Commentary: A Practical Guide for Translating Basic Research on Affective Science to Implementing Physiology in Clinical Child and Adolescent Assessments

Relation Between the Negative Cognitive Triad, Perceived Everyday Discrimination, Depressive Symptoms, and TNF-⍺ in Adolescents

Our study is guided by Beck's cognitive stress-vulnerability model of depression. We examined the associations between perceived everyday discrimination (PED) and TNF-⍺, an inflammatory biomarker associated with risk for severe illness, through the negative cognitive triad (NCT; negative thoughts about the self, world, and future) and depressive symptoms in adolescents. We utilized a sample of 99 adolescents (36.4% female; ages 13-16, M = 14.10, SD = 0.52) in our cross-sectional study. We used PROCESS and AMOS to compute regressions and direct, indirect, and total effects of PED, NCT aspects and depressive symptoms on TNF-⍺. Negative views of the self and world mediated between PED and depressive symptoms and that negative views of the self and future mediated between PED and TNF-⍺. In conclusion, Beck's theory can be expanded to physical health providing directions for addressing mental and physical health simultaneously by restructuring adolescents' negative view of the self.

How anxious is too anxious? State and trait physiological arousal predict anxious youth's treatment response to brief cognitive behavioral therapy

BACKGROUND

Exposure therapy is the gold standard for treating childhood anxiety, yet not all youth improve. Children do not always have insight on their distress, which can limit the utility of self-reported units of distress (SUDS) during exposures. Physiological assessment provides an objective means of monitoring emotional arousal. Electrodermal activity (EDA) in particular indexes sympathetic nervous system arousal which is heavily linked to anxiety. The aim of the current study was to examine the feasibility and utility of incorporating EDA assessment in an in-session exposure. We examined concordance between EDA and SUDS, and whether either predicted treatment response.

METHODS

Thirty-four youth who met DSM-5 criteria for generalized, separation, and/or social anxiety disorder completed brief CBT (8 sessions) and completed a survey on trait physiological arousal. EDA and SUDS were collected from 18 youth (9 female, ages 9-14) during a mid-treatment exposure. Changes in anxiety severity were examined post-treatment.

RESULTS

SUDS were not correlated with trait or state physiological arousal. There was a large association between heightened sympathetic arousal and poorer post-treatment response. Similarly, SUDS indices of greater fear activation and habituation were associated with poorer post-treatment response with a small to moderate effect size. Supplemental analyses among the full sample aligned: trait physiological arousal predicted poorer treatment response.

CONCLUSIONS

The lack of concordance between sympathetic arousal and SUDS indices highlights the limitations of relying solely on SUDS with pediatric populations. EDA provided unique data on youth's distress during exposures. Thus, results indicate that physiological assessment may exhibit clinical utility for aiding clinicians in monitoring youth's progress in exposure therapy.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02259036.

Depressive Symptoms, Rumination, and Emotion Reactivity Among Youth: Moderation by Gender

The emotion context-insensitivity hypothesis (ECI; Rottenberg et al., 2005) posits that depressive symptoms are associated with blunted emotional reactivity and is supported by the results of a meta-analysis (Bylsma et al., 2008). Yet it remains unclear how strongly ECI holds across emotional response domains, whether ECI operates similarly in male and female individuals, and whether this pattern of underreactivity is observed in youth. In contrast, rumination, a cognitive style strongly associated with depressive symptoms, may be associated with heightened reactivity. We assessed the effects of youth's depressive symptoms and rumination on subjective and physiological emotion reactivity (N = 160; M_age = 12.67, SD_age = 1.12; 48% female; 94% non-Hispanic). State sadness and respiratory sinus arrhythmia were assessed during a baseline activity (nature video) and a sad mood induction. As hypothesized, depressive symptoms predicted less subjective emotional reactivity, whereas rumination predicted more subjective reactivity. Exploratory analyses revealed that associations for physiological reactivity differed by child gender. ECI may be stronger in terms of subjective rather than physiological emotional reactivity.

Emotion regulation as a transdiagnostic factor in the development of internalizing and externalizing psychopathology: Current and future directions

In response to rapidly growing rates of comorbidity among psychiatric disorders, clinical scientists have become interested in identifying transdiagnostic processes that can help explain dysfunction across diagnostic categories (e.g., Kring & Sloan, 2009). One factor that has received a great deal of attention is that of emotion regulation, namely, the ability to modulate the intensity and/or duration of emotional states (e.g., Cicchetti, Ackerman, & Izard, 1995; Gross, 1998). Recent theoretical and empirical work has begun to emphasize the role that emotion regulation plays in the temporal comorbidity between internalizing and externalizing conditions (e.g., Aldao & De Los Reyes, 2015; De Los Reyes & Aldao, 2015; Drabick & Kendall, 2010; Jarrett & Ollendick, 2008; Patrick & Hajcak, 2016). However, close inspection of this work reveals two very pertinent areas of growth: (a) this literature is characterized by mixed findings that are likely explained, in part, by methodological heterogeneity; and (b) emotion regulation tends to be studied in relatively narrow terms. To address these issues, we provide a series of recommendations for facilitating cross-study comparisons and leveraging multifaceted approaches to studying emotion regulation processes within a developmental psychopathology framework. We hope that our perspective can enhance the organization and growth of this very important area of inquiry, and ultimately result in more effective prevention and treatment programs.

Introduction to the Special Issue: Discrepancies in Adolescent-Parent Perceptions of the Family and Adolescent Adjustment

Researchers commonly rely on adolescents' and parents' reports to assess family functioning (e.g., conflict, parental monitoring, parenting practices, relationship quality). Recent work indicates that these reports may vary as to whether they converge or diverge in estimates of family functioning. Further, patterns of converging or diverging reports may yield important information about adolescent adjustment and family functioning. This work is part of a larger literature seeking to understand and interpret multi-informant assessments of psychological phenomena, namely mental health. In fact, recent innovations in conceptualizing, measuring, and analyzing multi-informant mental health assessments might meaningfully inform efforts to understand multi-informant assessments of family functioning. Therefore, in this Special Issue we address three aims. First, we provide a guiding framework for using and interpreting multi-informant assessments of family functioning, informed by recent theoretical work focused on using and interpreting multi-informant mental health assessments. Second, we report research on adolescents' and parents' reports of family functioning that leverages the latest methods for measuring and analyzing patterns of convergence and divergence between informants' reports. Third, we report research on measurement invariance and its role in interpreting adolescents' and parents' reports of family functioning. Research and theory reported in this Special Issue have important implications for improving our understanding of the links between multi-informant assessments of family functioning and adolescent adjustment.

Is the Divide a Chasm?: Bridging Affective Science with Clinical Practice

This special section endeavors to facilitate the integration of biologically-based assessments of emotion into the clinical setting. This goal is consistent with the Research Domain Criteria (RDoC) initiative, which aims to identify transdiagnostic biobehavioral mechanisms that underlie mental disorders. We focus on four challenges to applying biologically-informed research on emotion and emotion regulation to clinical contexts: (1) How do we assess emotion in an RDoC framework? (2) How do we integrate measures of emotion with other systems in a wider context? (3) What do physiological indices of emotion tell us about clinical phenomena? and (4) How do we integrate physiological assessments into clinical practice? Throughout this comment, we refer to the articles in this special section to make our points, and, when possible, offer suggestions for future work to continue to address these challenges.

Introduction to the special issue: toward implementing physiological measures in clinical child and adolescent assessments

The National Institute of Mental Health recently launched the Research Domain Criteria (RDoC). The RDoC is an initiative to improve classification of mental health concerns by promoting research on the brain mechanisms underlying these concerns, with the ultimate goal of developing interventions that target these brain mechanisms. A key focus of RDoC involves opening new lines of research examining patients' responses on biological measures. The RDoC presents unique challenges to mental health professionals who work with children and adolescents. Indeed, mental health professionals rarely integrate biological measures into clinical assessments. Thus, RDoC's ability to improve patient care rests, in part, on the development of strategies for implementing biological measures within mental health assessments. Further, mental health professionals already carry out comprehensive assessments that frequently yield inconsistent findings. These inconsistencies have historically posed challenges to interpreting research findings as well as assessment outcomes in practice settings. In this introductory article, we review key issues that informed the development of a special issue of articles demonstrating methods for implementing low-cost measures of physiological functioning in clinical child and adolescent assessments. We also outline a conceptual framework, informed by theoretical work on using and interpreting multiple informants' clinical reports (De Los Reyes, Thomas, Goodman, & Kundey, 2013 ), to guide hypothesis testing when using physiological measures within clinical child and adolescent assessments. This special issue and the conceptual model described in this article may open up new lines of research testing paradigms for implementing clinically feasible physiological measures in clinical child and adolescent assessments.