Introduction to the Special Issue: Emotion Regulation as a Transdiagnostic Process

Transgenerational transmission of psychopathology: when are adaptive emotion regulation strategies protective in children?

BACKGROUND

Children of parents with a mental illness (COPMI) have multiple psychological and developmental risks, including an increased lifetime risk of developing a mental illness themselves. Emotion regulation (ER) has been identified as a potential underlying mechanism of the transgenerational transmission of mental disorders. This study compares ER strategies in parents with and without a mental illness and their children. Further, it aims to examine the relationship between parents and children's psychopathology with a focus on the role of parental and child ER.

METHODS

Participants were 96 COPMI (77% female) and 99 children of parents without mental illness (COPWMI, 83% female) aged 4-16 years and their parents. Psychopathology and ER strategies of parents and children were assessed with a series of questionnaires.

RESULTS

Both COPMI and their parents showed significantly more psychopathology and more maladaptive and adaptive ER strategies in comparison with COPWMI and their parents. Parent and child adaptive ER strategies mediated the relationship between the psychopathology of parents and children only when child maladaptive ER strategies were low.

CONCLUSIONS

The findings further our understanding of the processes by which parental psychopathology affects child outcomes. Our findings highlight the importance of implementing preventive programs that specifically target the reduction of maladaptive ER in children to interrupt the transgenerational transmission of psychopathological symptoms.

Daily-life reactivity and emotion regulation in children with social anxiety disorder

Prominent models of adult social anxiety disorder emphasize the role of hyperreactivity and emotion regulation (ER) difficulties. However, it is unclear whether these factors are relevant in childhood, a critical period for the development of this disorder. We used ecological momentary assessment with mobile phones to assess daily-life emotional reactivity and use and effectiveness of ER strategies in children aged 10-13 years. We compared three groups: Social anxiety disorder (n = 29), clinical controls with mixed anxiety disorders (n = 27) and healthy controls (n = 31). We also investigated long-term effects of ER on trait social anxiety 12 months later. Hierarchical linear modelling revealed higher emotional reactivity and more use of suppression in children with social anxiety disorder compared to clinical and healthy controls. Contrary to our expectations, children with social anxiety disorder reported more use of avoidance and reappraisal compared to clinical, but not healthy, controls. The groups did not differ in subjective effectiveness of ER strategies. Use of suppression, avoidance, and rumination each predicted an increase in social anxiety 12 months later. Taken together, our results extend previous findings from lab and questionnaire studies and illustrate the role of maladaptive ER for child social anxiety disorder.

Comparison of Emotional Processing Between Patients with Substance Use Disorder and Those with Dual Diagnosis: Relationship with Severity of Dependence and Use During Treatment

This study analyzed, in a Spanish sample, the differences in emotional processing in patients diagnosed with substance use disorder (SUD) and patients with a dual diagnosis (DD), and tested whether alterations in emotional regulation were related to the severity of dependence and consumption during treatment. A descriptive follow-up study was conducted with 88 adult outpatients (83% men) who were receiving treatment for alcohol and cocaine SUD. Of the sample, 43.2% presented dual diagnosis according to DSM-IV-TR criteria. Emotional processing was assessed with the IAPS, and dependence severity with the SDSS. Consumption was determined with self-reports and toxicological tests. Regression analyses revealed that the DD group had more difficulties in identifying the valence and arousal of the images than patients with SUD. Patients with DD presented more difficulty in identifying images in which valence was manipulated, but not in those in which arousal was manipulated. Cocaine use during treatment was associated with difficulties in identifying unpleasant (U = 734.0; p < .05) and arousing (U = 723.5; p < .05) images. Although these results are preliminary, findings suggest that impaired emotional processing is aggravated in dual patients, although it may be a common transdiagnostic factor in SUD and other comorbid mental disorders. Findings highlight the importance of evaluating emotional regulation to better understand its possible role in the maintenance of substance use.

Longitudinal Associations between Parental Warmth, Harsh Discipline, Child Emotion Regulation, and ODD Dimensions

Research has yet to investigate the mediating role of emotion regulation in the relation between parental warmth and harsh discipline with oppositional defiant disorder (ODD). Further, few studies have investigated ODD as both a unitary construct and as three distinct dimensions (anger, defiance, spitefulness). Thus, the present study aimed to investigate child emotion regulation (grade 2) as a mediator of the relation between parental warmth and harsh discipline (kindergarten, grade 1, grade 2) and ODD and its dimensions (grade 3). Participants included the high-risk and normative samples from the Fast Track project (N = 753, male = 58 %, Black = 46 %). Constructs were assessed using observation and parent and teacher reports. Although results demonstrated an absence of indirect effects, emotion regulation was negatively associated with overall ODD and anger and defiance, but not spitefulness. Findings illustrate how increased attention toward the study of ODD as distinct dimensions contributes to our ability to parse out heterogeneity among children with the disorder.

Emotion dysregulation in ADHD and other neurodevelopmental conditions: a co-twin control study

BACKGROUND

Emotion dysregulation (ED) is common in attention-deficit/hyperactivity disorder (ADHD) and often results in adverse outcomes. However, ED has been suggested as a transdiagnostic construct, why the specific association between ADHD and ED when adjusting for other mental health conditions needs further investigation. It is also important to determine the aetiological basis of the association between ADHD and ED to inform the theoretical conceptualization of ADHD.

METHOD

This study used a co-twin control design, including a sample of dizygotic (DZ) and monozygotic (MZ) twins (N = 389; 45.8% females, age = 8-31 years, MZ twin pairs 57.6%). ED was assessed using the dysregulation profile from the parent-rated Child Behaviour Checklist and its adult version. Regression analyses were used across individuals and within the pairs, while adjusting for diagnoses of autism, intellectual disability, other neurodevelopmental conditions and affective conditions.

RESULTS

ADHD was significantly associated with ED, even when adjusting for age, sex, attention problems and other mental health conditions, and was the diagnosis most strongly associated with ED. Within-pair analyses revealed that twins with ADHD had higher levels of ED compared to their co-twin without ADHD. This association remained within DZ twins and was non-significant in the MZ subsample, with non-overlapping confidence intervals between the DZ and MZ estimates.

CONCLUSION

ADHD is strongly and in part independently linked to ED, stressing the importance of early detection and treatment of emotional difficulties within this group. The findings from the within-pair analyses indicate a genetic influence on the association between ADHD and ED.

Conceptualizing Emotion Regulation and Coregulation as Family-Level Phenomena

The ability to regulate one’s emotions is foundational for healthy development and functioning in a multitude of domains, whereas difficulties in emotional regulation are recognized as a risk factor for a range of adverse outcomes in childhood, adolescence, and adulthood. Caregivers play a key role in cultivating the development of emotion regulation through coregulation, or the processes by which they provide external support or scaffolding as children navigate their emotional experiences. The vast majority of research to date has examined coregulation in the context of caregiver–child dyads. In this paper, we consider emotion regulation and coregulation as family-level processes that unfold within and across multiple family subsystems and explore how triadic and whole family interactions may contribute to the development of children’s emotion regulation skills. Furthermore, we will examine the implications of a family-centered perspective on emotion regulation for prevention of and intervention for childhood emotional and behavioral disorders. Because emotion regulation skills undergo such dramatic maturation during children’s first several years of life, much of our focus will be on coregulation within and across the family system during early childhood; however, as many prevention and intervention approaches are geared toward school-aged children and adolescents, we will also devote some attention to later developmental periods.

Effects of Cognitive Reappraisal on Subjective and Neural Reactivity to Angry Faces in Children with Social Anxiety Disorder, Clinical Controls with Mixed Anxiety Disorders and Healthy Children

Cognitive models of social anxiety suggest that social anxiety disorder (SAD) is characterized by both enhanced emotional reactivity and deficits in emotion regulation. Emotional reactivity to socially threatening children's faces and their modulation through reappraisal were measured via subjective ratings and electrocortical responses in children (age 10-13) with SAD (n = 28), clinical controls with mixed anxiety disorders (n = 28), and healthy controls (n = 29). Children with SAD showed higher subjective reactivity to the images of angry children's faces while all children reported reduced reactivity in their subjective ratings following reappraisal. Reduced electrocortical reactivity after reappraisal was only evident in older children and boys and was unrelated to anxiety. The present study indicates that cognitive reappraisal may be beneficial in reducing subjective reactivity in children with anxiety disorders, while neural effects of reappraisal may emerge at older ages.

In search of convergent regional brain abnormality in cognitive emotion regulation: A transdiagnostic neuroimaging meta-analysis

Ineffective use of adaptive cognitive strategies (e.g., reappraisal) to regulate emotional states is often reported in a wide variety of psychiatric disorders, suggesting a common characteristic across different diagnostic categories. However, the extent of shared neurobiological impairments is incompletely understood. This study, therefore, aimed to identify the transdiagnostic neural signature of disturbed reappraisal using the coordinate‐based meta‐analysis (CBMA) approach. Following the best‐practice guidelines for conducting neuroimaging meta‐analyses, we systematically searched PubMed, ScienceDirect, and Web of Science databases and tracked the references. Out of 1,608 identified publications, 32 whole‐brain neuroimaging studies were retrieved that compared brain activation in patients with psychiatric disorders and healthy controls during a reappraisal task. Then, the reported peak coordinates of group comparisons were extracted and several activation likelihood estimation (ALE) analyses were performed at three hierarchical levels to identify the potential spatial convergence: the global level (i.e., the pooled analysis and the analyses of increased/decreased activations), the experimental‐contrast level (i.e., the analyses of grouped data based on the regulation goal, stimulus valence, and instruction rule) and the disorder‐group level (i.e., the analyses across the experimental‐contrast level focused on increasing homogeneity of disorders). Surprisingly, none of our analyses provided significant convergent findings. This CBMA indicates a lack of transdiagnostic convergent regional abnormality related to reappraisal task, probably due to the complex nature of cognitive emotion regulation, heterogeneity of clinical populations, and/or experimental and statistical flexibility of individual studies.

Functional connectivity between the ventral anterior cingulate and amygdala during implicit emotional conflict regulation and daily-life emotion dysregulation

Emotional conflict adaptation involving ventral anterior cingulate cortex (ACC) suppression of the amygdala is thought to be important in emotion regulation, with evidence of impaired implicit emotion regulation in emotional distress disorders. However, it is unclear how this impairment is associated with daily-life emotion dysregulation in emotional distress disorders. In the current study, female participants with an emotional distress disorder (N = 27) were scanned with MRI while completing an implicit emotion conflict regulation task that involved identifying the facial expression of an image while ignoring an overlaid congruent or incongruent affect label. Participants then completed two weeks of ambulatory assessment of daily-life emotion dysregulation. Consistent with previous research on comorbid emotional distress disorders (Etkin and Schatzberg, 2011), there was no behavioral effect of emotional conflict adaptation (p = .701) but a significant effect of congruent adaptation (p = .006), suggesting impairment is specific to implicit emotional conflict regulation. Additionally, there was no neural evidence of emotional conflict adaptation in the ventral ACC and amygdala (ps > .766). Further, in our primary psychophysiological interactions analyses, we examined ventral ACC-amygdala functional connectivity. As hypothesized, increased ventral ACC-amygdala functional connectivity for emotional conflict adaptation was associated with increased daily-life affective instability (p = .022), but not mean daily-life negative affect (p = .372). Overall, results provide behavioral and neural evidence of impaired implicit emotional conflict adaptation in individuals with emotional distress disorders and suggests that this impairment is related to daily-life affective instability in these disorders.

Is "Self-Experience" Really a Transdiagnostic Concept? Preliminary Evidence in Favor of the Transdiagnostic Conception of Functional Analytic Psychotherapy

Functional Analytic Psychotherapy (FAP) offers a radically behavioral and transdiagnostic conception of the formation of the "self" and the appearance of a diversity of psychological problems. This study examined the extent to which a wide variety of psychological disorders (somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility/aggressiveness, phobic anxiety, paranoid ideation, and psychoticism) and a global index of psychopathological severity may in fact be linked to problems of the "self" according to the FAP conception. Two questionnaires, one related to self-experience according to FAP and the other to find the scores on several different psychopathology scales, were administered to 280 adult Spaniards for this purpose. The results confirmed the transdiagnostic nature of the "self"-experience. There are significant and strong correlations between all the psychopathology scales studied and self-experience. Linear regression analyses also show that, along with age and gender, in some cases, the score on self-experience predicts each and every one of the psychopathological variables studied, in addition to the Global Severity Index. These results are discussed and related to the transdiagnostic approach to psychopathology.

Creating "a Safe Haven": Emotion-Regulation Strategies Employed by Mothers and Young Children Exposed to Recurrent Political Violence

Growing evidence underscores the need to counteract the mental health risks for children growing up in traumatic situations of political violence. This study examined the concurrent emotional regulation (ER) strategies employed by mothers and their children in meeting this challenge. Following several incidents of rocket attacks, in southern Israel, we conducted semi-structured interviews with 30 mothers and their children (ages 5-7). Additionally, mothers completed the Emotion Regulation Questionnaire (Gross and John 2003). The main theme emerging from the qualitative analyses of the interviews with the children was adherence to the perception of the shelter room in the home as a "safe haven", supported by constructed knowledge and acquired skills related to physical safety, as well as the sense of emotional availability of their caregivers. The children used imagination, play and physiological regulation modeled by the mothers. The interviews with the mothers revealed their effort to convey a sense of calm and routine, even when these were interrupted. They used self-talk concerning the children's needs and tried to regulate their own physiological and psychological arousal. Mothers who expressed in the interviews satisfaction with the management of their ER reported significantly higher use of cognitive reappraisal strategies than those expressing dissatisfaction. Mothers help children construct meanings related to stressful events and teach and model evidence-based tactics for ER. Interventions for coping with a toxic reality should involve both psycho-education about children's needs and address mothers' own ER strategies, especially the use of cognitive reappraisal.

Reappraisal is an effective emotion regulation strategy in children with Tourette syndrome and ADHD

BACKGROUND AND OBJECTIVES

Difficulties in emotion regulation (ER) have been associated with several psychiatric disorders, emphasizing a need for a greater understanding of the concept and its associations with disruptive behavior. We aimed to study the ER strategy of cognitive reappraisal with an experimental test to increase our knowledge of emotional processes in child psychopathology.

METHODS

In the present study, we examined emotional reactivity and cognitive reappraisal with a computer task in 160 medication-naïve children aged 8-12 comprising four groups: Fifty-eight children with Tourette syndrome (TS), 26 children with attention-deficit/hyperactivity disorder (ADHD), 19 children with TS and ADHD, and 57 typically developing controls.

RESULTS

The use of cognitive reappraisal reduced negative affect across all participants and the ability to reappraise was positively correlated with age, whereas reactivity was not. Overall, groups did not differ in reactivity or regulation success. Looking at specific differences within groups, however, only the ADHD group did not significantly decrease negative affect when reappraising. Finally, the use of strategies considered to be efficacious was correlated with regulation success, whereas the use of a less adaptive strategy related to suppression was associated with reactivity, but not regulation of emotions.

LIMITATIONS

The study was limited by small, clinical contrast groups and a lack of blinding to diagnostic status in the coding of verbal strategies employed during the task.

CONCLUSIONS

Cognitive reappraisal appears to be a beneficial ER strategy for children regardless of diagnostic status. Our findings indicate that children can learn and employ an adaptive ER strategy when instructed in the technique, even in the presence of attention problems, which is highly relevant to therapeutic approaches to dysregulated behavior.

Psychometric Properties of the Emotion Dysregulation Inventory in a Nationally Representative Sample of Youth

Objective: The Emotion Dysregulation Inventory (EDI) is an informant questionnaire developed based on the Patient-Reported Outcomes Measurement Information System (PROMIS®) Scientific Standards and refined through factor analyses and item response theory (IRT) analyses. Although it was developed to improve measurement of emotion dysregulation in youth with autism spectrum disorder, emotion dysregulation has transdiagnostic significance. Therefore, the aim of this study was to evaluate the EDI's psychometric properties and to establish IRT-based scores for a general population of youth.Methods: Data were collected from a sample of 1000 caregivers of 6- to 17-year-old youth matched to the US census on age, gender, race/ethnicity, years of education, and region. Confirmatory factor analyses and IRT analyses using the two-parameter graded response model were performed to evaluate the EDI's structure and psychometric properties.Results: Analyses supported the original two-factor structure of the EDI, reflecting factors for Reactivity and Dysphoria. Simulations of computerized adaptive testing supported use of the same items for a Reactivity short form as those that emerged as most informative in the original autism psychometric analyses. IRT co-calibration with commonly used measures of emotion regulation and irritability in child clinical or community samples indicated the EDI scales provide more information across a wider range of emotion dysregulation. Validity was supported by moderate correlations with measures of related constructs and expected known-group differences.Conclusions: The EDI is an efficient and precise measure of emotion dysregulation for use in general community and clinical samples as well as samples of youth with ASD.

Real-Time Functional Connectivity-Informed Neurofeedback of Amygdala-Frontal Pathways Reduces Anxiety

BACKGROUND

Deficient emotion regulation and exaggerated anxiety represent a major transdiagnostic psychopathological marker. On the neural level these deficits have been closely linked to impaired, yet treatment-sensitive, prefrontal regulatory control over the amygdala. Gaining direct control over these pathways could therefore provide an innovative and promising intervention to regulate exaggerated anxiety. To this end the current proof-of-concept study evaluated the feasibility, functional relevance and maintenance of a novel connectivity-informed real-time fMRI neurofeedback training.

METHODS

In a randomized crossover sham-controlled design, 26 healthy subjects with high anxiety underwent real-time fMRI-guided neurofeedback training to enhance connectivity between the ventrolateral prefrontal cortex (vlPFC) and the amygdala (target pathway) during threat exposure. Maintenance of regulatory control was assessed after 3 days and in the absence of feedback. Training-induced changes in functional connectivity of the target pathway and anxiety ratings served as primary outcomes.

RESULTS

Training of the target, yet not the sham control, pathway significantly increased amygdala-vlPFC connectivity and decreased levels of anxiety. Stronger connectivity increases were significantly associated with higher anxiety reduction on the group level. At the follow-up, volitional control over the target pathway was maintained in the absence of feedback.

CONCLUSIONS

The present results demonstrate for the first time that successful self-regulation of amygdala-prefrontal top-down regulatory circuits may represent a novel intervention to control anxiety. As such, the present findings underscore both the critical contribution of amygdala-prefrontal circuits to emotion regulation and the therapeutic potential of connectivity-informed real-time neurofeedback.

The Puzzle of Emotion Regulation: Development and Evaluation of the Tangram Emotion Coding Manual for Children

The ability to regulate one's emotions is crucial to engaging successfully in social contexts. Difficulties in emotion regulation are seen in multiple psychiatric disorders, prompting an increased interest in the concept. Suitable methods for assessing emotion regulation, however, are lacking. In this study, we investigated the interrater and intrarater reliability, construct validity, and content validity of a new observational method for evaluating children's emotion regulation abilities (a complex puzzle task) in a sample of 62 children without psychiatric disorders and 23 children with attention-deficit/hyperactivity disorder (ADHD) aged 7-12, using intra-class correlation coefficients for the reliability analyses and Spearman's rank-order correlations for analyses of convergent and discriminant validity. A panel of experts examined the content validity of the test, and Mann-Whitney U-tests were used to investigate the ability of the test to differentiate the non-clinical group from the ADHD group. Results showed a high level of interrater and intrarater reliability of the test. There was mixed evidence for convergent and discriminant validity as expected due to the novelty and experimental nature of the test, making it difficult to compare with questionnaire-based measures. Content validity analysis was satisfactory, and the group comparison showed that the test differentiated the groups on the primary outcome measure. Overall, the measure demonstrated high feasibility and satisfactory psychometric properties. The generic nature of the test makes it suitable for use across psychiatric disorders and age groups with potential relevance in both research and clinical settings.

Meaning in life among adolescents: Factorial invariance of the purpose in life test and buffering effect on the relationship between emotional dysregulation and hopelessness

OBJECTIVE

The purpose of the present study was threefold: first, to analyse the psychometric properties of a 10-item Spanish version of the Purpose in Life Test, which assesses meaning in life (MiL), in a sample of community adolescents; second, to analyse the differences between the age and gender groups; and third, to analyse whether MiL buffers the relationship between emotional dysregulation and hopelessness.

METHOD

Participants were 1,599 adolescents from 12 to 19 years old, M = 15.69, SD = 2.14. The Purpose in Life Test-10 Items, the Beck Hopelessness Scale, and the Difficulties in Emotional Regulation Scale were used.

RESULTS

A nine-item version showed good fit, psychometric properties (internal consistency, construct, and concurrent validity), and factorial invariance across gender and age (12-15 years/16-19 years). Difference in MiL between boys and girls was not significant, whereas between age groups was significant. MiL had a strong buffering effect on the relationship between emotional dysregulation and hopelessness.

DISCUSSION

It is desirable to promote the sense of MiL in adolescents. MiL plays a significant and strong mediator role in the relationship between emotional dysregulation and hopelessness, reinforcing the positive role of MiL in mental health and as a resource for facing adversity.

Childhood maltreatment severity and alcohol use in adult psychiatric inpatients: The mediating role of emotion regulation difficulties

OBJECTIVE

Emotion regulation difficulties are a potentially key mechanism underlying the association between childhood maltreatment and alcohol use in adulthood. The current study examined the mediating role of emotion regulation difficulties in the association between childhood maltreatment severity (i.e., Childhood Trauma Questionnaire total score) and past-month alcohol use severity, including alcohol consumption frequency and alcohol-related problems (i.e., number of days of alcohol problems, ratings of "bother" caused by alcohol problems, ratings of treatment importance for alcohol problems).

METHOD

Participants included 111 acute-care psychiatric inpatients (45.0% female; Mage=33.5, SD=10.6), who reported at least one DSM-5 posttraumatic stress disorder Criterion A traumatic event, indexed via the Life Events Checklist for DSM-5. Participants completed questionnaires regarding childhood maltreatment, emotion regulation difficulties, and alcohol use.

RESULTS

A significant indirect effect of childhood maltreatment severity via emotion regulation difficulties in relation to alcohol use severity (β=0.07, SE=0.04, 99% CI [0.01, 0.21]) was documented. Specifically, significant indirect effects were found for childhood maltreatment severity via emotion regulation difficulties in relation to alcohol problems (β's between 0.05 and 0.12; all 99% bootstrapped CIs with 10,000 resamples did not include 0) but not alcohol consumption.

CONCLUSION

Emotion regulation difficulties may play a significant role in the association between childhood maltreatment severity and alcohol outcomes. Clinical implications are discussed.

A Web-Disseminated Self-Help and Peer Support Program Could Fill Gaps in Mental Health Care: Lessons From a Consumer Survey

BACKGROUND

Self-guided mental health interventions that are disseminated via the Web have the potential to circumvent barriers to treatment and improve public mental health. However, self-guided interventions often fail to attract consumers and suffer from user nonadherence. Uptake of novel interventions could be improved by consulting consumers from the beginning of the development process in order to assess their interest and their preferences. Interventions can then be tailored using this feedback to optimize appeal.

OBJECTIVE

The aim of our study was to determine the level of public interest in a new mental health intervention that incorporates elements of self-help and peer counseling and that is disseminated via a Web-based training course; to identify predictors of interest in the program; and to identify consumer preferences for features of Web-based courses and peer support programs.

METHODS

We surveyed consumers via Amazon's Mechanical Turk to estimate interest in the self-help and peer support program. We assessed associations between demographic and clinical characteristics and interest in the program, and we obtained feedback on desired features of the program.

RESULTS

Overall, 63.9% (378/592) of respondents said that they would try the program; interest was lower but still substantial among those who were not willing or able to access traditional mental health services. Female gender, lower income, and openness to using psychotherapy were the most consistent predictors of interest in the program. The majority of respondents, although not all, preferred romantic partners or close friends as peer counselors and would be most likely to access the program if the training course were accessed on a stand-alone website. In general, respondents valued training in active listening skills.

CONCLUSIONS

In light of the apparent public interest in this program, Web-disseminated self-help and peer support interventions have enormous potential to fill gaps in mental health care. The results of this survey can be used to inform the design of such interventions.

Specificity of emotion sequences in borderline personality disorder compared to posttraumatic stress disorder, bulimia nervosa, and healthy controls: an e-diary study

BACKGROUND

Patients with borderline personality disorder (BPD) exhibit dysregulated emotion sequences in daily life compared to healthy controls (HC). Empirical evidence regarding the specificity of these findings is currently lacking.

METHODS

To replicate dysregulated emotion sequences in patients with BPD and to investigate the specificity of the sequences, we used e-diaries of 43 female patients with BPD, 28 patients with posttraumatic stress disorder (PTSD), 20 patients with bulimia nervosa (BN), and 28 HC. To capture the rapid dynamics of emotions, we prompted participants every 15 min over a 24-h period to assess their current perceived emotions. We analyzed group differences in terms of activation, persistence, switches, and down-regulation of emotion sequences.

RESULTS

By comparing patients with BPD to HC, we replicated five of the seven previously reported dysregulated emotion sequences, as well as 111 out of 113 unaltered sequences. However, none of the previously reported dysregulated emotion sequences exhibited specificity, i.e., none revealed higher frequencies compared to the PTSD group or the BN group. Beyond these findings, we revealed a specific finding for patients with BN, as they most frequently switched from anger to disgust.

CONCLUSIONS

Replicating previously found dysregulated and unaltered emotional sequences strengthens the significance of emotion sequences. However, the lack of specificity points to emotion sequences as transdiagnostic features.