Factor structure of the Chinese version of Emotion Regulation Goals Scale

Recent studies in Western cultures suggested emotion regulation goals have important implications for mental health. This study aimed to test the factor structure of Emotion Regulation Goals Scale (ERGS) in a Chinese cultural context. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were first used to examine the factor structure of the ERGS, and then reliability and validity tests were conducted to examine the psychometric properties of the ERGS. Results showed that the original five-factor model demonstrated fit during both EFA and CFA, and was thus adopted for further psychometric analyses. Most of the five factors were significantly associated with emotion regulation tendencies and negative emotional outcomes (e.g., depression), except for the non-significant associations between pro-hedonic goals and expressive suppression, and pro-social and impression management goals with depression. The ERGS also showed good internal consistency and split-half reliability. However, the test-retest reliabilities varied substantially across the five factors. The pro-hedonic goal had a higher test-retest reliability, whereas the contra-hedonic, performance, pro-social, and impression management goals showed lower values, especially the latter two. In brief, the ERGS showed a promising five-factor structure in assessing emotion regulation goals in Chinese cultural context.

Validation of the Bipolar Recovery Questionnaire for the Portuguese Population: Recovery and Predictors in People with Bipolar Disorder

INTRODUCTION

The paradigm in mental health care is progressively moving towards a recovery-focused perspective. Thus, there is a need for validated instruments to measure recovery in bipolar disorder (BD). The Bipolar Recovery Questionnaire (BRQ) is the most used instrument to assess it. The aim of this study was to translate and perform a cross-cultural adaptation of the BRQ to European Portuguese (PT-PT) and to explore further associations of recovery with sociodemographic and emotional regulation, as well as recovery predictors to inform future research and clinical practice.

METHODS

The BRQ was forward-translated and back-translated until a consensus version was found, and a test-retest design was used to assess temporal stability. Participants were recruited in public hospitals and organizations supporting people with BD, either referred by their psychiatrists or psychologists or through self-referral. Eighty-eight individuals diagnosed with BD were recruited to complete a battery of Portuguese-validated self-report questionnaires to assess recovery (BRQ), clinical mood symptoms (Hospital Anxiety and Depression Scale), affect (Positive and Negative Affect Scale), well-being (brief Quality of Life for Bipolar Disorder; Satisfaction with Life Scale) and emotion regulation (Difficulties in Emotion Regulation Scale).

RESULTS

The BRQ showed excellent internal consistency with a Cronbach alpha of 0.92, and test-retest exhibited good reliability (r = 0.88). Construct validity was confirmed through/by positive and moderate correlations with quality of life (QoL; r = 0.58) and positive affect (r = 0.52), and negative moderate correlations with depression (r = -0.64), and negative affect (r = -0.55). Both satisfaction with life (β = 0.38, p = 0.010) and recovery (β = 0.34, p = 0.022) impacted quality of life, supporting the BRQ's incremental validity. Depressive symptoms and emotion dysregulation accounted for 51% of its variance.

CONCLUSION

The BRQ is a valid and reliable instrument to measure recovery in people with BD in the Portuguese population and is suitable for both clinical and research contexts.

Results From a Non-Randomized Pilot Study Evaluating the Impact of a Novel Group Treatment Program Targeting Aggressive Script Rehearsal and Emotion Regulation in a Sample of Incarcerated Males

This study compared the efficacy of a novel group-based aggressive script rehearsal treatment program with an emotion regulation program. Participants were 48 incarcerated adult males (28 in the script rehearsal program and 20 in the emotion regulation program). Outcomes, including the frequency of aggressive script rehearsal, aggressive behavior, and emotion regulation difficulties, were measured pre-and post-treatment and at 46 days (on average) after treatment completion, and 104 days (on average) following treatment completion. Linear Mixed Model analyses revealed no significant difference in the frequency of script rehearsal overtime for either program. There was a significant reduction in aggressive behavior associated with the script rehearsal program and a reduction in emotion regulation difficulties for both programs. Future iterations of this aggressive script rehearsal treatment program may benefit from greater intensity and incorporation of strategies that address the many cognitive, affective, and situational factors that trigger and maintain aggressive scripts.

Emotion dysregulation in bipolar disorder compared to other mental illnesses: a systematic review and meta-analysis

People with bipolar disorder (BD) often present emotion dysregulation (ED), a pattern of emotional expression interfering with goal-directed behavior. ED is a transdiagnostic construct, and it is unclear whether it manifests itself similarly in other conditions, such as major depressive disorder (MDD) or borderline personality disorder (BPD), or has specific features in BD. The present systematic review and meta-analysis explored ED and adopted emotion regulation (ER) strategies in BD compared with other psychiatric conditions. PubMed/MEDLINE, EMBASE, Scopus, and PsycINFO databases were systematically searched from inception to April 28th, 2022. Studies implementing validated instruments assessing ED or ER strategies in BD and other psychiatric disorders were reviewed, and meta-analyses were conducted. Twenty-nine studies yielding multiple comparisons were included. BD was compared to MDD in 20 studies (n = 2451), to BPD in six studies (n = 1001), to attention deficit hyperactivity disorder in three studies (n = 232), to anxiety disorders in two studies (n = 320), to schizophrenia in one study (n = 223), and to post-traumatic stress disorder in one study (n = 31). BD patients did not differ from MDD patients in adopting most adaptive and maladaptive ER strategies. However, small-to-moderate differences in positive rumination and risk-taking behaviors were observed. In contrast, patients with BPD presented an overall higher degree of ED and more maladaptive ER strategies. There were insufficient data for a meta-analytic comparison with other psychiatric disorders. The present report further supports the idea that ED is a transdiagnostic construct spanning a continuum across different psychiatric disorders, outlining specific clinical features that could represent potential therapeutic targets.

Identifying Relationships Between Difficulties with Emotion Regulation and Compulsive Sexual Behavior

Emotion dysregulation is an associated feature of compulsive sexual behavior disorder (CSBD), now recognized by the World Health Organization. Previous studies have identified associations between trait emotion dysregulation and CSBD. Given that difficulties with emotion regulation (DERS) is comprised of several facets (e.g., difficulty with impulse control and lacking awareness of one's feelings when upset), and that these facets differentially relate to other mental health concerns, the present study aimed to examine how DERS facets relate to compulsive sexual behavior (CSB). The present study also considered interpersonal emotion regulation via attachment avoidance and attachment anxiety. Hierarchical regression was conducted, first accounting for demographic covariates, then adding attachment styles, and finally all DERS subscales. Results indicated that, among a large, diverse, online U.S. sample (N = 915; Mage = 39.21, SD = 0.81; 54.3% men), difficulty controlling impulses when upset, difficulty with clarity of emotions, and non-acceptance of emotions were significantly positively associated with CSB (small to moderate effects). Attachment anxiety and avoidance were also significantly positively associated with CSB, although their effects were minimal when adding DERS facets. Overall, this study supports the theorized impact of emotion dysregulation on CSB. Assessment of individual differences in DERS and intervening on these concerns are important for treating CSB.

A network analysis of difficulties in emotion regulation, anxiety, and depression for adolescents in clinical settings

BACKGROUND

Difficulties in emotion regulation (DER) are widely considered to underlie anxiety and depression. Given the prevalence of anxiety and depression in adolescents and the fact that adolescence is a key period for the development of emotion regulation ability, it is important to examine how DER is related to anxiety and depression in adolescents in clinical settings.

METHODS

In the present study, we assessed 209 adolescents in clinical settings using the Difficulties in Emotion Regulation Scale (DERS) and the Hospital Anxiety and Depression Scale (HADS) and examined the associations between six components of DER and 14 symptoms of anxiety and depression. We used network analysis, constructed circular and multidimensional scaling (MDS) networks, and calculated network centrality, bridge centrality, and stability of centrality indices.

RESULTS

The results showed that: (1) The global centrality index shows that the Strategy component (i.e., lack of access to strategies) is the center in the whole network, ranking highest in strength, closeness, betweenness, and expected influence. (2) The MDS network showed a closeness of anxiety and depression symptoms, while Awareness component (i.e., lack of emotional awareness) stayed away from other DER components, but Awareness is close to some depression symptoms. (3) The bridge nodes of three groups, Strategy from DERS, Worry and Relax from anxiety symptoms, and Cheerful and Slow from depression symptoms, had the strongest relationships with the other groups.

CONCLUSION

Lack of access to strategies remains in the center not only in DER but also in the DER-anxiety-depression network, while lack of awareness is close to depression but not to anxiety. Worrying thoughts and inability to relax are the bridging symptoms for anxiety, while lack of cheerful emotions and slowing down are the bridging symptoms for depression. These findings suggest that making emotion regulation strategies more accessible to patients and reducing these bridging symptoms may yield the greatest rewards for anxiety and depression therapy.

Emotion dysregulation mediates the relationship between adverse childhood experiences and problematic gaming

Gaming disorder (i.e., gaming addiction) is a relatively common mental health disorder with a worldwide prevalence rate of 3.05%. In the present research, we examined whether emotion dysregulation mediates the relation between adverse childhood experiences and problematic gaming in two samples of current video game players. The first sample consisted of 1,262 students recruited from five universities across Canada. The second sample comprised 417 community adults residing in Canada. Both samples of participants completed an online survey which included measures of adverse childhood experiences, problematic gaming, and emotion dysregulation. A total of 45.64% (n = 576) in the university sample and 49.76% (n = 205) in the community sample met the threshold for problematic gaming. In the student sample, adverse childhood experiences were positively associated with problematic gaming. In contrast, there was no significant association between adverse childhood experiences and problematic gaming in the community sample. In both samples, adverse childhood experiences were positively associated with emotion dysregulation, and emotion dysregulation was positively associated with problematic gaming. Importantly for the present research, emotion dysregulation mediated the relationship between adverse childhood experiences and problematic gaming in both the university and community sample. Although adverse childhood experiences are distal and static risk factors for problematic gaming, emotion dysregulation is a more proximal and modifiable risk factor. The results suggest that increasing adaptive emotion regulation skills may decrease the risk of problematic gaming among individuals who have experienced an adverse childhood experience.

Understanding familial liability for emotion regulation difficulties in bipolar disorder

BACKGROUND

There has been relatively limited work focused on understanding whether relatives of individuals with bipolar disorder (BD) have difficulties in the regulation of emotion, particularly in relation to perceptions about whether emotions can be effectively regulated, or trait behaviours that acknowledge emotions as self-regulators themselves. In this study, we assessed the presence and extent of difficulties in these dimensions of emotion regulation in individuals with BD compared to unaffected first-degree biological relatives (FDR) for the first time.

METHODS

In total, 161 participants, including euthymic individuals with BD, unaffected FDRs, and healthy controls, were compared on the Difficulties in Emotion Regulation Scale (DERS) - a multi-dimensional measure of habitual emotion regulation. Clinical data were also collected and examined in relation to DERS scores in a secondary analysis.

RESULTS

In the BD group, difficulties were evident for most dimensions of emotion regulation as measured by the DERS; and correlated with an earlier onset of illness and more mood episodes. FDRs displayed generally normal emotion regulation, except in terms of their beliefs that emotions can be effectively regulated; on this dimension, their reported difficulty was intermediate to the BD group and controls.

CONCLUSION

Habitual emotion regulation difficulties in BD persist irrespective of mood state, are related to the course of illness, and should be targeted in psychological interventions. Further, the perception that emotions cannot be effectively regulated during times of distress seems to represent an endophenotype for BD.

Emotional dysregulation as trans-nosographic psychopathological dimension in adulthood: A systematic review

Introduction

Emotional dysregulation (ED) is characterized by inappropriate emotional reactions related to environmental or cognitive stimuli. In most recent years, increasing interest has been devoted to its definition and detection across mental disorders for its detrimental role progressively highlighted in both neurodevelopment and adult mental disorders, with implications on the severity of clinical manifestations. The aim of this systematic review was to evaluate and gather the scientific evidence about ED in adult psychiatric population to elucidate the concept of ED as trans-nosographic entity.

Methods

The electronics databases PubMed, Scopus and Web of Science was reviewed to identify studies in accordance with the PRISMA guidelines; at the end of the selection process a total of 29 studies (N = 709; N = 658; N = 1,425) was included. All studies included assessed the presence of ED symptoms, by means of a validate scale in adult (>18 years of age), in clinically diagnosed patients as well as healthy control participants.

Results

Our results suggest ED as a trans-diagnostic factor across multiple mental disorders, such as bipolar disorder, attention deficit hyperactivity disorder, autism spectrum disorder, personality disorders; a better definition of this concept could be helpful to interpret and clarify many clinical cases and improve their diagnostic and therapeutic management.

Elevated emotion reactivity and emotion regulation in individuals at clinical high risk for developing psychosis and those diagnosed with a psychotic disorder

AIMS

Disrupted affective processes are core features of psychosis; yet emotion reactivity and emotion regulation impairments have not been fully characterized in individuals at clinical high-risk for developing psychosis (CHR) or adolescents diagnosed with a psychotic disorder (AOP). Characterizing these impairments may provide a fuller understanding of factors contributing to psychosis risk and psychosis onset. Using cross-sectional and longitudinal data, we evaluated (1) group-level effects of emotion reactivity and regulation, (2) stability of group-level effects over time and age, (3) relationships between emotion reactivity and regulation, and (4) associations between these measures and psychosocial functioning and clinical symptomatology.

METHODS

Eighty-seven participants (CHR = 32, TD = 42, AOP = 13; 12-25 years, 1-5 visits) completed the Emotion Reactivity Scale, Difficulties in Emotion Regulation Scale, and Emotion Regulation Questionnaire. We assessed psychotic symptoms with the Structured Interview for Prodromal Syndromes and measured real-world functioning with the Global Functioning: Social and Role Scales. We used analysis of variance to assess Aim 1 and linear mixed models to address Aims 2-4.

RESULTS

CHR and AOP endorsed experiencing heightened levels of emotion reactivity and greater difficulty utilizing emotion regulation strategies compared to TD. These impairments were stable across time and adolescent development. Greater levels of emotion reactivity were associated with greater emotion regulation impairments. Greater impairments in emotion regulation were associated with lower social functioning and greater negative symptom severity.

CONCLUSION

Therapeutic interventions designed to reduce emotion reactivity and improve one's ability to utilize emotion regulation strategies may be effective in reducing clinical symptomatology and improving real-world functioning in CHR and AOP.

Mindfulness, mood symptom tendencies and quality of life in bipolar disorder: An examination of the mediating influence of emotion regulation difficulties

BACKGROUND

The aim of this cross-sectional study was to investigate dispositional mindfulness and its association with depression and manic tendencies, and subjective life quality in bipolar disorder (BD). Furthermore, this study sought to examine the potential mediating effects of emotion regulation difficulties on these relationships.

METHOD

Twenty-eight healthy controls (HC) and 66 clinically stable outpatients with a DSM-IV-TR diagnosis of BD completed the Mindfulness Attention Awareness Scale (MAAS), Difficulties in Emotion Regulation Scale (DERS), Seven Up (7 Up) Seven Down (7 Down) and the Quality of Life in Bipolar Disorder Questionnaire (QoL.BD). These variables were compared between groups and entered into a series of mediation analyzes using PROCESS in the BD group only.

RESULTS

Lower MAAS scores were detected amongst the BD patients compared to HCs. Lower MAAS scores in BD patients predicted higher 7 Up, 7 Down and lower QoL.BD scores. For the 7 Down and QoL.BD, the associations were completely mediated by DERS scores, with difficulties in strategy use and emotional clarity mediating the association between mindfulness and depressive tendencies and quality of life, respectively. No significant direct or indirect effects were detected for the 7 Up model.

LIMITATIONS

The cross-sectional design precludes causal inference. The MAAS conceptualises mindfulness as unidimensional. Self-report scales of depressive and manic tendencies utilised.

CONCLUSIONS

This study detected a significant association between dispositional mindfulness and depressive tendencies and life quality in BD, and found that these associations were influenced by emotion regulation difficulties. These findings encourage further investigation of mindfulness-based interventions in BD.

Recruiting and exploring vulnerabilities among young people at risk, or in the early stages of serious mental illness (borderline personality disorder and first episode psychosis)

INTRODUCTION

Many gaps exist in our understanding of the developmental pathways to severe mental illness (SMI), including borderline personality disorder (BPD) and psychosis. However, those who have experienced adverse childhood experiences (ACEs) are at an increased risk and there is evidence to suggest that one of the earliest markers is emotional dysregulation. An area which has received relatively less research attention is the role neurodevelopmental disorders (NDDs) play. The aim of this feasibility study was therefore to explore the clinical profiles of young people early in the course of SMI, including their profiles of ACEs, emotional regulation difficulties, borderline personality traits and NDDs.

METHODS

A cross-sectional study of young people (aged 15-25) at risk of SMI, currently being seen within NHS mental health services, was conducted. This included those with early symptoms of psychosis and/or BPD as assessed by diagnostic interview. Eligible participants self-completed a battery of sociodemographic, clinical, and psychological measures in the company of a researcher. This included assessments of: symptoms of NDDs; borderline pathology traits; ACEs; and difficulties in emotional regulation. Statistical analyses included Mann-Whitney U tests and multiple regression.

RESULTS

Of the 118 potentially eligible participants who were referred, 48 were ultimately included in the study. Young people early in the course of SMI reported a high prevalence of ACEs and deficits in emotional regulation. In total, 79% met criteria for attention deficit hyperactivity disorder (ADHD) and/or autism spectrum disorder (ASD). Emotional dysregulation was found to significantly mediate the association between both ACEs and the frequency of NDDs and borderline personality traits, however given the small sample size these results are preliminary in nature.

CONCLUSION

Young people early in the course of SMI are at an increased risk of experiencing multiple childhood adversities and our results indicate a high prevalence of NDDs amongst them. Emotional dysregulation emerged as a potentially significant early marker of future clinical severity. We suggest that the clinical implications of our findings include routine screening for NDDs and ACEs and an increased recognition of the significance of emotional dysregulation. However, larger scale longitudinal studies are needed to investigate these preliminary findings further.

Comparison of Patterns of Non-suicidal Self-Injury and Emotion Dysregulation Across Mood Disorder Subtypes

INTRODUCTION

Non-suicidal self-injury (NSSI) is frequently encountered in patients with mood disorders. Emotion dysregulation (ED), frequently observed in mood disorders, could be a major mediating factor in NSSI. The aim of this study was to explore differences in NSSI behavior and ED across mood disorder subtypes. The relationships between childhood trauma and NSSI and ED were also explored.

METHODS

A total of 191 patients with mood disorders were included in this study. The patterns of NSSI behavior and ED across patients with bipolar I disorder (BD-I), bipolar II disorder (BD-II), and major depressive disorder (MDD) were compared.

RESULTS

More than half (54%) of the subjects experienced NSSI. Patients with BD-II and MDD engaged in NSSI behavior more frequently than those diagnosed with BD-I. NSSI behaviors in patients with BD-II most commonly included cutting, whereas hitting behaviors were most common among other groups. Patients with BD-II and MDD reported more severe ED than those with BD-I. In the case of childhood trauma, those with BD-II and MDD reported greater emotional neglect than those with BD-I. Structural equation modeling revealed that ED mediated the association between childhood trauma and NSSI.

CONCLUSION

BD-I was associated with less frequent NSSI behavior and less severe ED than BD-II and MDD. ED mediated the association between childhood trauma and NSSI. Promoting emotion regulation strategies could prevent NSSI behavior in patients with mood disorders.

Assessing Emotion Regulation Ability for Negative and Positive Emotions: Psychometrics of the Perth Emotion Regulation Competency Inventory in United States Adults

People regulate both negative and positive emotions, and their ability to do this successfully is a cornerstone of adaptive psychological functioning. However, few measures have been available to assess emotion regulation ability across both valence domains. The Perth Emotion Regulation Competency Inventory (PERCI) was recently developed for this purpose. Here we present the first psychometric study of the PERCI in the United States (N = 508). Confirmatory factor analyses supported the intended eight-factor structure, which was invariant across age, gender, and education. PERCI scores had high internal consistency, and were associated with measures of psychopathology, emotional reactivity, and emotion regulation strategies in expected ways. These observed relationships between the PERCI and various regulation strategies may serve to establish a profile of what strategy patterns characterize differences in emotion regulation ability. Overall, the PERCI had strong psychometrics. Its capacity to assess both valence domains should enable more comprehensive assessments of emotion regulation ability.

Affective Saturation Index: A Lexical Measure of Affect

Affect plays a major role in the individual's daily life, driving the sensemaking of experience, psychopathological conditions, social representations of phenomena, and ways of coping with others. The characteristics of affect have been traditionally investigated through physiological, self-report, and behavioral measures. The present article proposes a text-based measure to detect affect intensity: the Affective Saturation Index (ASI). The ASI rationale and the conceptualization of affect are overviewed, and an initial validation study on the ASI's convergent and concurrent validity is presented. Forty individuals completed a non-clinical semi-structured interview. For each interview transcript, the ASI was esteemed and compared to the individual's physiological index of propensity to affective arousal (measured by heart rate variability (HRV)); transcript semantic complexity (measured through the Semantic Entropy Index (SEI)); and lexical syntactic complexity (measured through the Flesch-Vacca Index (FVI)). ANOVAs and bi-variate correlations estimated the size of the relationships between indexes and sample characteristics (age, gender), then a set of multiple linear regressions tested the ASI's association with HRV, the SEI, and the FVI. Results support the ASI construct and criteria validity. The ASI proved able to detect affective saturation in interview transcripts (SEI and FVI, adjusted R2 = 0.428 and adjusted R2 = 0.241, respectively) and the way the text's affective saturation reflected the intensity of the individual's affective state (HRV, adjusted R2 = 0.428). In conclusion, although the specificity of the sample (psychology students) limits the findings' generalizability, the ASI provides the chance to use written texts to measure affect in accordance with a dynamic approach, independent of the spatio-temporal setting in which they were produced. In doing so, the ASI provides a way to empower the empirical analysis of fields such as psychotherapy and social group dynamics.

Characterization and interrelationships of theory of mind, socially competitive emotions and affective empathy in bipolar disorder

OBJECTIVE

Evidence shows impaired theory of mind (ToM) in patients with bipolar disorder (BD), yet research examining its cognitive and affective components simultaneously is sparse. Moreover, recognition of socially competitive 'fortune of others' emotions (e.g. envy/gloat) may be related to ToM, but has not been assessed in BD. Finally, if and how ToM and 'fortune of others' emotions relate to affective empathy in BD is currently unclear. This study aimed to address these points.

METHODS

64 BD patients and 34 healthy controls completed the Yoni task, a visual task assessing first- and second-order cognitive and affective ToM as well as 'fortune of others' emotions. The Toronto Empathy Questionnaire was used to assess self-reported affective empathy.

RESULTS

Patients with BD showed no deficits in cognitive and affective ToM or recognition of 'fortune of others' emotions. The ability to infer 'fortune of others' emotions correlated with several ToM measures, indicating that these functions are part of the same system. Patients with BD reported similar levels of affective empathy to healthy controls, and this was not related to ToM or 'fortune of others' emotions, suggesting that affective empathy represents a separate social domain.

CONCLUSIONS

These findings highlight areas of spared social functioning in BD, which may be utilized in therapeutic strategies.

PRACTITIONER POINTS

Our results suggest theory of mind and empathy may represent areas of potentially spared cognitive functioning in BD. As many BD patients have experienced adversity during developmental periods in which theory of mind and empathy develop, our findings suggest that these abilities may be markers of resilience in the disorder. Our findings are important for the formulation of therapeutic interventions for BD, which may include considering practical ways that a patients' knowledge of intact ToM and empathy could be utilized to reduce self-stigma and promote self-efficacy, improved well-being and functioning.

Deficits in explicit emotion regulation in bipolar disorder: a systematic review

Background

This study aimed to compile and synthesize studies investigating explicit emotion regulation in patients with bipolar disorder and individuals at risk of developing bipolar disorder. The importance of explicit emotion regulation arises from its potential role as a marker for bipolar disorders in individuals at risk and its potent role in therapy for bipolar disorder patients.

Methods

To obtain an exhaustive compilation of studies dealing specifically with explicit emotion regulation in bipolar disorder, we conducted a systematic literature search in four databases. In the 15 studies we included in our review, the emotion-regulation strategies maintenance, distraction, and reappraisal (self-focused and situation-focused) were investigated partly on a purely behavioral level and partly in conjunction with neural measures. The samples used in the identified studies included individuals at increased risk of bipolar disorder, patients with current affective episodes, and patients with euthymic mood state.

Results

In summary, the reviewed studies' results indicate impairments in explicit emotion regulation in individuals at risk for bipolar disorder, patients with manic and depressive episodes, and euthymic patients. These deficits manifest in subjective behavioral measures as well as in neural aberrations. Further, our review reveals a discrepancy between behavioral and neural findings regarding explicit emotion regulation in individuals at risk for bipolar disorders and euthymic patients. While these groups often do not differ significantly in behavioral measures from healthy and low-risk individuals, neural differences are mainly found in frontostriatal networks.

Conclusion

We conclude that these neural aberrations are a potentially sensitive measure of the probability of occurrence and recurrence of symptoms of bipolar disorders and that strengthening this frontostriatal route is a potentially protective measure for individuals at risk and patients who have bipolar disorders.

The effects of childhood emotional maltreatment and alexithymia on depressive and manic symptoms and suicidal ideation in females with bipolar disorder: emotion dysregulation as a mediator

OBJECTIVES

The relations of childhood emotional maltreatment and alexithymia to the clinical course of bipolar disorder (BD) have been widely recognised. Difficulties in regulating emotions may explain these relationships. The current study evaluated the effects of childhood emotional maltreatment and alexithymia on depressive and manic symptoms as well as suicidal ideation in female patients with BD. Emotion dysregulation was evaluated as a mediating factor.

METHODS

Three hundred hospitalised female patients with a diagnosis of BD provided information regarding their history of childhood emotional maltreatment, alexithymia, difficulties in emotion regulation, depressive and manic symptoms, and suicidal ideation. A series of structural equation models (SEMs) were calculated to assess the associations between these variables.

RESULTS

Childhood emotional abuse and difficulty in identifying feelings were indirectly associated with depressive and manic symptoms as well as suicidal ideation. This association was mediated by emotion dysregulation. This association remained significant after depressive and manic symptoms were controlled in the model.

CONCLUSIONS

This study indicates that patients with BD who experienced emotional abuse during childhood and have difficulties identifying emotions report greater emotion dysregulation. These individuals, in turn, are more likely to experience more severe depressive and manic symptoms as well as suicidal ideation.Key pointsChildhood emotional maltreatment and emotional and clinical factors in bipolar disorder were assessed.Childhood emotional abuse indirectly affected clinical factors via emotion dysregulation.Difficulty in identifying feelings was linked to clinical factors via emotional dysregulation.Emotional dysregulation affected the links of childhood emotional maltreatment and difficulty in identifying feelings on suicidal ideation after controlling for clinical symptoms.Emotional dysregulation dimensions of impulse, strategies, and goals emerge in relation to suicidal ideation.

Group-based DBT skills training modules are linked to independent and additive improvements in emotion regulation in a heterogeneous outpatient sample

Objective: Dialectical Behavior Therapy (DBT) was initially developed to treat symptoms of Borderline Personality Disorder (BPD), but has also been shown to improve symptoms of several other mental health conditions. Emotion regulation difficulties comprise a key target of DBT as well as a common challenge for individuals with depression, anxiety, PTSD, and other conditions. The current study investigated the impact of a DBT skills-training group on emotion regulation, and whether improvement in specific facets of emotion regulation would be linked to training in specific modules.Method: One hundred and thirty-six patients diagnosed with heterogeneous mental health conditions participated in the study. Patients were enrolled in the group on a rolling basis, and emotion regulation was assessed at the beginning and end of every six- to eight-week module.Results: Mixed model analysis revealed that each DBT skills-training module (i.e., mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation) was associated with improvements in emotion regulation (all Bonferroni corrected ps < .003).Conclusions: These findings add to the growing literature on the applicability of DBT skills-training to heterogeneous psychological conditions, particularly when patients' challenges reflect underlying difficulties with emotion regulation.

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

BACKGROUND

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Mood Disorders in High-Functioning Autism: The Importance of Alexithymia and Emotional Regulation

Individuals with autism spectrum disorder (ASD) often have co-morbid anxiety and depression. Alexithymia and emotion regulation difficulties are commonly seen in individuals with ASD and in mood disorders. We hypothesized that alexithymia and emotional regulation would mediate the relationship between autistic features and anxiety/depression symptom severity. We collected data about emotional regulation, alexithymia, autistic symptoms and depression/anxiety in a sample of 64 young adults with ASD. We constructed two serial multiple mediator models, using autistic features as the independent variable and anxiety/depression symptoms as outcome variables. The serial relationship between alexithymia and emotional regulation mediated associations between autistic features and depression and anxiety, separately. The findings suggest that targeting alexithymia may benefit therapies designed to alleviate mood disorders in ASD.

Buffering against maladaptive perfectionism in bipolar disorder: The role of self-compassion

BACKGROUND

Maladaptive perfectionism is a transdiagnostic risk and maintaining factor for a range of mental health conditions, including bipolar disorder (BD). Self-compassion represents a potential protective factor against maladaptive perfectionism, however no studies to date have examined the relationship of these constructs in BD. The aim of the present study was to examine associations between maladaptive perfectionism, self-compassion and symptoms among individuals with BD.

METHODS

Baseline data were collected from 302 participants with a DSM-IV diagnosis of BD participating in an international randomised controlled trial. Participants completed measures of maladaptive perfectionism, self-compassion, symptom severity and emotion regulation difficulties. Clinician-administered measures of depression and mania severity were additionally collected. Correlation and mediation analyses were conducted.

RESULTS

Maladaptive perfectionism was positively associated with depression, anxiety and emotion regulation difficulties. Lower levels of self-compassion correlated with greater self-reported depression, anxiety and emotion regulation difficulties. Self-compassion partially mediated relationships between maladaptive perfectionism, depression, anxiety and emotion regulation difficulties.

LIMITATIONS

The cross-sectional design limits conclusions about causal relationships between study variables. Results may not be generalizable to other BD populations. The role of maladaptive perfectionism and self-compassion in elevated mood states of BD remains unclear.

CONCLUSION

Self-compassion represents one mechanism through which maladaptive perfectionism influences symptoms of depression, anxiety and emotion regulation difficulties in BD. Self-compassion represents a modifiable treatment target; individuals with BD exhibiting maladaptive perfectionistic tendencies may benefit from interventions fostering self-compassion.

Altered resting-state cerebral blood flow and functional connectivity of striatum in bipolar disorder and major depressive disorder

BACKGROUND

Clinically distinguishing bipolar disorder (BD) from major depressive disorder (MDD) during depressive states is difficult. Neuroimaging findings suggested that patients with BD and those with MDD differed with respect to the gray matter volumes of their subcortical structures, especially in their striatum. However, whether these disorders have different effects on functionally striatal neuronal activity and connectivity is unclear.

METHODS

Arterial spin labeling and resting-state functional MRI was performed on 25 currently depressive patients with BD, 25 depressive patients with MDD, and 34 healthy controls (HCs). The functional properties of striatal neuronal activity (cerebral blood flow, CBF) and its functional connectivity (FC) were analyzed, and the results from the three groups were compared. The result of the multiple comparisons was corrected on the basis of the Gaussian Random Field theory.

RESULTS

The patients with BD and those with MDD both had higher CBF values than the HCs in the right caudate and right putamen. The hyper-metabolism of right striatum in BD patients was associated with increased average duration per depressive episode. The two disorders showed commonly increased FC between the striatum and dorsolateral prefrontal cortex, whereas the altered FC of the striatum with precuneus/cuneus was observed only in patients with BD.

CONCLUSIONS

Patients with BD and those with MDD had a common deficit in their prefrontal-limbic-striatal circuits. The altered striato-precuneus FC can be considered as a marker for the differentiation of patients with BD from those with MDD.

Psychometric Properties of the Difficulties in Emotion Regulation Scale (DERS) and Its Short Forms in Adults With Emotional Disorders

Objective: The Difficulties in Emotion Regulation Scale (DERS) is a widely used self-report measure of subjective emotion ability, as defined by a prominent clinically derived model of emotion regulation (Gratz and Roemer, 2004). Although the DERS is often used in treatment and research settings for adults with emotional (i.e., anxiety, mood, obsessive-compulsive, or trauma-related) disorders, its psychometric properties are not well-characterized in this population.

Method: We examined the psychometric properties of the DERS and three popular short forms (DERS-16; DERS-18; and DERS-SF) in a large (N = 427) sample of treatment-seeking adults with one or more DSM-5 emotional disorders.

Results: For the original DERS, internal consistency was strong for all subscales except Awareness. A bifactor structure consisting of one general emotion dysregulation factor and five uncorrelated specific factors corresponding to the original DERS subscales (excluding Awareness) provided the best fit. A series of structural equation models (SEMs) demonstrated unique incremental contributions of the general factor and several specific factors to explaining concurrent clinical severity. The general factor and one specific factor (Goals) also prospectively predicted treatment outcome following a naturalistic course of outpatient cognitive-behavioral therapy (CBT) in a subset of participants (n = 202) for whom discharge data were available. Specifically, more severe emotion dysregulation at intake predicted better CBT response, while more severe impairment in goal-directed activity when distressed predicted worse CBT response. All three short forms showed a robust bifactor structure and good internal consistency and convergent validity vis-à-vis the original measure, albeit with a slight decrement in incremental utility (1–3% less variance explained in clinical severity).

Conclusion: With the Awareness items excluded, the DERS showed good internal consistency and a robust bifactor latent structure. The general factor and several specific factors incrementally and prospectively predicted clinical severity and treatment outcome, which suggests that the DERS may have clinical and predictive utility in treatment-seeking adults with emotional disorders. Additional research is needed to establish convergent and discriminant validity in this population. The use of a short form in lieu of the full DERS may be sufficient for many general clinical and research purposes, particularly when participant burden is a concern.

Emotional dysregulation in those with bipolar disorder, borderline personality disorder and their comorbid expression

BACKGROUND

Differentiation of the bipolar disorders (BP) from a borderline personality disorder (BPD) can be challenging owing to shared features, with emotional dysregulation being the likely principal one.

AIM

To assess differences in emotion regulation strategies in those with BP alone, BPD alone and those comorbid for both.

METHODS

We interviewed participants previously receiving a BP or BPD diagnosis, studying those who met DSM criteria for one or both conditions.

RESULTS

The sample comprised 83 with bipolar disorder, 53 with BPD and 54 comorbid for both. Analyses established linear trends, with the greatest impairment in emotion regulation strategies in the comorbid group followed by the BPD group, and with the lowest in the BP group. Specific deficits in the comorbid group included impulsivity, difficulties with goal directed behaviour, and accessing strategies. A similar linear profile was quantified for maladaptive cognitive emotion regulation strategies, weighted to catastrophizing and rumination. Adaptive emotion regulation strategies were superior in the bipolar group, without significant differences observed between the comorbid and BPD groups.

LIMITATIONS

Reliance on self-report measures; combined BP I and II participants limits generalisability of results to each bipolar sub-type; use of DSM diagnoses risking artefactual comorbidity; while there was an over-representation of females in all groups.

CONCLUSIONS

Differences in emotion regulation strategies advance differentiation of those with either BP or BPD, while we identify the specificity of differing strategies to each condition and their synergic effect in those comorbid for both conditions. Study findings should assist the development and application of targeted strategies for those with either or both conditions.

Emotion regulation in bipolar disorder: profile and utility in predicting trait mania and depression propensity

Current emotion regulation research in BD has tended to focus on the extent to which patients control their emotions using different cognitive strategies. Fewer studies have investigated whether patients with BD have difficulties in regulating other dimensions of emotion that serve a functional purpose and are thereby more amenable to change. To overcome this paucity of research we utilised a multi-dimensional measure of emotion regulation to characterise the emotion regulation profile of BD, and examine its utility in predicting trait mania and depression propensity. Fifty BD patients and 52 healthy controls completed the Difficulties in Emotion Regulation Scale (DERS) and the General Behaviour Inventory (GBI). Results indicated that patients had difficulties in emotion regulation across a range of dimensions. Impulse control difficulties most parsimoniously predicted trait (hypo)mania propensity in BD patients, whilst poor access to mood regulation strategies predicted depressive propensity. Predictors of the propensity to experience these moods differed in the control group. These findings represent an important step toward informing the development of new treatment strategies to remediate emotion regulation difficulties and improve BD symptomatology.

Emotion regulation strategies can predict task-switching abilities in euthymic bipolar patients

This study examined task-switching abilities and emotion regulation strategies in euthymic bipolar patients (EBP). Forty EBP and 40 healthy individuals performed face categorization tasks where they switched between emotion and non-emotion (i.e., gender) features among faces and completed emotion regulation questionnaire (Gross and John, 2003). Subject groups showed substantial differences in task-switching abilities and emotion regulation strategies: (1) there was a dissociation between emotion and gender classification in EBP. The switch cost was larger [i.e., higher reaction times (RTs) on switch as compared to no-switch trials] for gender categorization as compared to the emotion categorization task. In contrast, such asymmetries were absent among healthy participants. The differential pattern of task switching reflected functional disturbances in frontotemporal neural system and an attentional bias to emotion features of the faces in EBP. This suggests that when a euthymic bipolar patient is preoccupied with emotion recognition, an instruction to perform gender categorization results in greater cost on RTs. (2) In contrast to healthy individuals, EBP reported more frequent use of emotion suppression and lesser use of cognitive reappraisal as emotion regulation strategy. (3) Emotion regulation was found to be a significant predictor of task-switching abilities. It is argued that task switching deficits rely on maladaptive emotion regulation strategies in EBP specifically when tasks of emotional significance are involved.

Objective and subjective psychosocial functioning in bipolar disorder: an investigation of the relative importance of neurocognition, social cognition and emotion regulation

BACKGROUND

People with bipolar disorder (BD) experience significant psychosocial impairment. Understandings of the nature and causes of such impairment is limited by the lack of research exploring the extent to which subjectively reported functioning should be valued as an indicator of objective dysfunction, or examining the relative influence of neurocognition, social cognition and emotion regulation on these important, but different aspects of psychosocial functioning in the context of mania and depression symptoms. This study aimed to address this paucity of research by conducting a comprehensive investigation of psychosocial functioning in a well characterised group of BD patients.

METHODS

Fifty-one BD patients were compared to 52 healthy controls on objectively and subjectively assessed psychosocial outcomes. Relationships between current mood symptoms, psychosocial function and neurocognitive, social cognitive and emotion regulation measures were also examined in the patient group.

RESULTS

Patients had significantly worse scores on the global objective and subjective functioning measures relative to controls. In the patient group, although these scores were correlated, regression analyses showed that variance in each of the measures was explained by different predictors. Depressive symptomatology was the most important predictor of global subjective functioning, and neurocognition had a concurrent and important influence with depressive symptoms on objective psychosocial function. Emotion regulation also had an indirect effect on psychosocial functioning via its influence on depressive symptomatology.

LIMITATIONS

As this study was cross-sectional in nature, we are unable to draw precise conclusions regarding contributing pathways involved in psychosocial functioning in BD.

CONCLUSIONS

These results suggest that patients' own evaluations of their subjective functioning represent important indicators of the extent to which their observable function is impaired. They also highlight the importance of incorporating cognitive and emotion regulation assessments into clinical practice when working to reduce psychosocial dysfunction with patients diagnosed with BD.