A Mindfulness-Based Group Intervention for Enhancing Self-Regulation of Emotion in Late Childhood and Adolescence: A Pilot Study

Mindfulness-based group intervention for adolescents with type 1 diabetes: initial findings from a pilot and feasibility randomized controlled trial

OBJECTIVE

To evaluate feasibility/acceptability of a virtual, group mindfulness-based intervention (MBI) adapted for pediatric type 1 diabetes (T1D).

METHODS

This two-way controlled trial randomized adolescents 1:1 to MBI (n = 20) or health education (HE; n = 22) groups lasting 6-7 weeks. Eligibility included 12-17 years, T1D ≥ 1 year, and elevated scores on PROMIS depression or anxiety measures. Recruitment, retention, and session attendance were tracked to measure feasibility. Acceptability was measured via youth-reported post-session surveys. Adolescents completed depression, anxiety, and diabetes-specific surveys at baseline, immediately post-program, and 3 months post-program completion. HbA1c values approximating these timeframes were obtained from chart review.

RESULTS

55% of screened participants were eligible to participate, and 100% of eligible youth enrolled. There was 93% study retention and 96% session attendance rates. Survey data were 100% complete at baseline, and 93% complete at post-program and 3-month follow-ups; 83% and 78% of MBI participants rated sessions as at least somewhat enjoyable and helpful, respectively, and 91% and 82% of HE participants rated sessions as at least somewhat enjoyable and helpful, respectively. Mean scores showed declines in depression, anxiety, disordered eating, diabetes distress, and HbA1c in both groups across time, with trends toward potential greater reductions in depression and HbA1c in MBI.

CONCLUSIONS

This pilot provides preliminary evidence that virtual MBI and HE groups adapted for adolescents with T1D are feasible to deliver and acceptable, with potential improvement in psychosocial, behavioral, and diabetes-specific outcomes. Whether MBI is more effective for targeting negative affect and glycemic control in the context of adolescent T1D requires testing in a full-scale efficacy trial.

Improving Self-Regulation: Resiliency Skills in the Classroom

PURPOSE

The impact of daily living often results in unimaginable stress for children, which can be exhibited as lack of self-control. Children with decreased self-regulation are often not successful in school. Many schools do not have the resources needed to employ professionals who could provide programs to improve self-regulation. Creative programs that can be implemented into the classroom without disrupting the school day are needed. The current article describes a resiliency program that was implemented in a school setting to increase self-regulation.

METHOD

This pilot project used descriptive statistics to analyze the feasibility of incorporating resiliency skills into an elementary school curriculum and the resulting impact on self-regulation among school-aged children.

RESULTS

Improvements were identified in self-esteem, compassion, and classroom behavior.

CONCLUSION

Implementing resiliency skills into the curriculum can result in positive outcomes by improving self-regulation in school-aged children. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Clinical Characteristics of Youth with Trichotillomania (Hair-Pulling Disorder) and Excoriation (Skin-Picking) Disorder

Body-focused repetitive disorders (BFRBDs) are understudied in youth and understanding of their underlying mechanisms is limited. This study evaluated BFRBD clinical characteristics, and two factors commonly implicated in their maintenance - emotion regulation and impulsivity - in 53 youth aged 11 to 17 years: 33 with BFRBDs and 20 controls. Evaluators administered psychiatric diagnostic interviews. Participants rated BFRBD severity, negative affect, quality of life, family functioning, emotion regulation, distress tolerance, and impulsivity. Youth with BFRBDs showed poorer distress tolerance and quality of life, and higher impulsivity and negative affect than controls, with no differences in family impairment. BFRBD distress/impairment, but not BFRBD severity, correlated with anxiety and depression, and poorer distress tolerance. Findings suggest youth with BFRBDs show clinical patterns aligning with prior research; highlight the role of distress tolerance in child BFRBDs; and suggest the utility of acceptance and mindfulness-based therapies for unpleasant emotions in BFRBDs. Continued research should evaluate factors underlying BFRBDs in youth.

Cool and hot executive function problems in young children: linking self-regulation processes to emerging clinical symptoms

Self-regulation (SR) difficulties are implicated in a wide range of disorders which develop in childhood, including attention deficit hyperactivity disorder (ADHD), oppositional defiance disorder (ODD), anxiety and depression. However, the integration of the existing research evidence is challenging because of varying terminology and the wide range of tasks used, as well as the heterogeneity and comorbidity within and across diagnostic categories. The current study used the Research Domain Criteria (RDoC) framework to guide the examination of different SR processes in young children showing a wide range of symptomatology. Children (aged 4-8) referred by teachers for moderate-to-high conduct, hyperactivity and/or emotional problems at school (assessed using the Strengths and Difficulties Questionnaire (SDQ) subscales; n = 212), and children in SDQ typical ranges (n = 30) completed computerised cognitive control and decision-making tasks. Parents completed questionnaires to assess ADHD, ODD, anxiety and depression symptoms (n = 191). Compared to children with no teacher-reported difficulties, those with moderate-to-high problems showed poorer visuomotor control and decision-making. A factor analysis revealed that task variables adhered to RDoC dimensions and predicted variance in specific disorders: difficulties in cognitive control predicted ADHD symptoms, low reward-seeking was associated with depression and high reward-seeking was associated with ODD. This study highlights how the assessment of cognitive processes positioned within the RDoC framework can inform our understanding of disorder-specific and transdiagnostic difficulties in SR which are associated with diverse clinical symptoms in children.

Brain changes following mindfulness: Reduced caudate volume is associated with decreased positive urgency

Mindfulness training has been shown to improve psychological health and general well-being. However, it is unclear which brain and personality systems may be affected by this practice for improving adaptive behavior and quality of life. The present study explores the effects of a 5-week mindfulness-based intervention (MBI) at the neuroanatomical level and its relationship with dispositional mindfulness and impulsivity. Sixty-six risky drivers were quasi-randomly assigned to a mindfulness training group (MT) or a control group (N). Participants underwent magnetic resonance imaging and completed the Five Facet Mindfulness Questionnaire (FFMQ) and the UPPS-P impulsivity scale twice, at baseline and after receiving the MBI. We observed that MBI changes dispositional mindfulness in the non-reactivity and observing facets. Further, we observed that the magnitude of change in impulsivity was associated with the change in dispositional mindfulness. Whole-brain voxel-wise analysis revealed that the volume of the right caudate nucleus of the MT group (n = 27) showed a reduction compared to that of the control group (n = 33), which increased in terms of the pre-post measurement (MT=-1.76 mm3; N = 6.31 mm3). We also observed that reduced caudate nucleus volume correlated with decreased positive urgency in the MT group. Taken together, our results show that MBI improves the skills of observing and non-reactivity to inner experience, while producing changes in the structure of the caudate nucleus. These structural changes are associated with a reduction in impulsivity levels, decreasing the tendency to act rashly in situations that generate positive emotions and thus facilitating more adaptive behavior.

Emotion-related impulsivity is related to orbitofrontal cortical sulcation

Background

Emotion-related impulsivity (ERI) describes the trait-like tendency toward poor self-control when experiencing strong emotions. ERI has been shown to be elevated across psychiatric disorders and predictive of the onset and worsening of psychiatric syndromes. Recent work has correlated ERI scores with the neuroanatomy of the orbitofrontal cortex (OFC). Informed by a growing body of research indicating that the morphology of cortical folds (sulci) can produce insights into behavioral outcomes, the present study modeled the association between ERI and the sulcal morphology of OFC at a finer scale than previously conducted.

Methods

Analyses were conducted in a transdiagnostic sample of 118 individuals with a broad range of psychiatric syndromes. We first manually defined over 2000 sulci across the 118 participants. We then implemented a model-based LASSO regression to relate OFC sulcal morphology to ERI and test whether effects were specific to ERI as compared to non-emotion-related impulsivity.

Results

The LASSO regression revealed bilateral associations of ERI with the depth of eight OFC sulci. These effects were specific to ERI and were not observed in non-emotion-related impulsivity. In addition, we identified a new transverse component of the olfactory sulcus in every hemisphere that is dissociable from the longitudinal component based on anatomical features and correlation with behavior, which could serve as a new transdiagnostic biomarker.

Conclusions

The results of this data-driven investigation provide greater neuroanatomical and neurodevelopmental specificity on how OFC is related to ERI. As such, findings link neuroanatomical characteristics to a trait that is highly predictive of psychopathology.

An intervention to promote concrete thinking style in young adults: Effects on depressive symptoms and its protective factors

BACKGROUND AND OBJECTIVES

Individuals with low concreteness-experiential thought (CET) tend to have exacerbated depressive symptoms. Interventions aimed at increasing CET have been shown to influence depressive symptoms. The present study examined the effects of increasing CET on depressive symptoms and its protective factors.

METHODS

A two-armed experimental intervention was conducted with 86 healthy university students in Japan. They were randomly allocated to the intervention and waitlist groups. Participants in the intervention group engaged in an unguided and web-based (UW) intervention to increase CET (UW-CET). This intervention included a one-off session, to explain the rationale behind increasing CET via a psychoeducation video, and a five-session training on CET over a week. We assessed depressive symptoms, thought styles, and protective factors, such as mindfulness and goal striving, both pre- and-post-assessment and at the one-month follow-up.

RESULTS

Participants in the intervention group had marginally increased CET in the follow-up assessments; however, participants in the waitlist group did not. Furthermore, participants in the intervention showed marginally increased mindfulness tendencies and strivings toward their personal goals, but their depressive symptoms were not affected.

LIMITATIONS

The present study did not include any active control conditions. Additionally, the sample consisted of only healthy university students.

CONCLUSIONS

The findings suggest that the UW-CET can marginally increase adaptive thinking, such as CET, and promote positive psychological aspects in healthy young adults; however, the effect is small. The findings may also help expand clinical implementations to prevent depression in young adults.

Neuroanatomical Correlates of Emotion-Related Impulsivity

BACKGROUND

Emotion-related impulsivity (ERI) refers to chronically poor self-control during periods of strong emotion. ERI robustly predicts psychiatric disorders and related problems, yet its neuroanatomical correlates are largely unknown. We tested whether local brain morphometry in targeted brain regions that integrate emotion and control could explain ERI severity.

METHODS

One hundred twenty-two adults (ages 18-55 years) with internalizing or externalizing psychopathology completed a structural magnetic resonance imaging (MRI) scan, the Three-Factor Impulsivity Index, and the Structured Clinical Interview for DSM-5. The Three-Factor Impulsivity Index measures two types of ERI and a third type of impulsivity not linked to emotion. Cortical reconstruction yielded cortical thickness and local gyrification measurements. We evaluated whether morphometry in the orbitofrontal cortex (OFC), insula, amygdala, and nucleus accumbens was associated with ERI severity. Hypotheses and analyses were preregistered.

RESULTS

Lower cortical gyrification in the right lateral OFC was associated with high ERI severity in a full, preregistered model. Separate examinations of local gyrification and cortical thickness also showed a positive association between gyrification in the left lateral OFC and ERI. An integrated measure of hemispheric imbalance in lateral OFC gyrification (right < left) correlated with ERI severity. These findings were specific to ERI and did not appear with non-emotion-related impulsivity.

CONCLUSIONS

Local gyrification in the lateral OFC is associated with ERI severity. The current findings fit with existing theories of OFC function, strengthen the connections between the transdiagnostic literature in psychiatry and neuroscience, and may guide future treatment development.

Examining an individualized, group-based social skills training using a mixed-methods design: A feasibility study

Tailoring treatments to individual needs may be beneficial for treatment adherence and treatment effects. However, individualizing a group-based Social Skills Training (SST) may be complicated. Therefore, in this feasibility study, we examined outcomes after engagement in an individualized SST provided to 33 children aged 7-11 years (M = 9.39, SD = 1.09; 13 girls), who were referred to a mental health care center for various psychosocial problems. To analyze outcomes, we combined a top-down (including researcher-chosen measures: Questionnaires on pro-social, socially inadequate, and problem behavior) and a bottom-up (including participant-driven measures: Ratings of personal goals and evaluation reports) approach and used a mixed-methods design. After the SST, personal goals and pro-social behavior increased (large and small effects respectively). Also, socially inadequate behavior and problem behavior decreased (both small effects). Evaluation reports mainly showed improvements in social responsiveness, emotion regulation, and internalizing problems. At the same time, however, most parents also reported limitations (e.g., a lack of generalization). Altogether, we can conclude that (1) tailoring a group-based SST to the individual needs of children, as well as measuring progress on personal goals, is feasible and (2) mixed-method designs to study intervention effectiveness should be encouraged.

Outcomes From an Online Pilot Mindfulness Based Intervention with Adolescents: A Comparison by Categories of Risk

Comorbid psychiatric presentations, defined as those who present with more than one mental and/or behavioral health diagnosis at the same time, during adolescence are on the rise. Mindfulness-based interventions can alleviate psychological symptoms and improve emotion regulation in youth. Mindfulness is a multifaceted phenomenon, with five underlying facets (Observing, Describing, Acting with Awareness, Non-Judgment and Non-Reactivity of Inner Experience). Little evidence has documented which facets produce pronounced psychiatric symptom reduction for adolescents. This pilot study examined the efficacy of an online mindfulness-based intervention delivered to adolescents undergoing mental health treatment during COVID-19 to reduce psychiatric outcomes. Fifty-six adolescents (m = 14.5 years, 66.1% female) categorized as moderate-risk (treatment histories of outpatient therapy only) or high-risk (treatment histories with intensive service participation) participated in the 8-session mindfulness-based intervention. Significant reductions in psychiatric symptoms and increases in adaptive coping strategies were observed at post-test, particularly for those at moderate-risk. Multivariate stepwise regression found significant associations between mindfulness facet use and anxiety, depression, and somatic symptoms (R ² ranging from 42.5 to 52.8%). Results indicate preliminary efficacy for an online mindfulness-based intervention for adolescents, particularly those at moderate-risk, due to the introduction of new coping skills, given their history of less intense treatment. Further investigation is warranted to understand which mindfulness facet intervention components produce the most prominent outcomes.

Online administration of a pilot mindfulness-based intervention for adolescents: Feasibility, treatment perception and satisfaction

Adolescents may be more vulnerable to COVID-19-related impacts and require long-term mental health care. Services that bolster emotion regulation, such as mindfulness-based interventions (MBIs) promote positive impacts on psychosocial outcomes and have high acceptability. No studies have assessed feasibility, treatment perceptions and satisfaction of online MBIs with adolescents. 56 moderate- and high-risk adolescent (m = 14.5 years, 66.1% female, 26.8% LatinX) participants tested the feasibility, treatment perceptions and satisfaction of an 8-session online MBI focused on observing non-judgmentally, attending to positivity, and self-soothing. The study achieved acceptable feasibility with high attendance (m = 5.75) and retention rates (87.5%). The moderate- vs. high-risk group reported significantly higher ratings of treatment perceptions (t = 2.03, p < .05, d = 0.60). Significant associations were found between increased pre-test depression and anxiety symptomology and reduced intervention utility (rs = -0.34 and -0.32, ps < .05). This study demonstrated feasibility, treatment perceptions and satisfaction of an online MBI for adolescents presenting with two risk levels. Higher-risk adolescents may need a higher-touch intervention than moderate-risk, who may be more likely to find online MBIs acceptable. The impact of adjunctive MBIs for adolescents on treatment attendance and mental health outcomes over longer periods is necessary to understand patterns in effective adolescent treatment options.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-03025-x.

Depression, Rumination, and Impulsive Action: A Latent Variable Approach to Behavioral Impulsivity

Previous research on the relationship between rumination and behavioral impulsivity has been limited because impulsivity was assessed by using individual tasks. This study examined the concurrent associations of a latent variable named impulsive action with rumination and depression to alleviate the task-impurity problem and the low reliability of laboratory tasks assessing impulsivity. This study also examined whether stressors mediated the association between impulsive action and rumination. University students in Japan (N = 176) conducted three laboratory tasks assessing impulsive action: the Go/No-Go Task, the Stop Signal Task, and the Conners Continuous Performance Test 3rd Edition. They also completed self-report measures of rumination, stressors, and depression. Results indicated that the latent variable named impulsive action constructed from the performance in these three tasks was positively associated with rumination. Moreover, stressors mediated this association. Also, impulsive action was positively associated with depression via the increase in stressors and rumination. These findings and those of previous studies examining associations between rumination and self-reported impulsivity suggest that impulsivity might be a determinant of rumination.

Somatic interventions to improve self-regulation in children and adolescents

TOPIC

Children and adolescents who are exposed to stress and trauma often experience, as a result, an inability to regulate their emotions. Self-regulation is necessary to accurately respond to situations and ensure success in the academic setting. Self-regulation skills have been identified as improving resiliency and mitigating the effects of trauma on children and adolescents.

PURPOSE

The purpose of this review of the literature is to synthesize the available research on somatic interventions to improve self-regulation in the child and adolescent population.

SOURCES USED

A scoping review of literature utilizing the Arksey and O'Malley framework was conducted by a university health science librarian from 2006 to 2018 using PubMed, Scopus, CINAHL, ERIC, and Web of Science to identify studies that examined somatic self-regulation skills in children and adolescents. Search terms included were mindfulness, yoga, deep breathing exercises, and self-regulation. The PRISMA methodology was utilized to synthesize the available research on somatic interventions to improve self-regulation in the child and adolescent population.

CONCLUSION

Somatic interventions have been shown to improve self-regulation in the child and adolescent population. Future research is needed to identify dose-specific interventions and opportunities to improve self-regulation for children and adolescents.

Mindfulness and Self-Regulation in a Summer Camp Setting: An EBP Project

BACKGROUND

Guidelines for pediatric mental/behavioral health promotion call for preventative mental health services. Previous studies have found mindfulness an effective approach to addressing self-regulation/behavior concerns. Behavioral and self-regulation concerns had been identified in a summer camp program held in a large urban setting. Camp directors sought methods to address concerns, nurture the whole child and improve the overall program.

PURPOSE

The purposes of this evidence-based practice (EBP) project in a summer day-camp setting were to (1) implement an evidence-based mindfulness program for children and (2) evaluate the impact on child self-regulation skills and behavior.

METHODOLOGY

Two questions consistent with the purpose guided this project: 1) How can a mindfulness program be implemented in a summer camp setting 2) What impact does a mindfulness program have on self-regulation of school age participants in a camp setting? To achieve the purpose of this EBP project, an eight-week program guided by the Mindful Schools© curricula was implemented in a summer day camp program in a large urban setting. Descriptive statistics and qualitative methods were used for evaluation of the program.

RESULTS

We were able to show a decrease in emotional distress and assess the mindful strategies which most connected with a school age population. In addition, camp counselor responses illuminated the value of dyad instruction approach in which child and counselors engaged in the Mindful Schools© guided program.

CONCLUSIONS

Use of an evidenced-based programs allows for sustainability of programs in community settings outside of schools setting to broaden the reach of mental health promotion in a pediatric population.

Emotional Dysregulation in Children and Adolescents With Psychiatric Disorders. A Narrative Review

Background: Emotional dysregulation (ED) is a transdiagnostic construct defined as the inability to regulate the intensity and quality of emotions (such as, fear, anger, sadness), in order to generate an appropriate emotional response, to handle excitability, mood instability, and emotional overreactivity, and to come down to an emotional baseline. Because ED has not been defined as a clinical entity, and because ED plays a major role in child and adolescent psychopathology, we decided to summarize current knowledge on this topic based on a narrative review of the current literature. Methods: This narrative review is based on a literature search of peer-reviewed journals. We searched the databases ERIC, PsycARTICLES, PsycINFO and PSYNDEX on June 2, 2020 for peer reviewed articles published between 2000 and 2020 in English language for the preschool, school, and adolescent age (2-17 years) using the following search terms: "emotional dysregulation" OR "affect dysregulation," retrieving 943 articles. Results: The results of the literature search are presented in the following sections: the relationship between ED and psychiatric disorders (ADHD, Mood Disorders, Psychological Trauma, Posttraumatic Stress Disorder, Non-suicidal Self-Injury, Eating Disorders, Oppositional Defiant Disorder, Conduct Disorder, Disruptive Disruptive Mood Dysregulation Disorder, Personality Disorders, Substance Use Disorder, Developmental Disorders, Autism Spectrum Disorder, Psychosis and Schizophrenia, and Gaming Disorder), prevention, and treatment of ED. Conclusion: Basic conditions of ED are genetic disposition, the experience of trauma, especially sexual or physical abuse, emotional neglect in childhood or adolescence, and personal stress. ED is a complex construct and a comprehensive concept, aggravating a number of various mental disorders. Differential treatment is mandatory for individual and social functioning.

Effects of mindfulness interventions on depressive symptoms in adolescents: A meta-analysis

BACKGROUND

Depression among adolescents is rising globally and is the leading cause of illness and disability among adolescents. While antidepressants and psychotherapy are effective, only about 40% of depressed adolescents receive treatments due to lack of professionals and barriers such as cost and personal obstacles including stigma, lack of motivation, and negative perceptions of treatment. Use of alternative and complementary treatments for depression is growing. One such treatment is mindfulness meditation.

OBJECTIVE

We examined the effects of mindfulness interventions on depression among adolescents and explored the moderator effects of participants, methods, and intervention characteristics.

METHODS

We searched 17 databases from their inception to April 2019 to identify studies written in English. Search terms included depress* AND mindful* OR meditat* AND adolescen* OR student*; 29 studies met inclusion criteria. Two researchers independently coded data from all primary studies. Discrepancies were discussed with a third researcher to reach consensus. Using the random effects model, we computed the effect sizes (ESs) of mindfulness interventions on depression using standardized mean differences (Hedge's g) with 95% confidence intervals (CI). Funnel plot, Q statistics, and I² were used to test the heterogeneity across studies. We examined moderators to explore sources of heterogeneity.

RESULTS

Across 29 studies (N=3688), 1839 adolescents participated in mindfulness interventions; 1849 served as controls. Mean ages ranged from 10.2 to 19.5 years. Mindfulness groups showed reduced depression compared to control groups (g=.14, 95%CI[.01-.28], p<.042). Funded studies showed greater improvement in depression (g=.34, 95%CI[.09-.58], p<.008) compared to unfunded (g=.05, 95%CI[-.12-.22], p<.554). Interestingly, while only two research teams studied mindfulness-based cognitive therapy, they showed trends toward improvement (p=0.09) in depression (g=.76, 95%CI[.18-1.34], p<.010, s=2) compared to adapted mindfulness interventions (g=.13, 95%CI[-.04-.30], p<.140, s=16) or mindfulness-based stress reduction (g=.07, 95%CI[-.16-.29], p<.559, s=11). Mindfulness interventions with individual counseling tended (p=0.09) to improve depression (g=.46, 95%CI[.07-.85], p<.021, s=3) more than without (g=.10, 95%CI[-.04-.24], p<.168, s=26). Depression improved more when follow-up measures occurred further from the intervention (Slope=.002, τ²=.74, Q_between=4.10, p=.043, s=29). No quality indicators moderated the ES of mindfulness interventions on depression.

CONCLUSION

Mindfulness interventions are mildly effective interventions to reduce depressive symptoms among adolescents. Clinicians trained in mindfulness interventions might encourage mindfulness meditation as adjunctive/alternative treatment for adolescents with mild or moderate depressive symptoms as well as for at-risk adolescents to prevent depression. Funding, type of mindfulness interventions, individual counseling, and time to follow up were moderators of the effects of mindfulness interventions on depression in adolescents.

Pathways to Recovery among Homeless People with Mental Illness: Is Impulsiveness Getting in the Way?

OBJECTIVE

This study investigates the association between impulsiveness and six dimensions of recovery among homeless people with mental illness.

METHOD

The sample was composed of 418 participants of a randomized controlled trial of Housing First, a recovery-oriented program that provides immediate access to permanent housing. The reliable change index method was used to provide an estimate of the statistical and clinical significance of the change from baseline to 24 months (i.e., clinically meaningful improvement), on outcomes that pertain to recovery dimensions: psychiatric symptoms (clinical), physical health and substance use problems (physical), residential stability (functional), arrests (criminological), community integration (social), and hope and personal confidence (existential). We tested for the effect of impulsiveness, assessed with the Barratt Impulsiveness Scale-11, on clinically meaningful improvement on each specific outcome, adjusting for age, gender and intervention assignment, as both intervention arms were included in the analysis.

RESULTS

For every increase in total impulsiveness score by one standard deviation, the odds of experiencing clinically meaningful improvement decreased by 29% (OR = 0.71, 95% CI, 0.55 to 0.91) on the clinical dimension and by 53% (OR = 0.47, 95% CI, 0.32 to 0.68) on the existential dimension. However, changes in outcomes pertaining to physical, functional, criminological, and social dimensions were not significantly influenced by impulsiveness.

CONCLUSIONS

Findings highlight the importance of addressing impulsiveness in the context of recovery-oriented interventions for homeless people with mental illness. Further research may be required to improve interventions that are responsive to unique needs of impulsive individuals to support clinical and existential recovery.

The joint role of impulsivity and distorted cognitions in recreational and problem gambling: A cluster analytic approach

BACKGROUND AND AIMS

The Pathways Model (Blaszczynski & Nower, 2002) posits that problem gambling is a heterogeneous disorder with distinct subgroups (behaviorally conditioned gamblers, emotionally vulnerable gamblers, and antisocial-impulsivist gamblers). Impulsivity traits and gambling-related cognitions are recognized as two key psychological factors in the onset and maintenance of problem gambling. To date, these constructs have been explored separately, and their joint role in determining problem gambling subtypes has received little attention. The goal of our study was to identify subgroups of gamblers based on impulsivity traits and gambling-related cognitions, and to determine whether this approach is consistent with the Pathways model.

METHODS

Gamblers from the community (N = 709) and treatment-seeking pathological gamblers (N = 122) completed questionnaires measuring gambling habits, disordered gambling symptoms, gambling-related cognitions, and impulsivity traits.

RESULTS

Cluster analyses revealed that three clusters globally aligned with the pathways proposed by Blaszczynski & Nower (2002). Two other clusters emerged: (1) impulsive gamblers without cognitive-related cognitions; and (2) gamblers without impulsivity or gambling-related cognitions. Gamblers with both heightened impulsive traits and gambling-related cognitions had more severe problem gambling symptoms.

CONCLUSION

We successfully identified, based on an a priori theoretical framework, different subtypes of gamblers that varied in terms of problem gambling symptoms and clinical status. The diversity of the cluster profiles supports the development of personalized prevention strategies and psychological interventions.

Case conceptualization from a process-based and modular perspective: Rationale and application to mood and anxiety disorders

This article presents the theoretical, clinical, and practical arguments supporting a process-based transdiagnostic approach to psychotherapy. A working definition of "psychological process" is provided, as well as a tri-dimensional categorization of psychological processes potentially involved in psychopathology. Guidelines are proposed to select psychological interventions based on the active psychopathological processes evidenced in a given case. We also provide a rationale to organize treatment as a set of modules, each addressing a specific psychopathological process. Next, we review the main processes that may be active in mood and anxiety disorders, and that are accessible to clinicians in regular practice. For each process, we propose a validated assessment questionnaire. Finally, we offer a free-access web-based instrument that allows clients to fill in these questionnaires via an internet survey, and that provides therapists with a tool to easily decode and interpret the questionnaire results and to present them to the clients.

Impulsivity influences betting under stress in laboratory gambling

Although recent research suggests that acute stress influences subsequent decision-making under ambiguity, less is known about the role of personality variables in this relationship. This study tested whether impulsivity traits and acute stress differentially influence the way in which a prior feedback is incorporated into further decisions involving ambiguity. Sixty college students (50% male; aged 18-25 years) were randomly assigned to a stress versus a non-stress condition before completing a laboratory gambling task. The results revealed that independently of the stress condition, subjects behaved as if the odds of winning increase after a single loss. Additionally, stress effects varied as a function of impulsivity traits. Individuals who lacked perseverance (i.e., had difficulty focusing on a difficult or boring task) gambled more after experiencing a loss in the stress condition than did those in the control condition. The present study supports that impulsivity traits can explain the differential effect of stress on the relationship between prior feedback and choices made under ambiguity.