Advancing scalability and impacts of a teacher training program for promoting child mental health in Ugandan primary schools: protocol for a hybrid-type II effectiveness-implementation cluster randomized trial

BACKGROUND

Children in low-and-middle-income countries (LMICs) are facing tremendous mental health challenges. Numerous evidence-based interventions (EBIs) have been adapted to LMICs and shown effectiveness in addressing the needs, but most EBIs have not been adopted widely using scalable and sustainable implementation models that leverage and strengthen existing structures. There is a need to apply implementation science methodology to study strategies to effectively scale-up EBIs and sustain the practices in LMICs. Through a cross-sector collaboration, we are carrying out a second-generation investigation of implementation and effectiveness of a school-based mental health EBI, ParentCorps Professional Development (PD), to scale-up and sustain the EBI in Uganda to promote early childhood students' mental health. Our previous studies in Uganda supported that culturally adapted PD resulted in short-term benefits for classrooms, children, and families. However, our previous implementation of PD was relied on mental health professionals (MHPs) to provide PD to teachers. Because of the shortage of MHPs in Uganda, a new scalable implementation model is needed to provide PD at scale.

OBJECTIVES

This study tests a new scalable and sustainable PD implementation model and simultaneously studies the effectiveness. This paper describes use of collaboration, task-shifting, and Train-the-Trainer strategies for scaling-up PD, and protocol for studying the effectiveness-implementation of ParentCorps-PD for teachers in urban and rural Ugandan schools. We will examine whether the new scale-up implementation approach will yield anticipated impacts and investigate the underlying effectiveness-implementation mechanisms that contribute to success. In addition, considering the effects of PD on teachers and students will influence by teacher wellness. This study also examines the added value (i.e. impact and costs) of a brief wellness intervention for teachers and students.

METHODS

Using a hybrid-type II effectiveness-implementation cluster randomized controlled trial (cRCT), we will randomize 36 schools (18 urban and 18 rural) with 540 teachers and nearly 2000 families to one of three conditions: PD + Teacher-Wellness (PDT), PD alone (PD), and Control. Primary effectiveness outcomes are teachers' use of mental health promoting strategies, teacher stress management, and child mental health. The implementation fidelity/quality for the scale-up model will be monitored. Mixed methods will be employed to examine underlying mechanisms of implementation and impact as well as cost-effectiveness.

DISCUSSION

This research will generate important knowledge regarding the value of an EBI in urban and rural communities in a LMIC, and efforts toward supporting teachers to prevent and manage early signs of children's mental health issues as a potentially cost-effective strategy to promote child population mental health in low resource settings.

TRIAL REGISTRATION

This trial was registered with ClinicalTrials.gov (registration number: NCT04383327; https://clinicaltrials.gov/ct2/show/NCT04383327 ) on May13, 2020.

Observed parental spontaneous scaffolding predicts neurocognitive signatures of child emotion regulation

Emotion regulation (ER), a key predictor of positive adjustment throughout the lifespan, is forged in development with profound contributions from parents. In particular, parent scaffolding of child cognition and emotion serves to bolster child regulatory abilities beyond what they could achieve alone. Through habitual parent-child interactions, scaffolded ER likely becomes internalized and drives foundations of neurocognitive regulatory circuitry. Yet, biobehavioral research is needed to establish predictive links between parent scaffolding behaviors and neurocognitive signatures of adaptive child ER. The present study examined observed parental spontaneous scaffolding of child performance during emotionally and cognitively challenging behavioral tasks to predict a neurocognitive signature of adaptive ER: the late positive potential (LPP). The LPP is an event-related potential (ERP) that is modulated by reappraisal, a widely-studied ER strategy defined as interpreting a stimulus in a more positive light. Reduced magnitude of the LPP via reappraisal is a signature of adaptive ER because it predicts both reduced emotional arousal and increased use of adaptive ER strategies. Ninety-seven (49 females; M_age = 6.96, SD = 1.15) 5 to 9 year olds were recruited along with one parent each. Parents and children then completed a cognitively challenging blocks task and a frustrating waiting task, which were subsequently coded to quantify scaffolding quality. Participants completed a Directed Reappraisal Task (DRT) in which unpleasant pictures were paired with either reappraisal or negative interpretations while EEG was recorded. Results showed that greater parental use of high-quality scaffolding predicted greater reduction of the LPP via reappraisal. These findings suggest that habitual parent scaffolding supports adaptive ER measured at the neurocognitive level in childhood. Further, results highlight the importance of examining parent-child interactions when evaluating biological processes underlying ER in childhood.

Transcranial Electrical Stimulation for Psychiatric Disorders in Adults: A Primer

Transcranial electrical stimulation (tES) comprises noninvasive neuromodulation techniques that deliver low-amplitude electrical currents to targeted brain regions with the goal of modifying neural activities. Expanding evidence from the past decade, specifically using transcranial direct current simulation and transcranial alternating current stimulation, presents promising applications of tES as a treatment for psychiatric disorders. In this review, the authors discuss the basic technical aspects and mechanisms of action of tES in the context of clinical research and practice and review available evidence for its clinical use, efficacy, and safety. They also review recent advancements in use of tES for the treatment of depressive disorders, schizophrenia, substance use disorders, and obsessive-compulsive disorder. Findings largely support growing evidence for the safety and efficacy of tES in the treatment of patients with resistance to existing treatment options, particularly demonstrating promising treatment outcomes for depressive disorders. Future directions of tES research for optimal application in clinical settings are discussed, including the growing home-based, patient-friendly methods and the potential pairing with existing pharmacological or psychotherapeutic treatments for enhanced outcomes. Finally, neuroimaging advancements may provide more specific mapping of brain networks, aiming at more precise tES therapeutic targeting in the treatment of psychiatric disorders.

Mobile Attention Bias Modification Training Is a Digital Health Solution for Managing Distress in Multiple Sclerosis: A Pilot Study in Pediatric Onset

Introduction: Emotional health is important dimension of care for patients living with pediatric onset multiple sclerosis (POMS), but few options are available for stress and anxiety reduction. The high burden of interventions requiring regular in person and onsite visits for treatment are less feasible. Attention bias modification training (ABMT) is effective for anxiety reduction in adult and adolescent populations. We tested the feasibility and preliminary efficacy of ABMT delivered through a mobile gamified version as a digital emotional health tool for patients with POMS.

Methods: Participants with POMS were consecutively recruited from the NYU Langone Pediatric MS Care Center and enrolled to complete a 1-month intervention with use of the Personal Zen ABMT app on their mobile personal device. Feasibility was evaluated by use of the 1-month intervention and efficacy was measured by changes in depression, anxiety, and affect.

Results: A total n = 35 patients with POMS were enrolled in the study (M_age = 17.7, SD = 2.2 years, range 14–23). Feasibility criteria were met with 74% completing the full intervention time, and 100% of the sample completing at least 50% of targeted intervention use. Initial efficacy was found for a reduction in negative affect from baseline to intervention end [M = 22.88, SD = 9.95 vs. M = 19.56, SD = 7.37; t₍₃₃₎ = 2.47, p = 0.019]. Anxiety also significantly decreased from pre to post-intervention in adults [M = 11.82, SD = 9.90 vs. M = 7.29, SD = 7.17; t₍₁₆₎ = 3.88, p = 0.001] and youth [M = 51.14, SD = 19.66 vs. M = 40.86, SD = 27.48; t₍₁₃₎ = 3.17, p = 0.007].

Conclusion: Mobile ABMT with the Personal Zen app is a feasible and accessible digital emotional health tool for patients with POMS and may have broader application for managing distress across chronic neurological conditions.

Transcranial Direct Current Stimulation (tDCS) Augments the Effects of Gamified, Mobile Attention Bias Modification

Anxiety-related attention bias (AB) is the preferential processing of threat observed in clinical and sub-clinical anxiety. Attention bias modification training (ABMT) is a computerized cognitive training technique designed to systematically direct attention away from threat and ameliorate AB, but mixed and null findings have highlighted gaps in our understanding of mechanisms underlying ABMT and how to design the most effective delivery systems. One neuromodulation technique, transcranial direct current stimulation (tDCS) across the pre-frontal cortex (PFC) may augment the effects of ABMT by strengthening top-down cognitive control processes, but the evidence base is limited and has not been generalized to current approaches in digital therapeutics, such as mobile applications. The present study was a single-blind randomized sham-controlled design. We tested whether tDCS across the PFC, vs. sham stimulation, effectively augments the beneficial effects of a gamified ABMT mobile app. Thirty-eight adults (Mage = 23.92, SD = 4.75; 18 females) evidencing low-to-moderate anxiety symptoms were randomly assigned to active or sham tDCS for 30-min while receiving ABMT via a mobile app. Participants reported on potential moderators of ABMT, including life stress and trait anxiety. ECG was recorded during a subsequent stressor to generate respiratory sinus arrhythmia (RSA) suppression as a metric of stress resilience. ABMT delivered via the app combined with tDCS (compared to sham) reduced AB and boosted stress resilience measured via RSA suppression, particularly for those reporting low life stress. Our results integrating tDCS with ABMT provide insight into the mechanisms of AB modulation and support ongoing evaluations of enhanced ABMT reliability and effectiveness via tDCS.

Low working memory load facilitates attention bias modification training

Implementations of attention bias modification training (ABMT) attempt to retrain attention away from rather than towards threat, thereby disrupting the anxiety-related attentional bias (AB). Yet, results of ABMT studies have been mixed due to limitations in knowledge of mechanisms underlying ABMT efficacy. Dual-process models of anxiety posit that ABMT works primarily through strengthening of the top-down cognitive control of attention to threat. If this is the case, introducing a working memory load (WML) during ABMT should reduce training efficacy. However, prior studies employing this method show mixed results (Booth, Mackintosh, Mobini, Oztop, & Nunn, 2014; Clarke et al., 2017) and fail to directly compare low and high WML with no WML or to account for individual differences in anxiety and working memory capacity (WMC). The present study (N = 306) assessed trait anxiety and WMC in neurotypical adults who were then randomly assigned to ABMT that trained attention toward or away from threat, with either no, low, or high WML, for a total of six training groups. Attentional bias was assessed before and after training. Results showed ABMT successfully trained attention under low WML, but not under high or no WML, suggesting that ABMT is facilitated by engaging but not overtaxing WML.

White Matter Plasticity in Anxiety: Disruption of Neural Network Synchronization During Threat-Safety Discrimination

Recent evidence highlighted the importance of white matter tracts in typical and atypical behaviors. White matter dynamically changes in response to learning, stress, and social experiences. Several lines of evidence have reported white matter dysfunction in psychiatric conditions, including depression, stress- and anxiety-related disorders. The mechanistic underpinnings of these associations, however, remain poorly understood. Here, we outline an integrative perspective positing a link between aberrant myelin plasticity and anxiety. Drawing on extant literature and emerging new findings, we suggest that in anxiety, unique changes may occur in response to threat and to safety learning and the ability to discriminate between both types of stimuli. We propose that altered myelin plasticity in the neural circuits underlying these two forms of learning relates to the emergence of anxiety-related disorders, by compromising mechanisms of neural network synchronization. The clinical and translational implications of this model for anxiety-related disorders are discussed.

The future of emotion regulation research is in how we measure the dynamics of change

Change is the sine qua non of emotion regulation (ER) and, thus, to understand ER we must analyze its temporal dynamics. Articles in the ER section of this special issue provide strong empirical evidence for the centrality of temporal dynamics in the development of ER on 3 levels: Rapid changes in spatial and temporal dynamics across multimodal systems underlying ER; more slowly emerging ER change over periods of time and development; and change in ER across contexts, including social interactions, culture, and coregulation in parent-child interactions. I describe how the articles by Guassi Moreira and colleagues (2019) and Lavelli and colleagues (2019) exemplify the methodological and conceptual focus on temporal dynamics. Taken together, the articles on ER demonstrate the importance of interweaving a microlevel focus on neural and biological development with a more macrolevel focus on the broader contexts of ER to advance the science of emotional development. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The late positive potential as a neurocognitive index of emotion regulatory flexibility

A growing body of research has examined regulatory flexibility as the ability to dynamically modulate emotional expression and experience (Bonanno & Burton, 2013). The late positive potential (LPP), an event-related potential reflecting processing of emotionally-evocative stimuli, is sensitive to emotion regulation (ER) or the psychological processes that underlie the experience, expression, and management of emotions. However, few studies have used the LPP to index regulatory flexibility or tested its association with self-reported emotional well-being and ER. The results of the current study showed that regulatory flexibility indexed via the LPP was associated with self-reported use of specific ER strategies. Further, greater regulatory flexibility measured as the full LPP regulatory range (indexed following prompts to enhance and suppress emotional responses to stimuli) was specifically and uniquely associated with greater self-reported coping flexibility. Findings provide preliminary support for this neurocognitive approach to conceptualizing and assessing regulatory flexibility.

Conducting Event-Related Potential (ERP) Research with Young Children: A Review of Components, Special Considerations and Recommendations for Research on Cognition and Emotion

There has been an unprecedented increase in the number of research studies employing event-related potential (ERP) techniques to examine dynamic and rapidly-occurring neural processes with children during the preschool and early childhood years. Despite this, there has been little discussion of the methodological and procedural differences that exist for studies of young children versus older children and adults. That is, reviewers, editors, and consumers of this work often expect developmental studies to simply apply adult techniques and procedures to younger samples. Procedurally, this creates unrealistic expectations for research paradigms, data collection, and data reduction and analyses. Scientifically, this leads to inappropriate measures and methods that hinder drawing conclusions and advancing theory. Based on ERP work with preschoolers and young children from 10 laboratories across North America, we present a summary of the most common ERP components under study in the area of emotion and cognition in young children along with 13 realistic expectations for data collection and loss, laboratory procedures and paradigms, data processing, ERP averaging, and typical challenges for conducting this type of work. This work is intended to supplement previous guidelines for work with adults and offer insights to aid researchers, reviewers, and editors in the design and evaluation of developmental research using ERPs. Here we make recommendations for researchers who plan to conduct or who are conducting ERP studies in children between ages 2 and 12, focusing on studies of toddlers and preschoolers. Recommendations are based on both data and our cumulative experience and include guidelines for laboratory setup, equipment and recording settings, task design, and data processing.

Through a Screen Darkly: Use of Computer-Mediated Communication Predicts Emotional Functioning

Despite the pervasive use of computer-mediated communication, relatively little is known about its implications for emotional adjustment. Recent studies suggest that a preference for computer-mediated communication over other types of communication is associated with emotional vulnerabilities, and its active forms (e.g., direct communication) confer psychosocial benefits compared its passive forms (e.g., browsing Facebook). In this study, we simultaneously examined quality, quantity, and preferences for computer-mediated communication in relation to emotional competencies (emotion detection and regulation) and emotional well-being (self-report of mood and anxiety symptoms). In Study 1, participants (N = 123) completed a facial morphing task, a computerized assessment of the speed and accuracy of emotion detection, and the Social Media and Communication Questionnaire assessing quantity and preferences to communicate via computer-mediated communication versus face-to-face. More use of computer-mediated communication along with preferring it for casual communication, was associated with faster and more accurate emotion detection. More use of computer-mediated communication, along with preferring it for positive communication and expressing distress, was associated with more difficulties with emotion regulation. Study 2 (N = 32) added a task-based assessment of active and passive Facebook use in relation to measures of emotional functioning in Study 1. More active Facebook use was associated with greater emotional well-being, whereas more passive Facebook use was associated with less emotional well-being. Active and passive Facebook use was not significantly associated with self-report of broader computer-mediated communication preferences. Together, results suggest that greater use and preference for computer-mediated versus face-to-face communication may be related to heightened emotional sensitivity and more problems with emotion regulation, yet active versus passive use may serve to bolster emotional well-being.

Heterogeneity of the Anxiety-Related Attention Bias: A Review and Working Model for Future Research

The anxiety-related attention bias (AB) has been studied for several decades as a clinically-relevant output of the dynamic and complex threat detection-response system. Despite research enthusiasm for the construct of AB, current theories and measurement approaches cannot adequately account for the growing body of mixed, contradictory, and null findings. Drawing on clinical, neuroscience, and animal models, we argue that the apparent complexity and contradictions in the empirical literature can be attributed to the field's failure to clearly conceptualize AB heterogeneity and the dearth of studies in AB that consider additional cognitive mechanisms in anxiety, particularly disruptions in threat-safety discrimination and cognitive control. We review existing research and propose a working model of AB heterogeneity positing that AB may be best conceptualized as multiple subtypes of dysregulated processing of and attention to threat anchored in individual differences in threat-safety discrimination and cognitive control. We review evidence for this working model and discuss how it can be used to advance knowledge of AB mechanisms and inform personalized prevention and intervention approaches.

A Web-Based Interactive Tool to Reduce Childhood Obesity Risk in Urban Minority Youth: Usability Testing Study

Background

Childhood obesity is a serious public health issue among minority youth in the United States. Technology-enhanced approaches can be effective for promoting healthy behavior change.

Objective

The purpose of this study was to test the usability of prototypes of a Web-based interactive tool promoting healthy dietary behaviors to reduce childhood obesity risk in urban minority youth. The Web-based tool comprised a manga-style comic with interactive features (eg, sound effects, clickable pop-ups), tailored messaging, and goal setting, and was optimized for use on tablet devices.

Methods

Latino and black/African American children ages 9 to 13 years were recruited to participate in two rounds of usability testing. A modified think-aloud method was utilized. Self-reported surveys and field notes were collected. Audio recordings and field notes from usability testing sessions were systematically reviewed by extracting and coding user feedback as either positive comments or usability or negative issues. The quantitative data from self-reported questionnaires were analyzed using descriptive statistics.

Results

Twelve children (four female; eight black/African American) with a mean age of 10.92 (SD 1.16) years participated. Testing highlighted overall positive experiences with the Web-based interactive tool, especially related to storyline, sound effects, and color schemes. Specific usability issues were classified into six themes: appearance, content, special effects, storyline, terminology, and navigation. Changes to the Web-based tool after round 1 included adding a navigation guide, making clickable icons more visible, improving graphic designs, and fixing programming errors. In round 2 of testing (after modifications to the Web-based tool were incorporated), many of the usability issues that were identified in round 1 did not emerge.

Conclusions

Results of testing will inform further development and finalization of the tool, which will be tested using a two-group pilot randomized study, with the goal of reducing childhood obesity risk in minority, low-income youth.

Dynamic Measures of Anxiety-Related Threat Bias: Links to Stress Reactivity

Exaggerated attention to threatening information, or the threat bias, has been implicated in the development and maintenance of anxiety disorders. Recent research has highlighted methodological limitations in threat bias measures, such as temporal insensitivity, leading to the development of novel metrics that capture change and variability in threat bias over time. These metrics, however, have rarely been examined in non-clinical samples. The present study aimed to explore the utility of these trial-level metrics in predicting anxiety-related stress reactivity (stress-induced negative mood state) in trait anxious adults (N = 52). Following a stressor, participants completed the dot probe task to generate threat bias scores. Stress reactivity was measured via stress-induced changes in subjective mood state. More variability in trial-level bias scores and greater bias away from threat (both mean and peak negative trial-level bias scores) predicted increased stress reactivity. The temporal characteristics of threat bias and implications for clinically-relevant measurement are discussed.

A Single Session of Attentional Bias Modification Reduces Alcohol Craving and Implicit Measures of Alcohol Bias in Young Adult Drinkers

BACKGROUND

Attentional bias modification (ABM) techniques for reducing problematic alcohol consumption hold promise as highly accessible and cost-effective treatment approaches. A growing body of literature has examined ABM as a potentially efficacious intervention for reducing drinking and drinking-related cognitions in alcohol-dependent individuals as well as those at-risk of developing problem drinking habits.

METHODS

This study tested the effectiveness of a single session of visual probe-based ABM training in a cohort of 60 non-treatment-seeking young adult drinkers, with a focus on examining mechanisms underlying training efficacy. Participants were randomly assigned to a single session of active ABM training or a sham training condition in a laboratory setting. Measures of implicit drinking-related cognitions (alcohol Stroop and an Implicit Association Task) and attentional bias (AB; alcohol visual probe) were administered, and subjective alcohol craving was reported in response to in vivo alcohol cues.

RESULTS

Results showed that active ABM training, relative to sham, resulted in significant differences in measures of implicit alcohol-related cognition, alcohol-related AB, and self-reports of alcohol craving. Mediation analysis showed that reductions in craving were fully mediated by ABM-related reductions in alcohol-Stroop interference scores, suggesting a previously undocumented relationship between the 2 measures.

CONCLUSIONS

Results document the efficacy of brief ABM to reduce both implicit and explicit processes related to drinking, and highlight the potential intervention-relevance of alcohol-related implicit cognitions in social drinkers.

Digital disruption? Maternal mobile device use is related to infant social-emotional functioning

Mobile device use has become increasingly prevalent, yet its impact on infant development remains largely unknown. When parents use mobile devices in front of infants, the parent is physically present but most likely distracted and unresponsive. Research using the classic Still Face Paradigm (SFP) suggests that parental withdrawal and unresponsiveness may have negative consequences for children's social-emotional development. In the present study, 50 infants aged 7.20 to 23.60 months (M = 15.40, SD = 4.74) and their mothers completed a modified SFP. The SFP consisted of three phases: free play (FP; parent and infant play and interact), still face (SF; parent withdraws attention and becomes unresponsive), and reunion (RU; parent resumes normal interaction). The modified SFP incorporated mobile device use in the SF phase. Parents reported on their typical mobile device use and infant temperament. Consistent with the standard SFP, infants showed more negative affect and less positive affect during SF versus FP. Infants also showed more toy engagement and more engagement with mother during FP versus SF and RU. Infants showed the most social bids during SF and more room exploration in SF than RU. More frequent reported mobile device use was associated with less room exploration and positive affect during SF, and less recovery (i.e., engagement with mother, room exploration positive affect) during RU, even when controlling for individual differences in temperament. Findings suggest that the SFP represents a promising theoretical framework for understanding the impact of parent's mobile device use on infant social-emotional functioning and parent-infant interactions.

Emotional cue validity effects: The role of neurocognitive responses to emotion

The beneficial effect of valid compared to invalid cues on attention performance is a basic attentional mechanism, but the impact of emotional content on cue validity is poorly understood. We tested whether the effect of cue validity on attention performance differed when cues were angry, happy, or neutral faces. Moreover, we used scalp-recorded event-related potentials (ERPs) reflecting the capture of early visual attention (P1, N170) to test whether effects were strengthened when neurocognitive responses to angry or happy cues were enhanced (larger P1 and N170 amplitudes). Twenty-five participants completed a modified flanker task using emotional face cues to measure the effects of emotion on conflict interference. Attention performance was enhanced following valid versus invalid cues, but effects did not differ by emotion cue type. However, for participants showing relatively larger N170 amplitudes to angry face cues, attention performance was specifically disrupted on those trials. Conversely, participants with relatively larger N170 amplitudes to happy face cues showed facilitated performance across all valid trials. These findings suggest that individual neurocognitive sensitivities to emotion predict the impact of emotional content on the basic attentional phenomenon of cue validity.

Favorable associations with alcohol and impaired self-regulation: A behavioral economic analysis

BACKGROUND

Recent research has demonstrated that both poor self-regulation and favorable implicit associations toward alcohol can play important roles in predicting drinking. Less well studied, however, is how the interplay between implicit associations and self-regulation may impact decisions about alcohol consumption. Behavioral economics is one important tool that may provide insight into the cognitive processes that impact demand for alcohol and drinking decisions.

METHODS

Healthy young adult participants completed an Implicit Association Task (IAT) that measured the strength of associations between approach/avoid attributes and target alcohol/neutral images. Impaired self-regulation was assessed by a classic delay discounting task. Participants also completed an Alcohol Purchase Task (APT), which yields multiple behavioral economic indices, chief among which are intensity (the number of drinks a participant would consume if the drinks were free) and elasticity (the degree to which an increased per-drink price impacts the number of drinks consumed in a hypothetical drinking situation). Finally, participants completed a timeline follow-back assessment of past-90-day drinking.

RESULTS

Findings indicated that implicit approach associations toward alcohol predicted increased demand for alcohol on the APT. Although delay discounting did not have a direct effect on demand for alcohol, there was a significant interaction between IAT and delay discounting, such that higher implicit alcohol approach associations predicted particularly high demand for alcohol among participants with poorer self-regulation. APT and IAT, in turn, predicted self-reported drinking behavior.

CONCLUSIONS

These results suggest that favorable attitudes toward alcohol, together with poor self-regulation, can significantly impact drinking decisions in healthy young adults.

Computer-mediated communication preferences predict biobehavioral measures of social-emotional functioning

The use of computer-mediated communication (CMC) as a form of social interaction has become increasingly prevalent, yet few studies examine individual differences that may shed light on implications of CMC for adjustment. The current study examined neurocognitive individual differences associated with preferences to use technology in relation to social-emotional outcomes. In Study 1 (N = 91), a self-report measure, the Social Media Communication Questionnaire (SMCQ), was evaluated as an assessment of preferences for communicating positive and negative emotions on a scale ranging from purely via CMC to purely face-to-face. In Study 2, SMCQ preferences were examined in relation to event-related potentials (ERPs) associated with early emotional attention capture and reactivity (the frontal N1) and later sustained emotional processing and regulation (the late positive potential (LPP)). Electroencephalography (EEG) was recorded while 22 participants passively viewed emotional and neutral pictures and completed an emotion regulation task with instructions to increase, decrease, or maintain their emotional responses. A greater preference for CMC was associated with reduced size of and satisfaction with social support, greater early (N1) attention capture by emotional stimuli, and reduced LPP amplitudes to unpleasant stimuli in the increase emotion regulatory task. These findings are discussed in the context of possible emotion- and social-regulatory functions of CMC.