‘Felt sense of anomaly’‐type transdiagnostic dissociative experiences in adolescents: Endorsed phenomenology and plausible mechanisms

A large number of mechanisms, many relating to the processing of affect, have been proposed to cause dissociation. The aim of this study was to use network analyses to identify psychological processes most closely connected with ‘felt sense of anomaly’ dissociative experiences. Both an undirected model and a partially directed network model were estimated using data from 6161 general population respondents collected online. The networks were used to identify relationships between dissociation and ten candidate mechanisms: cognitive appraisals, behavioural responses to dissociation, affect intolerance, alexithymia, attentional control, body vigilance, anxiety sensitivity, general self-efficacy, perseverative thinking, and beliefs regarding stress. Both models indicated a highly connected network in which dissociation had direct connections with six psychological processes: cognitive appraisals, behavioural responses, perseverative thinking, alexithymia, general self-efficacy, and beliefs about being overwhelmed. The strongest connection in both networks was between dissociation and cognitive appraisals (causal effect 0.73). The causal direction of connections could not be statistically determined with confidence, apart from the strong probability that dissociation causes meta-cognitions about being overwhelmed (98.54% of 50,000 sampled directed acyclic graphs). Both networks suggest that cognitive appraisals and factors relating to heightened (negative) sensitivity to affect are closely connected to dissociation. Dissociative experiences may arise from a high sensitivity to affect leading to threat-based appraisals that are ruminated upon and maintained by unhelpful behaviours such as avoidance. Investigation of these relationships in clinical groups, and direct causal tests, are required.

Testing the mediating role of negative affect, affect intolerance, and dissociation in the relationship between sleep loss and psychotic experiences.

Dissociation is problematic in its own right for patients with psychosis but may also contribute to the occurrence of psychotic experiences. We therefore set out to estimate in a large cohort of patients with psychosis the prevalence of dissociative experiences, and assess using network models the relationships between dissociation, its potential maintenance mechanisms, and mental health symptoms.902 patients with non-affective psychosis attending UK mental health services participated. Both an undirected model and a partially directed network model were estimated to identify potential relationships between ‘felt sense of anomaly’ dissociative experiences, paranoia, hallucinations, psychological wellbeing, sleep, and six potential maintenance mechanisms (affect intolerance, perseverative thinking, general self-efficacy, alexithymia, cognitive appraisals, and cognitive-behavioural responses to dissociation).617 patients (65.4%) had experienced at least one dissociative symptom regularly over the past fortnight, with the average number experienced being 8.9 (SD = 8.0). Dissociation had direct relationships with paranoia, hallucinations, low psychological wellbeing, cognitive appraisals, cognitive-behavioural responses to dissociation, perseverative thinking, and low alexithymia. Dissociation was a probable cause of hallucinations (94.21% of 50,000 sampled directed acyclic graphs), with a trend towards also being a cause of paranoia (86.25% of 50,000 sampled directed acyclic graphs).Approximately two-thirds of patients with psychosis experience regular dissociative experiences. Dissociation is associated with low psychological wellbeing, and it is likely to have a direct causal influence on psychotic symptoms. Catastrophic cognitive appraisals, cognitive-behavioural responses to dissociation, factors related to affect sensitivity, and perseverative thinking may contribute to the occurrence of dissociation.

Dissociative experiences have been linked to panic symptoms in adolescents, yet the nature of the association remains unclear. In the present study, we investigated the longitudinal relationship between dissociative experiences (focusing on the felt sense of anomaly subtype) and panic, as well as the potential mediating roles of emotion regulation strategies (expressive suppression and cognitive reappraisal), alexithymia, and cognitive appraisals of dissociation. Four thousand five hundred one adolescents aged 13-18years were recruited via social media advertising to take part in an online survey at two timepoints, 1month apart. Analysis of 421 datasets found a significant positive relationship between initial dissociative experiences and panic symptoms reported 1month later. This was mediated by the emotion regulation strategy of cognitive reappraisal, and cognitive appraisals of dissociation. These two variables were no longer significant mediators when controlling for panic symptoms at the first time point, likely due to the stability of panic symptoms across both assessments. Neither alexithymia nor expressive suppression were significant mediators. Thus, dissociative experiences that are persistently misinterpreted in a catastrophic manner may lead to escalating anxiety and panic symptoms, which could in turn heighten and maintain the feared dissociation sensation. These results indicate that dissociative experiences are associated with panic symptoms in adolescence, with cognitive appraisals of dissociation and cognitive reappraisal playing a role in this relationship.

A positive correlation between the incidences of dissociative and psychotic experiences has been consistently reported in a variety of adult populations. The present study was a preliminary investigation of the association between dissociative and psychotic experiences in adolescents requiring inpatient mental health care. No previous research has investigated this relationship in an adolescent cohort. Adolescents currently under inpatient care (n = 18) completed questionnaires assessing their experience of dissociative and psychotic phenomena. In line with previous research, a significant positive correlation was found between dissociative and psychotic experiences that remained highly significant once similarities between measures were taken into account. Recognizing the relationship between psychotic and dissociative experiences may be important in developing appropriate and effective treatment for young people experiencing mental health difficulties. Although the study is cross-sectional in nature and has a small sample, the results offer further evidence of the robust relationship between dissociative and psychotic experiences.

Self-compassion and emotional regulation have been identified as constructive attitudes towards the self which can reduce emotional distress. This study is the first to examine the role of a self-compassionate attitude towards the self in reducing symptoms of social anxiety. The study also explored the role of emotional regulation strategies of cognitive reappraisal (CR) and expressive suppression (ES) as mechanisms that mediate the impact of self-compassion on social anxiety. Structural equation modelling (SEM) was conducted on cross-sectional correlational data with MPlus version 6. A sample of 750 undergraduate students (378 men and 372 women) completed an online survey comprised of well validated self-report measures of social anxiety, emotional regulation and self-compassion. Structural equation modelling showed that self-compassion predicted lower social anxiety directly and indirectly through lower ES. Higher self-compassion also predicted higher CR. Contrary to expectation, CR did not predict lower social anxiety. Exploratory analyses of self-compassion divided into Compassionate Self-responding (CSR) and Refraining from Non-compassionate Responding (RUSR) identified RUSR as a predictor of lower social anxiety directly and indirectly via ES and CR. CSR had no direct effect on social anxiety but did so indirectly via CR. The findings provide preliminary evidence that self-compassion can play an important role in alleviating social anxiety and that emotion regulation through ES and CR are important mechanisms of that influence. Adopting a more compassionate attitude towards the self can reduce the symptoms of social anxiety Emotional regulation through reducing emotional suppression may be a mechanism whereby higher levels of self-compassion reduce symptoms of social anxiety. Although higher levels of self-compassion predict greater use of emotional regulation through cognitive appraisal, cognitive appraisal does not predict levels of symptoms of social anxiety The capacity to refrain from non-compassionate self-responding may reduce symptoms of social anxiety directly and indirectly through lower levels of emotional suppression and greater cognitive reappraisal (CR). However, compassionate self-responding only influences symptoms of social anxiety through CR.

Objective: The aim of this study was to investigate the relationship between headache and anxiety sensitivity (AS), and also headache and dissociative experiences (DE) in adolescents. Methods: Patients were recruited from the adolescents who were admitted to Ankara University Faculty of Medicine Child Neurology Clinic with a complaint of headache and diagnoses of migraine (n=24) or tension type headache (TTH) (n=22). All patients and healthy controls (n=28) were encouraged to complete Childhood Anxiety Sensitivity Index (CASI) and Adolescent Dissociative Experiences Scale (ADES). Results: Patients with headache had higher scores from CASI and ADES instruments in comparison with the healthy adolescents. In case the patient group was divided into two groups regarding to their diagnoses, both migraine and TTH group had higher scores from CASI than control group. However, although TTH group had higher ADES scores than control group, there was no significant difference between migraine and control groups. Likewise, CASI and ADES scores of migraine and TTH groups were not different. Conclusion: Adolescents with headache are having higher AS and DE than normal controls. The diagnosis of migraine or TTH does not change these results in terms of AS. However, adolescents with migraine are not having higher DE than normal controls.

Eating disorders (EDs) are psychiatric illnesses in which emotions play an important role in their development and maintenance. These disorders are associated with expressive suppression, stress, and procrastination. The purpose of this work was to explain eating disorders from stress and procrastination, with expressive suppression as a mediating variable. It was attended by 918 students from three universities in Ecuador. The information was collected through four instruments: inventory of eating disorders, perceived stress scale, Tuckman procrastination scale and emotional regulation questionnaire. The data was analyzed through a mediational analysis in the Jasp program, version 15. The independent variables were: procrastination and stress, the dependent variable was risk of experiencing bulimia (REB) and the mediating variable was expressive suppression. Procrastination and stress, mediated by expressive suppression, were found to have no statistically significant effect on EBR. Procrastination has a direct effect on REB, although stress does not, and the model between expressive suppression and REB explains a good percentage of the variance.

Previous research has shown that problematic smartphone use (PSU) is related to several affect-related psychopathology variables. Emotion dysregulation has been regarded as a central psychological factor associated with that type of psychopathology. In this paper, the association between expressive emotional suppression, a form of emotion dysregulation, with PSU was investigated. Furthermore, we tested if types of smartphone use (process and social use) mediated that association. Three hundred American college students participated in a web-based survey that included the Smartphone Addiction Scale (for problematic smartphone use), Emotion Regulation Questionnaire (assessing suppression), and Process vs. Social Smartphone Usage scale. We found that expressive suppression was correlated with both process smartphone use and PSU severity. Mediation analysis showed that process smartphone use completely mediated relations between suppression and PSU severity. The findings suggest that dysfunctional emotion regulation could lead to more process smartphone use that, in turn, may manifest in PSU severity. Contributions and limitations of the study are discussed.KeywordsProblematic smartphone useSmartphone addictionSmartphone use disorderEmotion regulationExpressive suppressionSuppression

Previous research has shown that problematic smartphone use (PSU) is related to several affect-related psychopathology variables. Emotion dysregulation has been regarded as a central psychological factor associated with that type of psychopathology. In this paper, the association between expressive emotional suppression, a form of emotion dysregulation, with PSU was investigated. Furthermore, we tested if types of smartphone use (process and social use) mediated that association. Three hundred American college students participated in a web-based survey that included the Smartphone Addiction Scale (for problematic smartphone use), Emotion Regulation Questionnaire (assessing suppression), and Process vs. Social Smartphone Usage scale. We found that expressive suppression was correlated with both process smartphone use and PSU severity. Mediation analysis showed that process smartphone use completely mediated relations between suppression and PSU severity. The findings suggest that dysfunctional emotion regulation could lead to more process smartphone use that, in turn, may manifest in PSU severity. Contributions and limitations of the study are discussed.

Positive affect, negative affect, and emotion regulation strategies are related to sleep quality. Emotion regulation can also act as either a protective factor against the development of psychopathologies, or as a risk factor for their development, and therefore may be one mechanism linking mental health and sleep. However, currently it is not known whether affect can mediate the impact of emotion regulation strategy use on sleep quality. An opportunity sample in a healthy population completed the Positive and Negative Affect Schedule providing measures of positive and negative affect, the Pittsburgh Sleep Quality Index providing a measure of sleep quality, and the Emotion Regulation Questionnaire to record habitual use of emotion regulation strategies. Data were analysed using regression and mediation analyses. Negative affect and expressive suppression were positively correlated with PSQI score suggesting that as negative affect and expressive suppression use increased, sleep quality decreased. Positive affect was negatively correlated with PSQI score suggesting that as positive affect increased sleep quality improved. Further, mediation analyses revealed that both positive affect and negative affect mediated the impact of expressive suppression on sleep quality. Moreover, this partial mediation provides the first description that the influences of affect and expressive suppression on sleep quality are at least partially distinct. Targeting improvements in negative affect and effective emotion regulation strategy use may improve the efficacy of interventions aimed at improving sleep quality and the reduction in symptomology in psychopathologies.

Dissociative symptoms are associated with a range of negative outcomes, yet little is understood about how adolescents experience dissociation in their daily lives. This study aimed to describe adolescents’ dissociative symptoms from the perspective of adolescents, their parents, and their treating clinicians. Semi-structured interviews were conducted with 13 participants about adolescents’ experiences of dissociation. Participants were 6 female adolescent patients (aged 14–17 years, M = 15.67) from a psychiatric outpatient service, 3 parents, and 4 clinicians. Reflexive thematic analysis was used to analyse interview data. Dissociative experiences varied in frequency, duration, and type (theme 1, Dissociation is Diverse: “It can vary a lot”) . However, commonalities were also observed: intense emotions experienced during dissociation were described as qualitatively different from typical emotional dysregulation ( theme 2, Emotion Takes Over: “It’s like it just consumes me”) . During dissociation, adolescents reported a pronounced detachment from the present moment ( theme 3, Disconnecting from the Present: “I don’t really exist here” with subthemes of Affective Disconnection and Bodily Disconnection) . The dissociative state, not reality, felt real ( theme 4, Reality Feels Unreal: “I didn’t feel real”) . Finally, a marked decline in memory and attention was described (theme 5, Problems with Memory and Attention: “My brain stops working”). This study is the first to examine adolescent dissociative experiences from the perspective of adolescents, their parents, and their clinicians. Adolescents’ dissociative symptoms mostly aligned with symptoms for dissociative disorders in the DSM-5-TR/ICD-11. However, identity disruption appeared absent, while the presence of fantasy elements was potentially unique and warrants replication and clarification through formal assessment. Findings can inform the refinement of symptom criteria in diagnostic guides and the development of adolescent-focused assessment tools. This may support earlier and more accurate identification of dissociation and enable tailored interventions to improve clinical outcomes for this population.

Interpersonal emotion regulation is the dynamic process where the regulator aims to change the target's emotional state, which is presumed to engage three neural systems: cognitive control (i.e., dorsal and ventral lateral PFC, etc.), empathy/social cognition (i.e., dorsal premotor regions, temporal-parietal junction, etc.), and affective response (i.e., insula, amygdala, etc.). This study aimed to identify the underlying neural correlate (especially the interpersonal one), of interpersonal emotion regulation based on two typical strategies (cognitive appraisal, expressive suppression). Thirty-four female dyads (friends) were randomly assigned into two strategy groups, with one assigned as the target and the other as the regulator to downregulate the target's negative emotions using two strategies. A functional near-infrared spectroscopy system was used to simultaneously measure participants' neural activity. Results showed that these two strategies could successfully downregulate the targets' negative emotions. Both strategies evoked intrapersonal and interpersonal neural couplings between the cognitive control, social cognition, and mirror neuron systems (e.g., PFC, temporal-parietal junction, premotor cortex, etc.), whereas cognitive reappraisal (vs expressive suppression) evoked a broader pattern. Further, cognitive reappraisal involved increased interpersonal brain synchronization between the prefrontal and temporal areas at the sharing stage, whereas expressive suppression evoked increased interpersonal brain synchronization associated with the PFC at the regulation stage. These findings indicate that intrapersonal and interpersonal neural couplings associated with regions within the abovementioned systems, possibly involving mental processes, such as cognitive control, mentalizing, and observing, underlie interpersonal emotion regulation based on cognitive reappraisal or expressive suppression.SIGNIFICANCE STATEMENT As significant as intrapersonal emotion regulation, interpersonal emotion regulation subserves parent-child, couple, and leader-follower relationships. Despite enormous growth in research on intrapersonal emotion regulation, the field lacks insight into the neural correlates underpinning interpersonal emotion regulation. This study aimed to probe the underlying neural correlates of interpersonal emotion regulation using a multibrain neuroimaging (i.e., hyperscanning) based on functional near-infrared spectroscopy. Results showed that both cognitive reappraisal and expressive suppression strategies successfully downregulated the target's negative emotions. More importantly, they evoked intrapersonal and interpersonal neural couplings associated with regions within the cognitive control, social cognition, and mirror neuron systems, possibly involving mental processes, such as cognitive control, mentalizing, and observing. These findings deepen our understanding of the neural correlates underpinning interpersonal emotion regulation.

Moral injury (MI) and negative emotions (NE) are core psychological issues that severely impair the mental health and professional competence of medical staff, while emotion regulation serves as a crucial psychological resource for coping with occupational psychological distress. However, the latent severity profiles of MI among medical staff, as well as the differential mediating effects of emotion regulation strategies, i.e., cognitive reappraisal (CR) and expressive suppression (ES), between MI and negative emotion (NE) remain unexplored. This study aimed to identify the latent subtypes of MI among medical staff via latent profile analysis and to explore the mediating role of CR and ES between MI and NE, so as to provide empirical evidence for formulating targeted psychological intervention strategies for medical staff. This was a cross-sectional survey. 1001 medical staff were enrolled via a convenience sampling method. Questionnaires were used to assess MI, anxiety, depression and emotion regulation among medical staff, with latent profile analysis applied for subgroup identification. The relationships among variables were analyzed using Pearson correlation analysis and mediation analysis. Three profiles of MI were identified and designated as the low injury profile (62.84%), emotion injury profile (25.27%), and value injury profile (11.89%). MI correlated positively with NE (r = 0.38-0.41) and negatively with CR (r = -0.19). Overall, CR had mediated MI-NE associations, while ES did not. Critically, profile‑specific mediation showed that ES had mediated effects in value injury profile, whereas CR partially mediated effects in emotion injury profile. To mitigate negative emotions in medical staff, administrators should account for individual differences in MI profiles. For the emotion injury profile, prioritize CR to restructure self-blame. For value injury profile, focus on reducing ES and fostering healthy emotional expression. Tailoring emotion regulation strategies to specific MI profiles is essential to safeguard staff mental health and care quality.

This study examined whether cognitive reappraisal and expressive suppression mediate the association between physical activity and academic burnout among students at Huaihua Experimental Junior High School. A cross-sectional study was conducted among 1,529 junior high school students. Participants completed the Learning Burnout Scale for Middle School Students (LBS-MSS), the Emotion Regulation Questionnaire for Children and Adolescents (ERQ-CA), and the Physical Activity Rating Scale-3 (PARS-3). Data were analyzed using SPSS 28.0, Amos 27.0, and the PROCESS macro. Academic burnout was negatively associated with physical activity (r = -0.279, p < 0.01), cognitive reappraisal (r = -0.267, p < 0.01), and expressive suppression (r = -0.060, p < 0.05). Physical activity was positively associated with cognitive reappraisal (r = 0.493, p < 0.01) and expressive suppression (r = 0.503, p < 0.01). Regression analysis showed that physical activity significantly predicted academic burnout (β = -0.131, p < 0.001). Mediation analyses indicated that cognitive reappraisal significantly mediated this association (indirect effect = -0.084), whereas expressive suppression showed an attenuating indirect effect (effect = 0.056). Physical activity was negatively associated with academic burnout among junior high school students. Cognitive reappraisal partially mediated this association, whereas expressive suppression showed an inconsistent indirect effect that attenuated part of the protective association. Given the modest effect sizes, these findings should be interpreted cautiously but suggest that different emotion regulation strategies may play distinct roles in the link between physical activity and academic burnout.