symptoms, Emotion Dysregulation, and Alcohol-Related Consequences Among College Students With a Trauma History. J Dual Diagn 2015; 11:107-17. [PMID: 25793550 PMCID: PMC4437848 DOI: 10.1080/15504263.2015.1025013] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD), alcohol use, and alcohol-related consequences have been linked to emotion dysregulation. Sex differences exist in both emotion regulation dimensions and alcohol use patterns. This investigation examined facets of emotion dysregulation as potential mediators of the relationship between PTSD symptoms and alcohol-related consequences and whether differences may exist across sexes. METHODS Participants were 240 college students with a trauma history who reported using alcohol within the past three months and completed measures of PTSD symptoms, emotion dysregulation, alcohol consumption, alcohol-related consequences, and negative affect. The six facets of emotion dysregulation were examined as mediators of the relationship between PTSD symptoms and alcohol-related consequences in the full sample and by sex. RESULTS There were differences in sexes on several variables, with women reporting higher PTSD scores and lack of emotional awareness. Men reported significantly more drinks per week in a typical week and a heavy week. There were significant associations between the variables for the full sample, with PTSD showing associations with five facets of emotion dysregulation subscales: impulse control difficulties when upset, difficulties engaging in goal-directed behavior, nonacceptance of emotional responses, lack of emotional clarity, and limited access to emotion regulation strategies. Alcohol-related consequences were associated with four aspects of emotion dysregulation: impulse control difficulties when upset, difficulties engaging in goal-directed behavior, nonacceptance of emotional responses, and limited access to emotion regulation strategies. Two aspects of emotion regulation, impulse control difficulties and difficulties engaging in goal directed behavior, mediated the relationship between PTSD symptoms and alcohol-related consequences in the full sample, even after adjusting for the effects of negative affect. When examined separately by gender, impulse control difficulties remained a mediator for men and difficulties engaging in goal directed behavior for women. CONCLUSIONS These analyses shed light on processes that may underlie "self-medication" of PTSD symptoms. Gender-specific interventions targeting emotion dysregulation may be effective in reducing alcohol-related consequences in individuals with PTSD. Women may possibly benefit from interventions that focus on difficulties engaging in goal-directed behavior, while men may benefit from interventions that target impulse control difficulties when upset.
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209
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Fein G. Neuroplasticity in Human Alcoholism: Studies of Extended Abstinence with Potential Treatment Implications. Alcohol Res 2015; 37:125-41. [PMID: 26259093 PMCID: PMC4476599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Alcoholism is characterized by a lack of control over excessive alcohol consumption despite significant negative consequences. This impulsive and compulsive behavior may be related to functional abnormalities within networks of brain regions responsible for how we make decisions. The abnormalities may result in strengthened networks related to appetitive drive-or the need to fulfill desires-and simultaneously weakened networks that exercise control over behaviors. Studies using functional magnetic resonance imaging (fMRI) in abstinent alcoholics suggest that abstinence is associated with changes in the tone of such networks, decreasing resting tone in appetitive drive networks, and increasing resting tone in inhibitory control networks to support continued abstinence. Identifying electroencephalographic (EEG) measures of resting tone in these networks initially identified using fMRI, and establishing in longitudinal studies that these abstinence-related changes in network tone are progressive would motivate treatment initiatives to facilitate these changes in network tone, thereby supporting successful ongoing abstinence.
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210
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Siegel JP. Emotional Regulation in Adolescent Substance Use Disorders: Rethinking Risk. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2014. [DOI: 10.1080/1067828x.2012.761169] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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211
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Fowler JC, Charak R, Elhai JD, Allen JG, Frueh BC, Oldham JM. Construct validity and factor structure of the difficulties in Emotion Regulation Scale among adults with severe mental illness. J Psychiatr Res 2014; 58:175-80. [PMID: 25171941 DOI: 10.1016/j.jpsychires.2014.07.029] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 07/24/2014] [Accepted: 07/31/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Difficulties in Emotion Regulation Scale (DERS: Gratz and Roemer, 2004) is a measure of emotion-regulation capacities with good construct validity, test-retest reliability and internal consistency. Factor analytic studies have produced mixed results, with the majority of studies supporting the original 6-factor model while several studies advance alternative 5-factor models, each of which raises questions about the psychometric validity of the Lack of Emotional Awareness factor. A limitation of prior psychometric studies on the DERS is the reliance on healthy subjects with minimal impairment in emotion regulation. The current study assesses the construct validity and latent factor structure of the DERS in a large sample of adult psychiatric inpatients with serious mental illness (SMI). METHODS Inpatients with SMI (N = 592) completed the DERS, Acceptance and Action Questionnaire (AAQ-2), Patient Health Questionnaire (PHQ-SADS), and research diagnostic interviews (SCID I/II) at admission. RESULTS DERS total scores were correlated with AAQ-2 (r = .70), PHQ-Depression (r = .45), PHQ-Anxiety (r = .44) and moderately correlated with PHQ-Somatization (r = .28). Confirmatory factor analysis indicated that five and six-factor model produced equivalent fit indices. All factors demonstrated positive correlations with the exception of difficulty engaging in goal-directed behavior and lack of emotional awareness. CONCLUSIONS The DERS is a strong measure with excellent internal consistency and good construct validity. Caution is warranted in discarding the six-factor model given the equivalence with the five-factor model, particularly in light of the body of clinical research evidence utilizing the full scale.
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Affiliation(s)
- J Christopher Fowler
- The Menninger Clinic, Houston, TX 77035, USA; Baylor College of Medicine, Houston, TX 77030, USA.
| | - Ruby Charak
- University of Toledo, Toledo, OH 43606, USA; VU University Amsterdam, Amsterdam, The Netherlands
| | | | - Jon G Allen
- The Menninger Clinic, Houston, TX 77035, USA; Baylor College of Medicine, Houston, TX 77030, USA
| | - B Christopher Frueh
- The Menninger Clinic, Houston, TX 77035, USA; Baylor College of Medicine, Houston, TX 77030, USA; University of Hawaii, Hilo, HI 96720, USA
| | - John M Oldham
- The Menninger Clinic, Houston, TX 77035, USA; Baylor College of Medicine, Houston, TX 77030, USA
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212
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Wirtz CM, Radkovsky A, Ebert DD, Berking M. Successful application of adaptive emotion regulation skills predicts the subsequent reduction of depressive symptom severity but neither the reduction of anxiety nor the reduction of general distress during the treatment of major depressive disorder. PLoS One 2014; 9:e108288. [PMID: 25330159 PMCID: PMC4203678 DOI: 10.1371/journal.pone.0108288] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 08/10/2014] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Deficits in general emotion regulation (ER) skills have been linked to symptoms of depression and are thus considered a promising target in the treatment of Major depressive disorder (MDD). However, at this point, the extent to which such skills are relevant for coping with depression and whether they should instead be considered a transdiagnostic factor remain unclear. Therefore, the present study aimed to investigate whether successful ER skills application is associated with changes in depressive symptom severity (DSS), anxiety symptom severity (ASS), and general distress severity (GDS) over the course of treatment for MDD. METHODS Successful ER skills application, DSS, ASS, and GDS were assessed four times during the first three weeks of treatment in 175 inpatients who met the criteria for MDD. We computed Pearson correlations to test whether successful ER skills application and the three indicators of psychopathology are cross-sectionally associated. We then performed latent growth curve modelling to test whether changes in successful ER skills application are negatively associated with a reduction of DSS, ASS, or GDS. Finally, we utilized latent change score models to examine whether successful ER skills application predicts subsequent reduction of DSS, ASS, or GDS. RESULTS Successful ER skills application was cross-sectionally associated with lower levels of DSS, ASS, and GDS at all points of assessment. An increase in successful skills application during treatment was associated with a decrease in DSS and GDS but not ASS. Finally, successful ER skills application predicted changes in subsequent DSS but neither changes in ASS nor changes in GDS. CONCLUSIONS Although general ER skills might be relevant for a broad range of psychopathological symptoms, they might be particularly important for the maintenance and treatment of depressive symptoms.
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Affiliation(s)
- Carolin M. Wirtz
- Department of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Hesse, Germany
- Department of Clinical Psychology and Psychotherapy, University of Erlangen- Nuremberg, Erlangen, Baveria, Germany
| | - Anna Radkovsky
- Department of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Hesse, Germany
| | - David D. Ebert
- Department of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Hesse, Germany
- Division for Clinical Psychology and Psychotherapy, Department for Psychology, Leuphana University Lueneburg, Lueneburg, Lower Saxony, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, University of Erlangen- Nuremberg, Erlangen, Baveria, Germany
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213
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Lincoln TM, Hartmann M, Köther U, Moritz S. Do People With Psychosis Have Specific Difficulties Regulating Emotions? Clin Psychol Psychother 2014; 22:637-46. [DOI: 10.1002/cpp.1923] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 08/27/2014] [Accepted: 08/27/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Tania M. Lincoln
- Clinical Psychology and Psychotherapy; Institute of Psychology, University of Hamburg; Hamburg 20246 Germany
| | - Maike Hartmann
- Clinical Psychology and Psychotherapy; Institute of Psychology, University of Hamburg; Hamburg 20246 Germany
| | - Ulf Köther
- Department of Psychiatry and Psychotherapy; University Medical Center Hamburg-Eppendorf; Hamburg D-20246 Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy; University Medical Center Hamburg-Eppendorf; Hamburg D-20246 Germany
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214
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Dickens GL, Staniford J, Long CG. Smoking behaviour, motives, motivation to quit and self-efficacy among patients in a secure mental health service: comparison with staff controls. J Psychiatr Ment Health Nurs 2014; 21:483-90. [PMID: 23721124 DOI: 10.1111/jpm.12088] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2013] [Indexed: 11/26/2022]
Abstract
People with mental disorder account for a disproportionately large amount of smokers, and the problem is greatest in inpatient settings. 'Stop smoking' services should be tailored to the needs of individual patient groups. It is important therefore to investigate factors relevant to different groups in order to inform future quit smoking interventions. We compared 50 patients and 50 staff in a secure mental health hospital on measures of smoking and smoking motives, nicotine dependence, craving, previous cessation attempts, motivation to quit and quit smoking-related self-efficacy. Patients were significantly more dependent on nicotine with higher levels of craving; were more likely to smoke to cope with stress, for something to do when bored, for enjoyment and pleasure; and reported significantly less readiness to quit smoking. Staff were more likely to cite health concerns as reasons for quitting. Future pre-intervention work with inpatients should focus on increasing their readiness to quit smoking. Once motivation is increased, interventions should include advice on reducing cravings, finding alternative methods for coping with stress and boredom and achieving enjoyment and pleasure from alternative sources.
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Affiliation(s)
- G L Dickens
- St Andrew's Academic Centre, King's College London Institute of Psychiatry, Northampton, UK; School of Health, University of Northhampton, Northampton, UK
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215
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Heber E, Lehr D, Riper H, Berking M. Emotionsregulation: Überblick und kritische Reflexion des aktuellen Forschungsstandes. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2014. [DOI: 10.1026/1616-3443/a000265] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Die Forschung zum Thema Emotionsregulation erfreut sich auch im Bereich der Klinischen Psychologie einer zunehmenden Beliebtheit. Allerdings stellt sich die Frage, inwieweit die Popularität des Konstrukts im Einklang mit dessen Validität und tatsächlicher heuristischer Fruchtbarkeit steht. Vor diesem Hintergrund ist es Ziel der vorliegenden Arbeit, einen aktuellen Überblick über Konzeptualisierungen, Erfassungsmethoden, Befunde zum Zusammenhang mit psychischen Störungen sowie Möglichkeiten der therapeutischen Nutzung des Konzeptes Emotionsregulation zu geben. Aufbauend auf einer kritischen Reflexion bisheriger Konzepte, Vorgehensweisen und Befunde werden Vorschläge gemacht, wie die Validität und die heuristische Fruchtbarkeit des Emotionsregulationsparadigmas weiter gefördert werden können.
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Affiliation(s)
| | | | - Heleen Riper
- Leuphana Universität Lüneburg
- Freie Universität Amsterdam
| | - Matthias Berking
- Leuphana Universität Lüneburg
- Friedrich-Alexander-Universität Erlangen-Nürnberg
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216
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Anxiety disorders and risk for alcohol use disorders: the moderating effect of parental support. Drug Alcohol Depend 2014; 140:191-7. [PMID: 24846596 PMCID: PMC4076935 DOI: 10.1016/j.drugalcdep.2014.04.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 04/22/2014] [Accepted: 04/22/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND There have been mixed findings on the temporal relation between anxiety disorders and alcohol use disorders (AUDs), suggesting that the pathway to AUDs may differ among individuals. The aim of the current study was to test whether parental support moderated the association between anxiety disorders and the development of AUDs. We also tested whether our effects differed as a function of age of AUD onset. METHODS 817 individuals were assessed for lifetime diagnoses of psychopathology during 4-waves between adolescence (mean age=16) and adulthood (mean age=30). RESULTS Proportional hazards model analyses indicated that baseline anxiety disorders interacted with baseline perceived maternal support to prospectively predict onset of AUDs. At high levels of maternal support, anxiety disorders were associated with a reduced risk for AUD onset (HR=0.74, 95% CI=0.55-1.00). However, this effect was more robust for AUDs that developed prior to age 20. At low levels of maternal support, anxiety disorders were associated with an increased risk for AUD onset (HR=1.65, 95% CI=1.21-2.26). This effect was present for AUDs that developed across adolescence and adulthood. Paternal support was not associated with AUDs and did not interact with anxiety disorders. CONCLUSIONS Prevention and intervention efforts targeted at maternal support in adolescents with anxiety disorders may be valuable, as this may represent a factor that has a significant impact on the developmental course of AUDs.
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217
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Wilcox CE, Dekonenko CJ, Mayer AR, Bogenschutz MP, Turner JA. Cognitive control in alcohol use disorder: deficits and clinical relevance. Rev Neurosci 2014; 25:1-24. [PMID: 24361772 DOI: 10.1515/revneuro-2013-0054] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 11/27/2013] [Indexed: 01/25/2023]
Abstract
Cognitive control refers to the internal representation, maintenance, and updating of context information in the service of exerting control over thoughts and behavior. Deficits in cognitive control likely contribute to difficulty in maintaining abstinence in individuals with alcohol use disorders (AUD). In this article, we define three cognitive control processes in detail (response inhibition, distractor interference control, and working memory), review the tasks measuring performance in these areas, and summarize the brain networks involved in carrying out these processes. Next, we review evidence of deficits in these processes in AUD, including both metrics of task performance and functional neuroimaging. Finally, we explore the clinical relevance of these deficits by identifying predictors of clinical outcome and markers that appear to change (improve) with treatment. We observe that individuals with AUD experience deficits in some, but not all, metrics of cognitive control. Deficits in cognitive control may predict clinical outcome in AUD, but more work is necessary to replicate findings. It is likely that performance on tasks requiring cognitive control improves with abstinence, and with some psychosocial and medication treatments. Future work should clarify which aspects of cognitive control are most important to target during treatment of AUD.
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218
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Berking M, Wirtz CM, Svaldi J, Hofmann SG. Emotion regulation predicts symptoms of depression over five years. Behav Res Ther 2014; 57:13-20. [DOI: 10.1016/j.brat.2014.03.003] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 02/14/2014] [Accepted: 03/11/2014] [Indexed: 02/06/2023]
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219
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Bardeen JR, Fergus TA. An examination of the incremental contribution of emotion regulation difficulties to health anxiety beyond specific emotion regulation strategies. J Anxiety Disord 2014; 28:394-401. [PMID: 24726241 DOI: 10.1016/j.janxdis.2014.03.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 03/04/2014] [Accepted: 03/05/2014] [Indexed: 11/26/2022]
Abstract
Given the potential transdiagnostic importance of emotion dysregulation, as well as a lack of research examining emotion dysregulation in relation to health anxiety, the present study sought to examine associations among specific emotion regulation strategies (cognitive reappraisal and expressive suppression), emotion regulation difficulties, and health anxiety in a physically healthy sample of adults (N=482). As hypothesized, results of a series of hierarchical multiple regression analyses showed that emotion regulation difficulties provided a significant incremental contribution, beyond the specific emotion regulation strategies, in predicting each of the three health anxiety variables. Among the six dimensions of emotion regulation difficulties, the dimension representing perceived access to effective emotion regulation strategies was the only emotion regulation difficulty dimension that predicted all three health anxiety variables beyond the effects of the specific emotion regulation strategies. Results indicate that emotion regulation difficulties, and particularly one's subjective appraisal of his/her ability to effectively regulate emotions, may be of importance to health anxiety. Clinical implications are discussed.
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Affiliation(s)
- Joseph R Bardeen
- University of Mississippi Medical Center, Jackson, MS, United States.
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de Haan HA, van der Palen J, Wijdeveld TGM, Buitelaar JK, De Jong CAJ. Alexithymia in patients with substance use disorders: state or trait? Psychiatry Res 2014; 216:137-45. [PMID: 24534122 DOI: 10.1016/j.psychres.2013.12.047] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 07/25/2013] [Accepted: 12/29/2013] [Indexed: 01/12/2023]
Abstract
Previous research on substance use disorders (SUD) has yielded conflicting results concerning whether alexithymia is a state or trait, raising the question of how alexithymia should be addressed in the treatment of SUD-patients. The absolute and relative stabilities of alexithymia were assessed using the Toronto Alexithymia Scale (TAS-20) and its subscales. In total, 101 patients with SUD were assessed twice during a 3-week inpatient detoxification period while controlling for withdrawal symptoms and personality disorder traits. The relative stability of the total TAS-20 and subscales was moderate to high but showed remarkable differences between baseline low, moderate, and high alexithymic patients. A small reduction in the mean levels of the total TAS-20 scores and those of one subscale revealed the absence of absolute stability. The levels of alexithymia were unrelated to changes in withdrawal symptoms, including anxiety- and depression-like symptoms. The differences between low, moderate, and high alexithymic patients in terms of the change in alexithymia scores between baseline and follow-up indicated a strong regression to the mean. The findings suggest that alexithymia in SUD patients as measured using the TAS-20 is both a state and trait phenomenon and does not appear to be related to changes in anxiety- and depression-like symptoms.
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Affiliation(s)
- Hein A de Haan
- Tactus Addiction Treatment, 7400 AD Deventer, The Netherlands; Nijmegen Institute for Scientist-Practitioners in Addiction, 6500 HE Nijmegen, The Netherlands.
| | - Job van der Palen
- Department of Research Methodology, Measurement and Data Analysis, University of Twente, 7500 AE Enschede, The Netherlands; Medical School Twente, Medisch Spectrum Twente, 7513 ER Enschede, The Netherlands
| | - Toon G M Wijdeveld
- Nijmegen Institute for Scientist-Practitioners in Addiction, 6500 HE Nijmegen, The Netherlands
| | - Jan K Buitelaar
- Radboud University Nijmegen Medical Centre, Department of Cognitive Neuroscience, Nijmegen, The Netherlands
| | - Cor A J De Jong
- Nijmegen Institute for Scientist-Practitioners in Addiction, 6500 HE Nijmegen, The Netherlands
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221
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Ebert D, Tarnowski T, Gollwitzer M, Sieland B, Berking M. A transdiagnostic internet-based maintenance treatment enhances the stability of outcome after inpatient cognitive behavioral therapy: a randomized controlled trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2014; 82:246-56. [PMID: 23736751 DOI: 10.1159/000345967] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 11/15/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND High relapse rates following acute treatment for common mental health disorders support the importance of developing maintenance phase interventions. Internet-based interventions have been effective for a broad range of mental disorders, but less is known about their potential to enhance long-term outcomes of traditional face-to-face therapy. Therefore, the goal of the present study was to evaluate a transdiagnostic Internet-based maintenance treatment (TIMT) with the purpose of fostering long-term effects of inpatient psychotherapy. METHOD In this pragmatic randomized controlled trial, a sample of 400 inpatients with affective, neurotic, and/or behavioral disorders was assigned to either 12 weeks of TIMT + treatment as usual (TAU) or to TAU-only following hospital discharge. TIMT consists of a self-management module, asynchronous patient-coach communication, online patient support group, and online-based monitoring of psychopathological symptoms. Self-ratings of psychopathological symptoms were conducted at the beginning of inpatient treatment (t1), at discharge from inpatient treatment/start of TIMT (t2), and at 3-month (t3) and 12-month follow-ups (t4). RESULTS The TIMT + TAU group was superior to the TAU-only group with regard to differences in change of general psychopathological symptom severity from discharge to 3- and 12-month follow-up. Moreover, participants of the TIMT + TAU group showed less frequent symptom deteriorations and were more often in remission/recovery than controls. CONCLUSION TIMT effectively enhances long-term outcome of inpatient psychotherapy.
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Affiliation(s)
- David Ebert
- Philipps University Marburg, Marburg, Germany.
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222
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Berking M, Ebert D, Cuijpers P, Hofmann SG. Emotion regulation skills training enhances the efficacy of inpatient cognitive behavioral therapy for major depressive disorder: a randomized controlled trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2014; 82:234-45. [PMID: 23712210 DOI: 10.1159/000348448] [Citation(s) in RCA: 158] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 12/24/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Deficits in emotion regulation skills are possible factors maintaining major depressive disorder (MDD). Therefore, the aim of the study was to test whether integrating a systematic emotion regulation training (ERT) enhances the efficacy of routine inpatient cognitive behavioral therapy (CBT) for MDD. METHODS In a prospective randomized controlled trial, 432 inpatients meeting criteria for MDD were assigned to receive either routine CBT or CBT enriched with an intense emotion regulation skills training (CBT-ERT). RESULTS Participants in the CBT-ERT condition demonstrated a significantly greater reduction in depression (response rates - CBT: 75.5%, CBT-ERT: 84.9%; remission rates - CBT: 51.1%, CBT-ERT: 65.1%). Moreover, CBT-ERT participants demonstrated a significantly greater reduction of negative affect, as well as a greater increase of well-being and emotion regulation skills particularly relevant for mental health. CONCLUSIONS Integrating strategies that target emotion regulation skills improves the efficacy of CBT for MDD.
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Affiliation(s)
- Matthias Berking
- University of Marburg, Department of Clinical Psychology and Psychotherapy Gutenbergstrasse 18 DE–35032 Marburg, Germany.
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223
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Oscar-Berman M, Valmas MM, Sawyer KS, Ruiz SM, Luhar RB, Gravitz ZR. Profiles of impaired, spared, and recovered neuropsychologic processes in alcoholism. HANDBOOK OF CLINICAL NEUROLOGY 2014; 125:183-210. [PMID: 25307576 PMCID: PMC4515358 DOI: 10.1016/b978-0-444-62619-6.00012-4] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Long-term chronic alcoholism is associated with disparate and widespread residual consequences for brain functioning and behavior, and alcoholics suffer a variety of cognitive deficiencies and emotional abnormalities. Alcoholism has heterogeneous origins and outcomes, depending upon factors such as family history, age, gender, and mental or physical health. Consequently, the neuropsychologic profiles associated with alcoholism are not uniform among individuals. Moreover, within and across research studies, variability among subjects is substantial and contributes to characteristics associated with differential treatment outcomes after detoxification. In order to refine our understanding of alcoholism-related impaired, spared, and recovered abilities, we focus on five specific functional domains: (1) memory; (2) executive functions; (3) emotion and psychosocial skills; (4) visuospatial cognition; and (5) psychomotor abilities. Although the entire brain might be vulnerable in uncomplicated alcoholism, the brain systems that are considered to be most at risk are the frontocerebellar and mesocorticolimbic circuitries. Over time, with abstinence from alcohol, the brain appears to become reorganized to provide compensation for structural and behavioral deficits. By relying on a combination of clinical and scientific approaches, future research will help to refine the compensatory roles of healthy brain systems, the degree to which abstinence and treatment facilitate the reversal of brain atrophy and dysfunction, and the importance of individual differences to outcome.
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Affiliation(s)
- Marlene Oscar-Berman
- Boston University School of Medicine, L-815, 72 E. Newton St., Boston, MA 02118; ; telephone 617-638-4803
| | - Mary M. Valmas
- Boston University School of Medicine, L-815, 72 E. Newton St., Boston, MA 02118; ; telephone 617-638-4803
| | - Kayle S. Sawyer
- Boston University School of Medicine, L-815, 72 E. Newton St., Boston, MA 02118; ; telephone 617-638-4803
| | - Susan Mosher Ruiz
- Boston University School of Medicine, L-815, 72 E. Newton St., Boston, MA 02118; ; telephone 617-638-4803
| | - Riya B. Luhar
- Boston University School of Medicine, L-815, 72 E. Newton St., Boston, MA 02118; ; telephone 617-638-4803
| | - Zoe R. Gravitz
- Boston University School of Medicine, L-815, 72 E. Newton St., Boston, MA 02118; ; telephone 617-638-4803
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224
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Wirtz CM, Hofmann SG, Riper H, Berking M. Emotion regulation predicts anxiety over a five-year interval: a cross-lagged panel analysis. Depress Anxiety 2014; 31:87-95. [PMID: 24151095 DOI: 10.1002/da.22198] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 09/01/2013] [Accepted: 09/08/2013] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Emotion regulation (ER) deficits have been linked to symptoms of anxiety in cross-sectional studies. However, the direction of the relationship between ER and anxiety symptom severity (ASS) is unclear. METHODS In order to clarify the relationship between ER skills and ASS symptoms, we assessed skills and symptoms in 131 individuals twice over a 5-year interval. Cross-lagged panel analyses were conducted to test whether ER skills were a significant predictor of subsequent ASS or vice versa. Additionally, we explored whether specific ER skills differed in regard to the strength of prospective associations with subsequent ASS. RESULTS ER skills negatively predicted subsequent ASS over and above the effects of baseline ASS (whereas anxiety symptoms did not predict subsequent ER deficits). Acceptance, tolerance, and willingness to confront had the strongest prospective effects on lower subsequent ASS. CONCLUSIONS General ER skills may play an important role in the development and maintenance of anxiety disorders.
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Affiliation(s)
- Carolin M Wirtz
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
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225
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Gearhardt AN, Roberto CA, Seamans MJ, Corbin WR, Brownell KD. Preliminary validation of the Yale Food Addiction Scale for children. Eat Behav 2013; 14:508-12. [PMID: 24183146 PMCID: PMC3817415 DOI: 10.1016/j.eatbeh.2013.07.002] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 05/31/2013] [Accepted: 07/15/2013] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Evidence is growing that an addictive process may play a role in problematic eating behavior. The majority of research on this topic has examined the concept of "food addiction" solely in adult samples. If certain foods have addictive potential, children may be impacted as much as (or more) than adults due to psychological and neurobiological vulnerabilities at younger developmental stages. In the current study, we developed a measure of food addiction in children that reflects the diagnostic indicators of addiction. MATERIALS AND METHODS The content and reading level of the Yale Food Addiction Scale (YFAS) was altered to be appropriate for children (YFAS-C). The YFAS-C and other eating-related measures were administered to study participants to examine the validity and reliability of the YFAS-C. PARTICIPANTS 75 children were recruited from the community ranging from lean to obese. RESULTS The validation of the YFAC-C provides preliminary support for its convergent validity with like constructs and incremental validity in predicting body mass index. Internal consistency was adequate given the small number of items on the scale. DISCUSSION The YFAS-C appears to be a helpful tool for identifying addictive-like eating in children.
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Affiliation(s)
- Ashley N Gearhardt
- Department of Psychology, University of Michigan, 530 Church St., Ann Arbor, MI 48109, USA.
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226
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Siegel JP. An expanded approach to batterer intervention programs incorporating neuroscience research. TRAUMA, VIOLENCE & ABUSE 2013; 14:295-304. [PMID: 23978773 DOI: 10.1177/1524838013495982] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Batterer Intervention Programs have been critiqued for failing to incorporate treatment strategies that are supported by neurobiology research. This article reviews findings that have informed the treatment of disorders that are strongly represented among perpetrators of intimate violence, such as addiction, posttraumatic stress disorder, mood, anxiety, and personality disorders. The article argues for an expanded perspective that recognizes the relationships among childhood trauma, emotional regulation impairment, and intimate partner violence. Recommendations and ways to draw on emerging knowledge to invigorate existing programs are provided.
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Affiliation(s)
- Judith P Siegel
- 1Silver School of Social Work, New York University, New York, NY, USA
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227
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Cortical activation deficits during facial emotion processing in youth at high risk for the development of substance use disorders. Drug Alcohol Depend 2013; 131:230-7. [PMID: 23768841 PMCID: PMC3740548 DOI: 10.1016/j.drugalcdep.2013.05.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 04/15/2013] [Accepted: 05/13/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND Recent longitudinal studies demonstrate that addiction risk may be influenced by a cognitive, affective and behavioral phenotype that emerges during childhood. Relatively little research has focused on the affective or emotional risk components of this high-risk phenotype, including the relevant neurobiology. METHODS Non-substance abusing youth (N=19; mean age=12.2) with externalizing psychopathology and paternal history of a substance use disorder and demographically matched healthy comparisons (N=18; mean age=11.9) were tested on a facial emotion matching task during functional MRI. This task involved matching faces by emotions (angry, anxious) or matching shape orientation. RESULTS High-risk youth exhibited increased medial prefrontal, precuneus and occipital cortex activation compared to the healthy comparison group during the face matching condition, relative to the control shape condition. The occipital activation correlated positively with parent-rated emotion regulation impairments in the high-risk group. CONCLUSIONS These findings suggest a preexisting abnormality in cortical activation in response to facial emotion matching in youth at high risk for the development of problem drug or alcohol use. These cortical deficits may underlie impaired affective processing and regulation, which in turn may contribute to escalating drug use in adolescence.
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228
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Stasiewicz PR, Bradizza CM, Schlauch RC, Coffey SF, Gulliver SB, Gudleski GD, Bole CW. Affect regulation training (ART) for alcohol use disorders: development of a novel intervention for negative affect drinkers. J Subst Abuse Treat 2013; 45:433-43. [PMID: 23876455 DOI: 10.1016/j.jsat.2013.05.012] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 05/29/2013] [Accepted: 05/30/2013] [Indexed: 11/17/2022]
Abstract
Although negative affect is a common precipitant of alcohol relapse, there are few interventions for alcohol dependence that specifically target negative affect. In this stage 1a/1b treatment development study, several affect regulation strategies (e.g., mindfulness, prolonged exposure, distress tolerance) were combined to create a new treatment supplement called affect regulation training (ART), which could be added to enhance cognitive-behavioral therapy (CBT) for alcohol dependence. A draft therapy manual was given to therapists and treatment experts before being administered to several patients who also provided input. After two rounds of manual development (stage 1a), a pilot randomized clinical trial (N=77) of alcohol-dependent outpatients who reported drinking often in negative affect situations was conducted (stage 1b). Participants received 12-weekly, 90-minute sessions of either CBT for alcohol dependence plus ART (CBT+ART) or CBT plus a healthy lifestyles control condition (CBT+HLS). Baseline, end-of-treatment, and 3- and 6-month posttreatment interviews were conducted. For both treatment conditions, participant ratings of treatment satisfaction were high, with CBT+ART rated significantly higher. Drinking outcome results indicated greater reductions in alcohol use for CBT+ART when compared to CBT+HLS, with moderate effect sizes for percent days abstinent, drinks per day, drinks per drinking day, and percent heavy drinking days. Overall, findings support further research on affect regulation interventions for negative affect drinkers.
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Affiliation(s)
- Paul R Stasiewicz
- Research Institute on Addictions, University at Buffalo, 1021 Main St., Buffalo, NY 14203, USA.
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229
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Sleep disturbance and emotion dysregulation as transdiagnostic processes in a comorbid sample. Behav Res Ther 2013; 51:540-6. [PMID: 23831496 DOI: 10.1016/j.brat.2013.05.014] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 04/16/2013] [Accepted: 05/15/2013] [Indexed: 11/21/2022]
Abstract
Sleep disturbance and emotion dysregulation have been identified as etiologic and maintaining factors for a range of psychopathology and separate literatures support their relationships to anxiety, depression, PTSD, and alcohol dependence (AD) symptom severity. Previous studies have examined these relationships in isolation, failing to account for the high rates of comorbidity among disorders. It is not yet known whether these processes uniquely predict symptom severity in each of these domains. Participants were 220 patients in residential substance abuse treatment, who had experienced a potentially traumatic event and exceeded screening cutoffs for probable PTSD and problematic alcohol use. Controlling for emotion dysregulation and the interrelationships among the outcome variables, insomnia was uniquely associated with anxiety (B = .27, p < .001), depression (B = .25, p < .001), PTSD (B = .22, p < .001), and AD (B = .17, p = .01) symptom severity. Similarly, controlling for insomnia, emotion dysregulation was uniquely associated with anxiety (B = .40, p < .001), depression (B = .47, p < .001), PTSD (B = .38, p < .001), and AD (B = .26, p < .001) symptom severity. Insomnia and emotion dysregulation appear to be transdiagnostic processes uniquely associated with symptom severity across a number of different domains and might be important treatment targets for individuals with PTSD and AD.
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230
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Goldsmith RE, Chesney SA, Heath NM, Barlow MR. Emotion regulation difficulties mediate associations between betrayal trauma and symptoms of posttraumatic stress, depression, and anxiety. J Trauma Stress 2013; 26:376-84. [PMID: 23737296 DOI: 10.1002/jts.21819] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Emotion regulation difficulties following trauma exposure have received increasing attention among researchers and clinicians. Previous work highlights the role of emotion regulation difficulties in multiple forms of psychological distress and identifies emotion regulation capacities as especially compromised among survivors of betrayal trauma: physical, sexual, or emotional maltreatment perpetrated by someone to whom the victim is close, such as a parent or partner. It is unknown, however, whether links between emotion regulation difficulties and psychological symptoms differ following exposure to betrayal trauma as compared with other trauma types. In the present study, 593 male and female university undergraduates completed the Difficulties with Emotion Regulation Scale (Gratz & Roemer, 2004), the Brief Betrayal Trauma Scale (Goldberg & Freyd, 2006), the Impact of Event Scale (Horowitz, Wilner, & Alvarez, 1979), and the Trauma Symptom Checklist (Elliott & Briere, 1992). A path analytic model demonstrated that betrayal trauma indirectly impacted symptoms of intrusion (β = .11), avoidance (β = .13), depression (β = .17), and anxiety (β = .14) via emotion regulation difficulties, an effect consistent with mediation. Emotion regulation difficulties did not mediate the relationship between other trauma exposure and psychological symptoms. Results may inform treatment-matching efforts, and suggest that emotion regulation difficulties may constitute a key therapeutic target following betrayal trauma.
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Affiliation(s)
- Rachel E Goldsmith
- Mount Sinai School of Medicine, Department of Oncological Sciences, New York, NY 10029, USA.
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231
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Enebrink P, Björnsdotter A, Ghaderi A. The Emotion Regulation Questionnaire: Psychometric Properties and Norms for Swedish Parents of Children Aged 10-13 Years. EUROPES JOURNAL OF PSYCHOLOGY 2013. [DOI: 10.5964/ejop.v9i2.535] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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232
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Camchong J, Stenger VA, Fein G. Resting-state synchrony in short-term versus long-term abstinent alcoholics. Alcohol Clin Exp Res 2013; 37:794-803. [PMID: 23421812 DOI: 10.1111/acer.12037] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 09/24/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND We previously reported that when compared with controls, long-term abstinent alcoholics (LTAA) have increased resting-state synchrony (RSS) of the inhibitory control network and reduced synchrony of the appetitive drive network, and hypothesized that these levels of synchrony are adaptive and support the behavioral changes required to maintain abstinence. In this study, we investigate whether these RSS patterns can be identified in short-term abstinent alcoholics (STAA). METHODS Resting-state functional magnetic resonance imaging data were collected from 27 STAA, 23 LTAA, and 23 nonsubstance abusing controls (NSAC). We examined baseline RSS using seed-based measures. RESULTS We found ordered RSS effects from NSAC to STAA and then to LTAA within both the appetitive drive and executive control networks: increasing RSS of the executive control network and decreasing RSS of the reward processing network. Finally, we found significant correlations between strength of RSS in these networks and (i) cognitive flexibility, and (ii) current antisocial behavior. CONCLUSIONS Findings are consistent with an adaptive progression of RSS from short- to long-term abstinence, so that, compared with normal controls, the synchrony (i) within the reward network progressively decreases, and (ii) within the executive control network progressively increases.
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233
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Rumination and Hopelessness as Mediators of the Relation Between Perceived Emotion Dysregulation and Suicidal Ideation. COGNITIVE THERAPY AND RESEARCH 2013. [DOI: 10.1007/s10608-013-9524-5] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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234
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Ebert DD, Christ O, Berking M. Entwicklung und Validierung eines Fragebogens zur emotionsspezifischen Selbsteinschätzung emotionaler Kompetenzen (SEK-ES). DIAGNOSTICA 2013. [DOI: 10.1026/0012-1924/a000079] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zahlreiche Studien belegen die Relevanz von Emotionsregulationskompetenzen für die psychische Gesundheit. Problematisch ist jedoch, dass viele dieser Studien Selbsteinschätzungsmaße verwenden, die Kompetenzen im Umgang mit Emotionen oder Stimmungen im Allgemeinen zu erfassen suchen. Dadurch bleibt unklar, auf welche Emotionen sich die Probanden beim Ausfüllen beziehen und inwieweit Bewältigungskompetenzen über verschiedene Emotionen hinweg differieren. Ziel der Studie ist daher die Entwicklung und Validierung eines Fragebogens zur ökonomischen Selbsteinschätzung von sowohl emotionsübergreifenden als auch emotionsspezifischen Bewältigungskompetenzen. Auf Basis des emotionsunspezifischen SEK-27 ( Berking & Znoj, 2008 ) wurde ein Fragebogen zur emotionsspezifischen Selbsteinschätzung des konstruktiven Umgangs mit Stress, Angst, Ärger, Traurigkeit und depressiver Stimmung entwickelt (SEK-ES). Mit Hilfe einer nicht-klinischen (N = 358) und einer klinischen Stichprobe (N = 579) wurden Itemkennwerte, Reliabilität, Validität sowie Veränderungssensitivität des SEK-ES bestimmt. Die Befunde sprechen für gute bis sehr gute psychometrische Eigenschaften des Instrumentes und für die Notwendigkeit, emotionale Kompetenzen emotionsspezifisch zu erfassen.
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235
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Berking M, Poppe C, Luhmann M, Wupperman P, Jaggi V, Seifritz E. Is the association between various emotion-regulation skills and mental health mediated by the ability to modify emotions? Results from two cross-sectional studies. J Behav Ther Exp Psychiatry 2012; 43:931-7. [PMID: 22406495 DOI: 10.1016/j.jbtep.2011.09.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 08/29/2011] [Accepted: 09/07/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND AND OBJECTIVES In order to clarify mechanisms underlying the association between emotion regulation and psychopathology, we tested whether the ability to modify negative emotions mediates the associations of other emotion-regulation skills with psychopathological symptoms in two studies. METHODS The first study included 151 college students; the second included 121 psychiatric inpatients. Bootstrapping-enhanced mediation analyses were utilized to assess associations between self-reports of emotion-regulation skills and psychopathology, as well as potential mediation effects. RESULTS In both samples, the ability to modify emotions completely mediated the association between symptoms and skills for most skills, but not for the skill of accepting/tolerating negative emotions. LIMITATIONS Major limitations include the use of a cross-sectional design as well as exclusive use of self-report data. CONCLUSIONS The ability to modify negative emotions may be the common pathway by which many emotion-regulation skills exert their influence on mental health; however, the skill of accepting/tolerating negative emotions may be beneficial to mental health regardless of whether or not it facilitates modification of emotions.
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Affiliation(s)
- Matthias Berking
- University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstrasse 18, D-35032 Marburg, Germany.
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236
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Camchong J, Stenger A, Fein G. Resting-state synchrony during early alcohol abstinence can predict subsequent relapse. Cereb Cortex 2012; 23:2086-99. [PMID: 22819968 DOI: 10.1093/cercor/bhs190] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Short-term abstinent alcoholics have shown increased engagement of reward regions and reduced engagement of executive control regions. There is no report yet on whether these differences can predict relapse. This is the first study that investigates whether differences in resting-state networks can predict later relapse. Resting-state functional magnetic resonance imaging data were collected from 69 short-term abstinent alcoholics. Participants performed the affective go/no-go task outside of the scanner. At 6-month follow-up, participants were grouped as abstainers (N = 40; age: M = 46.70, standard deviation [SD] = 6.83) and relapsers (N = 29; age: M = 46.91, SD = 7.25). We examined baseline resting-state synchrony (RSS) using seed-based measures. Compared with abstainers, relapsers showed significantly decreased RSS within both the reward and executive control networks as well as within the visual network (P < 0.05). Lower RSS in relapsers could predict relapse (P < 0.05) and was significantly correlated with poor inhibitory control of emotional-laden stimuli (P < 0.017) and with alcohol use (P < 0.05). Results suggest that lower RSS during short-term abstinence may predict subsequent relapse. The association of lower RSS with poorer inhibitory control suggests that low RSS may constitute a faulty foundation for future responses to external cues, which can be manifested as the inability to inhibit behavior.
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237
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Camchong J, Stenger A, Fein G. Resting-state synchrony in long-term abstinent alcoholics. Alcohol Clin Exp Res 2012; 37:75-85. [PMID: 22725701 DOI: 10.1111/j.1530-0277.2012.01859.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 04/02/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Alcohol dependence is a disorder with an impulsive and compulsive "drive" toward alcohol consumption and an inability to inhibit alcohol consumption. Neuroimaging studies suggest that these behavioral components correspond to an increased involvement of regions that mediate appetitive drive and reduced involvement of regions that mediate executive control within top-down networks. Little is known, however, about whether these characteristics are present after long periods of abstinence. METHODS Resting-state functional magnetic resonance imaging data were collected to examine resting-state synchrony (RSS) differences between 23 long-term abstinent alcoholics (LTAA; 8 women, age: M = 48.46, SD = 7.10), and 23 nonsubstance abusing controls (NSAC; 8 women, age: M = 47.99, SD = 6.70). Using seed-based measures, we examined RSS with the nucleus accumbens (NAcc) and the subgenual anterior cingulate cortex (sgACC). All participants were assessed with the intra/extradimensional set shift task outside of the scanner to explore the relationship between RSS and cognitive flexibility. RESULTS Compared to NSAC, LTAA showed (i) decreased synchrony of limbic reward regions (e.g., caudate and thalamus) with both the anterior cingulate cortex seed and the NAcc seed and (ii) increased synchrony of executive control regions (e.g., dorsolateral prefrontal cortex) with both the NAcc seed and the sgACC seed. RSS differences were significantly correlated with task performance. CONCLUSIONS The results are consistent with an interpretation of an ongoing compensatory mechanism in LTAA evident during rest, in which decision-making networks show reduced synchrony with appetitive drive regions and increased synchrony with inhibitory control regions. In addition, RSS differences were associated with cognitive flexibility. These resting-state findings indicate an adaptive mechanism present in long-term abstinence that may facilitate the behavioral control required to maintain abstinence.
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Hofmann SG, Sawyer AT, Fang A, Asnaani A. Emotion dysregulation model of mood and anxiety disorders. Depress Anxiety 2012; 29:409-16. [PMID: 22430982 DOI: 10.1002/da.21888] [Citation(s) in RCA: 349] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 10/22/2011] [Accepted: 11/20/2011] [Indexed: 11/12/2022] Open
Abstract
In this review, we present a transdiagnostic emotion dysregulation model of mood and anxiety disorders. This model posits that a triggering event, in conjunction with an existing diathesis, leads to negative or positive affect, depending on the person's affective style. Mood and anxiety disorders are the result of emotion dysregulation of negative affect, coupled with deficiencies in positive affect. The theoretical background of the model is discussed and a range of clinical applications of the model is described.
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The relationship of alexithymia to emotional dysregulation within an alcohol dependent treatment sample. Addict Behav 2012; 37:469-76. [PMID: 22244705 DOI: 10.1016/j.addbeh.2011.12.011] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 12/16/2011] [Accepted: 12/19/2011] [Indexed: 11/22/2022]
Abstract
Difficulties regulating emotions have implications for the development, maintenance, and recovery from alcohol problems. One construct thought to impede the regulation of emotion is alexithymia. Alexithymia is characterized by difficulties identifying, differentiating and expressing feelings, a limited imagination and fantasy life, and an externally-oriented thinking style (e.g., prefer talking about daily activities rather than feelings). Given that poor emotion regulation skills have been found to predict posttreatment levels of alcohol use, and that several defining characteristics of alexithymia bear similarity to deficits in emotion regulation skills, it is possible that alexithymia may predict poorer alcohol treatment outcomes. Thus, the present study first examined the relationship of alexithymia to several other emotion regulation measures and then investigated the impact of alexithymia on attrition and alcohol treatment outcomes in men and women (N=77) enrolled in a 12-week cognitive-behavioral intervention for alcohol dependence. At baseline, higher scores on alexithymia were associated poorer emotion regulation skills, fewer percent days abstinent, greater alcohol dependence severity, and several high-risk drinking situations. Alexithymia was unrelated to attrition and to level of alcohol consumption at posttreatment. Overall, the construct of alexithymia is shown to be related to several theoretically-related constructs (e.g., emotion regulation, mindfulness) but demonstrated a limited relationship to drinking outcomes in those seeking treatment for alcohol dependence.
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Szasz PL, Szentagotai A, Hofmann SG. Effects of emotion regulation strategies on smoking craving, attentional bias, and task persistence. Behav Res Ther 2012; 50:333-40. [PMID: 22459732 DOI: 10.1016/j.brat.2012.02.010] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 02/23/2012] [Accepted: 02/24/2012] [Indexed: 11/28/2022]
Abstract
The goal of this study was to investigate the effects of different strategies for regulating emotions associated with smoking on subjective, cognitive, and behavioral correlates of smoking. Emotion regulation was manipulated by instructing participants to reappraise (n = 32), accept (n = 31), or suppress (n = 31) their emotions associated with smoking. The dependent measures included subjective reports of craving, negative affect, and attentional biases, as measured by a modified dot-probe task, and persistence during a task to measure distress tolerance. Individuals who were encouraged to reappraise the consequences of smoking showed diminished craving, lower negative affect, had reduced attentional biases for smoking-related cues, and exhibited greater task persistence than those who were instructed to accept and suppress their urge to smoke. These findings suggest that reappraisal techniques are more effective than acceptance or suppression strategies for targeting smoking-related problems.
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Affiliation(s)
- Paul Lucian Szasz
- Babeş-Bolyai University, No. 37 Republicii St., Cluj-Napoca, Cluj, Romania.
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Abstract
PURPOSE OF REVIEW In recent years, deficits in emotion regulation have been studied as a putative maintaining factor and promising treatment target in a broad range of mental disorders. This article aims to provide an integrative review of the latest theoretical and empirical developments in this rapidly growing field of research. RECENT FINDINGS Deficits in emotion regulation appear to be relevant to the development, maintenance, and treatment of various forms of psychopathology. Increasing evidence demonstrates that deficits in the ability to adaptively cope with challenging emotions are related to depression, borderline personality disorder, substance-use disorders, eating disorders, somatoform disorders, and a variety of other psychopathological symptoms. Unfortunately, studies differ with regard to the conceptualization and assessment of emotion regulation, thus limiting the ability to compare findings across studies. Future research should systematically work to use comparable methods in order to clarify the following: which individuals have; what kinds of emotion regulation difficulties with; which types of emotions; and what interventions are most effective in alleviating these difficulties. SUMMARY Despite some yet to be resolved challenges, the concept of emotion regulation has a broad and significant heuristic value for research in mental health.
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