Understanding Emotion Inflexibility in Risk for Affective Disease: Integrating Current Research and Finding a Path Forward

Social anxiety and emotion regulation flexibility: a daily diary approach

Previous research suggests that social anxiety symptoms are maintained and intensified by inflexible emotion regulation (ER). Therefore, we examined whether trait-level social anxiety moderates ER flexibility operationalised at both between-person (covariation between variability in emotional intensity and variability in strategy use across occasions) and within-person (associations between emotional intensity and strategy use on a given day) levels. In a sample of healthy college-aged adults (N = 185, Mage = 21.89), we examined overall and emotion-specific intensities (shame, guilt, anxiety, anger, sadness) and regulatory strategies (i.e. experiential avoidance, expressive suppression, and rumination) in response to each day's most emotionally intense event over 6 days. During the study period, we found a positive association between variability in emotional intensity and variability of experiential avoidance in individuals with lower, rather than higher, levels of trait social anxiety after controlling for key covariates (i.e. gender, personality traits, and stress exposure). However, we did not find evidence for the moderating role of trait social anxiety in ER flexibility assessed at within-person levels. Our findings highlight the need to delineate dynamic ER flexibility across everyday events.

If it Ain't Broke, Don't Fix it: Positive Versus Negative Emotion Regulation in Daily Life and Depressive Symptoms

BACKGROUND

Despite the importance of positive emotions for affective psychopathology, prior research primarily focused on negative emotion regulation. To address this gap, this ecological momentary assessment study compared a broad set of emotion regulation strategies in the context of positive versus negative emotions regarding their effectiveness and associations with depressive symptoms.

METHODS

We analyzed data from 1066 participants who were notified five times daily for seven consecutive days to complete a smartphone survey assessing their predominant emotions, strategies to regulate them, and subsequent emotional outcomes.

RESULTS

Findings show that the effectiveness of most regulation strategies depended on whether the emotional context was positive or negative. While acceptance and savoring predicted improved emotional outcomes across emotional contexts, reappraisal and problem-solving were associated with deteriorated emotional outcomes and increased depressive symptoms when regulating positive but not negative emotions.

LIMITATIONS

Future studies should replicate our findings in demographically and culturally diverse clinical samples to improve generalizability.

CONCLUSION

These results emphasize that strategies effective for regulating negative emotions may be less helpful in the context of positive emotions. Thus, context-specific interventions may be a promising approach to improve the treatment of affective disorders.

Facing Change: Using Automated Facial Expression Analysis to Examine Emotional Flexibility in the Treatment of Depression

OBJECTIVE

Depression involves deficits in emotional flexibility. To date, the varied and dynamic nature of emotional processes during therapy has mostly been measured at discrete time intervals using clients' subjective reports. Because emotions tend to fluctuate and change from moment to moment, the understanding of emotional processes in the treatment of depression depends to a great extent on the existence of sensitive, continuous, and objectively codified measures of emotional expression. In this observational study, we used computerized measures to analyze high-resolution time-series facial expression data as well as self-reports to examine the association between emotional flexibility and depressive symptoms at the client as well as at the session levels.

METHOD

Video recordings from 283 therapy sessions of 58 clients who underwent 16 sessions of manualized psychodynamic psychotherapy for depression were analyzed. Data was collected as part of routine practice in a university clinic that provides treatments to the community. Emotional flexibility was measured in each session using an automated facial expression emotion recognition system. The clients' depression level was assessed at the beginning of each session using the Beck Depression Inventory-II (Beck et al., 1996).

RESULTS

Higher emotional flexibility was associated with lower depressive symptoms at the treatment as well as at the session levels.

CONCLUSION

These findings highlight the centrality of emotional flexibility both as a trait-like as well as a state-like characteristic of depression. The results also demonstrate the usefulness of computerized measures to capture key emotional processes in the treatment of depression at a high scale and specificity.

Bidirectional associations between maladaptive cognitions and emotional symptoms, and their mediating role on the quality of life in adults with ADHD: a mediation model

Background/objectives

Adults with attention-deficit/hyperactivity disorder (ADHD) have more maladaptive cognitions, emotional problems and a poorer quality of life (QoL). A verification of the psychological model in clinical samples is needed for a better understanding of the mechanisms of ADHD diagnosis on QoL via maladaptive cognitions, emotional symptoms, and their interactions.

Methods

299 ADHD participants and 122 healthy controls were recruited. ADHD core symptoms, maladaptive cognitions, emotional symptoms and psychological QoL were rated. Pearson's correlation and structural equation modeling were analyzed to explore the relationship and influence of ADHD diagnosis on QoL.

Results

More maladaptive cognitions, emotional symptoms, and poorer QoL were found in the ADHD group, and the dysfunctional attitudes were on par between ADHD with or without medication (p = 0.368). Moderate to strong correlations were found between emotional symptoms, maladaptive cognitions and QoL, and ADHD core symptoms presented correlations among the above scores (r = 0.157 ~ 0.416, p < 0.01) in ADHD participants. The influence of ADHD diagnosis on QoL was mediated through maladaptive cognitions, emotional symptoms, and their bidirectional interactions (p < 0.05), especially those with stable medication.

Conclusion

Our study is the first to verify the psychological model in adults with ADHD in China. The findings determined the direct influence of ADHD diagnosis on QoL and the indirect influence through maladaptive cognitions, emotional symptoms, and their interactions, emphasizing the importance of interventions for emotional symptoms and maladaptive cognitions for ADHD patients both with or without medication for a better QoL outcome.

The Flexible Regulation of Emotional Expression Scale for Youth (FREE-Y): Adaptation and Validation Across a Varied Sample of Children and Adolescents

Flexible self-regulation has been shown to be an adaptive ability. This study adapted and validated the adult Flexible Regulation of Emotional Expression (FREE) Scale for use with youth (FREE-Y) in community and maltreatment samples. The FREE-Y measures the ability to flexibly enhance and suppress emotion expression across an array of hypothetical social scenarios. Participants (N = 654, 8-19 years) were included from three studies. Confirmatory factor analysis (CFA) confirmed a theoretically appropriate higher order factor structure. Using multiple-group CFAs, measurement invariance was achieved across maltreatment status, age, and gender. Reliabilities were adequate and construct validity was demonstrated through associations with measures of emotion regulation, psychopathology, IQ, and executive functioning. Group comparisons indicated lower Suppression and Flexibility scores for maltreated versus comparison participants. Findings suggest that the FREE-Y is a valid measure of expressive regulation ability in youth that can be applied across a range of populations.

Effectiveness of emotion regulation strategies measured by self-report and EMG as a result of strategy used, negative emotion strength and participants' baseline HRV

We investigated how emotion regulation (ER) effectiveness-on both a self-reported rating as well as emotional expression (corrugator supercilii muscle activity) level-is affected by the characteristics of the situation (low vs. high negativity), the strategy used (reinterpretation, distraction, suppression, no regulation control condition) and individual dispositions (low vs. high baseline Heart Rate Variability) as well as their interaction. For this purpose, 54 adult women participated in a laboratory study. All the included factors significantly influenced both corrugator activity and appraisals of pictures' negativity (in specific experimental conditions). For example, for high HRV participants, (1) distraction, suppression and reinterpretation significantly decreased corrugator activity compared to the control condition, and (2) distraction decreased appraised picture negativity for high negativity photos. For low HRV participants, distraction and suppression were most effective in decreasing corrugator responses, while suppression was more effective than reinterpretation in decreasing perceived picture negativity in the high negativity condition. Subjectively reported effort and success in applying ER strategies were also dependent on manipulated and dispositional factors. Overall, our results lend support to the flexible emotion regulation framework, showing that emotion regulation effectiveness relies on situational context as well as individual dispositions and their interaction.

The influence of psychological flexibility on persistent post concussion symptoms and functional status after mild traumatic brain injury

PURPOSE

This study investigated the predictive role of psychological flexibility on long-term mTBI outcomes.

METHOD

Adults with mTBI (N = 147) completed a context specific measure of psychological flexibility, (AAQ-ABI), psychological distress, and mTBI outcomes at less than three months post injury (M = 6.02 weeks after injury) and 6 months later (N = 102). Structural equation modelling examined the mediating effects of psychological flexibility on psychological distress and mTBI outcomes at six months. The direct effect of psychological flexibility at less than three months on mTBI outcomes at six months was entered into the model, plus pre-injury and injury risk factors.

RESULTS

The theoretically derived model had good overall fit (χ2 = 1.42; p = 0.09; NFI = 0.95; TLI = 0.95; CFI = 0.98 and RMSEA = 0.06). Psychological flexibility at less than 3 months was directly significantly related to psychological distress and post-concussion symptoms at six months. Psychological flexibility at 6 months significantly mediated the relationship between psychological distress and functional disability but not post-concussion symptoms at six months post injury.

CONCLUSION

The exploratory findings suggest that a context specific measure of psychological flexibility assessed acutely and in the chronic phase of recovery may predict longer-term mTBI outcomes.Implications for RehabilitationPersistent post-concussion symptoms (PPCS) after mild traumatic brain injury (mTBI) can have a significant impact on wellbeing, functional status, and quality of life.In this study, psychological flexibility early in recovery, was associated with higher levels of psychological distress and more severe post-concussion symptoms six months later.Psychological flexibility at six months post-injury also mediated the relationship between psychological distress and functional disability.A context specific measure of psychological flexibility may predict poorer long-term outcomes following mTBI.

The neural correlates of context driven changes in the emotional response: An fMRI study

Emotional flexibility reflects the ability to adjust the emotional response to the changing environmental context. To understand how context can trigger a change in emotional response, i.e., how it can upregulate the initial emotional response or trigger a shift in the valence of emotional response, we used a task consisting of picture pairs during functional magnetic resonance imaging sessions. In each pair, the first picture was a smaller detail (a decontextualized photograph depicting emotions using primarily facial and postural expressions) from the second (contextualized) picture, and the neural response to a decontextualized picture was compared with the same picture in a context. Thirty-one healthy participants (18 females; mean age: 24.44 ± 3.4) were involved in the study. In general, context (vs. pictures without context) increased activation in areas involved in facial emotional processing (e.g., middle temporal gyrus, fusiform gyrus, and temporal pole) and affective mentalizing (e.g., precuneus, temporoparietal junction). After excluding the general effect of context by using an exclusive mask with activation to context vs. no-context, the automatic shift from positive to negative valence induced by the context was associated with increased activation in the thalamus, caudate, medial frontal gyrus and lateral orbitofrontal cortex. When the meaning changed from negative to positive, it resulted in a less widespread activation pattern, mainly in the precuneus, middle temporal gyrus, and occipital lobe. Providing context cues to facial information recruited brain areas that induced changes in the emotional responses and interpretation of the emotional situations automatically to support emotional flexibility.

Addictive and other mental disorders: a call for a standardized definition of dual disorders

The persistent difficulty in conceptualizing the relationship between addictive and other mental disorders stands out among the many challenges faced by the field of Psychiatry. The different philosophies and schools of thought about, and the sheer complexity of these highly prevalent clinical conditions make progress inherently difficult, not to mention the profusion of competing and sometimes contradictory terms that unnecessarily exacerbate the challenge. The lack of a standardized term adds confusion, fuels stigma, and contributes to a "wrong door syndrome" that captures the difficulty of not only diagnosing but also treating addictive and other mental disorders in an integrated manner. The World Association on Dual Disorders (WADD) proposes the adoption of the term "Dual Disorder" which, while still arbitrary, would help harmonize various clinical and research efforts by rallying around a single, more accurate, and less stigmatizing designation.

Associating Flexible Regulation of Emotional Expression With Psychopathological Symptoms

Background: Stressful situations and psychopathology symptoms (e.g., depression and anxiety) shape how individuals regulate and respond to others’ emotions. However, how emotional expressions influence mental health and impact intrapersonal and interpersonal experiences is still unclear.

Objective: Here, we used the Flexible Regulation of Emotional Expression (FREE) scale to explore the relationship between emotional expression abilities with affective symptoms and mental health markers.

Methods: From a sample of 351 participants, we firstly validate a German version of the FREE scale on a final sample of 222 participants located in Germany, recruited through an online platform. Following this, we performed confirmatory factor analyses to assess the model structure of the FREE-scale. We then utilize a LASSO regression to determine which indicators of psychopathology symptoms and mental health are related to emotional expressive regulation and determine their particular interactions through the general linear model.

Results: We replicated the FREE scale’s four latent factors (i.e., ability to enhance and suppress positive as well as negative emotional expressions). After the selection of relevant instruments through LASSO regression, the suppress ability showed specific negative associations with depression (r = 0.2) and stress symptoms (r = 0.16) and positive associations with readiness to confront distressing situations (r = 0.25), self-support (r = 0.2), and tolerance of emotions (r = 0.2). Both, emotional expressions enhance and suppress abilities positively associated with coping markers (resilience) and emotion regulation skills. Finally, the interaction effects between emotional flexibility abilities and stress, depression, and anxiety symptoms evidenced that consistent with the flexibility theory, enhancing and suppressing abilities may predict psychopathological symptoms.

Conclusions: These findings emphasize the importance of considering the flexibility to express emotions as a relevant factor for preserved mental health or the development of psychopathological symptoms and indicate that online surveys may serve as a reliable indicator of mental health.

Interactions between emotion regulation and everyday flexibility in anorexia nervosa: Preliminary evidence of associations with clinical outcomes

The current study explored interactions between emotion regulation (ER) and cognitive-behavioral flexibility in everyday life in individuals with anorexia nervosa (AN). Participants were 97 female adults with current (57%) or past (43%) full or partial AN syndrome diagnosis. Participants completed the Difficulties with Emotion Regulation Scale, Emotion Regulation Questionnaire, Eating Disorder Flexibility Index, Eating Disorder Examination Questionnaire and Depression Anxiety Stress Scale short form. Lower flexibility was a strong independent predictor of more severe ED-related cognitions and higher frequency of compensatory behaviors beyond individual differences in emotion regulation and mood. ER measures did not predict clinical characteristics. However, two interactions between flexibility and ER measures were observed which suggested there was a stronger association between greater flexibility and higher BMI for individuals with either higher levels of cognitive reappraisal use, or higher levels of global ER difficulties. Interactions between flexibility and emotion regulation provide evidence that co-occurring difficulties may impact clinical outcomes in AN.

Optimal well-being in the aftermath of anxiety disorders: A 10-year longitudinal investigation

BACKGROUND

Although preliminary research has explored the possibility of optimal well-being after depression, it is unclear how rates compare to anxiety. Using Generalized Anxiety Disorder (GAD) and Panic Disorder (PD) as exemplars of anxiety, we tested the rates of optimal well-being one decade after being diagnosed with an anxiety disorder. Based on reward deficits in depression, we pre-registered our primary hypothesis that optimal well-being would be more prevalent after anxiety than depression as well as tested two exploratory hypotheses.

METHOD

We used data from the Midlife in the United States (MIDUS) study, which contains a nationally representative sample across two waves, 10 years apart. To reach optimal well-being, participants needed to have no symptoms of GAD, PD, or major depressive disorder (MDD) at the 10 year follow-up and exceed cut-offs across nine dimensions of well-being.

RESULTS

The results failed to support our primary hypothesis. Follow-up optimal well-being rates were highest for adults previously diagnosed with MDD (8.7%), then PD (6.1%), and finally GAD (0%). Exploratory analyses revealed optimal well-being was approximately twice as prevalent in people without anxiety or depression at baseline and provided partial support for baseline well-being predicting optimal well-being after anxiety. Results were largely replicated across different classifications of optimal well-being.

LIMITATIONS

Findings are limited by the somewhat unique measurement of anxiety in the MIDUS sample as well as the relatively high rate of missing data.

CONCLUSIONS

We discuss possible explanations for less prevalent optimal well-being after anxiety vs. depression and the long-term positivity deficits from GAD.

Emotional and cognitive conflict resolution and disruptive mood dysregulation disorder in adolescent offspring of parents diagnosed with major depressive disorder, bipolar disorder, and matched healthy controls

AIMS

Children of parents with mood disorders have an elevated risk for various psychopathologies. In this study rate of psychopathologies among adolescent offspring of parents with major depressive (MDDoff) and bipolar disorder (BDoff), including disruptive mood dysregulation disorder (DMDD) along with the offspring ability to resolve cognitive and emotional conflicts were evaluated.

METHOD

12-16 years old children of parents with MDD (n = 31, children= 36), BP (n = 20, children = 26) and controls (n = 25, children = 28) were enrolled. Children and parents were evaluated by using the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID); respectively. The parents completed the Child Behavior Checklist (CBCL)-dysregulation profile. The Stroop test-TBAG form and emotional Stroop test were given out to evaluate conflict resolution ability.

RESULTS

The most common diagnoses among the whole sample were attention deficit and hyperactivity, separation anxiety and oppositional defiant disorders. Five cases (5.5%) of lifetime DMDD were found (three from MDDoff, the rest from BDoff). Completion times for the Stroop test-TBAG form were ranked as: BDoff > MDDoff > Hoff. In the emotional Stroop test, the BDoff responded significantly later and had significantly reduced correct responses.

CONCLUSION

Rates of lifetime DMDD were similar in the MDDoff and BDoff groups. BDoff may experience greater difficulties in resolving cognitive and emotional conflicts.

The role of affective urgency and emotion regulation in vaping susceptibility

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Both positive and negative urgency are correlated with emotion dysregulation.

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Emotion dysregulation mediated the effect of negative urgency but not positive urgency on a measure of vaping susceptibility.

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Measures to prevent e-cigarette use should target individuals with high negative urgency and focus on building emotion regulation skills.

Introduction

The prevalence of E-cigarette use is increasing along with concerns about the negative health effects of their use. Understanding the psychological constructs associated with susceptibility to beginning regular e-cigarette use may be helpful for prevention efforts. Factors such as emotion regulation (ER) and impulsivity, specifically urgency, have been significantly correlated with patterns of drug addiction in the past. With few prior studies linking ER and impulsivity factors with e-cigarette susceptibility, the present study aims to assess their relationship in predicting e-cigarette susceptibility in university never-smokers.

Method

Two hundred and twenty-five students were surveyed online using a questionnaire measuring difficulties in ER, impulsivity, and e-cigarette susceptibility. Path analysis was used to understand the relationship between positive and negative urgency and ER in predicting susceptibility to use.

Results

Results indicated that negative urgency was mediated by difficulties in ER to predict susceptibility while positive urgency was not significantly related to susceptibility.

Conclusion

The results of this study offer insights into the role affective traits contribute to susceptibility to e-cigarettes, potentially improving future addiction prevention research.

A continuum hypothesis of psychotomimetic rapid antidepressants

Ketamine, classical psychedelics and sleep deprivation are associated with rapid effects on depression. Interestingly, these interventions also have common psychotomimetic actions, mirroring aspects of psychosis such as an altered sense of self, perceptual distortions and distorted thinking. This raises the question whether these interventions might be acute antidepressants through the same mechanisms that underlie some of their psychotomimetic effects. That is, perhaps some symptoms of depression can be understood as occupying the opposite end of a spectrum where elements of psychosis can be found on the other side. This review aims at reviewing the evidence underlying a proposed continuum hypothesis of psychotomimetic rapid antidepressants, suggesting that a range of psychotomimetic interventions are also acute antidepressants as well as trying to explain these common features in a hierarchical predictive coding framework, where we hypothesise that these interventions share a common mechanism by increasing the flexibility of prior expectations. Neurobiological mechanisms at play and the role of different neuromodulatory systems affected by these interventions and their role in controlling the precision of prior expectations and new sensory evidence will be reviewed. The proposed hypothesis will also be discussed in relation to other existing theories of antidepressants. We also suggest a number of novel experiments to test the hypothesis and highlight research areas that could provide further insights, in the hope to better understand the acute antidepressant properties of these interventions.

Intrinsic activity temporal structure reactivity to behavioural state change is correlated with depressive symptoms

The brain's intrinsic activity plays a fundamental role in its function. In normal conditions this activity is responsive to behavioural context, changing as an individual switches between directed tasks and task-free conditions. A key feature of such changes is the movement of the brain between corresponding critical and sub-critical states, with these dynamics supporting efficient cognitive processing. Breakdowns in processing efficiency can occur, however, in brain disorders such as depression. It was therefore hypothesised that depressive symptoms would be related to reduced intrinsic activity responsiveness to changes in behavioural state. This was tested in a mixed group of major depressive disorder patients (n = 26) and healthy participants (n = 37) by measuring intrinsic EEG activity temporal structure, quantified with detrended fluctuation analysis (DFA), in eyes-closed (EC) and eyes-open task-free states and contrasting between the conditions. The degree to which DFA values changed between the states was found to correlate negatively with depressive symptoms. DFA values did not differ between states in those with higher symptom levels, meaning that the brain remained in a less flexible sub-critical condition. This sub-critical condition in the EC state was further found to correlate with levels of maladaptive rumination. This may reflect a general cognitive inflexibility resulting from a lack in neural activity reactivity that may predispose people to overly engage in self-directed attention. These results provide an initial link between intrinsic activity reactivity and psychological features found in psychiatric disorders.

Dissociating Profiles of Social Cognitive Disturbances Between Mixed Personality and Anxiety Disorder

BACKGROUND

An emerging body of research has begun to elucidate disturbances to social cognition in specific personality disorders (PDs). No research has been conducted on patients with Mixed Personality Disorder (MPD), however, who meet multiple diagnostic criteria. Further, very few studies have compared social cognition between patients with PD and those presenting with symptomatic diagnoses that co-occur with personality pathologies, such as anxiety disorder (AD). The aim of this study was to provide a detailed characterization of deficits to various aspects of social cognition in MPD and dissociate impairments specific to MPD from those exhibited by patients with AD who differ in the severity of personality pathology.

METHOD

Building on our previous research, we administered a large battery of self-report and performance-based measures of social cognition to age-, sex- and education-matched groups of patients with MPD or AD, and healthy control participants (HCs; n = 29, 23, and 54, respectively). This permitted a detailed profiling of these clinical groups according to impairments in emotion recognition and regulation, imitative control, low-level visual perspective taking, and empathic awareness and expression.

RESULTS

The MPD group demonstrated poorer emotion recognition for negative facial expressions relative to both HCs and AD. Compared with HCs, both clinical groups also performed significantly worse in visual perspective taking and interference resolution, and reported higher personal distress when empathizing and more state-oriented emotion regulation.

CONCLUSION

We interpret our results to reflect dysfunctional cognitive control that is common to patients with both MPD and AD. Given the patterns of affective dispositions that characterize these two diagnostic groups, we suggest that prolonged negative affectivity is associated with inflexible styles of emotion regulation and attribution. This might potentiate the interpersonal dysfunction exhibited in MPD, particularly in negatively valenced and challenging social situations.