Characteristics of emotion regulation in recovered depressed versus never depressed individuals

A school-based intervention programme to prevent anxiety and depression among Chinese children during the COVID-19 pandemic

BACKGROUND

Child and adolescent mental health is a major public health concern worldwide. The development of children's social and emotional skills helps to improve mental health and wellbeing, and prevent anxiety and depression. The school-based social emotional learning (SEL) programmes have proved effective in a number of countries. But in Mainland China, there has been no empirical research of the effectiveness on children's mental health. The study conducted a SEL programme in China during the COVID-19 pandemic and aimed to determine whether: (1) a SEL programme can reduce anxiety and depression, (2) the intervention effect is influenced by sociodemographic characteristics, (3) the programme effects change children's emotion management and communication.

METHODS

Participants were 230 children aged 8-12 years in the intervention school and 325 in the control school in two poor villages in central China. The study was a quasi-experimental trial, comprising 16 weekly 90-minute sessions. It used a mixed-methods design, with a quantitative survey administered at baseline, post-intervention, and 5-month follow-up, and qualitative interviews. Linear mixed effects regression modeling was used to analyse the intervention effectiveness, linear models were conducted to examine the moderation effect of sociodemographic variables, and the inductive thematic analysis approach was used for interview data.

RESULTS

The intervention had no significant effect on anxiety or depression, except that intervention school children who lived with neither parent (left behind children) reported lower depression scores than control school at post-intervention and 5-month follow-up. Qualitative interviews showed after intervention children were more able to control tempers and better communicated their thoughts and feelings, improving their relationships with family and friends.

CONCLUSIONS

The programme was cheap, easy to implement, and warmly welcomed by children, schools and caregivers, suggesting it was feasible and potentially sustainable. More research is needed on the adaptation of the SEL programme in the Chinese context.

Internet-based emotion regulation training aimed at reducing violent revictimization and depressive symptoms in victimized depressed patients: Results of a randomized controlled trial

BACKGROUND

Depressed patients who have become victim of violence are prone to revictimization. However, no evidence-based interventions aimed at reducing revictimization in this group exist.

METHODS

This multicenter randomized controlled trial evaluated the effectiveness of an internet-based emotion regulation training (iERT) added to TAU in reducing revictimization, emotion dysregulation, and depressive symptoms in recently victimized, depressed patients compared to TAU alone. Adult outpatients (N = 153) with a depressive disorder who had experienced threat, physical assault, or sexual assault within the previous three years were randomly allocated to TAU+iERT (n = 74) or TAU (n = 79). TAU involved psychotherapy (mainly cognitive behavioral therapy [77.8 %]). iERT comprised six guided online sessions focused on the acquisition of adaptive emotion regulation skills. The primary outcome measure was the number of revictimization incidents at 12 months after baseline, measured with the Safety Monitor. Analyses were performed according to the intention-to-treat principle.

RESULTS

Both groups showed a large decrease in victimization incidents. Mixed-model negative binomial regression analyses showed that TAU+iERT was not effective in reducing revictimization compared to TAU (IRR = 0.97; 95%CI = 0.64,1.46; p = .886). Linear mixed-model analyses demonstrated that TAU+iERT yielded a larger reduction of emotion dysregulation (B = -7.217; p = .046; Cohens d = 0.33), but not depressive symptoms (B = -1.041; p = .607) than TAU.

LIMITATIONS

The study was underpowered to detect small treatment effects. Additionally, uptake of iERT was quite low.

CONCLUSIONS

Although TAU+iERT resulted in a larger decrease of emotion dysregulation than TAU alone, it was not effective in reducing revictimization and depressive symptoms. Patients' revictimization risk substantially decreased during psychotherapy.

Facial emotion recognition in children of parents with a mental illness

Objective

Facial emotion recognition (FER) is a fundamental social skill essential for adaptive social behaviors, emotional development, and overall well-being. FER impairments have been linked to various mental disorders, making it a critical transdiagnostic mechanism influencing the development and trajectory of mental disorders. FER has also been found to play a role in the transgenerational transmission of mental disorders, with the majority of research suggesting FER impairments in children of parents with a mental illness (COPMI). Previous research primarily concentrated on COPMI of parents with internalizing disorders, which does not cover the full spectrum of outpatient mental health service populations. Furthermore, research focuses on varying components of FER by using different assessment paradigms, making it challenging to compare study results. To address these gaps, we comprehensively investigated FER abilities in COPMI using multiple tasks varying in task characteristics.

Methods

We included 189 children, 77 COPMI and 112 children of parents without a diagnosed mental illness (COPWMI), aged 6 to 16 years. We assessed FER using three tasks with varying task demands: an emotional Go/NoGo task, a morphing task, and a task presenting short video sequences depicting different emotions. We fitted separate two-level hierarchical Bayesian models (to account for sibling pairs in our sample) for reaction times and accuracy rates for each task. Good model fit was assured by comparing models using varying priors.

Results

Contrary to our expectations, our results revealed no general FER deficit in COPMI compared to COPWMI. The Bayesian models fitted for accuracy in the morphing task and Go/NoGo task yielded small yet significant effects. However, Bayes factors fitted for the models suggested that these effects could be due to random variations or noise in the data.

Conclusions

Our study does not support FER impairments as a general feature of COPMI. Instead, individual factors, such as the type of parental disorder and the timing of its onset, may play a crucial role in influencing FER development. Future research should consider these factors, taking into account the diverse landscape of parental mental disorders.

Blending an internet-based emotion regulation intervention with face-to-face psychotherapy: Findings from a pilot randomized controlled trial

Background

Transdiagnostic interventions targeting shared mechanisms may improve treatment of mental health disorders. One way of providing such interventions is through blended treatment. This study examined the addition of an internet-based emotion regulation intervention to face-to-face psychotherapy in an outpatient setting.

Methods

In a pilot randomized controlled trial, 70 patients with a range of diagnoses were assigned to an internet-based program targeting emotion regulation + treatment as usual (face-to-face psychotherapy; TAU) (n = 35) or TAU (n = 35). Assessments occurred at baseline, after six, and after 12 weeks and included measures of symptom severity, emotion regulation, and various intervention feasibility parameters.

Results

ITT-analyses revealed no significant group-by-time interaction for the primary and almost all secondary outcomes. Descriptively, between-group effect sizes were in favor of the intervention group for almost all outcomes. Sensitivity analysis with patients who completed a minimum of three modules of the internet-based program showed a significant group-by-time interaction for the Difficulties in Emotion Regulation Scale in favor of the intervention group. The internet-based intervention showed good satisfaction ratings, user experience and usability. Findings from therapist measures complemented patient measures.

Conclusion

Preliminary results show that an internet-based emotion regulation intervention added to psychotherapy may not reduce symptom severity compared to psychotherapy alone. The intervention was rated positively by patients and therapists regarding several parameters, but certain features still need to be improved. An RCT powered to detect small between-group effect-sizes is necessary to consolidate findings.

Meaning in life as a protective factor against depression

The main objective of this study was to analyze the mediating role that meaning in life has between emotion dysregulation and depressive symptomatology in Spanish university students. Five hundred and sixty-six Spanish university students participated in the study. All of them completed the Difficulties in Emotion Regulation Scale (DERS), the Patient Health Questionnaire (PHQ-9) and the Purpose in Life Test (PIL-10). A mediation model was performed to test the hypothesis that meaning in life mediates the effect of emotional dysregulation on depressive symptomatology in college students. The results show a positive, moderate, and statistically significant correlation between depression and emotional dysregulation. In addition, a negative, moderate, and statistically significant correlation was found between depression and meaning in life, and a negative, small, and statistically significant correlation between emotional dysregulation and meaning in life. Finally, the results of the mediation model evidence the role of meaning in life in different emotional dysregulation strategies and depressive symptomatology. These findings suggest the importance of incorporating the meaning in life variable in the development and implementation of prevention and treatment programs for psychological disorders.

Does an Internet-Based Emotion Regulation Intervention Provide Added Value for Acute Psychiatric Inpatient Care? Protocol for a Randomized Controlled Pilot Trial

BACKGROUND

There is a lack of studies on internet-based interventions in inpatient settings. This is especially true for studies of internet-based interventions in acute psychiatric inpatient care. Internet-based interventions in this specific setting may provide benefits such as patient empowerment and overall improved treatment outcomes. However, there may also be specific barriers to their implementation that are unique due to the complexity of acute psychiatric inpatient care.

OBJECTIVE

The aim of this study is to examine the feasibility and preliminary evidence for effectiveness of a web-based emotion regulation intervention provided as an add-on to acute psychiatric inpatient care.

METHODS

The goal is to randomly allocate 60 patients with a range of different diagnoses in a 1:1 ratio to either treatment as usual (TAU), which consists of acute psychiatric inpatient treatment, or to the intervention group, which will receive TAU plus access to a web-based intervention that focuses on reduction of emotion regulation difficulties and improvement of emotion regulation skills. The primary outcome is symptom severity, assessed with the short form of the Brief Symptom Inventory at baseline, after 4 weeks, after 8 weeks, and at hospital discharge. Secondary outcomes include 2 emotion regulation parameters, intervention use, usability, patient satisfaction, and reasons for patient loss to follow-up.

RESULTS

Participant recruitment started in August 2021 and as of March 2023 was ongoing. First publication of study results is expected in 2024.

CONCLUSIONS

This study protocol describes a study that intends to examine a web-based emotion regulation intervention in acute psychiatric inpatient care. The study will provide information on the feasibility of the intervention and possible effects on symptom severity and emotion regulation. The results will provide new insights on blended treatment, in this case the combination of a web-based intervention and face-to-face psychiatric treatment, in an understudied patient group and setting.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04990674; https://clinicaltrials.gov/ct2/show/NCT04990674.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/47656.

Distinct adaptations of endocrine and cognitive functions may contribute to high variability in long-term weight loss outcome after bariatric surgery

BACKGROUND

Bariatric surgery has been widely recognized as the most efficient long-term treatment method in severe obesity, yet therapy success shows considerable interindividual variability. Postoperative metabolic adaptations, including improved gut hormone secretion (GLP-1, PYY and ghrelin), and restored executive function may play an explanatory role in weight loss, yet causes for poor success in individual patients remain unknown. This study investigates gut-hormonal and cognitive characteristics in extreme weight loss responders to bariatric surgery.

METHODS

Patients (n=47) with high or low excessive weight loss (EWL) at least 2 years after Roux-en-Y-gastric bypass or sleeve gastrectomy were allocated into good responders (GR, EWL 82.4 ± 11.6%) and poor responders (PR, EWL 24.0 ± SD 12.8%) to study differences in postprandial secretion of GLP-1, PYY, ghrelin and in working memory (WM).

RESULTS

Mean BMI was 47.1 ± 6.2 kg/m² in PR (n=21) and 28.9 ± 3.1 kg/m² in GR (n=26, p < 0.001). Fasted GLP-1 and PYY were comparable for GR and PR (p > 0.2) and increased strongly after a standardized test meal (300 kcal liquid meal) with a peak at 15 to 30 minutes. The increase was stronger in GR compared to PR (GLP-1, PYY: Time x Group p < 0.05). Plasma ghrelin levels already differed between groups at fasted state, showing significantly higher levels for GR (p < 0.05). Postprandially, ghrelin secretion was suppressed in both groups, but suppression was higher in GR (Time x Group p < 0.05). GR showed significantly higher WM scores than PR (p < 0.05). Postprandial ghrelin (iAUC), but not GLP-1 or PYY plasma levels, significantly mediated the relationship between EWL and a WM subscore (IS score, CI = 0.07 - 1.68), but not WM main score (MIS score, CI = -0.07 - 1.54), in mediation analyses.

CONCLUSION

Excess weight loss success after bariatric surgical procedures is associated with distinct profiles of gut-hormones at fasted and postprandial state, and differences in working memory. Better working memory performance in GR might be mediated by higher postprandial reduction in ghrelin plasma levels. Future studies need to integrate longitudinal data, larger samples and more sensitive cognitive tests.

The effect of emotion regulation on emotional eating among undergraduate students in China: The chain mediating role of impulsivity and depressive symptoms

This study aimed to examine the relationship between difficulties in emotion regulation and emotional eating and the role of impulsivity and depressive symptoms in mediating this chain. Four hundred ninety-four undergraduate students participated in the study. A self-designed questionnaire was used in the survey from February 6 to 13, 2022, to finish our purpose, including the Emotional Eating Scale (EES-R), Depression Scale (CES-D), Short Version of the Impulsivity Behavior Scale (UPPS-P) and Difficulties in Emotion Regulation Scale (DERS). The results showed that 1) difficulties in emotion regulation, impulsivity, depressive symptoms, and emotional eating were correlated; 2) impulsivity and depressive symptoms separately mediated the relationship between difficulties in emotion regulation and emotional eating; 3) impulsivity and depressive symptoms played a chain mediating role between difficulties in emotion regulation and emotional eating. The current study provided a better understanding of the psychologically related pathway of emotional eating. The results would be helpful for prevention and intervention of emotional eating among undergraduate students.

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

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

Optimizing outcomes in psilocybin therapy: Considerations in participant evaluation and preparation

Recent studies have demonstrated the promise of psilocybin therapies in creating positive changes for those with poor mental health across multiple diagnostic categories, including major depressive disorder (MDD), end-of-life anxiety, and obsessive-compulsive disorder (OCD). While there may be a large population that is eligible to participate in psilocybin therapy based on psychiatric diagnosis and medical clearance, little attention has been given to intrapersonal and interpersonal factors that might influence patient's readiness (i.e., eligibility and capacity) for psychedelic interventions. This paper proposes that readiness assessment includes both intrapersonal and interpersonal factors in order to improve safety, patient care, and treatment outcomes. While at the present time a reliable and valid instrument has not been developed, we propose that three specific areas of focus - patient presentation, therapeutic alliance, and patient safety - may be used to establish a patient's readiness for psilocybin therapy, thus increasing therapy optimization and personalization.

Hemodynamic correlates of emotion regulation in frontal lobe epilepsy patients and healthy participants

The ability to regulate emotions is indispensable for maintaining psychological health. It heavily relies on frontal lobe functions which are disrupted in frontal lobe epilepsy. Accordingly, emotional dysregulation and use of maladaptive emotion regulation strategies have been reported in frontal lobe epilepsy patients. Therefore, it is of clinical and scientific interest to investigate emotion regulation in frontal lobe epilepsy. We studied neural correlates of upregulating and downregulating emotions toward aversive pictures through reappraisal in 18 frontal lobe epilepsy patients and 17 healthy controls using functional magnetic resonance imaging. Patients tended to report more difficulties with impulse control than controls. On the neural level, patients had diminished activity during upregulation in distributed left-sided regions, including ventrolateral and dorsomedial prefrontal cortex, angular gyrus and anterior temporal gyrus. Patients also showed less activity than controls in the left precuneus for upregulation compared to downregulation. Unlike controls, they displayed no task-related activity changes in the left amygdala, whereas the right amygdala showed task-related modulations in both groups. Upregulation-related activity changes in the left inferior frontal gyrus, insula, orbitofrontal cortex, anterior and posterior cingulate cortex, and precuneus were correlated with questionnaire data on habitual emotion regulation. Our results show that structural or functional impairments in the frontal lobes disrupt neural mechanisms underlying emotion regulation through reappraisal throughout the brain, including posterior regions involved in semantic control. Findings on the amygdala as a major target of emotion regulation are in line with the view that specifically the left amygdala is connected with semantic processing networks.

The role of maladaptive emotion regulation in the bidirectional relation between sleep and depression in college students during the COVID-19 pandemic

Background: Emotion regulation deficits are an outcome and risk factor for both insomnia and depression, suggesting that maladaptive emotion regulation might in part explain the bi-directional links between sleep and depression. The current study tests this hypothesis during the COVID-19 pandemic in emerging adult undergraduate students, a high-risk population for both depression and sleep disturbance.Methods: A sample of 154 undergraduate students completed a series of online questionnaires bi-weekly on sleep, depression, and emotion regulation strategies across eight weeks during the early days of the COVID-19 pandemic (April 2nd to June 27th, 2020).Results: Sleep disturbance and depression prospectively predicted one another across eight weeks, and both directions were mediated by maladaptive emotion regulation. However, sleep and depression failed to predict change in one another controlling for baseline measures, directly or via emotion regulation.Conclusions: The results suggest that maladaptive emotion regulation is a potential mechanism through which sleep disturbance and depression help maintain high levels of one another in college students during the COVID-19 pandemic. Therefore, emotion regulation deficits are potentially an important target for interventions to interrupt the sleep disturbance-depression cycle.

Delayed affective recovery to daily-life stressors signals a risk for depression

OBJECTIVE

The aim of this study is to investigate the time to affective recovery from daily-life stressors between healthy controls (HC) and two groups with an increased risk for developing depression: individuals with subclinical symptoms of depression (SSD), and individuals remitted from a depressive episode with residual symptoms of depression (RRS).

METHOD

The experience sampling method (ESM) was used to measure affective recovery to daily-life stressors. Affective recovery was defined as the moment that negative affect (NA) returned to baseline level following the first stressful event of the day. We assessed two different operationalizations of the baseline: NA at the moment before the stressful event (t_-1), and mean-person NA. The effect of stress intensity, and cumulative stress were also assessed.

RESULTS

Survival analyses showed significantly longer recovery times for the at risk groups in comparison to healthy individuals, albeit no significant difference was found between the two at risk groups (i.e. SSD and RRS). There was also an effect of cumulative stress, but not stress intensity on time to recovery in that cumulative stress resulted in significantly longer recovery times for all three groups.

LIMITATIONS

The present study is limited by the ESM sampling design, assessments take place post-stress and therefore do not capture peak stress. Additionally, we are only able to assess patterns at the group level. Finally, there is a significant age difference between groups.

CONCLUSION

Individuals at risk for depression display a delayed recovery to daily-life stressors when compared to healthy controls, which is not explained by differences in stress intensity or cumulative stress. Understanding what is driving this delay may help combat the development of depression.

Association of Pre-existing Mental Health Conditions with Acute Mountain Sickness at Everest Base Camp

Hüfner, Katharina, Fabio Caramazza, Evelyn R. Pircher Nöckler, Agnieszka E. Stawinoga, Paolo Fusar-Poli, Sanjeeb S. Bhandari, Buddha Basnyat, Monika Brodmann Maeder, Giacomo Strapazzon, Iztok Tomazin, Ken Zafren, Hermann Brugger, and Barbara Sperner-Unterweger. Association of pre-existing mental health conditions with acute mountain sickness at Everest Base Camp. High Alt Med Biol. 23:338-344, 2022. Background: Mental health disorders are common, but limited data are available regarding the number of people with a past medical history of psychiatric diagnoses going to high altitude (HA). It is also unknown whether mental health conditions are associated with an increased risk of acute mountain sickness (AMS). Methods: We analyzed data from a previous study at Everest Base Camp. Participants self-reported their past medical history and history of substance use and had a brief history taken by a physician. AMS was assessed using the self-reported 2018 Lake Louise AMS Score. Results: Eighty-five participants (66 men and 19 women, age 38 ± 9 years) were included. When questioned by a physician, 28 participants reported prior diagnoses or symptoms compatible with depression (23%), anxiety disorder (6%), post-traumatic stress disorder (1%), and psychosis/psychotic experiences (9%). The prevalence of psychiatric diagnoses in the past medical history was much lower in the self-reported data (2/85) compared to data obtained via physician assessment (28/85). Increased risks of AMS were associated with a past medical history of anxiety disorder (odds ratio [OR] 22.7; confidence interval [95% CI] 2.3-220.6; p < 0.001), depression (OR 3.6; 95% CI 1.2-11.2; p = 0.022), and recreational drug use ever (OR 7.3; 95% CI 1.5-35.5; p = 0.006). Conclusions: Many people who travel to HA have a past medical history of mental health conditions. These individuals have an increased risk of scoring positive for AMS on the Lake Louise Score compared with people without a history of mental health conditions.

Exploring two models of emotion regulation: how strategy use, abilities, and flexibility relate to well-being and mental illness

BACKGROUND AND OBJECTIVES

The process model of emotion regulation (ER) focuses on strategies used to manage emotions, while the abilities model emphasizes the extent one adaptively responds to negative emotions. We sought to clarify the relationships between components of ER based on both of the abilities (i.e., dysregulation) and process (i.e., strategy use) models, as well as ER flexibility (i.e., choosing the optimal strategy for a given situation) with well-being (happiness, flourishing), internalizing symptoms (depression, anxiety), and disordered eating. Gender differences were explored.

DESIGN AND METHOD

Participants included 612 undergraduate students (M_age = 20.24) who completed questionnaires measuring ER, well-being, and mental illness. Structural equation modeling was used on cross-sectional data to explore the associations between ER and psychological outcomes.

RESULTS

Dysregulation was associated with reduced well-being and greater psychopathology. In terms of strategy use, reappraisal was related to greater well-being and fewer internalizing symptoms, while the opposite relationships were found for suppression. Suppression was also linked to disordered eating. ER flexibility was related to well-being for men only. Further, dysregulation had the largest association with all outcomes.

CONCLUSIONS

Findings suggest that ER abilities may underlie other components of ER and are most central to mental health and illness.

Emotion regulation strategy correlates with discrete state emotion in major depression

BACKGROUND AND OBJECTIVES

Research has shown that state emotion can affect emotion regulation strategies in healthy samples. Emotion regulation plays an important role in depression. We hypothesized that for depressed individuals, experiencing anxiety or anger affects emotion regulation strategy use differently than experiencing sadness.

DESIGN AND METHODS

Individuals diagnosed with chronic or recurrent depression (N = 386) responded to vignettes of hypothetical stressors and reported their state emotions and emotion regulation strategies in a thought-listing procedure. We modeled the effect of reporting anger or anxiety compared to sadness on the use of seven emotion regulation strategies: avoidance, distraction, other-blame, problem-solving, rumination, self-blame, and social support.

RESULTS

Compared to sadness, anger was associated with a greater likelihood of using other-blame, and a lower likelihood of using avoidance, rumination, or self-blame. Compared to sadness, anxiety was associated with a greater likelihood of using self-blame. Responses with anger or anxiety did not significantly differ from sadness in coder-rated adaptiveness.

CONCLUSIONS

Differences in observed emotion regulation strategy use were correlated with the discrete emotions experienced, and not overall adaptiveness of a response. These results highlight the importance of assessing for emotion type when studying emotion regulation strategy use in depression.

Validation of the Behavioral Anger Response Questionnaire for Children (BARQ-C) in a large community sample of Vietnamese middle adolescents in Hanoi

BACKGROUND

Depression and other forms of psychological distress are common among Vietnamese adolescents and increase the risk of mental health problems in adulthood. As anger coping is a robust predictor of adolescent mental health difficulties, and there appear to be cultural variations in anger coping, a measure of adolescent anger coping styles that has been validated using a non-Western adolescent sample is required to inform and support early intervention to prevent or treat mental health difficulties in Vietnamese adolescents. This study examined the construct validity (structural and external) of the Behavioral Anger Response Questionnaire for Children in Vietnam (BARQC-V).

METHODS

Baseline data sourced from a recent randomised control trial conducted with Grade 10 Vietnamese adolescents aged 14 to 16 (N = 1084) were used to examine multiple aspects of construct validity: factorial structure (evaluated using factor analysis); internal consistency (tested using Cronbach's alpha coefficient); and external aspect (assessed using Pearson's correlation coefficients between the BARQC-V and Vietnamese translations of the Coping Self-Efficacy Scale, Centre for Epidemiologic Studies Depression Scale Revised, Mental Health Continuum Short Form, and the Depression Anxiety and Stress Scale).

RESULTS

Evaluating factorial structure using confirmatory factor analysis failed to converge on a solution. Exploratory factor analysis yielded a 5-factor structure model that explained 49.32% of the BARQC-V's total variance and was deemed to be a good fit by the final confirmatory factor analysis. Cronbach's alpha coefficients of the 5 factors demonstrated acceptable internal reliability for the BARQC-V's sub-scales. Concerning concurrent validity, three sub-scales predicted well-being and mental health difficulties: the maladaptive anger coping styles Rumination and Direct Anger-out were positively associated with depression and distress, and negatively associated with coping self-efficacy and mental well-being; and the adaptive anger coping style Assertion was positively associated with coping self-efficacy and mental well-being, and negatively associated with depression.

CONCLUSIONS

The BARQC-V provides a validated measure of three anger coping strategies used by adolescents in Vietnam (Rumination, Direct Anger-out, and Assertion) that can be used to improve detection and treatment of mental health difficulties in this population, and as a starting point by future research to develop a much-needed gold standard measure of anger coping for adults, adolescents and children world-wide.

The antidepressant effect of cognitive reappraisal training on individuals cognitively vulnerable to depression: Could cognitive bias be modified through the prefrontal–amygdala circuits?

Cognitive reappraisal (CR) is one of the core treatment components of cognitive behavioral therapy (CBT) and is the gold standard treatment for major depressive disorders. Accumulating evidence indicates that cognitive reappraisal could function as a protective factor of cognitive vulnerability to depression. However, the neural mechanism by which CR training reduces cognitive vulnerability to depression is unclear. There is ample evidence that the prefrontal–amygdala circuit is involved in CR. This study proposes a novel cognitive bias model of CR training which hypothesizes that CR training may improve the generation ability of CR with altered prefrontal–amygdala functional activation/connectivity, thus reducing negative cognitive bias (negative attention bias, negative memory bias, negative interpretation bias, and/or negative rumination bias) and alleviating depressive symptoms. This study aims to (1) explore whether there is abnormal CR strategy generation ability in individuals who are cognitively vulnerable to depression; (2) test the hypothesis that CR training alleviates depressive symptoms through the mediators of cognitive bias (interpretation bias and/or rumination bias); (3) explore the neural mechanism by which CR training may enhance the ability of CR strategy generation; and (4) examine the short- and long-term effects of CR training on the reduction in depressive symptoms in individuals who are cognitively vulnerable to depression following intervention and 6 months later. The study is promising, providing theoretical and practical evidence for the early intervention of depression-vulnerable individuals.

Reverse-Coded Items Do Not Work in Spanish: Data From Four Samples Using Established Measures

The potential for suboptimal psychometric performance of reverse-coded items may be particularly pronounced when scales are translated and administered in Spanish with these problems exacerbated in youth respondents. This is a significant concern, given the rapid rise in Hispanic-American and Spanish-speaking individuals in the US and their rightful, growing representation in psychological research and clinical care. The aim of this study was to examine the psychometric performance of reverse-coded items across four Spanish-speaking samples spanning developmental stages including youth, college students, and parents (N = 1,084; Adolescents n = 107; M = 19.79; SD = 2.09; 41.1% female; Caregivers n = 58; M = 40.79; SD = 7.94; 60.3% female; Spanish-speaking adults in the US n = 157; M = 33.4; SD = 9.5; 68.8% female; and College students living in Latin America n = 783; M = 21.04; SD = 3.13; 69.2% female) and four scales (Big Five Inventory; Strengths and Difficulties Questionnaire; Difficulties in Emotion Regulation Scale; Beck Hopelessness Scale); we expected reverse-coded items would demonstrate inadequate item–total correlations and their inclusion would compromise scale internal consistency. Hypotheses were supported with evidence of poor psychometric performance for at least two reverse-coded items on each instrument, such that un-reversing the items improved their item–total correlations. Across every instrument, alpha was either improved by excluding reverse-coded items or by including them in an un-reversed fashion and, overall, there was a moderate, negative effect of reverse-coded items on scale alphas. In growing consensus with previous authors, we recommend that reverse-coded items not be included in Spanish scales.

The Mediating Role of Emotion Regulation Strategies in the Relationship Between Big Five Personality Traits and Anxiety and Depression Among Chinese Firefighters

Identification of protective factors to prevent firefighters' anxiety and depression is meaningful. We explored whether emotion-regulation strategies mediate the relationship between personality traits and anxiety and depression among Chinese firefighters. Approximately, 716 Chinese firefighters were recruited and completed the Emotion Regulation Questionnaire (ERQ), Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), and Big Five Inventory−2 (BFI-2) Scale. Results (N = 622) indicated that only negative emotionality traits could predict anxiety symptoms. Meanwhile, the multilevel mediation effect analyses showed that conscientiousness through cognitive reappraisal could reduce anxiety and depression symptoms in Chinese firefighters. Our findings clarify Chinese firefighters' underlying emotion-regulation process between personality traits and anxiety and depression. Implications, limitations, and future directions are discussed.

Neural basis of positive and negative emotion regulation in remitted depression

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RRMDD patients show deviant uninstructed neural emotion regulation.

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This is reflected in residual problems in daily strategy use.

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RRMDD patients are capable to engage frontolimbic areas upon instructed reappraisal.

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Neural regulation capacity is related to inadequate rumination.

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Positive, next to negative, affect is highly relevant for understanding vulnerability.

The recurrent nature of Major Depressive Disorder (MDD) necessitates a better understanding of mechanisms facilitating relapse. MDD has often been associated with abnormal emotion regulation, underpinned by aberrant interactions between the prefrontal cortex and subcortical areas. We assessed whether neural regulation abnormalities remain after remission and relate to emotion regulation problems in daily life.

At the baseline measurement of a randomized controlled trial, an emotion regulation task was performed during fMRI scanning by 46 remitted recurrent (rrMDD) patients and 24 healthy controls. We assessed both fMRI peak activity and the temporal dynamics of the neural response during passive attendance and explicit regulation of positive and negative emotions. Furthermore, we assessed regulation strategy use in daily life using questionnaires, and attentional biases using a modified attentional dot-probe task.

RrMDD patients showed lower activation and different temporal dynamics in occipital, parietal, and prefrontal brain regions during passive attendance of emotional material compared to healthy controls. During explicit downregulation of negative emotions, no group differences were found. However, during explicit upregulation of positive emotions, rrMDD patients showed a different neural response over time in the insula. Behaviourally, rrMDD patients were characterized by dysfunctional regulation strategies in daily life. Within rrMDD patients, rumination was associated with activation within a limbic- prefrontal network.

After remission, immediate emotional processing seems unaffected, but regulatory abnormalities remain, especially uninstructed and in daily life. Abnormal insula activation during positive upregulation suggests decreased monitoring of positive emotions. The relation between inadequate rumination and brain activity during emotion regulation suggests that regulation of both positive and negative affect is important in understanding neurocognitive underpinnings of resilience.

When Mindfulness Becomes a Mental Health Risk: The Relevance of Emotion Regulation Difficulties and Need Frustration

Although a great deal of research has shown the positive effects of mindfulness on mental health, some studies have provided evidence that mindfulness can have negative consequences. However, not much is known about the conditions that can account for such negative effects. We examined the moderating roles of difficulties in emotion regulation and basic psychological need frustration in the relationship between mindfulness and psychological ill-being. Longitudinal data were collected at three points in time during a 6-month period from two adult samples in Turkey and Germany. Self-report measures were used to measure ill-being, mindfulness, emotion regulation difficulties, and need frustration. In the German sample, difficulties in emotion regulation and need frustration were related to ill-being, but there were no significant interactions. In the Turkish sample, need frustration predicted ill-being, and the interaction between mindfulness and difficulties in emotion regulation also predicted ill-being. Mindfulness was a protective factor among people with no major difficulties in emotion regulation, whereas it was a risk factor among those with emotion regulation difficulties. The findings suggest that the relationship between mindfulness and ill-being may be more complex than previously thought.

Network analysis of cognitive emotion regulation strategies and depressive symptoms in young adults after recent stressful events: The moderation of childhood maltreatment

BACKGROUND

The present study explored the interrelations between cognitive emotion regulation strategies (CERS) and depressive symptoms to better understand how young adults with childhood maltreatment (CM) are more prone to depression after recent stressful events.

METHODS

The sample consisted of 342 young adults (M = 19.51 years, range = 17-28 years, 64% female) who had experienced stressful events in the last six months. Network analysis was used to examine the interrelations between nine CERS and four depressive symptom clusters in exposed ('CM'; n = 182) and not exposed to CM groups ('non-CM'; n = 160).

RESULTS

We found that somatic symptoms, rumination, putting into perspective, and catastrophizing had high expected influence (EI) in the whole sample network. Global and local connectivity differed between the CM and non-CM groups. More specifically, the structure of the CM network had higher overall connectivity than the structure of the non-CM network. Considering local connectivity, depressed affect, rumination, positive refocusing, and putting into perspective had marginally significantly higher levels of EI in the CM network. We found some significant differences in partial correlations among CERS, such as stronger positive correlations between positive refocusing-catastrophizing, rumination-refocus on planning, and putting into perspective-blaming others in the CM group.

LIMITATIONS

This study was cross-sectional and limited by the use of retrospective self-report tools.

CONCLUSIONS

The findings shed light on the complex interrelations between CERS and depressive symptoms in the context of recent stressful events. Additionally, they highlight potential directions for population-based interventions.

Emotional distress and coping strategies in COVID-19 anxiety

The present study aims to identify psychological factors affected by the COVID-19 pandemic given the information we have about reactions during previous pandemics, which documented features of anxiety, depression and post-traumatic stress disorder. We investigated the relationship between health anxiety, symptoms of depression, anxiety and stress, and coping mechanisms in the general population and among students. The study was conducted on Romanian population (n = 759), aged between 18-70 years old (M = 33.24), general population (n = 485), and students (n = 274). The results showed that the general population is more anxious when confronted with the new virus compared to students (t (757) = 1.902, p < .05, p = .029). Following the analysis of the hierarchical regression, the results revealed that when controlling the health anxiety variable, a high level of anxiety symptoms and stress, and a low level of depression symptoms could predict anxiety for COVID-19 (R 2  = .070, F change (3, 754) = 16.759, p ˂ .001). Also, we found that maladaptive strategies are the ones which explain the relationship between health anxiety and COVID-19-related anxiety (95% CI = .011 - .057). The results of this study bring extra knowledge and shed new light on the psychological aspects of the current sanitary crisis and contribute to the understanding of the way people relate to this disease.

Depressive symptoms in youth with ADHD: the role of impairments in cognitive emotion regulation

Youth with attention-deficit/hyperactivity disorder (ADHD) are at increased risk to develop co-morbid depression. Identifying factors that contribute to depression risk may allow early intervention and prevention. Poor emotion regulation, which is common in adolescents, is a candidate risk factor. Impaired cognitive emotion regulation is a fundamental characteristic of depression and depression risk in the general population. However, little is known about cognitive emotion regulation in youth with ADHD and its link to depression and depression risk. Using explicit and implicit measures, this study assessed cognitive emotion regulation in youth with ADHD (N = 40) compared to demographically matched healthy controls (N = 40) and determined the association with depressive symptomatology. As explicit measure, we assessed the use of cognitive emotion regulation strategies via self-report. As implicit measure, performance in an ambiguous cue-conditioning task was assessed as indicator of affective bias in the processing of information. Compared to controls, patients reported more frequent use of maladaptive (i.e., self-blame, catastrophizing, and rumination) and less frequent use of adaptive (i.e., positive reappraisal) emotion regulation strategies. This pattern was associated with the severity of current depressive symptoms in patients. In the implicit measure of cognitive bias, there was no significant difference in response of patients and controls and no association with depression. Our findings point to depression-related alterations in the use of cognitive emotion regulation strategies in youth with ADHD. The study suggests those alterations as a candidate risk factor for ADHD-depression comorbidity that may be used for risk assessment and prevention strategies.

Transdiagnostic Mechanisms of Mental Health During the COVID-19 Pandemic on Adults and Families in Germany: Study Protocol of a Cross-Sectional and 1-Year Longitudinal Study

Background: Since the outbreak of COVID-19 pandemic, psychological distress is increased. Transdiagnostic mechanisms, including trauma, personality functioning, mentalizing and emotion regulation are considered relevant to the development and maintenance of mental health problems and therefore may play a role in individuals’ reactions to the pandemic.

Aim: To identify moderating and mediating factors associated with pandemic-related distress and mental health problems in adults and families, we aim to investigate the interactions of interpersonal trauma (childhood trauma and domestic violence), psychological capacities (personality functioning, mentalizing and emotion regulation) and pandemic-related adversity on psychological distress during the COVID-19 pandemic. Furthermore, we aim to investigate behavioral and cognitive consequences of the pandemic (e.g., media consumption, vaccination status, conspiracy beliefs).

Methods: Using an online-based cross-sectional and longitudinal design, we will investigate a sample of adult participants recruited via online platforms in German-speaking countries over the course of 1 year with four measurements points via self-report instruments (personality functioning: PID5BF +; mentalizing: MentS, PRFQ; emotion regulation: DERS-SF; mental health problems: PHQ-9, GAD-7; a composite pandemic-related stress score). Structural equation and multi-level modeling will be performed for data analyses.

Implications: This study will provide data on the moderating and mediating effects of trauma, personality functioning and mentalizing during the pandemic in a large community sample, particularly on vulnerable groups like families. Identifying transdiagnostic mechanisms of psychopathology in the course of a pandemic crisis may provide valuable insight for the development of pre- and intervention measures for potential psychological distress during and post the pandemic.

EffECTively Treating Depression: A Pilot Study Examining Manualized Group CBT as Follow-Up Treatment After ECT

Background: There is an urgent need for effective follow-up treatments after acute electroconvulsive therapy (ECT) in depressed patients. Preliminary evidence suggests psychotherapeutic interventions to be a feasible and efficacious follow-up treatment. However, there is a need for research on the long-term usefulness of such psychotherapeutic offers in a naturalistic setting that is more representative of routine clinical practice. Therefore, the aim of the current pilot study was to investigate the effects of a half-open continuous group cognitive behavioral therapy (CBT) with cognitive behavioral analysis system of psychotherapy elements as a follow-up treatment for all ECT patients, regardless of response status after ECT, on reducing depressive symptoms and promoting psychosocial functioning.

Method: Group CBT was designed to support patients during the often-difficult transition from inpatient to outpatient treatment. In a non-controlled pilot trial, patients were offered 15weekly sessions of manualized group CBT (called EffECTiv 2.0). The Montgomery-Åsberg Depression Rating Scale was assessed as primary outcome; the Beck Depression Inventory, WHO Quality of Life Questionnaire–BREF, and the Cognitive Emotion Regulation Questionnaire were assessed as secondary outcomes. Measurements took place before individual group start, after individual group end, and 6months after individual group end.

Results: During group CBT, Post-ECT symptom reduction was not only maintained but there was a tendency toward a further decrease in depression severity. This reduction could be sustained 6months after end of the group, regardless of response status after ECT treatment. Aspects of quality of life and emotion regulation strategies improved during group CBT, and these improvements were maintained 6months after the end of the group.

Conclusion: Even though the interpretability of the results is limited by the small sample and the non-controlled design, they indicate that manualized group CBT with cognitive behavioral analysis system of psychotherapy elements might pose a recommendable follow-up treatment option after acute ECT for depressed patients, regardless of response status after ECT. This approach might not only help to further reduce depressive symptoms and prevent relapse, but also promote long-term psychosocial functioning by improving emotion regulation strategies and psychological quality of life and thus could be considered as a valuable addition to clinical routine after future validation.

Emotion Regulation Difficulties and Depression Among Individuals With Dermatological and Body Dysmorphic Concerns

ABSTRACT

Existing literature demonstrates strong links between emotion regulation (ER) difficulties and depression. Although high rates of depression are observed among individuals with body dysmorphic disorder and skin disease, little is known about these co-occurring syndromes. To advance our understanding of a vulnerable population, this study examined facets of ER difficulties in relation to depression among adults with skin disease symptoms and body dysmorphic concerns (N = 97). Participants were recruited online and completed self-report measures. The overall hierarchical regression model accounted for 61.6% of the variance in depression. After controlling for anxiety and stress, ER difficulties added 9.9% unique variance. In particular, limited access to ER strategies was the only ER dimension significantly associated with depression. This study integrates divergent literatures and suggests the important role of ER difficulties in depression in this unique sample, thereby highlighting directions for future investigation.

BED-online: Acceptance and efficacy of an internet-based treatment for binge-eating disorder: A randomized clinical trial including waitlist conditions

Objective

Internet‐based guided self‐help (GSH) programs increase accessibility and utilization of evidence‐based treatments in binge‐eating disorder (BED). We evaluated acceptance and short as well as long‐term efficacy of our 8‐session internet‐based GSH program in a randomized clinical trial with an immediate treatment group, and two waitlist control groups, which differed with respect to whether patients received positive expectation induction during waiting or not.

Method

Sixty‐three patients (87% female, mean age 37.2 years) followed the eight‐session guided cognitive‐behavioural internet‐based program and three booster sessions in a randomized clinical trial design including an immediate treatment and two waitlist control conditions. Outcomes were treatment acceptance, number of weekly binge‐eating episodes, eating disorder pathology, depressiveness, and level of psychosocial functioning.

Results

Treatment satisfaction was high, even though 27% of all patients dropped out during the active treatment and 9.5% during the follow‐up period of 6 months. The treatment, in contrast to the waiting conditions, led to a significant reduction of weekly binge‐eating episodes from 3.4 to 1.7 with no apparent rebound effect during follow‐up. All other outcomes improved as well during active treatment. Email‐based positive expectation induction during waiting period prior to the treatment did not have an additional beneficial effect on the temporal course and thus treatment success, of binge episodes in this study.

Conclusion

This short internet‐based program was clearly accepted and highly effective regarding core features of BED. Dropout rates were higher in the active and lower in the follow‐up period. Positive expectations did not have an impact on treatment effects.

The present internet‐based guided self‐help program adds to the existing research regarding online treatment of binge‐eating disorder and is currently one of the two existing validated programs available in German language. It is based on an established cognitive‐behavioural treatment approach, shows high acceptance by patients and high efficacy after eight guided online sessions, thereby representing the shortest duration of currently evaluated treatments

During the internet‐based therapy, the number of weekly binge‐eating episodes, depressive symptoms, eating disorder pathology as well as impairments in psychosocial functioning all significantly decreased. These positive effects were maintained during follow‐up (6 months). Abstainer rate (no binge‐eating during last month) continued to increase during follow‐up with booster sessions

An email‐based pre‐treatment positive expectation induction did not alter the temporal course and thus treatment success, of binge episodes

Implementation of mentalization-based treatment in a day hospital program for eating disorders-A pilot study

OBJECTIVE

Aim of the pilot study was to evaluate the effectiveness of a day hospital program for eating disorders (EDs) after implementation of mentalization-based treatment (MBT), including a comparison to a historical matched control group.

METHOD

All consecutively admitted patients with an ED were included in a prospective, observational study over a period of 2 years. Main outcome criteria were eating and overall psychopathology. Furthermore, changes in the capacity to mentalize (reflective functioning [RF]), difficulties with affect regulation and interpersonal problems were assessed at admission, discharge and a three months follow-up.

RESULTS

Thirty-eight out of fourty patients could be included. The program led to significant reductions in eating and general pathology. There was significant improvement in RF, difficulties in emotion regulation and interpersonal functioning. However, there was no advantage in comparison to a matched control group (main outcomes). ED symptoms showed a slight renewed increase after discharge, while body mass index further increased. RF change was predictive of change in overall psychopathology, but not ED symptoms. Drop-out rate was 13.2%.

CONCLUSION

The program showed no advantage in comparison to a historical control group concerning a reduction in eating and overall psychopathology. However, it was associated with low drop-out rates, and changes which MBT targets: An increase in RF and a reduction of interpersonal problems as well as difficulties in emotion regulation.

Suppression and acceptance in unipolar depression: Short-term and long-term effects on emotional responding

OBJECTIVES

Transdiagnostic treatments increasingly include emotion regulation training focused on use of emotional suppression and acceptance. Despite the frequent use of these treatments in depression, little is known about the effects of these strategies in this population.

DESIGN

An experimental study.

METHODS

Eighty Veterans with unipolar depression participated in a study examining effects of these strategies on emotional responding (subjective, behavioural, and physiological). Physiological measures included: heart rate (HR), respiration (Resp), skin conductance (SC), and corrugator electromyography. On Day 1, participants were randomised to one of three conditions (acceptance, suppression, or control) and underwent an autobiographical sad mood induction. On Day 2, participants underwent a similar mood induction one week later.

RESULTS

The suppression group demonstrated reduced physiological reactivity (Resp and SC) on Day 1. However, the suppression group reported decreased positive affect on Day 2.

CONCLUSIONS

Results support short-term effectiveness and longer term costs from suppression use among depressed individuals. Findings may inform application of transdiagnostic emotion regulation treatments and suggest suppression functions differently in depressed versus other clinical populations.

Affective factors explaining the association between depressive functioning and alcohol outcomes among college students

Rates of co-occurring depression and alcohol use are higher among college students than in the general population. Further research is needed to illuminate how the mechanisms with which individuals process negative emotions may clarify the link between depressive symptoms and drinking. Objective: To assess how three potential mediators representing affective functioning (ie, need for affect, distress tolerance, emotion regulation) explain the relationship between depressive symptoms and alcohol use (ie, quantity and problems). Participants: The sample consisted of 227 college student heavy drinkers. Methods: Participants completed computerized self-report surveys in Fall 2016. Results: Path analyses revealed need for affect mediated the association between depressive symptoms and alcohol quantity, while emotion regulation mediated the relationship between depressive symptoms and alcohol-related problems. Conclusions: Findings highlight the importance of various affective functioning mechanisms to the depressive symptom-drinking link. Future research could target these mechanisms in college interventions for co-occurring mood symptoms and alcohol use.

Can Better Emotion Regulation Protect Against Interpersonal Violence in Homeless Youth Social Networks?

Homeless youth experience all types of violence at higher rates than their housed counterparts. This is typically the result of many contributing factors including childhood experiences of trauma, subsistence survival strategies, and exposure to perpetrators while living on the streets. Reducing violence in the lives of homeless youth is imperative and can contribute to a young person's ability to safely and successfully exit the streets and lead a long and productive life in society. However, developing public health and social interventions to reduce violence in adolescent and young adult populations is difficult due to the complex interplay of extrinsic and intrinsic drivers of this phenomenon. Los Angeles area homeless youth (N = 366) were asked questions regarding recent violence experiences, emotion regulation, and their social network. Multivariable logistic regressions tested the overall effect of emotion regulation on violence, controlling for age, gender, race, sexual identity, experience of childhood abuse, and data collection site. In this sample, 56% of youth endorsed fighting in the previous year, and those who reported more difficulties with emotion regulation were significantly more likely to fight. In addition, youth who scored below the mean on difficulties with regulation and belonged to networks characterized by low-difficulty peers were 60% less likely to report fighting. Emotion regulation skills represent a malleable target for intervention that may contribute to reduced propensity for violence in this population. Implications for network-based interventions to improve individual emotion regulation and reduce overall violence among homeless youth and other at-risk populations are discussed.

Efficacy of a Specialized Group Intervention for Compulsive Exercise in Inpatients with Anorexia Nervosa: A Randomized Controlled Trial

INTRODUCTION

Treatment of compulsive exercise is recognized as a key unmet challenge in the treatment of anorexia nervosa (AN). To address this challenge, we developed the manualized group intervention "healthy exercise behavior" (HEB). This study evaluates the efficacy of HEB for the reduction of compulsive exercise as add-on to routine inpatient treatment (treatment as usual [TAU]) in a randomized controlled trial.

METHODS

Two hundred and seven adolescent and adult female inpatients with (atypical) AN were randomly allocated to TAU or to additional participation in HEB (TAU + HEB). HEB integrates elements of exercise-based therapy into a cognitive-behavioral approach. Assessments took place at admission, pre-intervention, post-intervention, discharge, and 6 months follow-up. Primary outcome was the severity of compulsive exercise assessed by the Commitment to Exercise Scale between pre- and post-intervention; secondary outcomes were additional aspects of compulsive exercise, assessed by the Compulsive Exercise Test, weight gain, eating disorder and general psychopathology, and emotion regulation.

RESULTS

In intention-to-treat analysis for the primary outcome, the TAU + HEB group showed significantly stronger reductions in the severity of compulsive exercise compared to the TAU group (z = -2.81; p = 0.005; effect size [ES] = -0.3). We also found significantly stronger reductions from admission to discharge (z= 2.62; p = 0.009; ES = -0.43), and from admission to follow-up (z = 2.1; p = 0.035; ES = -0.39). Regarding secondary outcomes, we found significant group differences between pre- and post-intervention in additional aspects of compulsive exercise (z = -2.55; p = 0.011; ES = -0.27). We did not find significant differences regarding weight gain, eating disorder and general psychopathology, and emotion regulation.

CONCLUSIONS

Our intervention proved efficacious in reducing compulsive exercise in inpatients with (atypical) AN.

Emotional awareness, affective dysregulation, and bipolar spectrum psychopathology: A path analysis

Affective dysregulation is present in those with subsyndromal symptoms of hypomania and mania and prospectively predicts the development of bipolar spectrum disorders. A crucial, understudied area related to the experience and regulation of emotion in this population is emotional awareness - emotional clarity (Clarity) and attention to emotion (Attention). We examined whether scores on the Hypomanic Personality Scale (HPS) were associated with deficits in emotional awareness and whether these deficits were associated with heightened intensity and instability of negative (NA) and positive affect (PA). Young adults (n=233), oversampled for high HPS scores completed self-reports and 14 days of experience sampling assessing high and low arousal NA and PA. HPS scores were associated with low Clarity and unassociated with Attention. High HPS scores were associated with greater high and low arousal NA intensity and instability only for those at low and mean levels of Attention. In contrast, there was a significant indirect association between HPS scores and intensity of high and low arousal NA and PA, as well as instability of high arousal NA, through low Clarity. Results highlighted that individual differences exist in the extent to which facets of emotional awareness differentially link scores on the HPS to emotional outcomes.

[Treatment Evaluation in Inpatient Psychiatry: Transdiagnostic Factors as Correlates of Treatment Outcome - Implications for Clinical Practice and for Effectiveness Research]

AIM

An inpatient psychiatric-psychotherapeutic treatment was evaluated in a naturalistic setting (effectiveness research). Transdiagnostic factors were examined as correlates of treatment outcome.

METHODS

Self-report questionnaires were administered at the beginning and the end of the inpatient treatment. The sample (N = 378) consisted of women and men (16-80 years, M = 40.4, SD = 15.8) with primary diagnoses of depressive, anxiety or eating disorders. The average treatment duration was 8.2 weeks (SD = 3.8). Primary outcome variables were severity of symptoms and level of psychosocial functioning. As transdiagnostic correlates, self-esteem, self-efficacy, and emotion regulation were included in the regression analyses.

RESULTS

The change in transdiagnostic factors explained a significant proportion of the treatment outcome (explained variance: 8-27 % self-efficacy, 23-42 % self-esteem, 10-26 % emotion regulation).

DISCUSSION/CONCLUSION

The present study shows that the evaluation of a treatment in a naturalistic clinical setting is feasible. Transdiagnostic factors explained a substantial part of the statistical variance in treatment outcome across all disorders. Even if the present study design does not allow conclusions about causality, the results underline the relevance of transdiagnostic trainings (e. g., in emotion regulation) to improve effectiveness of treatment approaches.

Mind Your Goals, Mind Your Emotions: Mechanisms Explaining the Relation Between Dispositional Mindfulness and Action Crises

Action crises describe the intra-psychic conflicts people face when deliberating whether to continue pursuing or to give up a goal for which difficulties keep accumulating. Action crises lead to negative consequences such as elevated distress and depression. Less is known about their predictors. We propose mindfulness as a negative predictor of action crises because mindful people should set more autonomous goals and better regulate their emotions. Three prospective studies examined the relation between mindfulness and action crises and explored goal motivation and emotion regulation as mediators (Study 1, N = 137 students, mean age 22; Study 2, N = 79 students, mean age 24.27; Study 3, N = 236 workers, mean age 40.71). Results showed that mindfulness predicts action crises over time and that this relation is mediated by goal motivation and emotion regulation. We discuss how mindfulness can affect action crises in the phases of the Rubicon Model of goal pursuit.

A pilot investigation of emotional regulation difficulties and mindfulness-based strategies in manic and remitted bipolar I disorder and major depressive disorder

Background

Both bipolar disorder and major depressive disorder are characterized by difficulties in emotion regulation. Little is known about which specific emotion regulatory patterns may be transdiagnostic versus disorder specific, and how such patterns change as a function of current mood states.

Methods

This preliminary investigation examined specific patterns of self-reported trait emotion regulation difficulties and mindfulness-based regulations strategies across four groups: remitted adults with bipolar I disorder (BD-remitted; n = 32), currently manic adults with bipolar I disorder (BD-manic; n = 19), remitted adults with major depressive disorder (MDD-remitted; n = 32), and healthy controls (CTL; n = 30).

Results

All three clinical groups reported significantly greater difficulties with emotion regulation and decreased overall mindfulness-based strategies.

Conclusions

These results suggest that increased emotion regulation difficulties, decreased mindfulness, and increased emotion-driven impulsivity may be transdiagnostic across mood disorders and states, and that impulsivity may be particularly impaired during periods of mania.

Anger and aggressiveness in obsessive-compulsive disorder (OCD) and the mediating role of responsibility, non-acceptance of emotions, and social desirability

According to psychodynamic and cognitive models of obsessive-compulsive disorder (OCD), anger and aggression play an important role in the development and maintenance of the disorder. (Sub-) clinical samples with OCD have reported higher anger and anger suppression. Patients with checking-related symptoms of OCD showed a less aggressive self-concept as assessed by an Implicit Association Test (IAT). This study assessed anger and aggressiveness self-concepts in OCD as well as possible mediators of the link between OCD and aggressiveness. A total of 48 patients with OCD and 45 healthy controls were included. Measures included the State-Trait Anger Expression Inventory-II and an aggressiveness self-concept IAT (Agg-IAT). An inflated sense of responsibility, non-acceptance of emotions, and social desirability were tested as mediators. As expected, patients with OCD reported higher trait anger and anger suppression compared to healthy controls. Contrary to hypotheses, the aggressiveness self-concept (Agg-IAT) did not differ between groups. The inflated sense of responsibility mediated the relationship between group and anger suppression. Non-acceptance of negative emotions mediated the relationship between group and trait anger, as well as anger suppression. However, comorbidities and medication may account for some effect in anger suppression. Elevated trait anger and anger suppression in OCD patients could be explained by dysfunctional beliefs or maladaptive emotion regulation strategies. Emotion regulation therapy might help to enhance awareness and acceptance of emotions and possibly improve treatment outcomes.

The mediating effect of difficulties in emotion regulation on the association between childhood maltreatment and borderline personality disorder

BACKGROUND

Childhood maltreatment and difficulties in emotion regulation are common in patients with Borderline Personality Disorder (BPD) and Depressive Disorders (DD).

OBJECTIVE

This study examines differences between patients with BPD and patients with DD, regarding childhood maltreatment and difficulties in emotion regulation as well as the mediating effect of different aspects of emotion regulation deficits on the association between childhood maltreatment and BPD-symptoms.

METHOD

A total of 305 participants, 177 with BPD and 128 with DD completed an assessment including the Childhood Trauma Questionnaire (CTQ), the Emotion Regulation Scale (DERS), the Brief Symptom Inventory (BSI), and the Structured Clinical Interview for DSM-IV (SCID). Data was analyzed using multiple analyses of variances and mediation analyses.

RESULTS

Patients with BPD reported more childhood maltreatment and more difficulties in emotion regulation than patients with DD. When general symptom severity, age, and gender were included in the analysis as covariates only group differences regarding 'impulse control difficulties' (F(1,299) = 38.97, p < .001, η_p² = .115), 'limited access to emotion regulation strategies' (F(1,299) = 4.66, p = .032, η_p² = .015), and 'lack of emotional clarity' (F(1,299) = 9.38, p = .002, η_p² = .030) remained statistically significant. A mediation analysis, including above-mentioned covariates, indicated an association between emotional abuse and BPD-symptoms, which was mediated by difficulties in emotion regulation (indirect effect B = .012, 95% CI [.001; .031], R² = .429). Subscale analyses revealed 'impulse control difficulties' as the aspect of difficulties in emotion regulation that has the greatest impact on this association (B = .021, 95% CI [.003; .045]).

CONCLUSIONS

Patients with BPD display more childhood maltreatment and difficulties in emotion regulation than patients with DD. Difficulties in emotion regulation, especially difficulties in impulse control, seem to play an important role in the association between childhood emotional abuse and BPD-symptoms.

REMOTION Blended Transdiagnostic Intervention for Symptom Reduction and Improvement of Emotion Regulation in an Outpatient Psychotherapeutic Setting: Protocol for a Pilot Randomized Controlled Trial

BACKGROUND

Emotion regulation has been identified as an important transdiagnostic factor relevant to the treatment of mental health disorders. Many empirically validated psychotherapeutic treatments incorporate elements targeting emotion regulation. Most of these treatment approaches are conceptualized as standard face-to-face treatments not as blended treatments, which include an internet-based intervention.

OBJECTIVE

The aim of this study is to examine, for the first time, a new internet-based intervention-REMOTION-that will be provided transdiagnostically, as an add-on to psychotherapy, to provide a blended treatment format.

METHODS

A total of 70 participants will be assigned (1:1 allocation ratio) to either the intervention group (REMOTION + psychotherapy) or the treatment-as-usual group that receives psychotherapy alone. To maximize external validity, a typical outpatient treatment sample of patients diagnosed with a range of disorders such as depression, anxiety disorders, and adjustment disorder will be recruited from a university outpatient clinic. Patients with bipolar disorder, psychotic disorders, or acute suicidality will be excluded from the study. The feasibility and potential effectiveness of the intervention will be examined by assessing data at baseline, 6 weeks (post), and 12 weeks (follow-up). The primary outcome is general symptom severity, assessed with the Brief Symptom Inventory. Secondary outcomes are emotion regulation, depressive symptoms, anxiety symptoms, health related quality of life, well-being, and a variety of feasibility parameters. Quantitative data will be analyzed on an intention-to-treat basis.

RESULTS

Participant recruitment and data collection started in February 2020, and as of November 2020, are ongoing. Results for the study are expected in 2022.

CONCLUSIONS

This pilot randomized controlled trial will inform future studies using transdiagnostic blended treatment.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04262726; http://clinicaltrials.gov/ct2/show/NCT04262726.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/20936.

Variability in emotion regulation strategy use is negatively associated with depressive symptoms

Variability in the emotion regulation (ER) strategies one uses throughout daily life has been suggested to reflect adaptive ER ability and to act as a protective factor in mental health. Moreover, psychological inflexibility and persistent negative affect (or affective inertia) are key features of depression and other forms of mental illness and are often further exacerbated by rigid or overly passive regulatory behaviours. The current study investigated the hypothesis that ER variability might serve as a protective factor against depressive symptoms and affective inertia. Using experience-sampling (N = 213), we tested whether two indictors of ER variability (between- and within-strategy SDs) were related to depressive symptoms and affective inertia. We found that people with higher between-strategy variability and within-strategy variability (specifically for reappraisal and distraction) reported fewer depressive symptoms. Both within- and between-strategy variability were negatively related to negative affective inertia. Between-strategy variability and negative affective inertia had unique effects on depression, when used as simultaneous predictors. Altogether, this study provides further evidence for the utility of ER as a factor buffering against depressive symptoms and particularly for the use of variable ER strategies.

The role of emotion regulation as a mediator between early life stress and posttraumatic stress disorder, depression and anxiety in Syrian refugees

Early life stress is an important factor in later psychopathology, including symptoms of posttraumatic stress disorder (PTSD), depression, and anxiety. The purpose of the present study was to investigate the effect of early life stress on psychiatric symptoms within a sample of Syrian refugees. In this model, the use of cognitive emotion regulation strategies was assessed as a potential mediator of the relationship between early life stress and current symptoms of PTSD, depression, and anxiety. Bootstrap analyses were generated to test the indirect effect of emotion regulation (Cognitive Emotion Regulation Questionnaire) on the relationship between early life stress (Childhood Trauma Questionnaire), PTSD (Harvard Trauma Questionnaire), depressive (PHQ-9) and anxiety (GAD-7) symptoms in eighty-nine Syrian refugees resided in Germany (n = 49) and Jordan (n = 40). The indirect effect of maladaptive strategies was significant between early life stress and psychopathology, whereas the mediation effect of adaptive strategies was not significant. The findings provide an evidence that emotional dysregulation is an underlying factor affecting psychological symptoms in refugees with adverse childhood experiences. These results suggest targeting cognitive emotion regulation in prospective prevention and treatment strategies.

The psychometric properties of the cognitive emotion regulation questionnaire (CERQ) in a clinical sample of adults with recurrent depression

BACKGROUND

Affective dysregulation is central to depression. However, emotion regulation (ER) tendencies in depression remain poorly understood. It is critical, therefore, to validate measures of habitual ER in clinical populations. The current study aimed to validate the Cognitive Emotion Regulation Questionnaire (CERQ) in a sample of individuals with a history of recurrent depression who are currently in remission.

METHOD

The CERQ measures ER tendencies with 36 self-report items that are divided into nine subscales. Each subscale is purported to assess one of five adaptive and four maladaptive ER strategies. The CERQ was administered to 476 adults (mean age = 46.76 years; 75% female) that were currently in remission with a history of recurrent depression, who were recruited from primary care settings. We first investigated the CERQ's nine factor structure, internal consistency, convergent and criterion validity.

RESULTS

The nine-factor structure did not fit the CERQ structure in a sample of individuals with recurrent depression and convergent validity was poor. Instead, a five-factor structure fit the data best and showed acceptable convergent and criterion validity.

LIMITATIONS

The generalisability of the findings may be limited due to relative lack of diversity in terms of gender and ethnicity of the sample.

CONCLUSION

These results suggest that the taxonomic structure of the CERQ does not fit emotion regulation patterns in adults with a history of depression. These findings highlight the importance of validating measures in clinical samples.

New Perspectives on Emotional Processing in People with Symptomatic Huntington's Disease: Impaired Emotion Regulation and Recognition of Emotional Body Language†

OBJECTIVE

Emotion regulation and emotional body language (EBL) recognition represent two fundamental components of emotional processing that have recently seen a considerable surge in research interest, in part due to the role they play in optimizing mental health. This appears to be particularly true for clinical conditions that can profoundly affect emotional functioning. Among these is Huntington's disease (HD), a neurodegenerative disorder that is associated with several psychological difficulties and cognitive impairments, including well-established deficits in facial emotion recognition. However, although the theoretical case for impairments is strong, the current evidence in HD on other components such as emotion regulation and EBL recognition is sparse.

METHOD

In this study, it was hypothesized that emotion regulation and recognition of EBL are impaired in people with symptomatic HD, and that these impairments significantly and positively correlate with each other. A between-subjects design was adopted to compare 13 people with symptomatic HD with 12 non-affected controls matched for age and education.

RESULTS

The results showed that emotion regulation and EBL recognition were significantly impaired in individuals with HD. Moreover, a significant positive correlation was observed between facial and EBL recognition impairments, whereas EBL performance was negatively related to the disease stage. However, emotion regulation and recognition performances were not significantly correlated.

CONCLUSIONS

This investigation represents the first evidence of a deficit of emotion regulation and EBL recognition in individuals with HD. The clinical implications of these findings are explored, and indications for future research are proposed.

Facial Emotion Recognition Abilities in Women Experiencing Eating Disorders

OBJECTIVE

Impairments in facial emotion recognition are an underlying factor of deficits in emotion regulation and interpersonal difficulties in mental disorders and are evident in eating disorders (EDs).

METHODS

We used a computerized psychophysical paradigm to manipulate parametrically the quantity of signal in facial expressions of emotion (QUEST threshold seeking algorithm). This was used to measure emotion recognition in 308 adult women (anorexia nervosa [n = 61], bulimia nervosa [n = 58], healthy controls [n = 130], and mixed mental disorders [mixed, n = 59]). The M (SD) age was 22.84 (3.90) years. The aims were to establish recognition thresholds defining how much information a person needs to recognize a facial emotion expression and to identify deficits in EDs compared with healthy and clinical controls. The stimuli included six basic emotion expressions (fear, anger, disgust, happiness, sadness, surprise), plus a neutral expression.

RESULTS

Happiness was discriminated at the lowest, fear at the highest threshold by all groups. There were no differences regarding thresholds between groups, except for the mixed and the bulimia nervosa group with respect to the expression of disgust (F(3,302) = 5.97, p = .001, η = .056). Emotional clarity, ED pathology, and depressive symptoms did not predict performance (RChange ≤ .010, F(1,305) ≤ 5.74, p ≥ .079). The confusion matrix did not reveal specific biases in either group.

CONCLUSIONS

Overall, within-subject effects were as expected, whereas between-subject effects were marginal and psychopathology did not influence emotion recognition. Facial emotion recognition abilities in women experiencing EDs compared with women experiencing mixed mental disorders and healthy controls were similar. Although basic facial emotion recognition processes seems to be intact, dysfunctional aspects such as misinterpretation might be important in emotion regulation problems.

CLINICAL TRIAL REGISTRATION NUMBER

DRKS-ID: DRKS00005709.