Emotional Processing in Individuals with Substance Use Disorder and Posttraumatic Stress Disorder

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

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

Psychometric properties of the emotional processing scale in individuals with psychiatric symptoms and the development of a brief 15-item version

The 25-item Emotional Processing Scale (EPS) can be used with clinical populations, but there is little research on its psychometric properties (factor structure, test-retest reliability, and validity) in individuals with psychiatric symptoms. We administered the EPS-25 to a large sample of people (N = 512) with elevated psychiatric symptoms. We used confirmatory factor analysis to evaluate three a priori models from previous research and then evaluated discriminant and convergent validity against measures of alexithymia (Toronto Alexithymia Scale-20), depressive symptoms (Patient Health Questionaire-9), and anxiety symptoms (Generalized Anxiety Disorder-7). None of the a priori models achieved acceptable fit, and subsequent exploratory factor analysis did not yield a clear factor solution for the 25 items. A 5-factor model did, however, achieve acceptable fit when we retained only 15 items, and this solution was replicated in a validation sample. Convergent and discriminant validity for this revised version, the EPS-15, was r = - 0.19 to 0.46 vs. TAS-20, r = 0.07- 0.25 vs. PHQ-9, and r = 0.29- 0.57 vs. GAD-7. Test-retest reliability was acceptable (ICC = 0.73). This study strengthens the case for the reliability and validity of the 5-factor structure of the EPS but suggest that only 15 items should be retained. Future studies should further examine the reliability and validity of the EPS-15.

The Structure of the Emotional Processing Scale (EPS-25)

Abstract. The Emotional Processing Scale (EPS) assesses emotional processing in terms of suppression, signs of unprocessed emotion, controllability of emotions, avoidance of emotional triggers, and impoverished emotional experience. Previous confirmatory factor analyses (CFA) yielded insufficient fit and questioned the EPS factors’ discriminant validity. The present study aimed to test unidimensional, five-factor, and bifactor models using exploratory structural equation modeling (ESEM) and CFA. We administered the scale to 350 Italian participants in good health and 346 gastrointestinal patients referred for endoscopy because of mild-to-severe gastrointestinal symptoms. ESEM models outperformed corresponding CFA models. The bifactor ESEM model was a good fit in single group analyses and achieved metric and scalar invariance in multigroup analyses. The inspection of latent mean differences revealed a consistent trend for patients to avoid emotional triggers and have less general emotional processing difficulties. The study clarified the EPS factor structure and supported its use to assess the emotional processing of medical patients and community participants.

Repeated transcranial direct current stimulation of dorsolateral-prefrontal cortex improves executive functions, cognitive reappraisal emotion regulation, and control over emotional processing in borderline personality disorder: A randomized, sham-controlled, parallel-group study

BACKGROUND

Borderline personality disorder (BPD) is primarily characterized by deficient emotion regulation. Impaired cognitive control over negative emotions is central to emotion dysregulation in BPD. Respective executive dysfunctions are associated with hypoactivation of prefrontal regions, and consecutive alterations of fronto-limbic network functionality. Here, we investigated the effect of increasing activity of the dorsolateral prefrontal cortex (DLPFC) with repeated transcranial direct current stimulation (tDCS) on (1) executive dysfunctions and (2) whether improving cognitive control affects emotion dysregulation and emotional processing in BPD.

METHODS

Thirty-two patients diagnosed with BPD were randomly assigned to active stimulation (N = 16) or sham stimulation (N = 16) group in a randomized, sham-controlled, parallel-group design. They received 10 sessions of active (2 mA, 20 min, anodal left- cathodal right DLPFC) or sham tDCS over 10 days. Major executive functions, emotion regulation strategies, and emotional processing of the patients were assessed before and immediately after the intervention.

RESULTS

The active stimulation group showed a significant improvement in major executive function domains. Importantly, cognitive reappraisal strategy of emotion regulation and several factors of emotional processing involved in the control of emotion significantly improved in the active stimulation group after the intervention. Factors related to emotional expression were, however, not affected.

LIMITATIONS

The single-blind design, absence of follow-up measures, and the intrinsically limited focality of tDCS are limitations of this study.

CONCLUSIONS

Increasing activity of the DLPFC improves executive functioning in BPD and improves ´cognitive control over negative emotions. Cognitive control interventions could be a potential, symptom-driven therapeutic approach in BPD.

Viewing an alpine environment positively affects emotional analytics in patients with somatoform, depressive and anxiety disorders as well as in healthy controls

BACKGROUND

Patients with somatoform, depressive or anxiety disorders often don't respond well to medical treatment and experience many side effects. It is thus of clinical relevance to identify alternative, scientifically based, treatments. Our approach is based on the recent evidence that urbanicity has been shown to be associated with an increased risk for mental disorders. Conversely, green and blue environments show a dose-dependent beneficial impact on mental health.

METHODS

Here we evaluate the effect of viewing stimuli of individuals in an alpine environment on emotional analytics in 183 patients with psychiatric disorders (mostly somatoform, depressive and anxiety disorders) and 315 healthy controls (HC). Emotional analytics (valence: unhappy vs happy, arousal: calm vs excited, dominance: controlled vs in control) were assessed using the Self-Assessment Manikin. Further parameters related to mental health and physical activity were recorded.

RESULTS

Emotional analytics of patients indicated that they felt less happy, less in control and had higher levels of arousal than HC when viewing neutral stimuli. The comparison alpine>neutral stimuli showed a significant positive effect of alpine stimuli on emotional analytics in both groups. Patients and HC both felt attracted to the scenes displayed in the alpine stimuli. Emotional analytics correlated positively with resilience and inversely with perceived stress.

CONCLUSIONS

Preventive and therapeutic programs for patients with somatoform, depressive and anxiety disorders should consider taking the benefits of natural outdoor environments, such as alpine environments, into account. Organizational barriers which are preventing the implementation of such programs in clinical practice need to be identified and addressed.