Heterogeneity of emotion regulation strategies in patients with alcohol use disorder during the first year of abstinence: a clustering analysis

AIMS

Studies examining the use of specific emotion regulation (ER) strategies in patients with severe alcohol use disorder (AUD) are mainly focused on intergroup comparisons to the detriment of intragroup variability. Yet, these patients are in fact characterized by emotional deficits of varying severity, and we seek to identify different patterns of ER strategies in people with AUD during their first year of abstinence.

METHODS

Based on the ER strategies used by a large sample of patients with AUD, we applied cluster analysis to identify the existence of subgroups using distinct patterns of adaptive and nonadaptive strategies. To characterize these groups, we compared their clinical characteristics and then their emotional regulation strategies to those of control consumers.

RESULTS

A first cluster, representing 61% of the sample, is constituted by individuals with high adaptive strategy scores and high nonadaptive strategy scores; a second cluster, representing 39% of the sample, corresponds to individuals with low adaptive strategy scores and high nonadaptive strategy scores. The individuals in these two clusters differed in terms of anxiety level and abstinence time. Compared with control consumers, the use of nonadaptive ER strategies remained lower for the two clusters, while the use of adaptative strategies differed.

CONCLUSIONS

Our results support the idea of considering the heterogeneity of emotional capacities in individuals with AUD during the first year of abstinence. The identification of these profiles suggests either the existence of different adaptive ER capacities at baseline or a specific recovery of adaptive strategies over this period.

Monitoring the emotional facial reactions of individuals with antisocial personality disorder during the retrieval of self-defining memories

While a deficit in the recognition of facial expression has been demonstrated in persons with antisocial personality disorder (ASPD), few studies have investigated how individuals with ASPD produce their own emotional facial expressions. This study examines the production of facial emotional expressions of male inpatients with ASPD in a forensic hospital compared with a control group as they retrieve autobiographical memories. This design constitutes a specific ecological experimental approach fostering the evocation of personal feelings. Two indicators characterizing the activation of facial expression were used: activation of emotional action units and emotional dominance. The results showed that individuals with ASPD 1) activated angrier facial expressions than control participants for both indicators, 2) displayed a higher dominance of angry facial expressions during the retrieval of positive self-defining memories than control participants and 3) recalled significant memories that were less associated with neutral facial states than the control sample, regardless of the valence of their memories. These findings highlight the core role of anger in ASPD and the possible development of pathological anger, which would distinguish trajectories toward anxious or mood disorders and trajectories characterized by external disorders.

Specificity and wealth of autobiographical memories in restrictive and mixed anorexic patients

The reduced specificity of positive and negative autobiographical memories observed in anorexic (AN) patients may reflect a global disturbance in their emotional information processing. However, their emotional difficulties may differ according to the subtype of AN, implying possible differences in the manifestation of autobiographical memory impairments. The aims of the study were (1) to confirm the autobiographical memory deficits in AN patients in terms of specificity and wealth of memories, and (2) to compare autobiographical deficits according to the AN subtype: restrictive type (AR) or binge/purging type (AB). Ninety-five non-clinical (NC) individuals and 95 AN patients including 69 AR and 22 AB patients were administered the Williams' and Scott's Autobiographical Memory Test. The results confirmed a lack of specificity regardless of emotional valence in the overall AN patient group without any distinction of subtype, which was linked to the number of hospitalizations. When the AN subtype was considered, AR patients demonstrated reduced specificity for negative memories only, suggesting differences in emotional functioning or in the mechanisms underlying reduced specificity between AR and AB patients. Furthermore, the overall AN group demonstrated lower variability and complexity in their memory content than the NC group. However, this difference in the complexity of recalled memories was only found in response to negative cues. When AN subtypes were considered, AR patients showed fewer complex memories than NC individuals. Beyond a reduced specificity, AN patients also depict a poverty in the range of event recall and a difficulty in developing narrative content. The clinical implications of such autobiographical memory deficits need to be further investigated.

Training emotion regulation processes in alcohol-abstinent individuals: A pilot study

The study aimed to assess whether abstinent individuals with alcohol use disorders (AUD) would benefit from enhanced emotional regulation (ER) strategies using the affect regulation training (ART) program based on weekly sessions comprising psycho-education, muscle and respiratory relaxation, awareness, acceptance and tolerance, compassionate personal support, emotion analysis and modification. Seventy-two participants with AUD benefited from ART and were compared on their ER ability, mindfulness, and their experience of abstinence to 40 participants not receiving the program, before it, at the end, and 6 months after. Improvements in ER were observed, particularly in positive centration, action centration or self-blame and in mindfulness abilities after the program and six months later. In addition, by comparing participants who received the program with a short (<18 months) or long (>18 months) abstinence duration, the results showed a greater decrease in the use of non-adaptive strategies, a greater increase in adaptive strategies and mindfulness abilities in short-term abstinent individuals. These results demonstrate improvement in ER skills after training in people who were abstinent from alcohol. ART is effective for consolidating abstinence and should be used especially at the beginning of withdrawal to promote the rapid implementation of new ER strategies.

Eating in case of emotion dys-regulation, depression and anxiety: Different pathways to emotional eating in moderate and severe obesity

Emotion dys-regulation is thought to be involved in the development and maintenance of emotional eating (EE), notably through its links with anxious and depressive symptoms. AIM: The aims of the study were to: (a) examine the mediating effect of depressive and anxious symptoms on the relationship between emotion dys-regulation and EE in obesity and (b) compare those links with various degrees of obesity severity. One hundred and twenty patients with obesity, including 60 with "n" (MO) (30 ≤ BMI < 40) and 60 with "severe obesity" (SO) (BMI > 40), completed self-report measures of emotion dys-regulation, depression, anxiety and EE. Partial least square structural equation modelling and multi-group analyses were performed. Emotion dys-regulation was found to be significantly associated with EE only when the severity of obesity was taken into account. In addition, although the MO and SO groups reported similar levels of emotional and eating disorders, significant differences were found between the groups in pathways leading to EE. In MO, emotion dys-regulation was only associated with more EE through more anxiety. In SO, emotion dys-regulation was both directly and indirectly associated with more EE, but only through more depression in the latter. Emotion dys-regulation, anxiety and depression do not have the same impact on EE depending on the severity of obesity. Psychotherapeutic interventions should aim at reducing emotion dys-regulation in obesity from MO onwards, but the focus should be on the management of anxiety-related affects in MO and depression-related affects in SO.

Characterisation of self-defining memories in criminals with antisocial personality disorder

Early aversive events are key factors in the development of antisocial personality disorder (ASPD) and are known to impact the ability to produce specific autobiographical memories and to modify self-construction. The present study assessed identity construction in forensic inpatients suffering from ASPD by comparing the characteristics (specificity, integration, valence, topic and period) of self-defining memories (SDM) of persons with ASPD hospitalised in a forensic hospital to those of control participants. Offenders with ASPD had difficulty in retrieving purely specific single events and tended to recall memories comprising multiple events. In addition, they produced significantly less meaning-making from their past experiences (low integration). These characteristics of SDM could be due to a defensive process used by offenders with ASPD in which they do not integrate aversive experiences, thereby creating a vicious circle where maladjustment of their personality is maintained.

Decreased emotional eating behavior is associated with greater excess weight loss five years after gastric banding

While significant weight loss has been observed in the first two years following adjustable gastric banding (AGB), research on the long-term effectiveness of gastric restriction (e.g., 5 years) both on weight loss and eating behavior changes is scarce. The present study examined obese patients' changes in eating behavior preoperatively and 5 years after AGB and examined their associations with excess weight loss (EWL). Specifically, we focused on the association between the modification of three eating behavior profiles (i.e., restrained eating, emotional eating and external eating) and %EWL at 5 years. Among the 197 participants who underwent AGB, 136 completed the clinical assessments (weight, depression with the BDI, eating behavior with the DEBQ) before surgery, and after 5 years. Resultsshowed that the mean percentage of EWL was 47% after 5 years. Moreover, patients reported lower emotional eating and external eating after 5 years in comparison to the baseline, whereas there were no differences concerning restrained eating. Importantly, patients who presented higher %EWL at 5 years also reported a greater decrease in emotional eating between the two sessions than those with low %EWL. Our study underlines that eating behaviors are major variables involved in weight loss after gastric restriction. Results showed that emotional and external eating decreased significantly at 5 years whereas restrained eating behaviors did not vary between the pre- and postoperative stages. Moreover, the data suggest that a decrease in emotional eating accounts for the extent of EWL.

Interoceptive reliance as a major determinant of emotional eating in adult obesity

This study examined the association between emotional eating, emotion dysregulations, and interoceptive sensibility in 116 patients with obesity by distinguishing an “awareness” and a “reliance” component of interoceptive sensibility. Deficits in interoceptive awareness were only associated with more emotional eating in obesity through less interoceptive reliance and more emotion dysregulations. The results suggest that good interoceptive awareness can increase the risk of emotional eating if not supported by good interoceptive reliance. Interoceptive reliance, like the ability to trust, positively consider, and positively use inner sensations, should be a privileged target of psychotherapeutic interventions in obesity.

What effort is required in retrieving self-defining memories? Specific autonomic responses for integrative and non-integrative memories

Self-defining memories (SDM) are autobiographical memories associated with the construction and maintenance of identity, and which play a core role in establishing and achieving goals in life. The aim of this study was to evaluate the effort required in retrieving SDM as reflected by physiological activity. We examined the neurovegetative responses associated with three dimensions of SDM: specificity, integrative meaning and emotional valence. Electrodermal activity (skin conductance response frequency, phasic driver) and the high frequency component of heart rate variability (HF-HRV) were recorded during the retrieval of SDM in 36 healthy participants to assess the activation of the sympathetic and parasympathetic systems, respectively. SDM were characterized by three independent investigators with satisfactory inter-rater reliability. Linear mixed effects analyses showed that only the integrative meaning dimension led to a main effect on electrodermal activity. In addition, an interaction effect showed that the retrieval of non-integrative and specific memories was associated with a higher level of electrodermal activity than the retrieval of integrative specific memories. No effects were obtained regarding the HRV indicators. The higher activation of the sympathetic nervous system associated with the retrieval of non-integrative SDM suggests that the ability to derive meaning from personal experiences plays a regulatory role and is a fundamental component in personal adjustment.

Difficulties in emotion regulation and deficits in interoceptive awareness in moderate and severe obesity

PURPOSE

Difficulties in emotion regulation and deficits in interoceptive awareness may be responsible for overeating and weight gain in obesity by increasing the risks of problematic eating behaviors. This study aimed to: (1) examine emotion regulation difficulties and interoceptive deficits in obesity; (2) compare the emotion regulation and interoceptive abilities of moderately and severely obese patients.

METHODS

Participants were recruited through the university, diabetology centers and bariatric surgery departments. A total of 165 participants were categorized in three groups, matched by age and gender, according to their Body Mass Index (BMI). The severely obese (SO), moderately obese (MO) and normal weight (NW) groups were constituted of 55 participants each. Self-report questionnaires were used to assess emotion regulation difficulties (CERQ-DERS) and interoceptive awareness (MAIA-FFMQ).

RESULTS

Overall, obese participants reported more emotion regulation difficulties and less interoceptive awareness than NW participants did. They also reported a lack of planning strategies and emotional awareness, as well as less ability to observe, notice and trust body sensations. No differences in emotion regulation and interoceptive abilities were found between MO and SO participants.

CONCLUSIONS

Emotion regulation and interoceptive awareness should be targeted in the psychotherapeutic care of obese people, regardless of their BMI.

LEVEL OF EVIDENCE

Level III, case-control analytic study.

Compromises of integration, specificity and emotional content of self-defining memories in patients with opioid-use disorder

Autobiographical memory plays a major role in the construction of identity. A particular type of memory has been described as more relevant in pursuit of personal goals: self-defining memory (SDM). In patients with opioid-use disorder (OUD), SDM recall has not yet been investigated despite deficits in the retrieval of autobiographical memories. This study aims to characterise SDM recall in OUD patients. Patients (N = 25) and non-dependent individuals (N = 25) were told to recall five SDM and to rate the emotion (valence and arousal) triggered during the retrieval. Specificity, valence, theme, integration and distance in time of the SDM were analysed while controlling for anxiety and depression levels. The SDM construction of the OUD patients was characterised by a lower specificity, more neutral memories and a lower integration, while emotions triggered during retrieval did not differ between the two groups. This may reflect an unsuccessful attempt to disconnect from one's own emotions in the OUD patients. This emotional disconnection and the difficulty of addressing meaning of past events may be due to substance use history coupled with the use of emotional strategies of avoidance. The implications for substance abuse relapse are discussed.

Mind reading abilities in opiate-dependent patients: An exploratory study

OBJECTIVES

Impairments in social cognition have been described as playing a major role in the maintenance of addictive behavior in substance abusers. This study aimed to investigate the Theory of Mind (ToM) ability of opiate-dependent (OD) patients and to explore whether TOM ability was correlated with length of substance abuse, age at onset of substance abuse and length of abstinence.

METHODS

OD patients (N = 29) and non-dependent individuals (NDI) (N = 29) were submitted to the Theory of Mind Assessment Scale (Th.o.m.a.s.), a semi-structured interview, and to the Versailles-Lecture Intentionnelle en Situation (V-LIS), a movie paradigm in which participants have to infer the characters' intentions.

RESULTS

The results confirmed a deficit in ToM ability in OD patients, with OD patients demonstrating poorer performance than NDI on both the V-LIS and the Th.o.m.a.s. The combination of perspective taking and reflecting on others' mental states was particularly difficult for OD patients. Furthermore, impairments in ToM abilities were not correlated with the age at onset of substance abuse or to the duration of substance abuse or abstinence.

CONCLUSIONS

The results suggest OD patients may have impaired social cognition, demonstrating deficits in even basic social interaction skills, which may constitute a risk factor for addiction. These findings underline the importance of developing interventions to improve social cognition ability during the rehabilitation of OD patients.

Autobiographical memory compromise in individuals with alcohol use disorders: Towards implications for psychotherapy research

It has been found that Autobiographical memory (i.e., memory for personal experiences and facts about the self) are not properly maintained in people with alcohol-use disorders (AUD). The present paper offers a comprehensive overview of findings regarding the consequences of AUD on autobiographical memory. More specifically, we offer a theoretical model (the AMAUD Autobiographical Memory and Alcohol Use Disorders model) according to which chronic alcohol consumption compromises emotion regulation as well as executive control, which maintains the construction of autobiographical memory. Compromises in emotional regulation and executive functioning can be linked to a weak aspiration to construct detailed memories (i.e., autobiographical overgenerality), compromises of subjective reliving, anterograde amnesia, negative self-defining memories, and a difficulty to mentally project oneself forward in time to generate complex autobiographical representations and self-images. By gathering cognitive and clinical aspects of autobiographical decline in AUD, this model constitutes a theoretical foundation that may lead to a better understanding of this decline. Different clinical perspectives are proposed for developing personalized autobiographical memory rehabilitation programs for individuals with AUD.

Flashbulb memories of Paris attacks: Recall of these events and subjective reliving of these memories in a case with Alzheimer disease

RATIONALE

Flashbulb memories are detailed and vivid memories of attributes of the reception context of surprising and emotionally arousing public events.

PATIENT CONCERNS AND DIAGNOSIS

This paper offers a fine-grained view of flashbulb memories in a patient with mild Alzheimer's disease (AD).

INTERVENTIONS

The patient underwent a directed interview about the 13 November 2015 attacks in Paris.

OUTCOMES

Unlike her memory about the date and month of the attacks, the patient provided accurate information about the year, time and places they occurred. The patient also provided accurate information about how she first became aware of the attacks, where she was, with whom, what she was doing, and what time it was when she learned about them. As for the affective characteristics of these memories, she tended to have high ratings of vividness and rehearsal. Negative emotional states and great surprise and novelty were also reported.

LESSONS

By assessing the impact of flashbulb memories in this patient with AD, this paper offers a unique view into how such memories may trigger a considerable recall of context as well much subjective reliving.

Cognitive and affective theory of mind abilities in alcohol-dependent patients: the role of autobiographical memory

BACKGROUND

Many studies of patients with alcohol dependence (AD) have highlighted their difficulty in identifying both their own emotional state and those of a social partner. We examined (1) the cognitive and affective theory of mind (ToM) abilities of AD patients and (2) how the efficiency of their autobiographical memory (AM) can affect the effectiveness of ToM ability.

METHOD

In a cross-sectional design, AD patients (N=50) and healthy controls (N=30) completed a ToM movie paradigm (Versailles-Situational Intention Reading, V-SIR) in which they inferred the intentions of characters in movies depicting social interactions, and the "Reading the Mind in the Eyes" Test (RMET), which assessed the emotional dimension of the ToM. AM was investigated using the "Autobiographical Memory Interview" (AMI) to assess both episodic and semantic components of AM.

RESULTS

Concerning ToM, patients with AD showed lower performance in the RMET than control participants, whereas no difference was observed on the V-SIR test. AD patients had lower scores than controls on the AMI, for both episodic and semantic components and for different periods of life. A multiple linear regression analysis also showed that AM deficits might predict lower ToM performance, especially for the RMET task.

CONCLUSIONS

Patients with AD have a specific affective ToM deficit. They used episodic memories to perceive the emotions of others, whereas controls used preferentially semantic memories to perform the task. Both these deficits could constitute a risk of relapse and should be a target for psychotherapeutic interventions.

Autobiographical memory and differentiation of schematic models in substance-dependent patients

BACKGROUND AND OBJECTIVES

This study aims at investigating reduced autobiographical memory specificity in substance-dependent patients. We examined whether this phenomenon is related to undifferentiated schematic models of self and to depression and anxiety levels. We also investigated the maintenance of these impairments after early clinical remission.

METHODS

Seventy-three dependent patients (including 30 active users, 23 methadone-maintained patients, 20 early abstinent patients) and 31 control participants were given Williams' and Scott's Autobiographical Memory Test (AMT) to evaluate the level of memory specificity. Depression and anxiety levels were assessed with the Hospital Anxiety and Depression Scale (HADS), and the ability of differentiation in affect-related schematic models of self with the Level of Emotional Awareness Scale (LEAS).

RESULTS

Dependent patients recall less specific memories than control individuals to the AMT. For all the participants, only the ability to differentiate emotional states predicts the level of specificity, whereas reduced specificity is not linked to depression and anxiety levels. The results also show that reduced specificity is still observable in methadone-maintained patients and in abstinent patients.

LIMITATIONS

Despite the absence of difference in the level of memory specificity in the three groups of dependent patients, we cannot state that reduced memory specificity is stable over time because non-active consumers may not remain in remission for a long period.

CONCLUSIONS

Only a lack of emotional differentiation seems to impede the access to specific memories in dependent patients and in general population. The reduced memory specificity observed in dependent patients seems to last after recent clinical improvement.