Emotion Regulation and the Transdiagnostic Role of Repetitive Negative Thinking in Adolescents with Social Anxiety and Depression

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.

Stress, repetitive negative thinking, and mental health in Chilean university students: an ecological momentary assessment study

Background

Mental disorders in university students are a growing attention problem in the international community due to their high prevalence and serious consequences. One possible reason is university students' difficulties in coping with stress. Repetitive negative thinking (RNT) is a transdiagnostic process that, when combined with stress, can lead to the development of various disorders. We aim to determine the effect of stress and RNT on predicting various mental health syndromes in university students across 7 days.

Method

Prospective observational study using Momentary Ecological Assessment (EMA) with the OURMIND Mobile App. On day one, 238 university students responded to the SCL-90R questionnaire for symptoms of depression, anxiety, hostility, obsession, psychoticism, paranoia, somatization, and interpersonal sensitivity; RNT styles questionnaires, RRS for rumination and negative reflection, PSWQ for worry; SISCO-II for term academic stress, and sociodemographic. EMA consisted of five assessments a day for 6 days; each time, the students answered items about academic and non-academic stress (EMA-stress), reactive RNT duration and intrusiveness (EMA-RNT process), and reactive RNT rumination, reflection, and worry (EMA-RNT content). On day eight, symptoms were re-assessed. Seven hierarchical stepwise linear regression models were used to test the predictive power of the study variables in the development of SCL-90R symptoms.

Results

When comparing models, adding baseline symptoms increased the models' predictive power in all symptom groups. In most cases, including EMA-stress generated greater predictive power, except for paranoia and interpersonal sensitivity. Adding the EMA-RNT process increased the prediction of paranoia and obsessive symptoms; for hostility symptoms, RNT styles increased predictive power. For the final regression models, considering the initial symptoms, the EMA-RNT process predicted the progression of symptoms in six out of eight groups, while EMA-non-academic stress predicted the remaining two. Additionally, living with other relatives or friends was a predictor of depressive symptoms.

Discussion

The stress of university life impacts the development of psychiatric symptoms in university students. These results provide evidence of RNT as a transdiagnostic process in several syndromic groups. Universal preventive programs should consider the impact of academic and non-academic stress on university students' mental health. Targeting RNT would also benefit selective preventive interventions.

Mediation of social anxiety and depression during internet-delivered treatment for social anxiety disorder

Many individuals with social anxiety disorder (SAD) have depressive symptoms that meet criteria for major depressive disorder (MDD). In our study, we examined the temporal relationship between symptoms of social anxiety and symptoms of depression during the course of an 11-week internet-delivered cognitive behavioral treatment (ICBT) for SAD (n = 170). Specifically, we investigated whether weekly changes in social anxiety mediated changes in depression, changes in depression mediated changes in anxiety, both or neither. In addition, we compared individuals with SAD and MDD (n = 50) and individuals with SAD and no MDD (n = 120) to examine the role of MDD as a moderator of the social anxiety-depression relationship. Lower-level mediational modeling revealed that changes in social anxiety symptoms mediated changes in depression symptoms to a greater extent than vice versa. In addition, mediation among individuals with SAD and MDD was significantly greater compared to individuals with SAD and no MDD. Our findings suggest that ICBT is effective in treating individuals with SAD regardless of comorbid depression, and that focusing ICBT interventions on social anxiety can lead to significant reductions in depression among individuals with SAD.

Reciprocal effects between negative affect and emotion regulation in daily life

The extended process model of emotion regulation provides a framework for understanding how emotional experiences and emotion regulation (ER) mutually influence each other over time. To investigate this reciprocal relationship, 202 adults completed a ten-day experience-sampling survey capturing levels of negative affect (NA) experience and use of ten ER strategies in daily life. Residual dynamic structural equation models (DSEMs) were used to examine within-person cross-lagged and autoregressive effects of NA and ER (strategy use and between-strategy variability). Results showed that NA predicted lower between-strategy variability, lower subsequent use of acceptance and problem-solving, but higher subsequent use of rumination and worry. Moreover, reappraisal and between-strategy variability predicted lower subsequent NA levels, while expressive suppression and worry predicted higher subsequent NA levels. Stable autoregressive effects were found for NA and for maladaptive ER strategies (e.g., rumination and worry). Exploratory correlation analyses revealed positive associations between NA inertia and maladaptive ER strategies. Together, these findings provide evidence of a dynamic interplay between NA and ER. This work deepens how we understand the challenges of applying ER strategies in daily life. Future clinical and translational research should consider these dynamic perspectives on ER and affect.

Specific emotion regulation difficulties and executive function explain the link between worry and subsequent stress: A prospective moderated mediation study

BACKGROUND

Worry is a transdiagnostic risk factor for stress-related mental health complaints such as anxiety, depression, and insomnia. Although worry may function as a form of avoidance of unwanted emotions and accordingly interfere with adaptive emotion regulation, the specific domains of emotion regulation that are perturbed by excessive worry to confer risk for stress-related symptoms are unclear. Further, it is unknown if cognitive control mechanisms that underlie successful emotion regulation influence the effect of worry on stress. The present study addressed these gaps in the literature by examining specific emotion regulation difficulties as mediators of the relationship between worry and subsequent stress, as well as executive function as a moderator of the mediated effects.

METHOD

656 community adults were assessed for trait worry, emotion dysregulation, stress, and executive dysfunction once per month for three months (time 1 - time 3).

RESULTS

The effect of worry (time 1) on subsequent stress (time 3) was partially mediated by difficulties with emotional clarity and difficulty engaging in goal-directed behavior when upset (time 2) after controlling for age, gender, and baseline stress. Moderated mediation models revealed that the indirect effect of worry on stress via difficulty with goal-directed behavior was significantly moderated by executive dysfunction, such that fewer executive function difficulties acted as a buffer against the harmful effects of worry.

LIMITATIONS

Limitations include reliance on self-report measures, lack of experimental manipulation, and a nonclinical sample.

CONCLUSIONS

Findings point to specific domains of emotion regulation as treatment targets for individuals with high worry proneness.

Can dialectical behavior therapy skills group treat social anxiety disorder? A brief integrative review

The purposes of this brief integrative review are to identify and critically evaluate recent work in the area of Dialectical Behavior Therapy-Skills Group (DBT-SG) for Social Anxiety Disorder (SAD) with suicidal ideation (SI) and to suggest further how DBT-based skills may be applied to cognitive maintenance factors of SAD. Accordingly, we first evaluate the relevance of DBT in treating SI in other disorders. Second, we evaluate the relationship between SI and SAD, providing considerations for the complexity of comorbid disorders and presentations. Finally, we extend this knowledge to discuss considerations for the use of DBT-SG skills to target specific etiological and maintenance elements of SAD, with a focus on four themes (interpersonal effectiveness, mindfulness, emotion regulation, and distress tolerance). Overall, we conclude that DBT-SG may prove beneficial in reducing SI and symptoms in SAD that impact social and emotional functioning.

Although I know it: Social anxiety is associated with a deficit in positive updating even when the cost of avoidance is Obvious

Social anxiety (SA) is associated with difficulties in positively updating negative social information when new information and feedback about chosen options (actual decisions) are received. However, it is unclear whether this difficulty persists when hidden information regarding unchosen options is explicitly presented. The aim of the current study was to address this gap. Participants (Mturk; n = 191) completed a two-phases novel task. In the task, participants chose to approach or avoid people, represented by images of faces. During the initial (learning) phase, participants learned, in a probabilistic context, which people are associated with negative outcomes and should be avoided, and which are associated with positive outcomes and should be approached. During the subsequent updating phase, people previously associated with negative outcomes became associated with positive outcomes and vice versa. Importantly, participants received feedback not only on their approach (actual) decisions, but also on their avoidance (counter-factual) decisions (e.g., approaching this person would have been beneficial). The results revealed that even when the consequences of avoidance were explicitly presented, SA was associated with difficulty in positive updating of social information. The findings support the view that biased updating of social information is a change-resistant mechanism that may underlie the maintenance of SA.

Hippocampal Involvement in Safety Signal Learning Varies With Anxiety Among Healthy Adults

Background

Safety signal learning (SSL), based on conditioned inhibition of fear in the presence of learned safety, can effectively attenuate threat responses in animal models and humans. Difficulty regulating threat responses is a core feature of anxiety disorders, suggesting that SSL may provide a novel mechanism for fear reduction. Cross-species evidence suggests that SSL involves functional connectivity between the anterior hippocampus and the dorsal anterior cingulate cortex. However, the neural mechanisms supporting SSL have not been examined in relation to trait anxiety or while controlling for the effect of novelty.

Methods

Here, we investigated the neural mechanisms involved in SSL and associations with trait anxiety in a sample of 64 healthy (non-clinically anxious) adults (ages 18-30 years; 43 female, 21 male) using physiological, behavioral, and neuroimaging (functional magnetic resonance imaging) data collected during an SSL task.

Results

During SSL, compared with individuals with lower trait anxiety, individuals with higher trait anxiety showed less fear reduction as well as altered hippocampal activation and hippocampal-dorsal anterior cingulate cortex functional connectivity, and lower inferior frontal gyrus and ventrolateral prefrontal cortex activation. Importantly, the findings show that SSL reduces threat responding, across learning and over and above the effect of novelty, and involves hippocampal activation.

Conclusions

These findings provide new insights into the nature of SSL and suggest that there may be meaningful variation in SSL and related neural correlates as a function of trait anxiety, with implications for better understanding fear reduction and optimizing interventions for individuals with anxiety disorders.

Mediating effect of social interaction anxiety between emotional intelligence and life satisfaction in physical education students: post-COVID-19 study

The aim of this research is to analyze the effect of social interaction anxiety on satisfaction with life mediated by emotional intelligence. The research design was descriptive, cross-sectional, and non-randomized. In total, 1,164 Mexican physical education students participated (Mage = 21.21; SD = 3.26; 30.0% female; 69.6% male; 0.4% other). The scales used were the Social Interaction Anxiety Scale, Trait Meta-Mood Scale and Satisfaction with Life and a structural equation analysis with latent variables was conducted. The results highlight that it can be asserted that emotional clarity and repair had a mediating effect between social interaction anxiety and satisfaction with life, as they did decrease the negative effects of social interaction anxiety on satisfaction with life. In addition, social interaction anxiety had a direct and positive effect on emotional attention and a negative effect on emotional clarity and repair.

Prefrontal hypoactivation induced via social stress is more strongly associated with state rumination than depressive symptomatology

Previous studies have consistently shown a pattern of prefrontal hypoactivation in depressed patients (DP); however, it remains unclear whether this neural correlate is a consequence or concomitant feature of depression and/or whether ruminative thinking might be underlying. Using a sample comprising 65 healthy controls (HC) and 77 DP, we investigated the behavioral and neural correlates in response to stress and their association with depressive symptomatology, trait and state rumination. Fitting repeated-measurement MANOVAs including 21 fNIRS-channels covering the bilateral Inferior Frontal Gyrus (IFG), Dorsolateral Prefrontal Cortex (DLPFC) and Somatosensory Association Cortex (SAC), we investigated the predictive value of diagnostic group (HC vs. DP) and state rumination. In DP, we observed significantly lower increases in cortical oxygenation under stress in channels of the right IFG and bilateral DLPFC. Participants reporting lower state rumination and no increases in state rumination under stress showed higher increases in cortical oxygenation compared to the other groups and in more channels compared to the analysis on diagnostic group. Re-running our fNIRS-analysis while correcting for performance resulted in time-dependent changes dependent on group (DP vs. HC) no longer yielding significance, however for the differentiation of state rumination groups.

The association between passive social network usage and depression/negative emotions with envy as a mediator

This study aimed to investigate the relationships between passive social network usage (PSNU) and depression/negative emotions over time with the mediating role of envy among Vietnamese adolescents. First, it revealed that PSNU had a simultaneous effect on depression/negative emotions as well as at different time points, indicating that social network site behaviors can predict psychological states over time (explained by the social comparison theory). Second, the autoregressive effect also confirmed a potential reciprocal relationship between PSNU and depression, whereas PSNU appeared to have an impact on negative emotions but not the other way around. Specifically, depression at Time 1 was positively associated with PSNU at Time 2, whereas negative emotions did not exhibit a similar pattern (explained by the cognitive dissonance theory). The different associations were interpreted as depression having cognitive elements, while negative emotions were thought to be purely emotional states. The results demonstrated that behavior may potentially have a long-lasting effect on mental health (both negative emotions and depression), while it was depression, rather than negative emotions, that had a long-term effect on behaviors. Third, envy played a mediating role that connected the changes of PSNU and depression/negative emotions. The implications and limitations of these findings are discussed.

Differential Associations of Cognitive Emotion Regulation Strategies with Depression, Anxiety, and Insomnia in Adolescence and Early Adulthood

While difficulties with emotion regulation (ER) are consistently linked to poor mental health in adulthood, findings in adolescence have been more mixed. Cognitive ER strategies, which involve the ability to manage emotions through mental processes, may be particularly important during different stages of development due to age-specific adjustments. We conducted two exploratory and cross-sectional studies to examine the relationships between cognitive ER strategies and mental health (i.e., depressive, anxiety, and insomnia symptoms) in two samples: 431 young adults (M_age = 20.66 ± 2.21; 70% women and 30% men) and 271 adolescents (M_age = 14.80 ± 0.0.59; 44.6% girls and 55.4% boys). The participants completed a group of questionnaires, including the Cognitive Emotion Regulation Questionnaire, the Insomnia Severity Index, the Beck Depression Inventory-II, the State-Trait Anxiety Inventory, and the Youth Self Report. We employed hierarchical multiple regressions to assess the unique contribution of cognitive ER strategies to mental health outcomes. Maladaptive strategies (such as rumination and catastrophizing) were consistently associated with impaired mental health in both samples, while adaptive strategies (such as positive refocusing and positive reappraisal) were only associated with better mental health in young adults. These findings support the importance of cognitive ER strategies as potential risk factors for psychopathology and suggest that interventions aimed at improving emotion regulation may be beneficial. The age-specific differences in the relationship between cognitive ER strategies and mental health may reflect the refinement of emotion regulation abilities across the lifespan.

Investigating the effects of emotion dysregulation and repetitive negative thinking on alcohol hangover anxiety and depression

INTRODUCTION

Underlying factors associated with alcohol hangover psychological symptoms, such as anxiety and depression, have not been identified. Emotion dysregulation and repetitive negative thinking (RNT) are transdiagnostic factors associated with psychopathology, including non-hangover anxiety and depression. The current study prospectively examined the role of emotion dysregulation on subsequent alcohol hangover anxiety and depression symptoms, as well as the moderating role of RNT on this relation among university students.

METHODS

One hundred thirty-six participants completed baseline assessments of emotion dysregulation (DERS-16) and non-hangover anxiety and depression (DASS-21). Thirty-nine participants reported experiencing alcohol hangover at 2-week follow up and completed assessments of RNT (PTQ) and hangover anxiety and depression (modified DASS-21). Two independent regression-based moderation analyses were conducted to examine the relation of baseline emotion dysregulation, 2-week follow-up RNT, and hangover anxiety and depression symptoms after accounting for baseline non-hangover anxiety and depression symptoms.

RESULTS

Among those experiencing alcohol hangover (n = 39), emotion dysregulation and RNT were not associated with hangover related anxiety beyond non-hangover anxiety. Emotion dysregulation significantly predicted hangover depression but was rendered non-significant by the addition of RNT, which was significantly associated with hangover depression. RNT moderated the emotion dysregulation-hangover depression relation such that emotion dysregulation was not associated with future hangover depression at low levels of RNT but was positively associated with hangover depression at moderate to high levels of RNT.

CONCLUSION

Results provide preliminary support for the role of emotion dysregulation and RNT in hangover depression severity.

Does an app designed to reduce repetitive negative thinking decrease depression and anxiety in young people? (RETHINK): a randomized controlled prevention trial

BACKGROUND

The first onset of common mental health disorders, such as mood and anxiety disorders, mostly lies in adolescence or young adulthood. Hence, effective and scalable prevention programs for this age group are urgently needed. Interventions focusing on repetitive negative thinking (RNT) appear especially promising as RNT is an important transdiagnostic process involved in the development of depression and anxiety disorders. First clinical trials indeed show positive effects of preventative interventions targeting RNT on adult as well as adolescent mental health. Self-help interventions that can be delivered via a mobile phone app may have the advantage of being highly scalable, thus facilitating prevention on a large scale. This trial aims to investigate whether an app-based RNT-focused intervention can reduce depressive and anxiety symptoms in young people at risk for mental health disorders.

METHODS

The trial will be conducted in a sample (planned N = 351) of individuals aged 16-22 years with elevated levels of RNT but no current depression or anxiety disorder. In a randomized controlled between-subjects design, two versions of the app-based self-help intervention will be compared to a waiting list control condition. The full RNT-focused intervention encompasses a variety of RNT-reducing strategies, whereas the concreteness training intervention focuses on only one of these strategies, i.e., concrete thinking. The primary outcome (depressive symptoms) and secondary outcomes (anxiety symptoms and RNT) will be measured at pre-intervention, post-intervention (6 weeks after pre-intervention), and follow-up (18 weeks after pre-intervention).

DISCUSSION

This trial aims to find out whether targeting RNT via an app is an effective and feasible way of preventing depression and anxiety disorders in adolescents. Since app-based interventions are highly scalable, this trial might contribute to tackling challenges related to the increasing rates of mental health disorders among young people.

TRIAL REGISTRATION

https://www.drks.de , DRKS00027384. Registered on 21 February 2022-prospectively registered.

Emotion regulation as a mediator on the relationship between emotional awareness and depression in elementary school students

As a cognitive skill, emotional awareness plays a fundamental role in emotional intelligence and significant effect on the development of individuals’ social adaptation. However, the role of emotional awareness in children’s social adaptation, especially emotional development, remains unclear, the current study sought to determine the significant influence of emotional awareness in children’s emotional development. By using cross-sectional and longitudinal study designs, the current study explored the relationship between emotional awareness and children’s depression, as well as the mediation effect of emotion regulation on this relationship. The sample comprised 166 Chinese elementary school students (89 girls and 77 boys) ranging from 8 to 12 years old. After adjusting for demographic variables (gender, grade, etc.), the results showed that children with high emotional awareness were less likely to adopt expressive suppression as an emotion regulation strategy and had lower depression levels currently and in the future. In contrast, children with low emotional awareness were more likely to use suppression strategies and showed higher depression levels. Thus, the results indicated that emotional awareness could predict children’s current and future depression status. Meanwhile, emotional regulation strategies are an important mediating variable explaining the relationship between emotional awareness and children’s depression. Implications and limitations were also discussed.

Child abuse and automatic emotion regulation in children and adolescents

Child abuse is associated with elevated risk for psychopathology. The current study examined the role of automatic emotion regulation as a potential mechanism linking child abuse with internalizing psychopathology. A sample of 237 youth aged 8-16 years and their caregivers participated. Child abuse severity was assessed by self-report questionnaires, and automatic emotion regulation was assessed using an emotional Stroop task designed to measure adaptation to emotional conflict. A similar task without emotional stimuli was also administered to evaluate whether abuse was uniquely associated with emotion regulation, but not cognitive control applied in a nonemotional context. Internalizing psychopathology was assessed concurrently and at a 2-year longitudinal follow-up. Child abuse severity was associated with lower emotional conflict adaptation but was unrelated to cognitive control. Specifically, the severity of emotional and physical abuse, but not sexual abuse, were associated with lower emotional conflict adaptation. Emotional conflict adaptation was not associated with internalizing psychopathology prospectively. These findings suggest that childhood emotional and physical abuse, in particular, may influence automatic forms of emotion regulation. Future work exploring the socioemotional consequences of altered automatic emotion regulation among youth exposed to child abuse is clearly needed.

Social anxiety and depression symptoms in Chinese left-behind children after the lifting of COVID-19 lockdown: A network analysis

BACKGROUND

Returning to social life after the lifting of COVID-19 lockdown may increase risk of social anxiety, which is highly co-morbid with depression. However, few studies have reported the association between them.

AIMS

To explore the complex relationship between social anxiety and depression symptoms in left-behind children after the lifting of the COVID-19 lockdown.

METHODS

A cross-sectional survey was conducted 6 months after the lockdown removal. A total of 3,107 left-behind children completed the survey with a mean age of 13.33 and a response rate of 87.77%. Depression and social anxiety severity were assessed by the DSM-5 Patient Health Questionnaire for Adolescents and the DSM-5 Social Anxiety Disorder Questionnaire, respectively. The symptom-level association between the two disorders was examined using network analysis.

RESULTS

After the lifting of COVID-19 lockdown, the prevalence of depression and social anxiety in left-behind children was 19.57% and 12.36%, respectively, with a co-morbidity rate of 8.98%. Network analysis showed that "Social tension" and "Social avoidance" had the greatest expected influence; "Humiliation" and "Motor" were bridge symptom nodes in the network. The directed acyclic graph indicated that "Social fright" was at the upstream of all symptoms.

CONCLUSION

Attention should be paid to social anxiety symptoms in left-behind children after the lifting of COVID-19 lockdown. Prevention and intervention measures should be taken promptly to reduce the comorbidity of social anxiety and depression symptoms in the left-behind children after the lifting of lockdown.

Please Don’t Compliment Me! Fear of Positive Evaluation and Emotion Regulation—Implications for Adolescents’ Social Anxiety

In recent years, fear of positive evaluation has emerged as one of the key aspects of social anxiety, alongside fear of negative evaluation. Fears of evaluation intensify during adolescence, a time when individuals are expected to navigate new, emotionally challenging situations. The purpose of this study was to examine the associations between social anxiety, fear of positive and negative evaluation, and three emotion regulation strategies relevant to social anxiety, i.e., suppression, acceptance, and rumination. To this end, data were collected from 647 adolescents via an online survey and analyzed using structural equation modeling. We found that fear of negative evaluation was significantly related to rumination, whereas fear of positive evaluation was significantly and negatively related to acceptance. We further found an indirect effect of social anxiety on suppression via fear of positive evaluation and acceptance in a serial mediation and an indirect effect of social anxiety on rumination via fear of negative evaluation. Not only do fears of positive and negative evaluation appear to be distinct constructs, but they are also differentially associated with three emotion regulation strategies pertinent to social anxiety. Fear of evaluation and its associations with emotion regulation deficits might hinder the therapeutic process by acting as a deterrent to positive reinforcement or potentially impeding the development of a successful therapeutic alliance.

Sleep to Internalizing Pathway in Young Adolescents (SIPYA): A proposed neurodevelopmental model

The prevalence of internalizing disorders, i.e., anxiety and depressive disorders, spikes in adolescence and has been increasing amongst adolescents despite the existence of evidence-based treatments, highlighting the need for advancing theories on how internalizing disorders emerge. The current review presents a theoretical model, called the Sleep to Internalizing Pathway in Young Adolescents (SIPYA) Model, to explain how risk factors, namely sleep-related problems (SRPs), are prospectively associated with internalizing disorders in adolescence. Specifically, SRPs during late childhood and early adolescence, around the initiation of pubertal development, contribute to the interruption of intrinsic brain networks dynamics, both within the default mode network and between the default mode network and other networks in the brain. This interruption leaves adolescents vulnerable to repetitive negative thought, such as worry or rumination, which then increases vulnerability to internalizing symptoms and disorders later in adolescence. Sleep-related behaviors are observable, modifiable, low-stigma, and beneficial beyond treating internalizing psychopathology, highlighting the intervention potential associated with understanding the neurodevelopmental impact of SRPs around the transition to adolescence. This review details support for the SIPYA Model, as well as gaps in the literature and future directions.

Application of unified protocol as a transdiagnostic treatment for emotional disorders during COVID-19: An internet-delivered randomized controlled trial

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has been an emotionally challenging time, especially for young adults. It is associated with a substantial increase in the prevalence of mental health problems, negative symptoms, and stressful experiences that compromise well-being. In low-income countries, internet-delivered psychological services could have a remarkable impact on the population’s mental health, given the lack of mental health professionals.

AIM

To investigate the efficacy of internet-delivered cognitive-behavior therapy (CBT)-transdiagnostic intervention for adults with emotional disorders.

METHODS

In this internet-delivered randomized controlled trial, 102 students with an emotional disorder (mean age = 28.20 years, standard deviation = 5.07) were randomly allocated to receive unified protocol (UP) (n = 51) or treatment as the usual intervention. Following a semi-structured clinical interview, participants completed an online survey including the Overall Anxiety Severity and Impairment Scale, Overall Depression Severity and Impairment Scale, Difficulties in Emotion Regulation Scale, Positive and Negative Affect Schedule, and Emotional Style Questionnaire.

RESULTS

The participants showed a high degree of adherence. In total, 78% (n = 40) of the experimental group participants completed the UP treatment. Considering the intention to treat procedure, the results of the analysis of covariance indicated that participants who received UP showed statistically significant changes in depression symptoms [Cohen’s d = -1.50 with 95% confidence interval (CI): -1.90 to -1.10], anxiety (Cohen’s d = -1.06 with 95%CI: -1.48 to -0.65), difficulties with emotion regulation (Cohen’s d = -0.33 with 95%CI: -0.7 to -0.06), positive affect (Cohen's d = 1.27 with 95%CI: 0.85 to 1.68), negative affect (Cohen’s d= -1.04 with 95%CI: -1.46 to -0.63), and healthy emotionality (Cohen’s d = 0.53 with 95%CI: 0.09 to 0.13) compared with the control group.

CONCLUSION

This study’s findings highlight the potential value of transdiagnostic internet-delivered programs for young adults with an emotional disorder during the COVID-19 pandemic, and expand the research examining emotional well-being improvements resulting from CBT-transdiagnostic interventions. The findings suggest that UP, which generally concentrates on reducing negative effects, can increase positive effects.

School bullying victimization-associated anxiety in Chinese children and adolescents: the mediation of resilience

BACKGROUND

School bullying victimization is associated with increased risk of anxiety in children and adolescents. However, little is known about the role of resilience in this association. The purpose of this study was to investigate the possible mediation by resilience in this association in a large group of Chinese children and adolescents.

METHODS

A population-based cross-sectional study adopting two-stage simple random cluster sampling was implemented in Yunnan province, southwestern China. A comprehensive questionnaire was used to collect information from the participants. Among all the participants, 4624 were included in the final analysis. Descriptive statistics were used to present general characteristics of the study participants. Univariate and multivariate logistic regression models were adopted to estimate crude and adjusted associations among bullying victimization, anxiety, and resilience. A path model was used to analyze the hypothesized mediation by resilience in the association between bullying victimization and anxiety.

RESULTS

Analytical results of multivariate logistic regression models suggested that bullying victimization was significantly associated with anxiety in Chinese children and adolescents; compared with individuals who had not been bullied, victims of bullying were more likely to experience anxiety symptoms, with an adjusted odds ratio (OR) of 3.02 (95% CI 2.46-3.71). Path analysis revealed a prominent mediating effect of resilience in the association between bullying victimization and anxiety, accounting for 31.89% of the total association. Further analysis indicated that, among the five dimensions of resilience, emotional regulation, interpersonal assistance, and family support were significant mediators, accounting for 30.34%, 10.79%, and 8.35% of the total association.

CONCLUSIONS

Our major findings highlighted the promising role of resilience-based intervention measures in reducing the risk of anxiety associated with school bullying victimization in Chinese children and adolescents.

The Automatic Emotion Regulation of Children Aged 8–12: An ERP Study

Emotion regulation in childhood and adolescence is related to their social development. Better emotion regulation is associated with great individual academic performance and mental health. However, compared with the research on emotion regulation strategies, children’s automatic emotion regulation has been less investigated. Using event-related potential (ERP) technology, this study adopts the cued-emotion Go/Nogo paradigm to investigate the processing characteristics of automatic emotion regulation in children aged 8–12 years. The current study selected 34 younger group [16 boys, 18 girls, mean (M) ± SD = 8.91 ± 0.75], and 31 older group [18 boys, 13 girls, M ± SD = 11.26 ± 0.45]. The results showed that, for Nogo trials, the amplitude of N2 and P3 evoked by emotional faces were significantly larger than those evoked by neutral faces, reflecting the cognitive conflict experienced and the process of children’s automatic response inhibition to emotional stimuli, respectively. However, no significant difference in N2 and P3 amplitude were found in Go trials, which may indicate that children aged 8–12 showed similar top-down control and similar motivated attention in this experiment, respectively. Further analysis found that the negative affect of temperament was significantly positively correlated with Nogo-P3 induced by neutral pictures (r = 0.37, p < 0.001), and preadolescents’ social anxiety was significantly positively correlated with Nogo-P3 followed by neutral pictures (r = 0.31, p < 0.01). These findings can provide inspiration and empirical support for the promotion and intervention of emotion regulation in children and adolescents.

The Role of Comorbid Mood Disorders in Cognitive Behavioral Therapy for Childhood Social Anxiety

Background

Children with a social anxiety disorder have worse treatment outcomes after Cognitive Behavior Therapy (CBT) than children with other anxiety disorders. Anxiety disorders and mood disorders are strongly related and especially social anxiety is related to high comorbidity rates with mood disorders. The aim of the study was to investigate how comorbid mood disorders are related to treatment outcomes after CBT and whether this can explain the worse outcomes for childhood social anxiety.

Methods

Participants were 152 referred clinically children (7–18 years) with either a social anxiety disorder (n = 52) or another anxiety disorder (n = 100) of whom 24.3% (n = 37) had a comorbid mood disorder. Child anxiety, internalizing symptoms, and quality of life were measured pre-treatment, post-treatment, 3 months and 1 year after treatment, using child and both parents’ report.

Results

Children with a primary social anxiety disorder more often had a comorbid mood disorder than children with another primary anxiety disorder. Children with a mood disorder had more severe anxiety problems before treatment. Comorbid mood disorders were related to greater anxiety reductions after treatment. The worse outcomes for children with a primary social anxiety disorder remained after controlling for comorbid mood disorders.

Conclusions

Findings stress the importance of future studies examining why the presence of a comorbid mood disorder is associated with greater anxiety reductions, and other factors that explain the worse treatment outcomes found for childhood social anxiety disorder.

Trait rumination and social anxiety separately influence stress-induced rumination and hemodynamic responses

We aimed to investigate stress-reactive rumination in response to social stress and its association with social anxiety and trait rumination. From previous investigations we know that people with a certain vulnerability to rumination show increased stress-reactive rumination. However, up to date the possible influence of social anxiety on this relationship is still unclear. Therefore, we reanalyzed the data of two of our previous studies assessing healthy low and high trait ruminators and depressed patients performing the Trier Social Stress Test (TSST). We measured cortical oxygenation using functional Near-Infrared Spectroscopy (fNIRS) as well as different behavioral outcome measures (subjective stress levels, negative affect, state rumination). On a behavioral level, we found an influence of both, social anxiety and trait rumination, on state rumination, even when correcting for the other factor, respectively, implying two potentially independent factors of influence. On a neural level, we observed reduced activation in brain regions of the cognitive control network (CCN) for higher social anxiety and trait rumination, which might be a result of reduced cognitive and attentional control. Results indicate a specific role of social anxiety, at least on a behavioral level, and therefore implicate a crucial factor to be considered in the treatment of depression.

Social Anxiety in 15-19 Year Adolescents in Association with Their Subjective Evaluation of Mental and Physical Health

BACKGROUND

Studies show that social anxiety in adolescence have negative impact on quality of life. The study evaluates social anxiety links with mental and physical health factors in adolescents aged 15-19 years.

METHODS

The research was performed in 2018 in secondary schools in Lithuania and included 1722 participants (46.1% males and 53.9% females). The social anxiety was assessed using Social Anxiety and Avoidance Scale for Adolescents. The main results were obtained using univariate and multivariate logistic regression analysis.

RESULTS

Total of 58.5% of adolescents were characterized by high social anxiety and 14.7% by high avoidance. Females more often were characterized by high anxiety compared to males. Multivariate logistic regression revealed that good mental health was a significant protective factor against high SA in adolescents. For females, high anxiety and avoidance were associated with living with both parents, for males, high anxiety was linked with mother's university education. Very common stomach and abdominal pain in females as well as severe and very common stomach or abdominal pain in males, increase the risk of major social anxiety.

CONCLUSIONS

High social anxiety were more prevalent between females than males and was linked with various well-being and health aspects in adolescents.

Anxiety, Loneliness, Drug Craving, and Depression Among Substance Abusers in Sichuan Province, China

Studies have reported that anxiety had a positive effect on depression among substance abusers in males. However, little is known about the mechanism underlying this relationship in substance abusers in males. The purpose of this study was to investigate the mediating effect of loneliness and drug craving between anxiety and depression in substance abusers in males. State-Trait Anxiety Inventory, The UCLA Loneliness Scale, Drug Craving Scale, and The Center for Epidemiologic Studies Depression Scale were employed into this study to investigate 585 substance abusers in males (age range of 20–58 years: M = 33.21, SD = 6.97). Structural equation modeling and the bootstrap approach were used to analyze the mediating effect of loneliness and drug craving on the relationship between anxiety and depression. The results indicated that: Loneliness had a significant positive correlation with anxiety (r = 0.37, p < 0.001) and depression (r = 0.49, p < 0.001); Drug craving had a significant positive correlation with anxiety (r = 0.28, p < 0.001) and depression (r = 0.39, p < 0.001). Loneliness and drug craving mediated the link between anxiety and depression. There was a significant positive correlation between substance abusers in male’s anxiety, loneliness, drug craving, and depression. Loneliness and drug craving had a significant mediating effect on the relationship between anxiety and depression. Therefore, it was suggested that substance abusers in male’s anxiety and depression might be improved and driven by decreasing loneliness and drug craving. Targeted interventions to decrease substance abusers in male’s loneliness and drug craving should be developed, implemented, and help them to recover.

Alexithymia Is Linked with a Negative Bias for Past and Current Events in Healthy Humans

Although research provides a rich literature about the influence of emotional states on temporal cognition, evidence about the influence of the style of emotion processing, as a personality trait, on temporal cognition is extremely limited. We provide a novel contribution to the field by exploring the relationship between difficulties of identifying and describing feelings and emotions (alexithymia) and time perspective. One hundred and forty-two healthy participants completed an online version of the TAS-20 scale, which measures alexithymia, and the Zimbardo Time Perspective Inventory, which monitors individual differences in time-orientation regarding the past, present, and future. The results show greater attention to past negative aspects in participants whose TAS-20 score was indicating borderline or manifest alexithymia, as compared to non-alexithymic individuals. Moreover, the higher the TAS-20 score, the higher the tendency was to focus on negative aspects of the past and interpret the present fatalistically. These results suggest that difficulties in identifying and describing feelings and emotions are associated with a negative bias for past and present events. Theoretical and clinical implications of this finding are discussed.

Emotion regulation therapy for social anxiety disorder: a single case series study

BACKGROUND

Despite the vast majority of evidence indicating the efficacy of traditional and recent cognitive behaviour therapy (CBT) therapies in treating social anxiety disorder (SAD), some individuals with SAD do not improve by these interventions, particularly when co-morbidity is present.

AIMS

It is not clear how emotion regulation therapy (ERT) can improve SAD co-morbid with symptoms of generalized anxiety disorder (GAD) and depression. This study investigated this gap.

METHOD

Treatment efficacy was assessed using a single case series methodology. Four clients with SAD co-occurring with GAD and depression symptoms received a 16-session version of ERT in weekly individual sessions. During the treatment, self-report measures and clinician ratings were used to assess the symptom intensity, model-related variables, and quality of life, work and social adjustment of participants every other week throughout the treatment. Follow-up was also conducted at 1, 2 and 3 months after treatment. Data were analysed using visual analysis, effect size (Cohen's d) and percentage of improvement.

RESULTS

SAD clients with depression and GAD symptoms demonstrated statistically and clinically significant improvements in symptom severity, quality of life, work, social adjustment and model-related measures (i.e. negative emotionality/safety motivation, emotion regulation strategies). The improvements were largely maintained during the follow-up period and increased for some variables.

CONCLUSION

These findings showed preliminary evidence for the role of emotion dysregulation and motivational factors in the aetiology and maintenance of SAD and the efficacy of ERT in the treatment of co-morbid SAD.

Trajectories of Depressive Symptoms in Adolescence: The Interplay of Maternal Emotion Regulation Difficulties and Youth ADHD Symptomatology

Objective: ADHD and depression co-occur at higher than chance levels in adolescence, but moderators of this association are not well understood. Consistent with a developmental-transactional framework, one such moderator may be maternal emotion regulation (ER) difficulties. Using latent growth curve modeling, the current study examined the independent and interactive effects of adolescent ADHD symptoms and maternal ER difficulties on the trajectory of depressive symptoms across adolescence. Method: This study included a community sample of 247 adolescents (M_age = 13.06 years) assessed annually over a 6-year period. Results: Findings suggested that youth with greater ADHD symptoms whose mothers evidenced more ER difficulties demonstrated steeper increases in depressive symptoms over time relative to their peers with lower ADHD symptoms or whose mothers reported fewer ER difficulties. Conclusion: This work highlights the importance of maternal ER difficulties in predicting the trajectory of depressive symptoms among adolescents with ADHD symptomatology.

The Role of Emotional Regulation in Anxiety and Depression Symptom Interplay and Expression among Adolescent Females

Depression and anxiety are highly comorbid constructs. However little is known about the mechanisms that underpin this comorbidity/connectivity or the divergence between constructs that seems to occur in adolescence. The current study targeted emotion regulation (ER) as a potential plausible mechanism for explaining how anxiety and depression symptoms in adolescence might begin to connect, perpetuate, and ultimately diverge from one another. Using data from a cross-sectional school-based study, of adolescent females (age 11–18 years; N = 615; majority were white (97.7%)), we modelled variation in ER using latent profile analysis. Then, using network analysis (NA), we generated separate depression-anxiety symptom networks for adolescents at varying levels of ER. Three latent classes of ER were identified (low ER 15%, intermediate ER 34%, high ER 51%). The results of the network comparison test found no significant differences in global strength between the ‘low ER’ and the ‘intermediate ER’ ability network. This study is among the first to attempt to model change in depression-anxiety symptom connectivity in adolescence in relation to a common contextual/risk factor. The current study therefore offers a unique contribution to the examination of the role of transdiagnostic factors in the study of adolescent depression and anxiety from a network perspective, and provides a promising framework for the study of ER among anxiety and depression symptomatology in adolescence.

The Mediating Effects of Self-Esteem on Anxiety and Emotion Regulation

Individuals with anxiety disorders maladaptively appraise interpersonal threat cues leading to inaccurate interpretations of the self and others. However, little is known about the factors that mediate this association, therefore, the main aim of this study was to examine the relationship between state and trait anxiety, self-esteem, and emotion regulation strategies: reappraisal and suppression. Young adults aged between 18-26 years participated in the study. They completed a set of self-reports measuring emotion regulation, self-esteem, state-trait anxiety, and positive and negative attributes. Participants also completed an experimental task, using the dot-probe paradigm, which measures threat bias and response inhibition. The findings showed that trait and state anxiety predicted suppression, reappraisal, and internalising problems, and is linked to response inhibition. Importantly, low self-esteem, significantly mediated the relationship between increased anxiety and suppression. Taken together, these results show specific associations between emotion regulation and anxiety, highlighting the significant impact of self-esteem in young adults.

Stressors, Repetitive Negative Thinking, and Insomnia Symptoms in Adolescents Beginning High School

OBJECTIVE

Although the first year of high school may represent a particularly stressful time for adolescents, no research addresses how stressors are related to insomnia symptoms during this time. Thus, we examined how stress relates to concurrent and prospective insomnia symptoms in adolescents beginning high school (Aim 1). Additionally, we assessed repetitive negative thinking (RNT) as a mediator (Aim 2). We also evaluated whether the pattern of associations differed for boys and girls (Aim 3).

METHODS

Adolescents (N = 502; M age = 14.22 years; 58.2% girls; 91.2% Hispanic/Latinx) completed questionnaires about stressors related to beginning high school (e.g., school performance, peer pressure), family support, RNT, and insomnia symptoms at the beginning and end of their first year of high school. Multiple group structural equation models assessed relationships between these variables and evaluated differences between boys and girls.

RESULTS

School/leisure conflict and low family support were directly associated with insomnia symptoms at both times, and RNT mediated these relationships in both boys and girls. In girls, peer pressure and low family support were indirectly associated with Time 1 and Time 2 insomnia symptoms via RNT. In boys, school performance was indirectly associated with Time 1 and Time 2 insomnia symptoms via RNT.

CONCLUSIONS

Stressful experiences at the beginning of high school negatively affect sleep in adolescents both in the short and long term. Pediatric psychologists should educate adolescents and their parents about the risk of sleep problems during this time period and provide strategies for stress management and for proper sleep hygiene.

Development of the A-DISS rejection task to demonstrate the unique and overlapping affective features of social anxiety and depression

BACKGROUND

Social anxiety (SA) and depression are prevalent, often comorbid disorders, associated with poor psychosocial functioning. Experimental psychopathology approaches can clarify the transdiagnostic mechanisms underlying these disorders, but most laboratory tasks are limited. We developed and validated the Audio-Dialogue Inductions of Social Stress (A-DISS) experimental task to model real-time rejection sensitivity in a realistic and developmentally relevant context. Participants are asked to imagine overhearing peers at a party talking badly about them (Rejection) or a teacher at their school (Neutral).

METHODS

Study 1 focused on identifying and refining stimuli that elicited relevant emotional responses for Rejection (e.g., increased anxiety) and Neutral (e.g., no emotional changes) conditions (N=48). Study 2 examined whether participants' SA and depression symptoms moderated the effects of A-DISS condition (N=52).

RESULTS

The Rejection condition elicited higher negative affect/lower positive affect while the Neutral condition sustained stable affect. Findings were consistent across gender and race/ethnicity. Moderation analyses were statistically significant; participants with elevated SA or depression reported feeling more rejected, insecure, and anxious after Rejection than those with below average symptoms.

CONCLUSIONS

Findings provide preliminary validation of a novel peer rejection task for research on understanding the affective experience of real-time rejection overall, especially for those with elevated SA and depression. SA and depression symptoms each uniquely moderating the effects of Rejection exposure on similar affective states, suggests individuals with SA or depression may benefit from interventions targeting specific reactions to rejection/stress and transdiagnostic risk factors.

Validity, Reliability, and Optimal Cut-off Scores of the WHO-5, PHQ-9, and PHQ-2 to Screen Depression Among University Students in Iran

This study aimed to investigate the validity, reliability, and optimal cut-off points for the Patient Health Questionnaire-2 (PHQ-2), Patient Health Questionnaire-9 (PHQ-9), and Well-being Index (WHO-5) to screen mild depression among 400 Iranian students who completed these tools and Beck Depression Inventory (BDI-13). Further, a psychiatrist diagnosed the depression by using the "Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders." The validity and internal consistency of tools assessed and the accuracy were computed using the receiver operating characteristic (ROC) and area under the curve (AUC). The internal consistency values of PHQ-2, PHQ-9, and WHO-5 were .73, .88, and .94, respectively. The PHQ-2 (.53), PHQ-9 (.60), and WHO-5 (.54) were significantly associated with the BDI. The PHQ-2, PHQ-9, and WHO-5 had optimal cut-off points of 2, 5, and 9 with an AUC of .809, .851, and .823, respectively. Based on these findings, it is recommended to use the PHQ-9 for mild depression screening among medical university students in Iran because of its high sensitivity and specificity.

Emotion regulation in adolescents: Influences of internal representations of relationships - An ERP study

Emotion regulation (ER) strategies can decrease the intensity or modify the experience of emotions. Deficits in emotion regulation are implicated in a wide range of psychopathologies. It is argued that interpersonal, socio-cognitive, and developmental variables play an important role in ER. This is the first study to explore the contribution of individual differences in internal representations of relationships (IRR) to neural correlates of ER in a sample of adolescents. Event related potentials of 53 adolescents (12 to 17 years old) were collected while performing an ER task. IRR was assessed with the social cognition and object relations scale (SCORS-G; Westen, 1995) coding of narratives from interviews. Results show that individual differences in IRR significantly predicted the modulation of emotional responses by expressive suppression in adolescents, accounting for 48% of the variance of changes in occipital late positive potentials (LPP). Thus, it appears that IRR are implicated in an individual's ability to regulate emotions. The clinical implications of the findings are discussed.

The role of emotion regulation in socially anxious children and adolescents: a systematic review

While numerous studies suggest that emotion dysregulation is important in maintaining social anxiety among adults, the role of emotion regulation in children and adolescents with social anxiety is not yet well understood. In this systematic review, we use the process model of emotion regulation as a framework for understanding emotion regulation in children and adolescents with social anxiety. We performed a systematic literature search in the electronic data bases Medline and PsycINFO. Additional studies were identified by hand search. We identified 683 studies, screened their titles and abstracts, viewed 142 studies, and included 55 of these. Study results indicate that children and adolescents with social anxiety disorder or high social anxiety show emotion dysregulation across all five domains of emotion regulation, such as enhanced social avoidance, more safety behaviors, repetitive negative thinking, biased attention and interpretation of social information, and reduced emotional expression. While enhanced social avoidance seems to be specific to childhood social anxiety, other maladaptive emotion regulation strategies, such as repetitive negative thinking, seem to occur transdiagnostically across different childhood anxiety disorders. Implications for current theory, interventions and future research are discussed.

The role of the MTG in negative emotional processing in young adults with autistic-like traits: A fMRI task study

BACKGROUND

Few previous studies explored negative emotion processing in autistic-like traits people using task-based fMRI. In this study, we applied task fMRI to determine the relationship between negative emotion processing and social skill within autistic-like traits people. aimed to find which brain areas specificity play a key role in emotional processing.

METHODS

106 of Chinese individuals measured with AQ. Then applied emotion regulation task to explore the difference in brain activation and functional connectivity in individuals with autistic traits.

RESULTS

The results showed increased activation in the right middle temporal gyrus (MTG). The mediation analysis showed the right MTG mediates the relationship between autistic-like traits and negative emotion. Generalized psychophysiological interaction (gPPI) analysis also suggested that the right MTG shows significant functional connectivity with the left parahippocampal gyrus (PHG) and left precuneus cortex.

LIMITATIONS

Our sample are university students, there may have a bias in the sample compared to sub-average and have no differences between the gender, we will broaden the sample size and take the gender into account. We use two conditions as our focused theme, we want to use a more specific task to explore negative emotion in autistic-like traits people.

CONCLUSIONS

The results showed that the right MTG was an important brain region in individuals with autistic-like traits, and our study provides a wider discussion about autism brain activation and functional connectivity patterns and the use the MTG as a hallmark in individuals with autistic-like traits.

Transdiagnostic treatment of emotional disorders in people with multiple sclerosis: randomized controlled trial

BACKGROUND

Multiple sclerosis (MS) is a neurodegenerative disease of the central nervous system. MS is significantly associated with a high rate of psychological, behavioral, and emotional consequences. Despite the frequent mental disorders, high rate of psychological comorbidities, and emotional problems in people with MS (PwMS), these conditions are often underdiagnosed and undertreated. This study aimed to examine the efficacy of a group format of the unified protocol for the transdiagnostic treatment of emotional disorders in adult PwMS associated with an emotional disorder.

METHODS

Seventy adult PwMS were randomized using an internet-based computer system to either the unified protocol (n = 35) or treatment as usual condition. The assessment protocol included semi-structured clinical interviews and self-reports evaluating diagnostic criteria, depression, anxiety and worry symptoms, emotional dysregulation, and affectivity.

RESULTS

The parametric test of analysis of covariance, followed the intent to treat analyses, revealed the unified protocol significantly changed depression symptoms (Cohen's d = 1.9), anxiety symptoms (Cohen's d = 2.16), worry symptoms (Cohen's d = 1.27), emotion dysregulation (Cohen's d = 0.44), positive affect (Cohen's d = 1.51), and negative affect (Cohen's d = 1.89) compared with the control group. The unified protocol also significantly improved outcome scores at the end of treatment relative to baseline (p < .001).

CONCLUSION

The findings support that the unified protocol could be an additional efficient psychological treatment for PwMS. Trial registration IRCT, number: IRCT20190711044173N1. Registered 31october 2019, https://en.irct.ir/user/trial/40779/view .

Transdiagnostic treatment of emotional disorders for women with multiple sclerosis: a randomized controlled trial

BACKGROUND

Multiple sclerosis (MS) is a chronic, unpredictable, neurodegenerative disease, significantly associated with psychological, behavioral, cognitive, and emotional consequences. MS is more common in females than males and frequently affects women during their reproductive years. Despite the frequent mental disorders, comorbidities, and emotional problems in People with MS (PwMS), these conditions are too often underdiagnosed and undertreated.

OBJECTIVE

This study aimed to examine the efficacy of a group format of the Unified Protocol (UP) for the Transdiagnostic treatment of depression and anxiety disorders in females with MS.

METHODS

In the present study, Sixty-four adult females diagnosed with MS were randomized to either the UP (n = 32) or treatment-as-usual conditions. The assessment protocol included semi-structured clinical interviews and self-reports evaluating diagnostic criteria, depression, anxiety and worry symptoms, emotional regulation, and affectivity.

RESULTS

Repeated measure analysis of variance (ANOVA) revealed that the UP significantly improved depression scores [Cohen's d = - 2.11, 95% CI (- 2.72, - 1.50)], anxiety scores [Cohen's d = - 3.34, 95% CI (- 4.01, - 2.58)], positive and negative affect scale (PANAS)-positive affect scores [Cohen's d = 1.46, 95% CI (1.46, 2.01)], PANAS-negative affect scores [Coen's d = - 2.21, 95% CI (- 2.84, - 1.60)], difficulties emotion regulation scale scores [Cohen's d = 1.40, 95% CI (- 0.87, - 0.03)], and Worry scale scores [Cohen's d = - 0.45, 95% CI (- 0.95, - 0.04)] at the end of treatment relative to compared to the control condition. Also, treatment gains were maintained at the three-month follow-up (p < 0.001).

CONCLUSION

The findings provide the support that the UP could be an additional efficient psychological treatment for females with MS. ISRCTN Number: ISRCTN95459505.

Transdiagnostic treatment of emotional disorders in people with multiple sclerosis: randomized controlled trial

Background

Multiple sclerosis (MS) is a neurodegenerative disease of the central nervous system. MS is significantly associated with a high rate of psychological, behavioral, and emotional consequences. Despite the frequent mental disorders, high rate of psychological comorbidities, and emotional problems in people with MS (PwMS), these conditions are often underdiagnosed and undertreated. This study aimed to examine the efficacy of a group format of the unified protocol for the transdiagnostic treatment of emotional disorders in adult PwMS associated with an emotional disorder.

Methods

Seventy adult PwMS were randomized using an internet-based computer system to either the unified protocol (n = 35) or treatment as usual condition. The assessment protocol included semi-structured clinical interviews and self-reports evaluating diagnostic criteria, depression, anxiety and worry symptoms, emotional dysregulation, and affectivity.

Results

The parametric test of analysis of covariance, followed the intent to treat analyses, revealed the unified protocol significantly changed depression symptoms (Cohen’s d = 1.9), anxiety symptoms (Cohen’s d = 2.16), worry symptoms (Cohen’s d = 1.27), emotion dysregulation (Cohen’s d = 0.44), positive affect (Cohen’s d = 1.51), and negative affect (Cohen’s d = 1.89) compared with the control group. The unified protocol also significantly improved outcome scores at the end of treatment relative to baseline (p < .001).

Conclusion

The findings support that the unified protocol could be an additional efficient psychological treatment for PwMS.

Trial registration IRCT, number: IRCT20190711044173N1. Registered 31october 2019, https://en.irct.ir/user/trial/40779/view.

The role of frontal-subcortical connectivity in the relation between coping styles and reactivity and downregulation of negative emotion

Coping styles (CS) reflect individuals' habitual use of strategies for coping with negative events in daily life. Although research into coping has not reached consistent agreement about classifying coping strategies as either inherently adaptive or maladaptive, the influence of maladaptive CS on mental health is noticeable. CS might also be related to emotion regulation and associated brain systems. Participants (N = 165) completed measurements of CS, trait emotions including trait anxiety, depressive symptoms and happiness and then performed an emotion regulation task, in conjunction with functional MRI. Individual differences in maladaptive CS use were associated with higher trait negative emotionality and higher state reactivity of negative emotion. Concurrent bilateral amygdala-right middle frontal gyrus (MFG) connectivity during passive negative stimulus processing mediated the relation between maladaptive CS and negative emotion ratings. Psychophysiological interaction analyses showed that maladaptive and adaptive CS were linked to patterns of frontal-subcortical connectivity during state emotion regulation. These results suggest that maladaptive CS might be related to negative emotion processing and weaker spontaneous regulation and indicate that maladaptive CS is a risk factor in individual mental health.

Social anxiety disorder in children: investigating the relative contribution of automatic thoughts, repetitive negative thinking and metacognitions

BACKGROUND

Social anxiety disorder (SAD) is common in youths. However, our understanding of SAD in children is inferior to that of SAD in adolescents or adults, and it is unclear if known adult SAD maintenance mechanisms may also operate in children with SAD.

AIM

The paper sets out to investigate the specificity of positive automatic thoughts, social threat negative automatic thoughts, repetitive negative thinking, positive and negative metacognitions in predicting SAD symptoms and diagnoses in clinically anxious children.

METHOD

We enrolled 122 clinically anxious children aged 7-13 years; of these, 33 had an SAD diagnosis.

RESULTS

SAD symptoms correlated positively with social threat negative automatic thoughts, repetitive negative thinking, and negative metacognitions, and negatively with positive automatic thoughts. Linear regression indicated that, of these variables, only social threat negative automatic thoughts predicted social anxiety symptoms. Logistic regression indicated that social threat negative automatic thoughts, a higher number of diagnoses and negative metacognitive beliefs specifically predicted the presence of SAD diagnosis.

CONCLUSIONS

Our findings suggest that content-specific social threat negative automatic thoughts was the only variable that specifically distinguished both higher levels of social anxiety symptoms and diagnoses.

Multi-group analysis using generalized additive kernel canonical correlation analysis

Multivariate analysis has been widely used and one of the popular multivariate analysis methods is canonical correlation analysis (CCA). CCA finds the linear combination in each group that maximizes the Pearson correlation. CCA has been extended to a kernel CCA for nonlinear relationships and generalized CCA that can consider more than two groups. We propose an extension of CCA that allows multi-group and nonlinear relationships in an additive fashion for a better interpretation, which we termed as Generalized Additive Kernel Canonical Correlation Analysis (GAKCCA). In addition to exploring multi-group relationship with nonlinear extension, GAKCCA can reveal contribution of variables in each group; which enables in-depth structural analysis. A simulation study shows that GAKCCA can distinguish a relationship between groups and whether they are correlated or not. We applied GAKCCA to real data on neurodevelopmental status, psychosocial factors, clinical problems as well as neurophysiological measures of individuals. As a result, it is shown that the neurophysiological domain has a statistically significant relationship with the neurodevelopmental domain and clinical domain, respectively, which was not revealed in the ordinary CCA.

Mindfulness-Based Interventions for Adolescent Social Anxiety: A Unique Convergence of Factors

Social anxiety disorder (SAD) is a debilitating and often chronic psychiatric disorder that typically onsets during early adolescence. Cognitive behavior therapy (CBT), the current "gold-standard" treatment for SAD, tends to focus on threat- and fear-based systems hypothesized to maintain the disorder. Despite this targeted approach, SAD ranks among the least responsive anxiety disorders to CBT in adolescent samples, with a considerable proportion of individuals still reporting clinically significant symptoms following treatment, suggesting that the CBT-family of interventions may not fully target precipitating or maintaining factors of the disorder. This gap in efficacy highlights the need to consider new therapeutic modalities. Accordingly, this brief review critically evaluates the emergent literature supporting the use of mindfulness-based interventions (MBIs) for treating adolescent SAD. MBIs may be particularly relevant for addressing maintaining factors within this diagnosis, as they may target and interrupt cycles of avoidance and de-motivation. Despite limitations in the relative lack of randomized controlled trials (RCTs) on this topic, a unique convergence of factors emerge from the extant literature that support the notion that MBIs may hold particular promise for attenuating symptoms of SAD in adolescents. These factors include: (1) MBIs demonstrate the ability to directly engage symptoms of SAD; (2) MBIs also show consistent reduction of anxiety, including symptoms of social anxiety in adolescent populations; and (3) MBIs demonstrate high rates of feasibility and acceptability in anxious adolescent samples. We briefly review each topic and conclude that MBIs are an encouraging treatment approach for reducing symptoms of social anxiety in adolescents. However, given the lack of research within MBIs for adolescent SAD in particular, more research is needed to determine if MBIs are more advantageous than other current treatment approaches.

Augmenting usual care SSRIs with cognitive behavioral therapy for insomnia to improve depression outcomes in youth: Design of a randomized controlled efficacy-effectiveness trial

IMPORTANCE

Extant treatments for youth depression are only modestly effective. Alternative approaches are needed to improve health outcomes. A novel approach to improve depression outcomes is suggested by epidemiological studies finding that insomnia often predates and may contribute to depression risk. We test whether treating insomnia among youth starting a new course of SSRI antidepressants improves depression outcomes. This paper describes our study design.

DESIGN

2-arm randomized controlled efficacy-effectiveness trial.

SETTING

A large non-profit health maintenance organization.

PARTICIPANTS

165 adolescents aged 12-19 with research-confirmed depression and insomnia diagnoses, starting a new episode of selective serotonin reuptake inhibitor (SSRI) antidepressant treatment prescribed by their usual care provider.

INTERVENTIONS

Two sleep interventions, each 6-7 sessions, both overlaying "treatment as usual" (TAU) SSRIs: a sleep hygiene (SH) attention control condition, and cognitive-behavioral therapy for insomnia (CBTI).

CONCLUSIONS AND RELEVANCE

If CBT-I improved sleep is shown to improve depression-related outcomes, this may provide an additional, easily tolerated intervention for an important public health target.

TRIAL REGISTRATION

clinicaltrials.gov, NCT02290496, https://clinicaltrials.gov/ct2/show/NCT02290496.