The relationship between executive functions and emotion regulation in females attending therapeutic community treatment for substance use disorder

Effectiveness of internet-delivered dialectical behavior therapy skills training on executive functions among college students with borderline personality traits: a non-randomized controlled trial

Given the enormous influence of emotions on cognitive processes, individuals with borderline personality disorder (BPD) suffer from marked deficits in higher-order thinking abilities. Considering the prevalence of BPD among college students, this study aimed to investigate the changes in perceived executive functioning among college students with traits/presence of BPD undergoing internet-delivered dialectical behavior therapy skills training (DBT-ST) that included the mindfulness and emotion regulation modules. An internet-delivered version of DBT-ST was opted for, as technological advancements in the present era promote the use of online platforms for psychotherapy. This non-randomized controlled trial consisted of 36 college students with traits/presence of BPD. The intervention group attended 13 sessions of DBT-ST, and the control group attended 13 sessions of behavioral activation. Perceived executive functioning was assessed using the Behavior Rating Inventory of Executive Functions for Adults. A 2-way repeated measures analysis of variance was used to evaluate the treatment impact on the outcome variable. Results showed that the DBT-ST group had larger improvements in their abilities to initiate, plan, and organize current and future-oriented task demands and to organize their everyday environment, compared to the control group. Both, the DBT-ST group and the control group demonstrated improvements in emotional control, working memory, and their abilities to shift and task monitor. Findings suggest that the internet-delivered version of DBT-ST, consisting of the mindfulness and emotion regulation modules, can foster notable improvements in executive functions among college students with traits/presence of BPD. Improved executive functioning is one of the several multifaceted outcomes of dialectical behavior therapy.

Neurocognition of females with substance use disorder and comorbid personality disorder: Divergence in subjective and objective cognition

At least one in four patients with substance use disorder (SUD) meet criteria for personality disorder and overlapping neurocognitive deficits may reflect shared neurobiological mechanisms. We studied neurocognition in females attending residential SUD treatment by comparing SUD with (n = 20) or without (n = 30) comorbid personality disorder. Neuropsychological testing included working memory, inhibition, shifting, verbal fluency, design fluency, psychomotor speed, immediate and delayed verbal memory, processing speed, premorbid functioning, cognitive screening, and self-reported executive function. As expected, whole-sample deficits included working memory (d = -.91), self-reported executive function (d = -.87), processing speed (d = -.40), delayed verbal memory recall (d = -.39), premorbid functioning (d = -.51), and cognitive screening performance (d = -.61). Importantly, the comorbid personality disorder group showed greater self-reported executive dysfunction (d = -.67) and poorer shifting performance (d = -.65). However, they also evidenced better working memory (d = .84), immediate (d = .95) and delayed (d = .83) verbal memory, premorbid functioning (d = .90), and cognitive screening performance (d = .77). Overall executive dysfunction deficits were concordant with those observed in previous SUD studies. Surprisingly, comorbid personality disorder was associated with a pattern indicating poorer subjective (self-report) but better objective performance on a number of tasks, apart from shifting deficits that may relate to emotion dysregulation. Subjective emotional dysfunction may influence the cognitive deficits observed in the personality disorder group.

Everyday Cognitive Control and Emotion Dysregulation in Young Adults With and Without ADHD: An Ecological Momentary Assessment Study

OBJECTIVE

This study examined the contribution of the temporal dynamics of two cognitive control mechanisms-inhibitory control (IC) and working memory (WM)-to emotion dysregulation (ED) in attention-deficit/hyperactivity disorder (ADHD) in ecological settings.

METHOD

One hundred twenty-two participants (age 18-33 years; 60 with ADHD) reported their ED at baseline, followed by a 5-day ecological momentary assessment (EMA) study, with short behavioral IC and WM tasks performed five times/day.

RESULTS

For IC, mean and lability of performance over EMA significantly accounted for differences in ED but not baseline performance. For WM, both baseline and mean of EMA, but not EMA lability, accounted for ED variance. ADHD status further contributed to the explained variance of ED.

CONCLUSIONS

Our results support the contribution of dynamic IC processes to ED in ADHD, in addition to WM performance level, and highlight the importance of dynamic and ecological investigation of different cognitive control components.

Executive Function Deficits and Borderline Personality Disorder Symptomatology in a Nonclinical Adult Sample: A Latent Variable Analysis

While borderline personality disorder (BPD) symptomatology has been studied extensively in clinical populations, the mechanisms underlying its manifestation in nonclinical populations remain largely understudied. One aspect of BPD symptomatology in nonclinical populations that has not been well studied is cognitive mechanisms, especially in relation to executive functions. To explore the cognitive mechanisms underlying BPD symptomatology in nonclinical populations, we analysed a large-scale dataset of 233 young adults that were administered with nine executive function tasks and BPD symptomatology assessments. Our structural equation modelling did not find any significant relations between latent factors of executive functions and the severity of BPD symptomatology. Contrary to our hypothesis, our result suggests that deficits in executive functions were not a risk factor for BPD symptomatology in the nonclinical young adult sample.

Neuropsychological performance and predictors of pharmacological treatment response in obsessive compulsive disorder

BACKGROUND

Obsessive Compulsive Disorder (OCD) is characterized by the presence of executive dysfunctions. As organizational strategies may play an important role as a possible endophenotype of the disorder, we decided to investigate non-verbal memory and organizational abilities in OCD. We also investigated how organization and non-verbal memory differ between responder and non-responder patients to pharmacological treatment, to test whether cognitive functions can predict the response to pharmacological treatment.

METHODS

In Study 1, executive and clinical functioning measures were applied to 162 OCD and 95 controls. In Study 2, clinical, intelligence and executive functioning measures were applied to 72 OCD responders and 63 OCD non-responder patients.

RESULTS

OCD patients and controls from Study 1 differed in copy organization (p < 0.01) and delayed recall (p = 0.048). In Study 2, the OCD responders displayed better copy organization (p = 0.013) and lower depressive, anxious and OCD symptoms (p < 0.01 in the three cases). Scores in the following instruments were found to predict the response to pharmacological treatment: HDRS, Y-BOCS, Raven progressive matrices, and Direct digit subtest from the Wechsler's scale (p < 0.01 in all four cases).

LIMITATIONS

In Study 1, the imbalance of the sample can be considered a limitation, whilst in Study 2, some of the levels of pharmacological resistance were not represented.

CONCLUSIONS

In this study, non-verbal memory and organization was affected in OCD. Responder patients also displayed better executive functioning and fluid intelligence. Organizational ability is a predictor of pharmacological response to SSRI monotherapy in a predictive model controlling for anxious symptoms.

Early and Late Luteal Executive Function, Cognitive and Somatic Symptoms, and Emotional Regulation of Women with Premenstrual Dysphoric Disorder

Objective: Cognitive and somatic symptoms were vital factors in developing personalized treatment of depressive disorder. The study aimed to evaluate the following: (1) the cognitive and somatic symptoms of premenstrual dysphoric disorder (PMDD) in the early luteal (EL) and later luteal (LL) phase; and (2) their association with depression and functional impairment of PMDD. Methods: We prospectively evaluated executive function, emotion regulation, cognitive and somatic symptoms, and depression in the EL and LL phases in women with PMDD. Sixty-three women with PMDD and 53 healthy controls completed Simon’s task and questionnaire to assess emotion regulation, inattention, fatigue, insomnia, and depression. Results: Women with PMDD had a poor performance in Simon’s task during the LL phase. They were less likely to exercise cognitive reappraisal during EL and LL phases. Their cognitive reappraisal positively correlated with executive function and negatively associated with depression. In the LL phase, they also experience higher inattention, insomnia, and fatigue, which correlate with the depression and functional impairment of PMDD. Inattention is the most associated factor of PMDD and functional impairment in controlling depression. Conclusion: Executive function was impaired in women with PMDD during the LL phase. Its performance correlated positively with emotion regulation and negatively with depression. The association between inattention and PMDD functional impairment indicates that evaluation and intervention for cognitive impairment were essential in treating women with PMDD. Further studies were required to elucidate the possible etiology underlying these associations.

Executive function, repetitive behaviour and restricted interests in neurodevelopmental disorders

BACKGROUND

Individuals with genetic syndromes show unique profiles of repetitive behaviours and restricted interests (RRBs). The executive dysfunction account of RRBs suggests that in autistic (AUT) individuals executive function impairments underpin RRBs, but not communication and social interaction autistic characteristics.

AIMS

To 1) describe profiles of behavioural manifestations of executive function (EF behaviours) and 2) explore the relationship between EF behaviours and autistic traits across individuals with Cornelia de Lange (CdLS), fragile X (FXS) and Rubinstein-Taybi syndromes (RTS), and AUT individuals.

METHOD

Carers completed the Behavior Rating Inventory of Executive Function - Preschool Version and the Social Communication Questionnaire. Data reporting on 25 individuals with CdLS (Mage = 18.60, SD = 8.94), 25 with FXS (Mage = 18.48, SD = 8.80), 25 with RTS (Mage = 18.60, SD = 8.65) and 25 AUT individuals (Mage = 18.52, SD = 8.65) matched on chronological age and adaptive ability were included in analyses.

RESULTS

All groups showed impairments across EF behaviours compared to two-to-three-year-old typically developing normative samples with no differences between groups. Different EF behaviours predicted RRBs in the syndrome groups with no associations found in the AUT group.

CONCLUSIONS

Syndrome related differences should be considered when developing targeted interventions that focus on EF behaviours and/or RRBs in these groups.

Executive Functioning and Emotion Regulation in Children with and without ADHD

Difficulties with emotion regulation affect the majority of youth with attention-deficit/hyperactivity disorder (ADHD) and predict greater functional impairment than ADHD symptoms alone. Deficits in executive functioning are also present for most children with ADHD, and have been linked with emotion regulation difficulties in both clinical and neurotypical populations throughout development. The current study was the first to assess all three core executive functions (working memory, inhibitory control, set shifting) simultaneously in a clinically-diverse sample of children with and without ADHD and common comorbidities and investigate the extent to which they uniquely predict emotion dysregulation. A sample of 151 children ages 8-13 years (M = 10.36, SD = 1.52; 52 girls; 70.2% White/Non-Hispanic) were assessed using a criterion battery of executive functioning tasks, teacher-reported ADHD symptoms, and parent-reported emotion regulation. Results of the bias-corrected, bootstrapped conditional effects path model revealed that better-developed working memory predicted better emotion regulation (β = 0.23) and fewer ADHD symptoms (β = -0.21 to -0.37), that ADHD symptoms (β = -0.18 to -0.20) independently predicted emotion dysregulation, and that working memory exerted indirect effects on emotion regulation through both inattention and hyperactivity/impulsivity (β = 0.04-0.07). Sensitivity analyses indicated that these effects were generally robust to control for age, sex, executive function interrelations, and inclusion/exclusion of children with co-occurring ASD. These findings underscore the importance of working memory (relative to inhibitory control and set shifting) and its relations with ADHD symptoms for understanding children's emotion regulation skills, and may help explain the limited efficacy of first-line ADHD treatments, which do not target working memory, for improving emotion regulation skills.

The mediating role of tolerance for psychological pain in the relationship of childhood trauma to suicidal ideation in individuals with a substance use disorder

OBJECTIVES

The association between childhood trauma and suicidal ideation has been well documented in several populations, including individuals with a substance use disorder (SUD). However, a gap still exists in the literature regarding the mechanisms by which childhood trauma later impacts suicide risk. This cross-sectional study tested the effect of childhood trauma on suicidal ideation, as well as the mediating effect of tolerance for psychological pain (managing the pain and enduring the pain) in that relationship, controlling for the effect of depressive symptoms, in individuals with a SUD.

METHODS

A sample of 102 adults with a SUD participated in the study. Path analysis by structural equation␣modelling tested a mediation model.

RESULTS

Depressive symptoms and lower levels of managing the pain were found to fully mediate the association between childhood trauma and suicidal ideation.

CONCLUSIONS

Our results suggest that depressive symptoms and a lack of ability to manage psychological pain contribute towards explaining why traumatic childhood experiences may result in suicidal cognitions in individuals with SUDs. Moreover, they have relevant implications for prevention and clinical interventions regarding suicidal ideation in this population.

PRACTITIONER POINTS

Childhood trauma relates to suicidal ideation in individuals with a substance use disorder. Depressive symptoms contribute towards explaining why traumatic childhood experiences may result in suicidal cognitions. A lack of ability to manage psychological pain also contributes towards explaining this relationship. The obtained results have relevant implications for the prevention of and clinical intervention for suicidal ideation in SUD individuals.

Cross-Cultural Adaptation and Validation of the Emotional Inhibition Scale in a Chinese Cancer Sample

The Emotional Inhibition Scale (EIS) is a brief measure based on a four-factor model with documented validity in a mood disorder sample that may be useful for assessing emotional inhibition in patient populations, such as individuals with cancer. The present study adapted the EIS to Chinese conditions and examined the psychometric characteristics of the EIS in patients with cancer. The recruited participants comprised a sample of 100 patients (sample 1) and a sample of 202 patients (sample 2) with cancer. The two samples (sample 1 and sample 2) with cancer completed surveys including the EIS. The Toronto Alexithymia Scale-20 was completed by the two sample groups to assess criterion validity. Statistical analyses included internal consistency (sample 1), exploratory factor analyses (EFAs; sample 1), and confirmatory factor analyses (CFAs; sample 2). The results showed that EFA and CFA confirmed the four-factor solution proposed by the original authors (verbal inhibition, self-control, disguise of feelings, and timidity). The internal consistency and test-retest reliability of the EIS were satisfactory. In conclusion, the EIS demonstrated acceptable reliability and validity for assessing emotional inhibition in Chinese-speaking patients with cancer and may be a useful measure for assessing the level of emotional inhibition and the effect of emotional disclosure interventions.

Executive functions and emotion regulation in substance use disorder

ABSTRACT Objective The executive functions (EF) and emotion regulation (ER) and their relationship with the substance use disorder (SUD) were analyzed. Methods A cross-sectional design was used. The sample consisted of 130 volunteers divided into three groups: group 01 (n = 60), composed of participants who did not meet the diagnostic criteria for any type of SUD; group 02 (n = 51), with users with alcohol and/or tobacco use disorder; group 03 (n = 19), with users with multiple substance use disorder, including at least one illicit substance. Results Group 02 presented worse performance in EF and ER when compared to group 01, and showed a significant correlation between the working memory and the use of maladaptive ER. Group 03 showed great losses in EF and ER when compared to the other groups. Conclusion This study supports the idea that EF, ER and SUD are related. In addition, it was observed that people with SUD had worse performance in EF and ER when compared to people without SUD, greater damage being observed in people with SUD of polysubstances.

Individual differences in emotion regulation and face recognition

Face recognition ability is highly variable among neurologically intact populations. Across three experiments, this study examined for the first time associations between individual differences in a range of adaptive versus maladaptive emotion regulation strategies and face recognition. Using an immediate face-memory paradigm, in which observers had to identify a self-paced learned unfamiliar face from a 10-face target-present/ target-absent line-up, Experiment 1 (N = 42) found high levels of expressive suppression (the ongoing efforts to inhibit emotion-expressive behaviors), but not cognitive reappraisal (the cognitive re-evaluation of emotional events to change their emotional consequences), were associated with a lower level of overall face-memory accuracy and higher rates of misidentifications and false positives. Experiment 2 (N = 53) replicated these finding using a range of face-matching tasks, where observers were asked to match pairs of same-race or different-race face images taken on the same day or during different times. Once again, high levels of expressive suppression were associated with a lower level of overall face-matching performance and higher rates of false positives, but cognitive reappraisal did not correlate with any face-matching measure. Finally, Experiment 3 (N = 52) revealed that the higher use of maladaptive cognitive emotion regulation strategies, especially catastrophizing, was associated with lower levels of overall face-matching performances and higher rates of false positives. All told, the current research provides new evidence concerning the important associations between emotion and cognition.

The Potential Interaction Between Time Perception and Gaming: A Narrative Review

Compromised time control is a variable of interest among disordered gamers because time spent on videogames can directly affect individuals’ lives. Although time perception appears to be closely associated with this phenomenon, previous studies have not systematically found a relationship between time perception and gaming. Therefore, the purpose of this narrative review is to explore how gaming disorder may be associated with time perception. It has been found that gamers exhibit a stronger attentional focus as well as an improved working memory compared with non-gamers. However, gamers (and especially disordered gamers) exhibit a stronger reaction to gaming cues which—coupled with an altered emotion regulation observed among disordered gamers—could directly affect their time perception. Finally, “'flow states”' direct most of the attentional resources to the ongoing activity, leading to a lack of resources allocated to the time perception. Therefore, entering a flow state will result in an altered time perception, most likely an underestimation of duration. The paper concludes that the time loss effect observed among disordered gamers can be explained via enhanced emotional reactivity (facilitated by impaired emotion regulation).

An Examination of Relations Among Working Memory, ADHD Symptoms, and Emotion Regulation

Emotion regulation difficulties are present in many, if not most, children with attention-deficit/hyperactivity disorder (ADHD) and confer risk for a host of adverse outcomes. Little is known, however, regarding the neurocognitive and behavioral mechanisms that underlie these difficulties. A well-characterized, clinically evaluated sample of 145 children ages 8-13 years (M = 10.33, SD = 1.47; 55 girls; 69% White/non-Hispanic) were administered multiple, counterbalanced working memory tests and assessed for emotion dysregulation and ADHD symptoms via multiple-informant reports. Bias-corrected, bootstrapped conditional effects modeling indicated that underdeveloped working memory exerted significant direct effects on emotion regulation in all tested models as well as indirect effects on emotion regulation via parent-reported hyperactive/impulsive symptoms (95% CIs excluded zero). Interestingly, hyperactive/impulsive symptoms also predicted emotion dysregulation when controlling for the influence of working memory. Inattention failed to predict emotion regulation difficulties in all tested models (all 95% CIs included zero). This pattern of results replicated across parent and teacher models and were robust to control for mono-informant bias, age, and gender. These findings suggest that emotion dysregulation in ADHD reflects, in part, both a direct outcome of underdeveloped working memory and an affective outcome of hyperactive and/or impulsive symptomatology, both attributable to and independent of the role of underlying working memory deficits.

Modality-specific overlaps in brain structure and function in obsessive-compulsive disorder: Multimodal meta-analysis of case-control MRI studies

Neuroimaging research has shown that patients with obsessive-compulsive disorder (OCD) may present brain structural and functional alterations, but the results across imaging modalities and task paradigms are difficult to reconcile. Are the same brain systems that are structurally different in OCD patients also involved in executive function and emotional processing? To answer this, we conducted separate meta-analyses of voxel-based morphometry studies, executive function functional magnetic resonance imaging (fMRI) studies, and emotional processing fMRI studies. Next, with a multimodal approach (conjunction analysis), we identified the common alterations across meta-analyses. Patients presented increased gray matter volume and hyperactivation in the putamen, but the putamen subregions affected differed depending on the psychological process. Left posterior/dorsal putamen showed hyperactivation during executive processing tasks, while predominantly right anterior/ventral putamen showed hyperactivation during emotional processing tasks. Interestingly, age was significantly associated with increased right putamen volume. Finally, the left dorsolateral prefrontal cortex was hyperactive in both functional domains. Our findings highlight task-specific correlates of brain structure and function in OCD and help integrate a growing literature.

The association between executive functioning and parental stress and psychological distress is mediated by parental reflective functioning in mothers with substance use disorder

Mothers with a substance use disorder (SUD) have been found to exhibit heightened experience of stress and deficits in executive functioning (EF) and in parental reflective functioning (PRF). Although experiences of stress, EF and PRF are important for caregiving capacities; no studies have explored associations between the phenomena in mothers with SUD. This study aimed to examine the association between EF (working memory, inhibition, and cognitive flexibility) and different forms of stress (parental stress, general life stress, and psychological distress) in 43 mothers with SUD with infants. We further aimed to investigate whether PRF had a mediating function between EF and the experience of stress. The mothers completed self-report questionnaires regarding experiences of different types of stress, and we also used neuropsychological tests to assess EF and a semistructured interview to assess PRF. Results identified problems in EF were associated with higher parental stress and psychological distress but not with general life stress. Cognitive flexibility contributed uniquely to variance in parental stress, whereas working memory was a unique contributor to variance in psychological distress. PRF had a mediating function between EF and parental stress and between EF and psychological distress. Findings highlight the importance of considering individual differences in PRF when targeting EF in interventions trying to reduce the experience of parental stress and psychological distress in mothers with SUD.

The Severity of Personality Pathology: A Risk Factor for Concurrent Substance Use Disorders in Alcohol Use Disorder

Objective: Co-occurrence of substance use disorders (CO-substance use disorders) among individuals with alcohol use disorder (AUD) is largely recognized as a critical clinical issue. However, the specific clinical variables involved are still unclear. The recent findings are controversial in pointing out the unique contribution of both impulsivity and emotion dysregulation on CO-substance use disorders. Furthermore, the co-variation between AUD and other substance use disorders includes different aspects of maladaptive personality functioning (i.e., overall severity and specific features). Therefore, this study aims at clarifying the role of impulsivity, emotional dysregulation, and severity of personality pathology on CO-substance use disorders among treatment-seeking individuals with AUD. Methods: One hundred ninety-three treatment-seeking individuals with AUD (DSM-IV-TR) were consecutively recruited. Impulsivity (Barratt Impulsiveness Scale [BIS-11]), emotional dysregulation (Difficulties in Emotion Regulation Scale [DERS]), and personality pathology (Structured Clinical Interview for DSM-IV Axis II Personality Disorder [SCID-II]) were assessed after a 2-week detoxification period. The analyses were based on several stepwise forward logistic regressions. The total score of BIS-11 and DERS together with the number of SCID-II criteria were considered, in following the order, as independent variables controlling for the comorbidity with other lifetime Axis I disorders. CO-substance use disorders was the dependent variable (i.e., any CO-substance use disorders, benzodiazepine and cannabis/cocaine use disorders). Results: The number of SCID-II criteria was the only significant predictor of overall CO-substance use disorders, odds ratio (OR) = 1.16; 95% confidence interval (CI) [1.07, 1.26], p < .01, and cannabis/cocaine use disorders, OR = 1.19; 95% CI [1.08, 1.31], p < .01. On the contrary, DERS total score was the most robust predictor of benzodiazepine use disorder, OR = 1.02; 95% CI [1.01, 1.04], p < .01, albeit the severity of maladaptive personality functioning was also significantly associated with this disorder, OR = 1.09; 95% CI [1.00, 1.18], p < .05. Conclusions: The severity of maladaptive personality pathology represents one of the main aspects involved in CO-substance use disorders among individuals with AUD. This dimension predicts the CO-substance use disorders above and beyond specific personality dimensions and other psychiatric conditions. Therefore, personality functioning should be precisely assessed and personality pathology should be addressed in the framework of AUD treatments for promoting effective long-term outcomes.