1
|
Dickie DT, Langhinrichsen-Rohling J, McAnulty RD. College students' adverse childhood experiences and their anticipated risky behaviors: Early maladaptive schemas and emotion regulation difficulties as potential mediators. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024:1-9. [PMID: 38917370 DOI: 10.1080/07448481.2024.2369854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 06/14/2024] [Indexed: 06/27/2024]
Abstract
Objective: This study explicates the relationship between college student's adverse childhood experiences (ACEs) and their anticipated engagement in five types of risky behaviors. Two transdiagnostic mechanisms were tested cross-sectionally: disconnection/rejection early maladaptive schemas (cognitive) and difficulties in emotional regulation (emotional). Participants: 521 college student participants were majority female (66.8%), White (57.2%), freshman (54.9%), and heterosexual (72.2%). Methods: Participants completed an online, self-report, survey. Pearson bivariate correlations and parallel mediation analyses were conducted. Results: Sixty percent of students endorsed at least one ACE. Among the total sample, disconnection/rejection schemas partially mediated the relationship between ACEs and anticipated engagement in irresponsible academic/work behaviors, drug use, aggressive/illegal activities, and heavy drinking. Difficulties in emotion regulation partially mediated anticipated risky sexual activities and irresponsible academic/work behaviors. Sex differences were noted. Conclusions: Preventing irresponsible academic activity and other risky behaviors is critically important to college students, parents, and administrators. Intervention efforts should address cognitive and emotional mechanisms.
Collapse
Affiliation(s)
- Daniel T Dickie
- Department of Psychological Science, University of North Carolina at Charlotte, Charlotte, NC, USA
| | | | - Richard D McAnulty
- Department of Psychological Science, University of North Carolina at Charlotte, Charlotte, NC, USA
| |
Collapse
|
2
|
Estévez A, Momeñe J, Macía L, Iruarrizaga I, Olave L, Aonso-Diego G. The Mediating Effect of Coping Strategies and Emotion Regulation in the Relationship between Impulsivity, Metacognition, and Eating Disorders. Nutrients 2024; 16:1884. [PMID: 38931239 PMCID: PMC11206882 DOI: 10.3390/nu16121884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/10/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Risk factors for eating disorders are multifaceted and complex, so it is crucial to elucidate the role of executive functions, including impulsivity and metacognition, and coping strategies in the severity of eating behaviors. The study aims were threefold: (1) to analyze gender differences in impulsivity, metacognition, coping strategies, emotion regulation, and eating disorders; (2) to examine the correlation between the study variables; and (3) to test the mediating role of coping and emotion-regulation strategies in the relationship between metacognition, impulsivity, and eating disorders. METHODS A total of 1076 participants (Mage = 21.78, SD = 5.10; 77.7% women) completed a set of questionnaires. Two mediation analyses were conducted to test the mediating role of coping strategies, including emotion regulation, in the relationship between executive functions (i.e., impulsivity and metacognition) and eating disorders. RESULTS Women displayed higher coping strategies, specifically emotional expression, wishful thinking, and social support, whereas men presented greater social withdrawal. Mediational analyses showed a significant association between impulsivity, metacognition, and eating disorders, whose relationship was partially mediated by coping strategies and mainly by emotion regulation. CONCLUSION Interventions based on coping strategies and emotion regulation could be a feasible and effective option to deal with eating disorders among the young population.
Collapse
Affiliation(s)
- Ana Estévez
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Avda. de las Universidades 24, 48007 Bilbao, Spain; (J.M.); (L.M.); (G.A.-D.)
| | - Janire Momeñe
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Avda. de las Universidades 24, 48007 Bilbao, Spain; (J.M.); (L.M.); (G.A.-D.)
| | - Laura Macía
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Avda. de las Universidades 24, 48007 Bilbao, Spain; (J.M.); (L.M.); (G.A.-D.)
| | - Iciar Iruarrizaga
- Department of Experimental Psychology, Cognitive Psychology and Speech & Language Therapy, Faculty of Psychology, Complutense University of Madrid, 28040 Madrid, Spain; (I.I.); (L.O.)
| | - Leticia Olave
- Department of Experimental Psychology, Cognitive Psychology and Speech & Language Therapy, Faculty of Psychology, Complutense University of Madrid, 28040 Madrid, Spain; (I.I.); (L.O.)
| | - Gema Aonso-Diego
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Avda. de las Universidades 24, 48007 Bilbao, Spain; (J.M.); (L.M.); (G.A.-D.)
| |
Collapse
|
3
|
Fornaro S, Menardi A, Vallesi A. Topological features of functional brain networks and subclinical impulsivity: an investigation in younger and older adults. Brain Struct Funct 2024; 229:865-877. [PMID: 38446245 PMCID: PMC11003924 DOI: 10.1007/s00429-023-02745-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/28/2023] [Indexed: 03/07/2024]
Abstract
Impulsive traits (i.e., the tendency to act without forethought regardless of negative outcomes) are frequently found in healthy populations. When exposed to risk factors, individuals may develop debilitating disorders of impulse control (addiction, substance abuse, gambling) characterized by behavioral and cognitive deficits, eventually leading to huge socioeconomic costs. With the far-reaching aim of preventing the onset of impulsive disorders, it is relevant to investigate the topological organization of functional brain networks associated with impulsivity in sub-clinical populations. Taking advantage of the open-source LEMON dataset, we investigated the topological features of resting-state functional brain networks associated with impulsivity in younger (n = 146, age: 20-35) and older (n = 61, age: 59-77) individuals, using a graph-theoretical approach. Specifically, we computed indices of segregation and integration at the level of specific circuits and nodes known to be involved in impulsivity (frontal, limbic, and striatal networks). In younger individuals, results revealed that impulsivity was associated with a more widespread, less clustered and less efficient functional organization, at all levels of analyses and in all selected networks. Conversely, impulsivity in older individuals was associated with reduced integration and increased segregation of striatal regions. Speculatively, such alterations of functional brain networks might underlie behavioral and cognitive abnormalities associated with impulsivity, a working hypothesis worth being tested in future research. Lastly, differences between younger and older individuals might reflect the implementation of age-specific adaptive strategies, possibly accounting for observed differences in behavioral manifestations. Potential interpretations, limitations and implications are discussed.
Collapse
Affiliation(s)
- Silvia Fornaro
- Department of Neuroscience (DNS), University of Padova, Padova, Italy.
- Padova Neuroscience Center, University of Padova, Padova, Italy.
| | - Arianna Menardi
- Department of Neuroscience (DNS), University of Padova, Padova, Italy
- Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Antonino Vallesi
- Department of Neuroscience (DNS), University of Padova, Padova, Italy.
- Padova Neuroscience Center, University of Padova, Padova, Italy.
| |
Collapse
|
4
|
Faerman A, Nabasny A, Wright B, Juengst SB. Associations of Nightmares and Sleep Disturbance With Neurobehavioral Symptoms Postconcussion. J Head Trauma Rehabil 2024; 39:E105-E112. [PMID: 38709831 DOI: 10.1097/htr.0000000000000891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
OBJECTIVE This study investigates the association of nightmares beyond general sleep disturbance on neurobehavioral symptoms in adults with mild traumatic brain injury (mTBI). DESIGN Secondary analysis of a concussion cohort study. PARTICIPANTS One hundred and eleven adults older than 20 years with mTBI were recruited from a specialized concussion treatment center. MAIN MEASURES Behavioral Assessment Screening Tool, Pittsburgh Sleep Quality Index, and self-report of nightmare frequency in the past 2 weeks. RESULTS Among adults with mTBI, nightmares accounted for the greatest amount of variability in negative affect (β = .362, P < .001), anxiety (β = .332, P < .001), and impulsivity (β = .270, P < .001) after adjusting for age and sex. Overall sleep disturbance had the strongest association with depression (β = .493, P < .001), fatigue (β = .449, P < .001), self-reported executive dysfunction (β = .376, P < .001), and overall burden from concussive symptoms (β = .477, P < .001). CONCLUSIONS Nightmares and sleep disturbance are differentially associated with variance in neurobehavioral symptoms. Nightmares were independently associated with neurobehavioral symptoms representing an excess of normal functioning (eg, anxiety, impulsivity), while general sleep disturbance was associated with neurobehavioral symptoms representing functioning below normal levels (eg, depression, fatigue, self-reported executive dysfunction). Clinical and research implications are discussed.
Collapse
Affiliation(s)
- Afik Faerman
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, California (Dr Faerman); Departments of Applied Clinical Research (Mr Nabasny and Dr Wright) and Physical Medicine and Rehabilitation (Drs Wright and Juengst), University of Texas Southwestern Medical Center, Dallas; Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas (Dr Juengst); and Department of Physical Medicine and Rehabilitation, UT Health Sciences Center at Houston, Houston, Texas (Dr Juengst)
| | | | | | | |
Collapse
|
5
|
Moskal KR, Teeters JB, McCollum DC. Examining Differences in Emotion Dysregulation Between Emerging Adult Alcohol-Only Users, Abstainers, and Simultaneous Users. CANNABIS (ALBUQUERQUE, N.M.) 2023; 6:34-48. [PMID: 38035171 PMCID: PMC10683745 DOI: 10.26828/cannabis/2023/000166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Objective Simultaneous use of alcohol and cannabis is associated with more negative consequences than use of either substance alone. Research suggests that emotion dysregulation is linked to alcohol, cannabis, and polysubstance use. However, no previous research has examined whether emotion dysregulation scores differ among individuals without past month substance use (abstainers), individuals who report past-month alcohol use only (no past month cannabis or simultaneous use; alcohol-only users), and individuals who engage in past-month simultaneous alcohol and cannabis use (simultaneous users). Our aim was to examine differences in overall levels of emotion dysregulation and emotion dysregulation subscales between these groups. Methods The sample included 468 college students. Participants completed an online survey assessing demographics, emotion dysregulation, average number of drinks per week, days of monthly cannabis use, and simultaneous use of alcohol and cannabis. Results A one-way ANOVA showed significant differences in emotion dysregulation between alcohol-only users, abstainers, and simultaneous users. A Bonferroni post hoc analysis revealed significant differences in emotion dysregulation for simultaneous users (p = .004) compared to alcohol-only users and abstainers. A series of ANOVAs were run to examine emotion dysregulation subscale scores and significant differences were found for impulse control difficulties (p = .003) and limited access to emotion regulation strategies (p = .005) for simultaneous users compared to alcohol-only users and abstainers, and for non-acceptance of emotional responses (p = .018) for simultaneous users compared to and alcohol-only users. Conclusion These findings indicate that simultaneous users have higher levels of emotion dysregulation, higher levels of impulse control difficulties, greater non-acceptance of emotions, and greater lack of access to emotion regulation strategies compared to abstainers and alcohol-only users.
Collapse
Affiliation(s)
- Katie R. Moskal
- Department of Psychological Sciences, Western Kentucky University
| | - Jenni B. Teeters
- Department of Psychological Sciences, Western Kentucky University
| | | |
Collapse
|
6
|
Weidberg S, González-Roz A, Castaño Y, Secades-Villa R. Emotion dysregulation in relation to cannabis use and mental health among young adults. Addict Behav 2023; 144:107757. [PMID: 37224581 DOI: 10.1016/j.addbeh.2023.107757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/08/2023] [Accepted: 05/18/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Emotion dysregulation (ED) is a transdiagnostic variable that accounts for the onset and maintenance of mental health disorders. The interplay between ED, cannabis use and mental health has not been appraised in the young adult population and whether there are sex-dependent effects has yet to be examined. This study looked at whether ED mediates the association between past-month cannabis use and mental health, while considering sex as a moderator. METHODS 2,762 (64.2% women) undergraduate Spanish students completed an online battery. Among others, they fulfilled the Depression Anxiety Stress Scale-21 (DASS-21) and the Difficulties in Emotion Regulation Scale (DERS-28). A two-way ANOVA assessed the effects of sex and past-month cannabis use on participants' DASS-21 scores. A set of moderated mediations tested whether the indirect effect of past-month cannabis use on DASS-21 through DERS differed by sex. RESULTS Past-month cannabis female users showed higher levels of depression, anxiety and stress (M = 51.10, SD = 26.72) than did men [(M = 33.76, SD = 20.31); F(1, 2758) = 5.119, p =.024, η2p =.002]. In female young adults only, the effect of past-month cannabis use on mental health was mediated by ED (total score), non-acceptance of emotional responses, lack of emotional control, difficulties in engaging in goal-directed behavior, and lack of emotional clarity (all p's < 0.005) CONCLUSIONS: Findings indicate the importance of considering ED in assessment and intervention practices. Interventions targeting ED may be particularly effective for female young adult cannabis users.
Collapse
Affiliation(s)
- Sara Weidberg
- Department of Psychology. Addictive Behaviors Research Group (GCA), University of Oviedo. Plaza Feijoo s/n, 33003, Oviedo, Spain
| | - Alba González-Roz
- Department of Psychology. Addictive Behaviors Research Group (GCA), University of Oviedo. Plaza Feijoo s/n, 33003, Oviedo, Spain.
| | - Yasmina Castaño
- Department of Psychology. University of the Balearic Islands. Ctra. Valldemossa, km 7.5, 07122, Palma, Spain
| | - Roberto Secades-Villa
- Department of Psychology. Addictive Behaviors Research Group (GCA), University of Oviedo. Plaza Feijoo s/n, 33003, Oviedo, Spain
| |
Collapse
|
7
|
Effects of Impulsivity on Competitive Anxiety in Female Athletes: The Mediating Role of Mindfulness Trait. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063223. [PMID: 35328913 PMCID: PMC8951821 DOI: 10.3390/ijerph19063223] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/21/2022] [Accepted: 03/06/2022] [Indexed: 02/04/2023]
Abstract
It has been demonstrated that athletes in competitive sports suffer from high levels of competitive anxiety, especially in the case of females. In this sense, it is necessary to identify possible risk and protective factors of those athletes in this collective who suffer from this type of anxiety. However, few studies analyze the relationship between Physical Activity (PA) and anxiety, identifying the possible mediation effect of trait variables such as impulsivity and mindfulness in female athletes. Hence, the aims of this study were: to determine differences between PA levels with anxiety, mindfulness, and impulsiveness; to identify the predictive value of sociodemographic factors and physical activity, impulsivity, and mindfulness on anxiety factors; and to analyze the possible mediating effects of mindfulness on the relationship between impulsivity and anxiety. A total of 242 female athletes underwent an assessment of physical activity, anxiety, mindfulness traits, and impulsivity using validated questionnaires. Data were analyzed according to (1) individual or collective sport, and (2) PA levels according to energy expended (METs min/day). Participants were grouped by light, moderate, and vigorous PA levels. There were 30.5% elite athletes and 73.2% collective sports athletes. Mean age was 22.1 years and mean light, moderate, and vigorous PA were 86.1 ± 136.2, 114.4 ± 159.8, and 370.1 ± 336.3 METs min/day, respectively. Those athletes performing vigorous PA exhibited lower levels of impulsiveness and higher mindfulness traits. As expected, the mindfulness trait was a mediating factor in the relationship between impulsiveness and each factor of competitive anxiety (cognitive, somatic, and self-efficacy). Female athletes could suffer competitive anxiety, especially those who present higher levels of impulsivity. However, higher levels of mindfulness traits seem to be a protective factor in the effects of impulsivity on anxiety in this population and have demonstrated to be significant mediators in this association. Further studies are needed with other female athletes to replicate these results and to determine the specific protective mechanisms of mindfulness traits in preventing competitive anxiety.
Collapse
|
8
|
Bresin K, Mekawi Y, Stevens JS, Hinrichs R, Fani N, Michopoulos V, Powers A. From alcohol to aggression: Examining the structure and nomological network of dysregulated behaviors in a trauma-exposed community sample. J Clin Psychol 2021; 78:1220-1239. [PMID: 34862625 DOI: 10.1002/jclp.23288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 09/08/2021] [Accepted: 11/14/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE A large body of research has shown that alcohol use, drug use, aggression, and self-harm often co-occur within the same individuals, suggesting the possibility of shared etiologies. Research has yet to determine the factor structure of these dysregulated behaviors. METHODS Participants (Mage = 40.33; 74% women) completed self-report and interview-based measures of dysregulated behaviors (alcohol use, drug use, aggression, and self-harm), emotion dysregulation, maladaptive personality traits, and symptoms of DSM disorders (e.g., borderline personality disorder [BPD], depression). RESULTS Results showed support for a bifactor model (i.e., all indicators load on a common dysregulated behavior factor and on unique alcohol, drug, aggression, and self-harm factors), which provided a better fit to the data than other models. In line with our hypotheses, the general dysregulated behavior factor was positively associated with emotion regulation difficulties, negative affect, and BPD symptoms. CONCLUSIONS These results have implications for several areas of psychopathology and intervention research.
Collapse
Affiliation(s)
- Konrad Bresin
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA
| | - Yara Mekawi
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia, USA
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia, USA
| | - Rebecca Hinrichs
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia, USA
| | - Negar Fani
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia, USA
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia, USA
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia, USA
| |
Collapse
|
9
|
Buckner JD, Lewis EM, Abarno CN, Morris PE, Glover NI, Zvolensky MJ. Difficulties with emotion regulation and drinking during the COVID-19 pandemic among undergraduates: the serial mediation of COVID-related distress and drinking to cope with the pandemic. Cogn Behav Ther 2021; 50:261-275. [PMID: 33522892 DOI: 10.1080/16506073.2020.1861084] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has contributed to thousands of hospitalizations and deaths worldwide. Although alcohol use has increased in response to the pandemic, no known studies have identified transdiagnostic risk factors for greater drinking in response to COVID-related distress. Individuals with more difficulty with emotion regulation may drink more during the pandemic to manage pandemic-related distress. The current study tested whether difficulty with emotion regulation was related to greater estimated blood alcohol content (eBAC) during a typical week in the past month and if this was due to COVID-related distress and drinking to cope with the pandemic. The sample consisted of 347 past-month drinking undergraduates in Louisiana, a state with some of the U.S. highest rates of COVID-19 infections and related deaths. Difficulty with engaging in goal-directed behaviors was related to greater past-month eBAC and this relation was mediated by the sequential effects of COVID-related worry and drinking to cope with the pandemic. Results indicate that individuals with difficulty engaging in goal-directed behaviors are especially vulnerable to greater eBAC during the COVID-19 pandemic which may be due in part to their vulnerability to more COVID-related worry which may lead to more drinking to cope with the pandemic.
Collapse
Affiliation(s)
- Julia D Buckner
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Elizabeth M Lewis
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Cristina N Abarno
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Paige E Morris
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Nina I Glover
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA.,Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
10
|
Profiles of Emotion Dysregulation Among University Students Who Self-Injure: Associations with Parent-Child Relationships and Non-Suicidal Self-Injury Characteristics. J Youth Adolesc 2021; 50:767-787. [PMID: 33449284 DOI: 10.1007/s10964-020-01378-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
More research is needed to understand the different vulnerability profiles of university students who engage in non-suicidal self-injury (NSSI). This study sought to classify university students (n = 479; 83.8% female) aged 17-25 years (M = 18.77; SD = 1.42) who had engaged in NSSI within the past year into latent profiles based on their self-perceived difficulties in regulating both positive and negative emotions. Independent samples of students who had a past history of NSSI but had not self-injured within the previous year (n = 439; 82.9% females; Mage = 19.03, SD = 1.62) and who had no history of NSSI (n = 1551; 69.9% females; Mage = 19.02, SD = 1.55) were recruited for comparison purposes. Latent cluster analyses revealed three emotion regulation profiles within the NSSI sample-the Average Difficulties (47.4%), Dysregulated (33.0%), and Low Difficulties (19.6%) profiles-each of which differed meaningfully from both comparison samples on mean emotion regulation difficulties. Students across profiles also differed in their self-reported experiences with parents, particularly with fathers (pressure, antipathy, unresolved attachment, psychological control), and in the extent to which they felt alienated from parents. Lastly, students across profiles differed in the frequency, methods, functions, and addictive properties of their NSSI. Findings highlight that university students who self-injure experience distinct patterns of difficulties with emotion regulation, which are associated with variation in parent-child relational risk factors and NSSI outcomes.
Collapse
|