Attentional Control as a Moderator of the Relationship Between Difficulties Accessing Effective Emotion Regulation Strategies and Distress Tolerance

The relationship between distress tolerance and behavioral activation on anxiety and depression symptomatology in autistic youth: Leveraging self and caregiver perspectives

Anxiety and depression are prevalent among autistic adolescents and may be difficult to accurately diagnose and treat given various factors (e.g., diagnostic overshadowing, heterogeneity). Therefore, efforts to examine transdiagnostic factors (i.e., distress tolerance, behavioral activation) may afford more parsimonious means for assessment and treatment. To our knowledge, there has been little research on distress tolerance, behavioral activation, and depressive and anxiety symptoms in autistic adolescents to guide diagnostic practices and treatment planning. In the current study, we examined the interrelationships between these transdiagnostic factors and depressive and anxiety symptoms using ratings from 100 verbally fluent autistic adolescents without intellectual disability (Mage = 13.70, SDage = 2.23, Range: 11:00-17:11 years) and 100 of their caregivers. Many adolescents reported male sex assigned at birth (61%), cisgender (87%), not Hispanic/Latinx (90%), and White (80%) identities. A series of correlational analyses were employed to examine associations between these constructs from youth and caregiver perspectives, and multiple linear regression analyses were conducted to explore the mediating roles of distress tolerance and behavioral activation. Preliminary results show that low distress tolerance and behavioral activation were associated with more severe internalizing symptoms per self- and caregiver-report. Some differences by rater emerged, which highlight the importance of multi-informant ratings in autism. Results from mediation analyses may show that behavioral activation may be more salient to assessments and treatment planning for depression than distress tolerance, while distress tolerance may be important for both anxiety and depression; however, findings are preliminary given the cross-sectional nature of the data. Findings suggest that these transdiagnostic concepts may be important to individualizing treatment approaches, including the timing of certain approaches, for anxiety and/or depression in autistic adolescents.

The Factorial Structure, Psychometric Properties and Sensitivity to Change of the Distress Tolerance Scale for Children with Emotional Disorders

BACKGROUND

The Distress Tolerance Scale (DTS) was adapted for American and Chinese youth, but never for European youth. Moreover, the factor structures found in these previous studies were not consistent.

METHODS

The DTS was adapted for Portuguese children and then validated among 153 children aged 6-13 years with emotional disorders. A confirmatory factor analysis (CFA) was conducted; the DTS reliability and validity were analyzed, and sex and age differences were explored. A sub-sample of children who received a transdiagnostic CBT (Unified Protocol for Children) was used to analyze the DTS's sensitivity to therapeutic change.

RESULTS

The five tested models (based on previous studies) exhibited adequate fit in the CFA. However, the model previously reported for use in American children with emotional disorders was selected as the most appropriate. The DTS demonstrated adequate psychometric properties, and its validity was established through significant negative associations with measures of anxiety, depression and negative affect, as well as positive associations with positive affect. Age and sex differences were discussed. The DTS scores significantly increased from pre- to post-treatment, demonstrating sensitivity to therapeutic change.

CONCLUSIONS

The DTS is a suitable and useful measure for assessing children's distress tolerance and to assess the efficacy of CBT.

An Integrative Model of Youth Anxiety: Cognitive-Affective Processes and Parenting in Developmental Context

Multiple theoretical frameworks have been proposed to provide a more comprehensive picture of the risk factors that influence anxiety-related developmental trajectories. Nonetheless, there remains a need for an integrative model that outlines: (1) which risk factors may be most pertinent at different points in development, and (2) how parenting may maintain, exacerbate, or attenuate an affective style that is characterized by high negative emotional reactivity to unfamiliar, uncertain, and threatening situations. A developmentally informed, integrative model has the potential to guide treatment development and delivery, which is critical to reducing the public health burden associated with these disorders. This paper outlines a model integrating research on many well-established risk mechanisms for anxiety disorders, focusing on (1) the developmental progression from emotional reactivity constructs early in life to those involving higher-level cognitive processes later in youth, and (2) potential pathways by which parenting may impact the stability of youth's cognitive-affective responses to threat-relevant information across development.

Applying a bifactor model to the functions of relational aggression: Associations with hostile attribution biases and difficulties with emotion regulation

Previous research suggests that reactive and proactive aggression likely have distinct underlying mechanisms that uniquely contribute to the perpetration of each as a result of faulty cognitive and emotional processes. Still, very little work has examined the association of the functions of relational aggression with emotion dysregulation and hostile attribution biases. In addition, it is important to examine relational aggression in its pure and co-occurring functions given that past work finds reactive and proactive aggression to occur both jointly and distinctly. Thus, the current study employed a bifactor model to distinguish between pure reactive, pure proactive, and co-occurring relational aggression in emerging adulthood (N = 647, M_age  = 19.92, SD = 2.83), a developmental time period for which relational aggression is particularly prominent. To further address gaps in the relational aggression literature, indirect pathway models revealed that relational hostile attribution biases emerged as a concurrent indirect path in the relationship between emotion dysregulation and pure reactive relational aggression. Furthermore, emotion dysregulation was directly positively associated with both pure functions as well as co-occurring relational aggression, and hostile attribution biases for relational provocations were directly associated with both pure functions of relational aggression, though the association was negative for pure proactive and positive for pure reactive relational aggression. Findings highlight the potential influence of emotion dysregulation and attributing hostile intent to social situations on engaging in the different functions of relational aggression.

Self-Regulation Predicts Mental Health and Well-Being During the Covid-19 Pandemic: A Prospective Study

Introduction: As evidence of the psychological effects of the COVID-19 pandemic emerge, examining the role of self-regulation may yield key insights. This prospective study tested whether pre-pandemic self-regulation was associated with mental health, well-being, and substance use during the initial COVID-19 surge. Methods: Participants (N = 236; Mage = 30.3; 64% female) were assessed 1–3 years prior to the pandemic and again in April of 2020. Markers of self-regulation (vagal tone, attachment insecurity, stress-reactive rumination, and attentional control) were assessed at Time 1, as were depressive symptoms, sleep problems, relationship satisfaction, perceived stress, and substance use. These outcomes were assessed again during the pandemic, along with anxiety symptoms and peri-traumatic distress. Results: Poor pre-pandemic self-regulation was associated with higher peri-pandemic depressive and anxiety symptoms, peri-traumatic distress, and cannabis use. Self-regulation was not associated with sleep, relationship satisfaction, alcohol use, or drug use and did not moderate changes over time. Discussion: Prospective analyses indicated simultaneous, independent associations of cognitive and emotional self-regulation with mental health and well-being during the initial COVID-19 pandemic surge, yet pre-pandemic self-regulation did not account for trajectories of change over time. Findings emphasize the importance of prospective data for understanding biopsychosocial resilience during the pandemic and beyond.

Distress Tolerance as a Mechanism Linking Violence Exposure to Problematic Alcohol use in Adolescence

Adolescents exposed to violence are at elevated risk of developing most forms of psychopathology, including depression, anxiety, and alcohol abuse. Prior research has identified emotional reactivity and difficulties with emotion regulation as core mechanisms linking violence exposure with psychopathology. Scant research has examined behavioral responses to distress as a mechanism in this association. This study examined the association of violence exposure with distress tolerance-the ability to persist in the face of distress-and whether lower distress tolerance linked violence exposure with subsequent increases in depression, anxiety, and alcohol abuse problems during adolescence. Data were collected prospectively in a sample of 287 adolescents aged 16-17 (44.3% male; 40.8% White). At Time 1, participants provided self-report of demographics, violence exposure, and psychopathology, and completed a behavioral measure of distress tolerance, the Paced Auditory Serial Addition Task. Four months later, participants (n = 237) repeated the psychopathology assessments. Violence exposure was associated with lower distress tolerance (β = -.21 p = .009), and elevated concurrent psychopathology (β = .16-.45, p = .001-.004). Low distress tolerance was prospectively associated with greater likelihood of abusing alcohol over time (OR = .63, p = .021), and mediated the association between violence exposure and greater levels (β = .02, 95% CI [.001, .063]) and likelihood (OR = .03, 95% CI [.006, .065]) of alcohol use over time. In contrast, low distress tolerance was not associated concurrently or prospectively with internalizing symptoms. Results persisted after controlling for socio-economic status. Findings suggest that distress tolerance is shaped by early experiences of threat and plays a role in the association between violence exposure and development of problematic alcohol use in adolescence.

The Moderating Effect of Attentional Control on the Relationship Between COVID Stress and Generalized Anxiety Symptoms

The recent global pandemic (i.e., COVID-19) has had a serious impact on psychological health, as the stress associated with the pandemic increases the likelihood of developing clinically significant anxiety. Evidence suggests that attentional control may protect those individuals with outcome-specific vulnerabilities from developing maladaptive psychological outcomes. In the present study, attentional control was examined as a moderator of the relation between COVID-19 stress and generalized anxiety symptoms in a community sample (N = 359 adults). As predicted, the relationship between COVID-19 stress and anxiety was moderated by attentional control. Specifically, as attentional control decreased, the strength of the association between COVID-19 stress and anxiety increased. The results suggest that, among those with higher levels of COVID-19 stress, attentional control may act as a protective factor against developing anxiety. It may be beneficial as a matter of standard public health guidance to recommend that the general public engages in activities that are known to improve attentional control and alleviate emotional distress (e.g., mindfulness-based techniques) at the outset of a pandemic or other global catastrophe to reduce the likelihood that prolonged event-related stress will lead to impairing anxiety.

Distress intolerance mediates attentional control on posttraumatic stress symptoms: Evidence from two clinical samples

Theoretical models emphasize the importance of both affective and cognitive risk factors in the development of posttraumatic stress symptoms (PTSS). Two such factors predicting PTSS have been studied extensively: distress intolerance (DI) - an affective factor indicative of the ability to tolerate negative affective states - and attentional control (AC), a cognitive factor reflecting the ability to flexibly shift and maintain attention to goal-relevant tasks. Previous work primarily highlights the independent contributions of DI and AC and their interaction to predict PTSS. Some models, however, suggest a mediational pathway such that AC indirectly affects PTSS via diminished DI. The current paper addressed this gap by first attempting to replicate prior findings, while also exploring this mediation model. Results were examined in two clinical samples - a trauma-exposed sample of adults (study 1; N = 73) and trauma-exposed treatment-seeking adults (study 2; N = 204). Results partially supported our hypotheses; both studies failed to replicate prior moderation findings, but our mediational hypothesis was supported in both samples. Low AC appears to decrease an individual's tolerance for distressing situations, which in turn increases the severity of PTSS. Results suggest that PTSD treatments may benefit by incorporating components of AC, DI, or a combination of the two to mitigate PTSS. Taken together, this study provides a novel examination of how cognitive and affective risk factors, namely AC and DI, work in tandem to increase PTSS.

Expanding our understanding of the relationship between nonsuicidal self-injury and suicide attempts: The roles of emotion regulation self-efficacy and the acquired capability for suicide

OBJECTIVE

Although past literature has emphasized the role of acquired capability in the relationship between nonsuicidal self-injury (NSSI) and suicide attempts, support for the indirect relationship of NSSI to suicide attempts through acquired capability is limited. Thus, research examining other factors that may underlie this relationship is needed. Across two studies, this research examined the indirect relationships of NSSI frequency to suicide attempts through both acquired capability and emotion regulation self-efficacy (ERSE).

METHOD

Two large samples of adults (one nationwide community sample and one clinical sample of patients with substance use disorders) completed questionnaires and/or interviews.

RESULTS

Results revealed significant indirect relationships of NSSI frequency to lifetime suicide attempts through ERSE, but not acquired capability, within both samples.

CONCLUSIONS

Results highlight the relevance of ERSE to both suicide attempts and the NSSI-suicide attempt relationship, and suggest the potential utility of interventions aimed at increasing ERSE among individuals with repeated NSSI.

Confirming the Factor Structure and Validity of the Distress Tolerance Scale (DTS) in Youth

Distress tolerance (DT) is an individual's ability to handle uncomfortable emotion states or sensations (Simons and Gaher in Motiv Emot 29(2): 83-102, 2005). DT is associated with heightened risk for psychopathology, including internalizing symptoms. However, little research has examined the feasibility of assessing DT via youth self-report. The purpose of this investigation was to assess the psychometric properties of the Distress Tolerance Scale (DTS) (Simons and Gaher in Motiv Emot 29(2): 83-102, 2005) in community (n = 117; ages 10-19; 56.4% female) and clinical samples (n = 165; ages 10-18, 52.7% female) of youth. Predictors of DT and its association with internalizing symptoms were investigated. The majority of fit indices confirmed a four-factor hierarchical structure for the clinical sample data. Females reported lower DT than males and DT was associated with internalizing symptoms. Validation of the factor structure of the DTS allows for investigation of child and adolescent-reported perceptions of DT as a risk factor for psychopathology in youth.

Mindful self-regulation of attention is a key protective factor for emotional dysregulation and addictive behaviors among individuals with alcohol use disorder

Individuals with alcohol use disorder (AUD) and other substance use disorders (SUDs) frequently show co-occurrent behavioral addictions (BAs) (i.e., gambling and compulsive sex) and other inflexible behaviors (IBs) (i.e., compulsive buying and dysfunctional eating behaviors). The covariation of these conditions might be explained by a role of emotion dysregulation (ED) and executive dysfunctions. This study aims at investigating whether ED and self-regulation of attention (SRA) could be common processes that underpin BAs and other IBs among individuals with AUD. The study hypothesized that SRA should represent a key protective factor for the relationships between ED and BAs/IBs. The research included 319 treatment-seeking individuals with a primary diagnosis of AUD. Five independent multiple parallel mediational models were tested. Self-report instruments were administered in order to assess ED, BAs and other IBs, which represented independent and dependent variables respectively. SRA was self-report assessed and, it was considered the key mediator variable. The analyses highlighted significant total effects of ED on the severity of BAs and IBs. SRA fully mediated the relationships between ED and BAs/IBs, with exception of gambling. ED and SRA should be considered common dimensions that explain the covariation of BAs and IBs among individuals with AUD. SRA represents an adaptive form of emotion regulation that sustains the engagement in goal-oriented behaviors. Future neuroimaging and longitudinal studies are recommended in order to demonstrate the role of ED and SRA on development, maintenance and treatment of BAs and IBs among individuals with SUDs.

Emotion Regulation Difficulties Are Not Always Associated With Negative Outcomes on Women: The Buffer Effect of HRV

The Heart Rate Variability (HRV) is regularly associated with depression and trait emotion regulation. However, the interaction between HRV and emotional disturbances is still debated. Only a few studies indicate that HRV moderates the effect of personality traits involved in psychopathological disorders. Since the regulation of emotions is a transdiagnostic factor for most psychological disorders, this study aimed to explore whether HRV moderates the relationship between trait emotion dysregulation and depressive symptoms. We collected data from 148 participants via online questionnaires and HRV measurements at rest. Results show for the 114 female remaining in the study that whereas high emotion regulation difficulties led to higher depressive symptoms severity when resting HRV is low, depressive symptoms remain stable in the same condition but when resting HRV is high. Overall, high resting HRV appears to dampen the consequences of trait emotion regulation difficulties. Further studies are needed to confirm this result, but this suggests that usual response tendencies could be overcome by deactivating or inhibitory processes such as those implied in cognitive flexibility reflected through HRV, according to the neurovisceral integration model.

Direct and indirect associations between perception of childhood trauma and suicidal ideation through emotion dysregulation in males who use heroin

Emotion dysregulation is considered as one of the factors related to suicide in individuals with childhood trauma (CT). However, no research has been performed on the role of emotion dysregulation in the relationship between perception of CT and suicidal ideation in individuals who use heroin. This study aimed to evaluate direct and indirect relationships between perception of CT and suicidal ideation through emotion regulation difficulties (ERD) and cognitive emotion regulation strategies (CERSs) in males with a DSM diagnosis of heroin dependence. In a cross-sectional design, 310 males with a DSM diagnosis of heroin dependence completed the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Difficulties in Emotion Regulation Scale (DERS), the Cognitive Emotion Regulation Questionnaire-Short version (CERQ-Short), the Obsessive-Compulsive Drug Use Scale-Form Heroin (OCDUS-Form Heroin), and the Depression Anxiety Stress Scales (DASS). The results revealed that perception of CT had no direct relation to suicidal ideation. Perception of CT was indirectly associated with suicidal ideation through some ERD dimensions [e.g., non-acceptance of emotional responses (Non-acceptance), limited access to emotion regulation strategies (Strategies), lack of emotional awareness (Awareness)] and the CERS of positive reappraisal. The findings suggest that high suicidal ideation may stem from a perception of CT and subsequently emotion dysregulation in individuals who use heroin. Also, the findings of this research may have implications for the prevention and treatment of suicidal ideation in individuals using heroin with a perception of CT. The results of the present study require further examination through longitudinal studies.

Inattention in misophonia: Difficulties achieving and maintaining alertness

Introduction: Misophonia is marked by abnormal negative reactions to specific and idiosyncratic sounds. Despite unclear etiology and diagnostic conceptualization, neuropsychology may be able to help characterize the syndrome. In the current study, we administered the Attention Network Test (ANT) under symptom provocation conditions, as well as secondary measures of concept formation, perseveration, processing speed, and frustration tolerance. We assessed treatment seeking individuals with misophonia and non-clinical controls. We hypothesized higher alerting, orienting, and conflict effects on the ANT suggesting overall poorer performance for the misophonia group.Methods: The sample consisted of symptomatic individuals recruited from a randomized treatment trial prior to the mandatory waitlist (n = 11) and age, gender matched controls (n = 11). Symptomatic individuals were screened with the Misophonia Questionnaire, as well as a number of additional self-report and diagnostic measures.Results: Robust Bayesian estimation in multi-level models suggested worse alerting attention for symptomatic individuals, β_Median = 2.766, β_SD = 1.253, 95% CI [0.322, 5.2876], Bayes factor = 31.41. There were no effects respective to block (i.e., blocks before versus during and after symptom provocation) or interaction effects. There were also no effects particular to executive functioning measures but some evidence this domain should be further explored (e.g., ANT conflict effects, perseveration, and serial math accuracy).Conclusions: We propose that symptom provocation alone does not explain the observed group difference in alerting attention, which could reflect a long-standing neuropsychological weakness. Future studies should attempt to characterize misophonia with more comprehensive neuropsychological batteries and larger samples.

Effects of childhood emotional maltreatment on depressive symptoms through emotion dysregulation in treatment-seeking patients with heroin-dependence

BACKGROUND

Although individuals who experience childhood emotional maltreatment (CEM) are more likely to use maladaptive emotion regulation strategies, resulting in vulnerability to depression, no research has examined whether emotion dysregulation may explain the association between CEM and current depressive symptoms in a clinical sample of heroin-dependent individuals.

OBJECTIVES

The current study aimed to assess the direct effect of CEM on current depressive symptoms and its indirect effect via emotion dysregulation in a treatment-seeking sample of males with heroin dependence. In a cross-sectional design, participants (N = 350) completed the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Difficulties in Emotion Regulation Scale (DERS), the Obsessive-Compulsive Drug Use Scale (OCDUS), and the Beck Depression Inventory-II (BDI-II).

RESULTS

Emotional abuse and neglect severity had significant direct effects on current depressive symptoms and significant indirect effects through emotion dysregulation after controlling for clinical factors related to heroin use.

LIMITATIONS

Study limitations include the cross-sectional design and use of self-report scales.

CONCLUSIONS

Findings suggest emotion dysregulation may increase depressive symptoms in heroin users who experienced CEM. Training in emotion regulation strategies may decrease depressive symptoms in heroin-dependent individuals with CEM. Additional research with a longitudinal design to confirm these results is warranted.

Relationships Among Dispositional Mindfulness, Distress Tolerance, and Women's Dating Violence Perpetration: A Path Analysis

Scant research examined mechanisms underlying the relationship between dispositional mindfulness and dating violence (DV) perpetration. Using a cross-sectional design with 203 college women, we examined whether distress tolerance mediated the relationship between dispositional mindfulness and DV perpetration (i.e., psychological aggression and physical assault). Path analyses results revealed indirect effects of mindfulness facets nonjudging of inner experiences and nonreactivity to inner experiences on both psychological aggression and physical assault through distress tolerance. Mindfulness facets observing, describing, and acting with awareness were not linked to DV perpetration through distress tolerance. Results suggest that women who allow internal experiences to come and go without assigning criticism or avoidance are better able to tolerate transient distress and less likely to abuse a dating partner. Future research may examine distress tolerance and dispositional mindfulness facets as potential intervention targets for women who abuse dating partners.

The role of emotion dysregulation in the relation of childhood trauma to heroin craving in individuals with heroin dependence

OBJECTIVES

Difficulties in emotion regulation (DER) may be important in heroin craving in individuals with heroin dependence who have experienced childhood trauma (CT). However, no research has been performed on DER in the context of heroin dependence. The aim of this study was to evaluate direct and indirect relations of CT to the subscales of heroin craving (i.e., heroin thoughts and interference, intention to use heroin and control of its consumption, and resistance to thoughts and decisions to use heroin) via DER dimensions in individuals with a DSM diagnosis of heroin dependence.

METHODS

In a cross-sectional design, 330 males with heroin dependence completed the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Difficulties in Emotion Regulation Scale (DERS), the Obsessive-Compulsive Drug Use Scale-Form Heroin (OCDUS-Form Heroin), and the Depression Anxiety Stress Scales (DASS).

RESULTS

The results revealed that CT had no direct relations to the subscales of heroin craving, but it indirectly was related to all three subscales of heroin craving via one of the DER dimensions named limited access to emotion regulation strategies (Strategies) after adjusting for demographic and clinical factors.

CONCLUSIONS

The findings suggest that Strategies may be related to heroin craving in individuals with heroin dependence who have CT. This proposes that treatment and prevention attempts focused on training the use of effective emotion regulation strategies may be useful to reduce heroin craving in individuals with heroin dependence who have experienced a history of CT.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Addressing Psychometric Limitations of the Attentional Control Scale via Bifactor Modeling and Item Modification

The purpose of this three-part study was to identify and correct psychometric limitations of the Attentional Control Scale (ACS; Derryberry & Reed, 2002) via bifactor modeling and item modification. In Study 1 (N = 956), results from exploratory factor analyses (EFAs) and confirmatory factor analyses (CFAs) suggested that the multidimensionality of the ACS might be a function of a method effect (i.e., reverse coding). In Study 2 (N = 478), reverse-coded items were recoded in a straightforward manner and submitted to EFA. Results supported retention of 15 items and 2 factors. In Study 3 (N = 410), CFA was used to test the model identified in Study 2 and compare it to competing models (i.e., 1-factor, bifactor). The bifactor model exhibited the best fit to the data. However, results from bifactor analysis suggested that the structure of the ACS is more consistent with a unidimensional rather than multidimensional model. Additionally, the second domain-specific factor appears to be redundant with the general factor and both domain-specific factors are poorly defined and might be of little practical value. Taken together, results caution the use of the ACS subscales independent of the total score. Moreover, they support coding ACS items in a straightforward manner.

Reduction of Distress Intolerance With Salutotherapeutic Interventions: Results From a Randomized Controlled Clinical Trial

Background

Distress tolerance is the ability to pursue one’s goals in the presence of (chronic) stressors, hardship, adversities and negative internal states, and psychological distress. By contrast, distress intolerance is a transdiagnostic indicator of mental illness and a mediator in coping with problems in life, work demands, or stress in general. There is a lack of data regarding intervention strategies. The objective of the present study is to test the differential effects of two treatment approaches: “regeneration fostering” versus “resistance training.”

Methods

Inpatients of a psychosomatic hospital were randomly allocated to either a resistance training group therapy (n = 65)—that is, active coping with demands and endurance—or a regeneration fostering group therapy (n = 62)—that is, recovery, mindful indulgence, and creative activities. They were compared with a group of patients who received treatment as usual (n = 43), without special treatments for distress intolerance, and the outcome was measured with the “Distress Intolerance Scale.” One-way and repeated measure analyses of variance and paired t tests were used for the analysis.

Results

The “regeneration” group showed a significant improvement in distress intolerance, whereas there was no significant change for the treatment-as-usual group and in the “resistance” group. Post hoc tests were conducted with paired sample t tests for pre–post comparisons for each group. No differences were found for the treatment-as-usual group (mean difference: 0.03, SD (mean difference): 0.89; t(42) = 0.266, p = 0.792, d = 0.04) and for the resistance group (mean difference:−0.07, SD (mean difference): 0.73; t(63) = −0.736, p = 0.464, d = 0.08). The regeneration group showed a significant decline in distress intolerance (mean difference: 0.29, SD (mean difference): 0.72; t(61) = 3.156, p = 0.002, d = 0.38).

Conclusions

In the treatment of distress intolerance, it seems promising to focus on positive psychology interventions and resources. Limitations of the study are that it was conducted with psychosomatic inpatients only and that no follow-up data are available.

Moderator Role of Looming Cognitive Style (LCS) in the Relationship Between Attentional Control and Anxiety: Difference Between Shifting and Focusing Dimensions

Attentional control (AC) that is composed of shifting and focusing dimensions had been suggested as a transdiagnostic risk factor, associated with development and maintenance of various psychological disorders. In comparison, Looming Cognitive Style (LCS) had been documented as a trait-based, disorders-specific characteristic that is linked to high levels of subjectively felt anxiety. The present study investigated whether individual differences in LCS moderated the association of shifting and focusing with anxiety. Participants were 402 individuals between ages 18 and 68 recruited through advertisements posted on various forums, e-mail groups, and social media websites. They filled out questionnaires assessing AC, LCS, anxiety, and depression online. Results of the moderation analyses indicated that at high levels of LCS, low attentional shifting ability was associated with more intense anxiety. A similar relationship with LCS was not observed for focusing. In conclusion, for individuals who have high LCS and low shifting ability, content of and distress coming from looming images is experienced in a more intense manner due to difficulty in shifting to another (perhaps less anxiety provoking) content more flexibly. The findings are providing support for the interactive-synergistic perspective, indicating that deficits in shifting capacity may potentiate negative impact of looming cognitions.

Disruptive Mood Dysregulation Disorder (DMDD): An RDoC perspective

In recent years, there has been much debate regarding the most appropriate diagnostic classification of children exhibiting emotion dysregulation in the form of irritability and severe temper outbursts. Most recently, this has resulted in the addition of a new diagnosis, Disruptive Mood Dysregulation Disorder (DMDD) in the DSM 5. The impetus for including this new disorder was to reduce the number of diagnoses that these children would typically receive; however, there is concern that it has only complicated matters rather than simplifying them. For example, a recent epidemiologic study shows that DMDD cannot be differentiated from oppositional defiant disorder (ODD) based on symptoms alone. Thus, these children are an ideal population in which to apply RDoC constructs in order to obtain greater clarity in terms of underlying processes and ultimately, inform nosology and appropriate interventions. The aim of this article is to provide a foundation for future research by examining extant theoretical and empirical evidence for the role of four key RDoC constructs in DMDD.

The Interactive Effect of Attention to Emotions and Emotional Distress Intolerance on Anxiety and Depression

Emotional distress intolerance (EDI) has been identified as a risk factor for mood and anxiety disorders. One factor that may influence the association between EDI and psychopathology is attention to emotions (AE). Recent evidence suggests that AE may encompass two dissociable components: voluntary and involuntary AE. This study aimed to examine the moderating role of both voluntary and involuntary AE in the association between EDI and psychological symptoms (i.e., anxiety, depression) in a sample of 955 community adults. We hypothesized that voluntary AE would buffer, and involuntary AE would enhance, the association between EDI and psychological symptoms. In partial support of our hypotheses, involuntary, but not voluntary, AE moderated the relationship between EDI and both symptom outcomes such that the positive associations between EDI and psychological symptoms were significantly stronger at higher, versus lower, levels of involuntary AE. Thus, individuals with relatively higher EDI and involuntary AE may be at particularly high risk for experiencing anxiety and depression. Clinical implications are discussed.