Temperamental vulnerability to emotion dysregulation and risk for mental and physical health challenges

Linking a latent variable trait-state-occasion model of emotion regulation to cognitive control

Emotion dysregulation (ED) is a vulnerability factor for affective disorders that may originate from deficits in cognitive control (CC). Although measures of ED are often designed to assess trait-like tendencies, the extent to which such measures capture a time-varying (TV) or state-like construct versus a time-invariant (TI) or trait-like personality characteristic is unclear. The link between the TV and TI components of ED and CC is also unclear. In a 6-wave, 5-month longitudinal study, community participants (n = 1281) completed the Difficulties in Emotion Regulation Scale (DERS-16), a commonly used measure of ED and measures of CC. A latent variable (trait-state-occasion) model showed that the proportion of TI factor variance (.80) was greater than the TV factor variance (.19). Although TV factor stability was significant, the coefficients were small in magnitude. Furthermore, regression weights for the ED TI factor (average β  = -.62) were significant and larger than those for the TV factor (average β  = -.10) in predicting latent CC at each of the six-time points. These findings suggest that ED, as assessed by the DERS-16, is largely TI and this TI component is more strongly linked to CC than the TV component.

Systematic Review and Meta-Analysis: Early Irritability as a Transdiagnostic Neurodevelopmental Vulnerability to Later Mental Health Problems

OBJECTIVE

Irritability is a transdiagnostic indicator of child and adolescent internalizing and externalizing problems that is measurable from early life. The objective of this systematic review was to determine the strength of the association between irritability measured from 0 to 5 years and later internalizing and externalizing problems, to identify mediators and moderators of these relationships, and to explore whether the strength of the association varied according to irritability operationalization.

METHOD

Relevant studies published in peer-reviewed, English-language journals between the years 2000 and 2021 were sought from EMBASE, PsycINFO, MEDLINE, CINAHL, and ERIC. We synthesized studies that included a measure of irritability within the first 5 years of life and reported associations with later internalizing and/or externalizing problems. Methodological quality was assessed using the JBI-SUMARI Critical Appraisal Checklist.

RESULTS

Of 29,818 identified studies, 98 met inclusion criteria, with a total number of 932,229 participants. Meta-analysis was conducted on 70 studies (n = 831,913). Small, pooled associations were observed between infant irritability (0-12 months) and later internalizing (r = 0.14, 95% CI = 0.09, 0.20) and externalizing symptoms (r = 0.16, 95% CI = 0.11, 0.21) symptoms. For toddler/preschool irritability (13-60 months), small-to-moderate pooled associations were observed for internalizing (r = 0.21, 95% CI = 0.14, 0.28) and externalizing (r = 0.24, 95% CI = 0.18, 0.29) symptoms. These associations were not moderated by the lag between irritability and outcome assessment, although the strength of the associations varied according to irritability operationalization.

CONCLUSION

Early irritability is a consistent transdiagnostic predictor of internalizing and externalizing symptoms in childhood and adolescence. More work is required to understand how to accurately characterize irritability across this developmental period, and to understand mechanisms underlying the relationship between early irritability and later mental health problems.

DIVERSITY & INCLUSION STATEMENT

One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as living with a disability. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group.

STUDY PREREGISTRATION INFORMATION

Early irritability as a transdiagnostic neurodevelopmental vulnerability to early onset mental health problems: A systematic review; https://www.crd.york.ac.uk/prospero/; CRD42020214658.

Public health nurse-delivered cognitive behavioral therapy for postpartum depression: Assessing the effects of maternal treatment on infant emotion regulation

The effects of maternal postpartum depression (PPD) on offspring emotion regulation (ER) are particularly deleterious as difficulties with ER predict an increased risk of psychopathology. This study examined the impact of maternal participation in a public health nurse (PHN)-delivered group cognitive behavioral therapy (CBT) intervention on infant ER. Mothers/birthing parents were ≥ 18 years old with an Edinburgh Postnatal Depression Scale (EPDS) score ≥ 10, and infants were < 12 months. Between 2017 and 2020, 141 mother-infant dyads were randomized to experimental or control groups. Infant ER was measured at baseline (T1) and nine weeks later (T2) using two neurophysiological measures (frontal alpha asymmetry (FAA) and high-frequency heart rate variability (HF-HRV)), and informant-report of infant temperament. Mothers were a mean of 30.8 years old (SD = 4.7), 92.3% were married/ common-law, and infants were a mean of 5.4 months old (SD = 2.9) and 52.1% were male. A statistically significant group-by-time interaction was found to predict change in HF-HRV between T1 and T2 (F(1,68.3) = 4.04, p = .04), but no significant interaction predicted change in FAA or temperament. Results suggest that PHN-delivered group CBT for PPD may lead to adaptive changes in a neurophysiological marker of infant ER, highlighting the importance of early maternal intervention.

Infant emotion regulation in the context of stress: Effects of heart rate variability and temperament

Stressful events are inherently emotional. As a result, the ability to regulate emotions is critical in responding effectively to stressors. Differential abilities in the management of stress appear very early in life, compelling a need to better understand factors that may shape the capacity for emotion regulation (ER). Variations in both biologic and behavioural characteristics are thought to influence individual differences in ER development. We sought to determine the differential contributions of temperament and heart rate variability (HRV; an indicator of autonomic nervous system function) to infant resting state emotionality and emotional reactivity in response to a stressor at 6 months of age. Participants included 108 mother-infant dyads. Mothers completed a measure of infant temperament at 6 months postnatal. Mother and infant also participated in a standardized stressor (the Repeated Still Face Paradigm) at that time. Electrocardiographic data were acquired from the infant during a baseline resting state and throughout the stressor. Fast Fourier Transformation was used to analyse the high frequency (HF) domain of HRV, a measure of parasympathetic nervous system activity. Infant ER was measured via standardized coding of emotional distress behaviours from video-records at baseline and throughout the stressor. Severity of mothers' depressive symptoms was included as a covariate in analyses. Results of linear regression indicate that neither temperament nor HRV were associated significantly with an infant's emotional resting state, although a small effect size was found for the relationship between infant negative affectivity and greater emotional distress (β = 0.23, p = 0.08) prior to the stressor. Higher HF-HRV (suggesting parasympathetic dominance) was related to greater emotional distress in response to the stressor (β = 0.34, p = 0.009). This greater emotional reactivity may reflect a more robust capacity to mount an emotional response to the stressor when infants encounter it from a bedrock of parasympathetic activation. Findings may inform eventual markers for assessment of ER in infancy and areas for intervention to enhance infant management of emotions, especially during stressful events.

The biosocial correlates and predictors of emotion dysregulation in autistic adults compared to borderline personality disorder and nonclinical controls

BACKGROUND

Emotion dysregulation (ED) is a core symptom of borderline personality disorder (BPD), whose aetiology has been attributed to biosocial factors. In autism spectrum condition (ASC), although ED is prevalent and is associated with decreased well-being (e.g. self-harm, suicidality), it has been understudied, especially in adults. It is therefore crucial to further understand ED in autistic adults to improve its treatment. Our study investigates ED, its behavioural correlates (e.g. self-harm, suicidality) and biosocial predictors in autistic adults relative to BPD and nonclinical controls (NC).

METHODS

A total of 724 participants (ASC = 154; BPD = 111; NC = 459) completed 11 self-reported questionnaires assessing ED, ASC and BPD traits, co-occurring disorders, alexithymia, emotional vulnerability and invalidating experiences (e.g. bullying, autistic camouflaging). The occurrence of ED behavioural correlates (i.e. self-harm, history of suicide attempts, and psychiatric hospitalizations) was collected. In addition, between-groups analyses, linear regressions and machine learning (ML) models were used to identify ED predictors in each group.

RESULTS

ED and its behavioural correlates were higher in ASC compared to NC, but milder than in BPD. While gender did not predict ED scores, autistic women had increased risk factors to ED, including sexual abuse and camouflaging. Interestingly, BPD traits, emotional vulnerability and alexithymia strongly predicted ED scores across the groups. Using ML models, sensory sensitivity and autistic camouflaging were associated with ED in ASC, and ADHD symptoms with ED in BPD.

LIMITATIONS

ASC and BPD diagnoses were self-reported, which did not allow us to check their accuracy. Additionally, we did not explore the transactional and the moderating/mediating relationships between the different variables. Moreover, our research is cross-sectional and cannot draw conclusions regarding the direction and causality of relationships between ED and other clinical dimensions.

CONCLUSIONS

ED and its behavioural correlates are heightened in BPD compared to ASC and nonclinical controls. In the ASC group, there were no gender differences in ED, despite the heightened exposure of autistic women to ED risk factors. BPD traits, emotional vulnerability, and alexithymia are core to ED regardless of diagnosis. Although less central, sensory sensitivity and autistic camouflaging seem to be specific predictors of ED in autistic adults.

Associations between cortical thickness and parasympathetic nervous system functioning during middle childhood

Positive associations have been found between cortical thickness and measures of parasympathetic cardiac control (e.g., respiratory sinus arrhythmia, RSA) in adults, which may indicate mechanistic integration between neural and physiological indicators of stress regulation. However, it is unknown when in development this brain-body association arises and whether the direction of association and neuroanatomical localization vary across development. To investigate this, we collected structural magnetic resonance imaging and resting-state respiratory sinus arrhythmia data from children in middle childhood (N = 62, Mage  = 10.09, range: 8.28-12.14 years). Whole-brain and exploratory ROI analyses revealed positive associations between RSA and cortical thickness in four frontal and parietal clusters in the left hemisphere and one cluster in the right. Exploratory ROI analyses revealed a similar positive association between cortical thickness and RSA, with two regions surviving multiple comparison correction, including the inferior frontal orbital gyrus and the Sylvian fissure. Prior work has identified these cortical areas as part of the central autonomic network that supports integrative regulation of stress response (e.g., autonomic, endocrine, and behavioral) and emotional expression. Our results suggest that the association between cortical thickness and resting RSA is present in middle childhood and is similar to the associations seen during adulthood. Future studies should investigate associations between RSA and cortical thickness among young children and adolescents.

Potential applications of Schema Therapy in the treatment of adolescents with anorexia nervosa: a theoretical analysis

Purpose

The main purpose of the article is to present basic theoretical assumptions on Schema Therapy and its hypothetical application among adolescents suffering with anorexia nervosa.

Views

Anorexia nervosa is a very deadly mental disease, more frequently suffered by females than males, with the mean age of onset at approximately 14-15. Studies underline the relatively poor effectiveness of currently applied treatment methods and the need for new approaches that could be recommended for adolescent patients suffering with this disease. The results of studies conducted to date lead to the conclusion that Schema Therapy is a promising approach for this group. It is a transdiagnostic method of work that compiles elements known in other therapeutic approaches, aiming at an increase in the individual's awareness of their feelings and emotional needs, applied both in adolescent and adult groups of patients. Since the symptoms of eating disorders observed in adolescents are strongly connected with family systems it seems reasonable to use treatment techniques that rigorously address the unmet needs and rejected emotions of the individual.

Conclusions

Based on the data published so far it might be hypothesized that the techniques characteristic for Schema Therapy (e.g. imagery rescripting, chairwork, limited reparenting) could be eligible for use with adolescent patients with anorexia nervosa.They address unmet needs, rejected emotions, and early maladaptive schemas that are very frequent in patients with AN. Since the analysis presented provides only hypotheses and the discussion of theoretical aspects, empirical research in this area is needed.

The Relation between Cognitive and Emotional Processes in Children and Adolescents with Neurodevelopmental Disorders-A Meta-Analysis

BACKGROUND

Up to 80% of children with autism spectrum disorders (ASDs) have mental health issues-either emotional or behavioral problems. The underlying mechanisms are still unknown, even if emotional regulation (ER) is considered to play a major role in child and adolescent psychopathology. Several studies link the ability to regulate the intensity and quality of emotions with executive functioning. Therefore, we aimed to investigate the association between executive functions (EFs) and ER and affective problems in children with ASD.

METHODS

This meta-analysis is based on a literature search of peer-reviewed journals from the following databases: Scopus, ProQuest, Ebsco, Science Direct, Springer Link and Clarivate. We analyzed 15 studies that investigated the link between EF, ER or affective problems (APs) in children and adolescents with ASD aged between 2 and 18 y with ASD. To assess the effect size of the relationship between EF and ER, and EF and AP, 15 studies comprising 54 effect sizes were analyzed.

RESULTS

Our findings revealed a small effect size regarding the association between EF and ER, r = 0.331, p = 0.034, and a small effect size regarding the association between EF and AP, r = -0.213, p = 0.024. No significant moderators were found. The results are presented in regard to the two analyses developed, as well as a short review of the studies included in the meta-analysis.

CONCLUSION

Even if there are several limitations of this study, especially considering the small number of studies included, the results suggest that it is worth considering EF as an underlying mechanism for the appearance of emotional or behavioral problems in children with ASD. These findings have important implications for the development of ASD intervention plans, as well as for increasing awareness among specialists about the importance of executive functions in school adjustment and social functioning.

The impact of peer-delivered cognitive behavioral therapy for postpartum depression on infant emotion regulation

BACKGROUND

Postpartum depression (PPD) affects up to one in five and negatively affects mothers, birthing parents, and their infants. The impact of PPD exposure on infant emotion regulation (ER) may be particularly harmful given its associations with later psychiatric problems. It remains unclear if treating maternal PPD can improve infant ER.

OBJECTIVE

To examine the impact of a nine-week peer-delivered group cognitive behavioral therapy (CBT) intervention on infant ER assessed across physiological and behavioral levels.

METHODS

Seventy-three mother-infant dyads were enrolled in a randomized controlled trial from 2018 to 2020. Mothers/birthing parents were randomized to the experimental group or waitlist control group. Measures of infant ER were collected at baseline (T1) and nine weeks later (T2). Infant ER was assessed using two physiological measures (frontal alpha asymmetry (FAA) and High Frequency-Heart Rate Variability (HF-HRV)), and parental-report of infant temperament.

RESULTS

Experimental group infants displayed more adaptive changes in both physiological markers of infant ER from T1 to T2 (FAA (F(1,56) = 4.16, p = .046) and HF-HRV (F(1,28.1) = 5.57, p = .03)) than those in the waitlist control group. Despite improvements in maternal PPD, no differences were noted in infant temperament from T1 to T2.

LIMITATIONS

A limited sample size, potential lack of generalizability of our results to other populations, and an absence of long-term data collection.

CONCLUSIONS

A scalable intervention designed for those with PPD may be capable of adaptively improving infant ER. Replication in larger samples is needed to determine if maternal treatment can help disrupt the transmission of psychiatric risk from mothers/birthing parents to their infants.

Linehan's biosocial model applied to emotion dysregulation in autism: a narrative review of the literature and an illustrative case conceptualization

Emotion dysregulation (ED) is a transdiagnostic difficulty prevalent in autism spectrum condition (ASC). Importantly, recent research has suggested that ED is involved in self-harm and suicidality. Pre-existing models on the etiology of ED in ASC focus mainly on biological factors to ASC features, such as sensory sensitivities, poor flexibility, and sensitivity to change. However, although psychosocial factors seem to play a role in the emergence of ED in ASC as well (e.g., childhood maltreatment and camouflaging), there is a lack of a comprehensive model conceptualizing biosocial factors involved in ED in autistic people. Linehan's biosocial model (1993) is one of the leading etiological models of ED in borderline personality disorder (BPD). It conceptualizes ED as emerging from transactions between a pre-existing emotional vulnerability in the child and an invalidating developmental environment. Beyond its clinical relevance, Linehan's model has gathered empirical evidence supporting its pertinence in BPD and in other psychiatric disorders. Although ASC and BPD are two distinct diagnoses, because they may share ED, Linehan's biosocial model might be useful for understanding the development of ED in ASC. Hence, this article aims to provide an application and extension of Linehan's model to conceptualize ED in ASC. To do so, we conducted a narrative review of the literature on ED and its underlying factors in ASC from a developmental perspective. To investigate the pertinence of the biosocial model applied to ED in autistic people, we were interested on data on (i) ED and its behavioral correlates in ASC, in relation to the biosocial model, (ii) the potential biological and psychosocial correlates of ED in ASC and (iii) the overlapping difficulties in ASC and BPD. Finally, to assess the pertinence of the model, we applied it to the case of an autistic woman presenting with ED and suicidal behaviors. Our review and application to the case of an autistic woman suggest that ED in ASC encompasses factors related to both biological and psychosocial risk factors as conceptualized in the BPD framework, although in both domains ASC-specific factors might be involved.

Systematic Review: Questionnaire-Based Measurement of Emotion Dysregulation in Children and Adolescents

OBJECTIVE

Emotion dysregulation, understood as a critical transdiagnostic factor in the etiology and maintenance of psychopathology, is among the most common reasons youth are referred for psychiatric care. The present systematic review examined 2 decades of questionnaires used to assess emotion (dys)regulation in youth.

METHOD

Using "emotion (dys)regulation," PsycINFO, PubMed, and Web of Science were searched for empirical, peer-reviewed journal studies published before May 2021 in clinical and/or nonclinical youth. A total of 510 studies met selection criteria and were included.

RESULTS

Across the literature, 115 distinct self-, parent-, or other informant-reported measures of emotion (dys)regulation were used in cross-sectional (67.1%), longitudinal (22.4%), intervention (9.0%), and mixed design (1.6%) studies. Out of 115 different questionnaires, a subset of 5 measures of emotion (dys)regulation were used in most of the literature (ie, 59.6% of studies). Moreover, reviewed studies examined emotion (dys)regulation in more than 20 distinct clinical groups, further supporting emotion dysregulation as a transdiagnostic construct.

CONCLUSION

Numerous themes emerged. Broadly, measures differed in their ability to capture internal vs external components of emotion dysregulation, the use of adaptive vs maladaptive responses, and subjective experiences more broadly vs particular affective states. These findings serve to guide researchers and clinicians in selecting appropriate measurement tools for assessing specific domains of child and adolescent emotion dysregulation.

Associations of household tobacco smoking status with childhood temperament among U.S. preschool-aged children

BACKGROUND

This study investigated the association between household tobacco smoking status and temperament among U.S. 3-5-year-olds.

METHODS

A secondary analysis of 2019-2020 National Survey of Children's Health data (N = 11,100) was conducted. Temperament dimensions of effortful control (characterized by attention focusing), negative affectivity (characterized by anger and soothability), and surgency (characterized by activity level and shyness) were assessed. Weighted ordinal regression models were conducted while adjusting for child and family covariates.

RESULTS

Approximately 13 % of children lived with smokers. Compared to children who did not live with smokers, children living with smokers displayed behaviors of poorer effortful control and were more likely to be easily distracted (AOR = 1.59, 95%CI = 1.24-2.04) and less likely to keep working on tasks until finished (AOR = 0.56, 95%CI = 0.44-0.71). Children living with smokers displayed behaviors of greater negative affectivity and were at increased odds of being angry or anxious when transitioning between activities (AOR = 1.50, 95%CI = 1.13-1.98) and losing their temper when things did not go their way (AOR = 1.53, 95%CI = 1.20-1.96), and were at decreased odds of calming down quickly when excited (AOR = 0.54, 95%CI = 0.42-0.70). Children living with smokers displayed behaviors of poorer surgency and were less likely to play well with others (AOR = 0.58, 95%CI = 0.45-0.76) and sit still compared to same-aged children (AOR = 0.56, 95%CI = 0.44-0.71).

LIMITATIONS

The NSCH uses a cross-sectional survey design; longitudinal associations and objective measures could not be assessed. However, the NSCH is nationally representative and results are generalizable to U.S. 3-5-year-olds.

CONCLUSIONS

Findings suggest household tobacco smoking influences temperament in early childhood. Results signify the need to promote household tobacco cessation.

Preliminary findings of emotion regulation in 12-month-old infants of mothers enrolled in a randomized controlled trial assessing a nutrition + exercise intervention

Improved offspring emotion regulation (ER) has been associated with maternal intake of single nutrients or exercise during pregnancy but has not been examined in randomized trials. We investigated the impact of a maternal nutrition + exercise intervention during pregnancy on offspring ER at 12 months of age. Mothers in the Be Healthy In Pregnancy randomized controlled trial were randomly assigned to an individualized nutrition + exercise intervention plus usual care (UC) or UC alone (control group). A multimethod assessment of infant ER using parasympathetic nervous system function (high frequency heart rate variability [HF-HRV] and root mean square of successive differences [RMSSD]) as well as maternal reports of infant temperament (Infant Behavior Questionnaire- Revised short form) was completed with a subsample of infants of enrolled mothers (intervention = 9, control = 8). The trial was registered at www.clinicaltrials.gov (NCT01689961). We observed greater HF-HRV (M = 4.63, SD = 0.50, p = .04, ƞ² _p  = .25) and RMSSD (M = 24.25, SD = 6.15, p = .04, ƞ² _p  = .25) in infants of mothers in the intervention versus control group. Intervention group infants also had higher maternally rated surgency/extraversion (M = 5.54, SD = 0.38, p = .00, ƞ² _p  = .65) and regulation/orienting (M = 5.46, SD = 0.52, p = .02, ƞ² _p  = .81), and lower negative affectivity (M = 2.70, SD = 0.91, p = .03, ƞ² _p  = .52). These preliminary results suggest that pregnancy nutrition + exercise interventions could improve infant ER but these findings require replication in larger, more diverse samples.

Preschooler screen time and temperamental anger/frustration during the COVID-19 pandemic

BACKGROUND

In the context of increased media use and family distress during the pandemic, we examine whether preschooler screen time at age 3.5 contributes to later expressions of anger/frustration at 4.5, while also considering the inverse association.

METHODS

Data are from a cohort of 315 Canadian preschool-aged children during the COVID-19 pandemic. Parent-reported measures included child h/day of screen time and child temperamental anger/frustration, both measured at 3.5 and 4.5 years of age. Indicators of family distress include use of childcare and child sleep, family income, parenting stress, and parent education, marital and employment status. We also consider child sex as a control variable.

RESULTS

A crossed-lagged panel model revealed continuity in screen time between the ages of 3.5 and 4.5 (ß = 0.68) and temperamental anger/frustration from 3.5 to 4.5 (ß = 0.60). Child screen time at age 3.5 predicted increased proneness to anger/frustration at age 4.5 (ß = 0.14). Anger/frustration at age 3.5 did not predict screen time at age 4.5.

CONCLUSION

Our results suggest that preschooler screen time during the pandemic may have undermined the ability to regulate negative emotions, a key component of social and academic competence. Supporting parents in implementing healthy media habits post pandemic may benefit young children's development.

IMPACT

Key message: this study observes prospective bidirectional associations between preschoolers screen time and temperamental displays of anger or frustration during the COVID-19 pandemic. What does it add: we provide evidence that preschool screen time at age 3.5 prospectively contributes to the tendency to react in anger/frustration at age 4.5. In contrast, greater proneness to anger/frustration did not predict later exposure to screen time. What is the impact: health practitioners should enquire about media use habits during well-child visits to foster children's healthy development during the preschool years.

Persistence, Reward Dependence, and Sensitivity to Reward Are Associated With Unexpected Salience Response in Girls but Not in Adult Women: Implications for Psychiatric Vulnerabilities

BACKGROUND

Adolescence is a critical period for the development of not only personality but also psychopathology. These processes may be specific to sex, and brain reward circuits may have a role. Here, we studied how reward processing and temperament associations differ across adolescent and adult females.

METHODS

A total of 29 adolescent girls and 41 adult women completed temperament assessments and performed a classical taste conditioning paradigm during brain imaging. Data were analyzed for the dopamine-related prediction error response. In addition, unexpected stimulus receipt or omission and expected receipt response were also analyzed. Heat maps identified cortical-subcortical brain response associations.

RESULTS

Adolescents showed stronger prediction error and unexpected receipt and omission responses (partial η² = 0.063 to 0.166; p = .001 to .043) in insula, orbitofrontal cortex (OFC), and striatum than adults. Expected stimulus receipt response was similar between groups. In adolescents versus adults, persistence was more strongly positively related to prediction error (OFC, insula, striatum; Fisher's z = 1.704 to 3.008; p = .001 to .044) and unexpected stimulus receipt (OFC, insula; Fisher's z = 1.843 to 2.051; p = .014 to .033) and negatively with omission (OFC, insula, striatum; Fisher's z = -1.905 to -3.069; p = .001 to .028). Reward sensitivity and reward dependence correlated more positively with unexpected stimulus receipt and more negatively with stimulus omission response in adolescents. Adolescents showed significant correlations between the striatum and FC for unexpected stimulus receipt and omission that correlated with persistence but were absent in adults.

CONCLUSIONS

Associations between temperamental traits and brain reward response may provide neurotypical markers that contribute to developing adaptive or maladaptive behavior patterns when transitioning from adolescence to adulthood.

Emotion dysregulation and eating disorder outcome: Prediction, change and contribution of self-image

OBJECTIVES

Eating disorders (EDs) are severe disorders with unsatisfactory outcome. Emotion dysregulation and self-image are suggested maintenance factors; this study examined emotion dysregulation as potential predictor and/or mechanism of change in relation to ED outcome, and associations between change in emotion dysregulation and self-image in relation to outcome.

DESIGN

Registry data from initial and 1-year follow-up assessments for 307 patients with a wide range of EDs in specialized ED treatment were used.

METHODS

Initial and change (∆) in emotion dysregulation were examined as predictors of 1-year outcome. Direct and indirect associations between ∆emotion dysregulation and ∆self-image as either independent variable or mediator in relation to ∆ED psychopathology as dependent were also examined.

RESULTS

Higher initial emotion dysregulation was weakly associated with higher follow-up ED psychopathology, but not remission, while relative increase in emotion dysregulation was associated with both higher follow-up psychopathology and increased risk of still having a diagnosis. Change in emotion dysregulation primarily had an indirect effect (through change in self-image), while change in self-image had a direct effect, on change in ED psychopathology improvement (such that improvement in one was associated with improvement in the other).

CONCLUSIONS

Results identify emotion dysregulation as a potential mechanism of change in relation to ED outcome. However, this association was mainly mediated by change in self-image. Results indicate that, in order to improve emotion regulation as a means to reduce ED psychopathology, improving self-image is essential.

Reliability and validity of the Chinese version of the Brief Emotion and Regulation Beliefs Scale in Chinese nursing students

Background

Nursing students are experiencing complex learning environments and will experience complex work environments in future clinical work, which lead to emotional problems easily. However, one’s beliefs about controlling their emotions portend a series of vital psychological outcomes. So, it is especially important to search for suitable tools to assess the emotion and regulation beliefs of nursing students and give timely intervention to improve their physical and mental health. This study aimed to translate the American version of the Emotion and Regulation Beliefs Scale (ERBS) into Chinese, revise the original scale and form a simplified version, and assess the reliability and validity of the brief Chinese version in nursing students.

Methods

The study adopted a cross-sectional design and the multistage sampling design. The ERBS was translated into Chinese, and the reliability and validity of the Chinese version were tested in 980 nursing students.

Results

The content validity index was 0.920. Exploratory factor analysis supported a three-factor model for the Chinese version of Brief-ERBS, and confirmatory factor analysis indicated that the model fit the Brief-ERBS well. Furthermore, the three-factors model was obtained by using exploratory factor analysis, explaining 51.023% variance, and the communalities of the items ranged from 0.359 to 0.680. With modified confirmatory factor analysis, the fit indices were chi-square/degree of freedom (CMIN/DF) = 4.092, goodness of fit index (GFI) = 0.949, adjusted goodness of fit index (AGFI) = 0.927, comparative fit index (CFI) = 0.913, incremental fit index (IFI) = 0.914, Tucker Lewis index (TLI) = 0.908, root-mean-square error of approximation (RMSEA) = 0.061. The two-tailed independent samples t-test showed the scores of the top (50%) and low (50%) groups reached the level of significance (P < 0.001). A highly positive correlation between the Brief-ERBS total score and the ERBS total score was found (r = 0.972, P < 0.01). The Cronbach’s α coefficient of the scale was 0.798, the split-half reliability coefficient was 0.784, and the retest coefficient was 0.879.

Conclusion

The Chinese version of Brief-ERBS has good reliability and validity, and may be used for the beliefs about emotional management in Chinese nursing students.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-022-00992-1.

The Effects of Emotion Regulation Treatment on Disruptive Behavior Problems in Children: A Randomized Controlled Trial

Disruptive behavior problems are a frequent reason for children’s referrals to psychological services and can have negative effects on social and academic functioning. Most treatment programs involve parents as recipients and implementation of intervention programs in school is low. Deficits in emotion regulation have recently been implicated in the development of disruptive behavior disorders, making child directed early intervention programs focusing on increasing emotion regulation skills feasible. The purpose of this study was to assess the effects of Tuning Your Temper, a brief cognitive behavioral program for children with disruptive behavior problems, in a randomized controlled trial. A total of 125 children with disruptive behavior problems at school, aged 6–11 years old were randomized to either intervention or wait-list control condition. Treatment was conducted at school. Assessments included teacher and parent ratings on the Strengths and Difficulties Questionnaire (SDQ) and the Disruptive Behavior Rating Scale (DBRS) pre- and post-treatment and at 6-month follow-up. Results showed a significant reduction in behavior problems for the treatment condition on both measures and effects were maintained at 6-month follow-up. Results were more robust for teacher ratings, with medium to large effect sizes. Tuning Your Temper appears to be a promising early intervention program for children with disruptive behavior problems at school.

Preschool Temperament as a Factor of Risk and Protection for Later Childhood Psychopathology

BACKGROUND

Temperament might be considered as a risk factor as well as a resilience factor for later externalizing and internalizing disorders. Therefore, this study examines different dimensions of temperament in preschool age with regard to their predictive value for psychopathology later in childhood.

METHODS

A total of 76 patients (63.2% male) were assessed in a special psychiatric consultation for preschool age at measuring point time t1 (x = 4.2) and measuring point time t2 (x = 9.2). At t1, the Integrative Child Temperament Inventory (ICTI) was used for assessment. At t2, parents completed the Strengths and Difficulties Questionnaire SDQ. Multiple regression analyses were used to test if the temperament factors of the ICTI predicted clinical abnormalities in the SDQ subscales or total difficulties score.

RESULTS

SDQ total difficulties score as an indicator of total psychiatric disturbance in childhood appears to be good predicted by the temperament factor frustration/anger. Sensory sensitivity in preschoolers serves as a risk factor for later emotional symptoms, whereas high activity levels appear to prevent later emotional symptoms. Behavioral inhibition appears to protect against hyperactivity/inattention.

CONCLUSION

Our data suggests that preschool temperament contributes differently to the development of externalizing and internalizing problems in childhood. The temperament factor frustration/anger in preschool children might be a strong predictor of the general mental condition in childhood at nine years of age and can therefore be used as a target for prevention of psychopathology in children. On one hand, high sensory sensitivity can be a predictor to identify preschool children at risk for later emotional symptoms, on the other hand, activity level acts as a protective factor against later emotional symptoms. An increased level of behavioral inhibition might be protective against the development of hyperactivity/inattention symptoms. Overall, this study illustrates the complexity and ambiguity of temperament in child development.

Effects of the Parental Friendship Coaching Intervention on Parental Emotion Socialization of Children with ADHD

Parental emotion-related socialization behaviors shape children's socioemotional functioning and appear important for children with attention-deficit/hyperactivity disorder (ADHD). The Parental Friendship Coaching (PFC) intervention teaches parents to coach their children with ADHD in friendship skills, which includes managing emotions. We examined whether PFC, relative to psychoeducation and social support (Coping with ADHD through Relationships and Education; CARE), improved parental emotion-related socialization behaviors, child affect with a friend, and child social behaviors related to emotional difficulties. Participants were 172 families of children with ADHD (ages 6-11, 30% female), randomized to PFC or CARE. At baseline, children and their real-life friends interacted and their affect was coded. Parents coached their child in friendship skills before and after the child-friend interaction, and parents' praise, warmth, criticism, and discussion of emotion-related friendship strategies were coded. Parents and teachers reported children's withdrawn/depressed and aggressive behaviors. Results suggested that PFC (relative to CARE) led to parents providing more emotion strategies and praise at post-treatment and follow-up, and more warmth at follow-up, and to children showing less withdrawn/depressed behavior at follow-up. For bidirectional relationships from baseline to post-treatment, more parental warmth was associated with less child withdrawn/depressed behavior, and more parental criticism with more child aggression. More child withdrawn/depressed behavior and positive affect at post-treatment were associated with more parental criticism at follow-up. After corrections for multiple comparisons, only PFC effects on praise and emotion strategies at post-treatment, and praise and withdrawn/depressed behavior at follow-up, maintained. Implications are discussed for supporting socioemotional functioning in children with ADHD.

Targeted self-regulation interventions in low-income children: Clinical trial results and implications for health behavior change

Self-regulation, known as the ability to harness cognitive, emotional, and motivational resources to achieve goals, is hypothesized to contribute to health behaviors across the lifespan. Enhancing self-regulation early in life may increase positive health outcomes. During pre-adolescence, children assume increased autonomy in health behaviors (e.g., eating; physical activity), many of which involve self-regulation. This article presents results from a clinical trial (NCT03060863) that used a factorial design to test behavioral interventions designed to enhance self-regulation, specifically targeting executive functioning, emotion regulation, future-oriented thinking, and approach biases. Participants were 118 children (9-12 years of age, M = 10.2 years) who had a history of living in poverty. They were randomized to receive up to four interventions that were delivered via home visits. Self-regulation was assayed using behavioral tasks, observations, interviews, and parent- and child-report surveys. Results were that self-regulation targets were reliably assessed and that interventions were delivered with high fidelity. Intervention effect sizes were very small to moderate (d range = .02-.65, median = .14), and most were not statistically significant. Intercorrelation analyses indicated that associations between measures within each target varied based on the self-regulation target evaluated. Results are discussed with regard to the role of self-regulation-focused interventions in child health promotion. Implications of findings are reviewed for informing next steps in behavioral self-regulation interventions among children from low-income backgrounds.

Changes in infant emotion regulation following maternal cognitive behavioral therapy for postpartum depression

BACKGROUND

Exposure to maternal postpartum depression (PPD) increases the risk for emotion regulatory and psychiatric problems in offspring. This study aimed to determine if maternal cognitive behavioral therapy (CBT) for PPD improves infant emotion regulatory capacity.

METHODS

Participants were 40 infants of mothers with a primary diagnosis of major depressive disorder matched 1:1-40 healthy control infants of nondepressed mothers on infant age, sex, and socioeconomic status. Mothers with PPD received nine weeks of group CBT. Dyads were tested at two time points. Visit 1 occurred following the first CBT session (baseline visit for control infants). Visit 2 took place after CBT (nine weeks post-baseline for controls). At both visits, infant emotion regulation was assessed using resting-state frontal electroencephalography alpha asymmetry (FAA), heart rate variability (HRV), and maternal and partner ratings of orientation or regulation behaviors (infant behavior questionnaire-revised [short form]). Changes in maternal characteristics (depression, bonding, and emotion regulation) from pretreatment to posttreatment were examined to determine if they explained infant changes.

RESULTS

At Visit 1, infants of women with PPD exhibited poorer emotion regulation relative to the healthy control infants. At Visit 2, following maternal PPD treatment, infants exhibited improved emotion regulation (shifted from right to left FAA [p = .01, d = 0.60], increased HRV [p = .003, d = 0.56], mother [p = .015, d = 0.29] and partner [p = .049, d = 0.35] reported orientation or regulation behaviors) such that they no longer differed from the healthy control infants. Changes in maternal characteristics did not appear to account for these changes.

CONCLUSION

Treating PPD may promote adaptive changes in physiological and behavioral systems underlying infant emotion regulation.

Moving the dial on prenatal stress mechanisms of neurodevelopmental vulnerability to mental health problems: A personalized prevention proof of concept

Prenatal stress exposure increases vulnerability to virtually all forms of psychopathology. Based on this robust evidence base, we propose a "Mental Health, Earlier" paradigm shift for prenatal stress research, which moves from the documentation of stress-related outcomes to their prevention, with a focus on infant neurodevelopmental indicators of vulnerability to subsequent mental health problems. Achieving this requires an expansive team science approach. As an exemplar, we introduce the Promoting Healthy Brain Project (PHBP), a randomized trial testing the impact of the Wellness-4-2 personalized prenatal stress-reduction intervention on stress-related alterations in infant neurodevelopmental trajectories in the first year of life. Wellness-4-2 utilizes bio-integrated stress monitoring for just-in-time adaptive intervention. We highlight unique challenges and opportunities this novel team science approach presents in synergizing expertise across predictive analytics, bioengineering, health information technology, prevention science, maternal-fetal medicine, neonatology, pediatrics, and neurodevelopmental science. We discuss how innovations across many areas of study facilitate this personalized preventive approach, using developmentally sensitive brain and behavioral methods to investigate whether altering children's adverse gestational exposures, i.e., maternal stress in the womb, can improve their mental health outlooks. In so doing, we seek to propel developmental SEED research towards preventive applications with the potential to reduce the pernicious effect of prenatal stress on neurodevelopment, mental health, and wellbeing.

Developmental patterns of respiratory sinus arrhythmia from toddlerhood to adolescence

Parasympathetic nervous system functioning as indexed by respiratory sinus arrhythmia (RSA) is widely used as a measure of physiological regulation. We examined developmental patterns of children's resting RSA and RSA reactivity from 2 to 15 years of age, a period of time that is marked by considerable advances in children's regulatory abilities. Physiological data were collected from a community sample of 270 children (116 males) during a resting period and during a frustration laboratory task when the children were 2, 4, 5, 7, 10, and 15 years old. We examined both stability and continuity in resting RSA and RSA reactivity across time. We found stability in resting RSA but not RSA reactivity from toddlerhood to adolescence. Separate multilevel models were used to examine changes in resting RSA and RSA reactivity from Age 2 to Age 15. The rate of change in resting RSA slowed from Age 2 to Age 15 with a plateau around Age 10. A splined growth model indicated that the rate of RSA reactivity increased from Age 2 to Age 7 and a modest slowing and leveling off from Age 7 to Age 15. Understanding the developmental characteristics of RSA across childhood and adolescence is important to understanding the larger constructs of self- and emotion regulation. (PsycINFO Database Record (c) 2020 APA, all rights reserved).