The Role of Emotion Regulation in Clinical Interventions.

Children and adolescents with externalizing problems show physiological hypo-reactivity toward affective stimuli, which may relate to their disruptive, antisocial, and thrill-seeking behaviors. This study examines differences in explicit and implicit emotion regulation between preadolescents with and without externalizing problems as well as the role of emotion regulation in subjective and autonomic responses to emotional stimuli. Preadolescents showing self- and other-reported externalizing psychopathology, and a control sample, without such difficulties, participated in a passive affective picture-viewing task with neutral, fearful, joyful, and sad images, while their heart rate and heart rate variability were measured. Participants also reported on their emotion regulation difficulties using the Difficulties in Emotion Regulation Scale. Compared to controls, youths scoring high on externalizing problems (1) reported greater emotion regulation difficulties, especially a lack of emotional clarity and difficulty in controlling impulsive actions, (2) showed higher resting heart rate variability and a lower resting heart rate, suggestive of higher emotion/autonomic regulation ability, and (3) showed both subjective and physiological hypo-arousal to emotional pictures. Heart rate variability and, to a lesser degree difficulties in emotional clarity, modulated the effects of emotional pictures on subjective and physiological arousal. Findings suggest that interventions to improve emotion regulation and awareness may help to prevent externalizing problems.

Sleep bruxism (SB) is an oral behavior characterized by high levels of repetitive jaw muscle activity during sleep, leading to teeth grinding and clenching, and may develop into a disorder. Despite its prevalence and negative outcomes on oral health and quality of life, there is currently no cure for SB. The etiology of SB remains poorly understood, but recent research suggests a potential role of negative emotions and maladaptive emotion regulation (ER). This study's primary aim investigates whether ER is impaired in individuals with SB, while controlling for affective and sleep disturbances. The secondary aim tests for the presence of cross-sectional and longitudinal mediation pathways in the bidirectional relationships among SB, ER, affect, and sleep. The study used a nonrandomized repeated-measures observational design and was conducted remotely. Participants aged 18-49 years underwent a 14-day ambulatory assessment. Data collection was carried out using electronic platforms. We assessed trait and state SB and ER alongside affect and sleep variables. We measured SB using self-reported trait questionnaires, ecological momentary assessment (EMA) for real-time reports of SB behavior, and portable electromyography for multinight assessment of rhythmic masticatory muscle activity. We assessed ER through self-reported trait questionnaires, EMA for real-time reports of ER strategies, and heart rate variability derived from an electrocardiography wireless physiological sensor as an objective physiological measure. Participants' trait affect and real-time emotional experiences were obtained using self-reported trait questionnaires and EMA. Sleep patterns and quality were evaluated using self-reported trait questionnaires and sleep diaries, as well as actigraphy as a physiological measure. For the primary objective, analyses will test for maladaptive ER in terms of strategy use frequency and effectiveness as a function of SB using targeted contrasts in the general linear model. Control analyses will be conducted to examine the persistence of the SB-ER relationship after adjusting for affective and sleep measures, as well as demographic variables. For the secondary objective, cross-sectional and longitudinal mediation analyses will test various competing models of directional effects among self-reported and physiological measures of SB, ER, affect, and sleep. This research received funding in April 2017. Data collection took place from August 2020 to March 2022. In all, 237 participants were eligible and completed the study. Data analysis has not yet started. We hope that the effort to thoroughly measure SB and ER using gold standard methods and cutting-edge technology will advance the knowledge of SB. The findings of this study may contribute to a better understanding of the relationship among SB, ER, affect, and sleep disturbances. By identifying the role of ER in SB, the results may pave the way for the development of targeted interventions for SB management to alleviate the pain and distress of those affected. DERR1-10.2196/41719.

Why is alexithymia a risk factor for affective disorder symptoms? The role of emotion regulation

Emotional and behavioural problems are closely associated with impairments in regulating emotions and in executive functions (EF). To examine this further, the aim of the present study was to determine whether EF and emotion regulation at baseline would predict emotional and behavioural problem scores post-intervention, and further explore the extent to which emotion regulation mediates these outcomes. Participants were 41 primary school children who exhibited emotional and/or behavioural problems, aged 8 to 11 years. All the children completed measures of emotional and behavioural problems, cognitive emotion regulation, anxiety symptoms, and performed two experimental tasks to measure working memory and response inhibition before and after participating in a transdiagnostic Cognitive Behaviour Therapy-based programme, “Super Skills for Life” (SSL), and at 3-months follow-up. Results revealed significant reduction in the use of maladaptive emotion regulation strategy catastrophising and other blame following the intervention. Additionally, EF and emotion regulation was associated with outcomes for emotional problems and conduct problems. More specifically maladaptive emotion regulation strategy such as catastrophising and other blame was closely related with self-reports of emotional problems, likewise other blame, was also linked with scores of conduct problems. This study provides preliminary empirical support for EF and emotion regulation in predicting outcomes of emotional and behavioural problems in children following intervention.

The current study used a longitudinal design (via three biweekly assessments) to assess the association of state aggression and somatic symptoms and the potential role of trait emotion regulation and distress tolerance in these associations in a sample of 186 college students. Multilevel modeling was used to examine the influence of state psychological aggression and state physical aggression on somatic symptoms (i.e., within-person variables) and the moderation of emotion regulation and distress tolerance (i.e., between-person variables) on the relation between aggression and somatic symptoms. The results indicated that state psychological aggression was positively associated with somatic symptoms. Emotion regulation moderated the influence of psychological aggression on somatic symptoms, in which psychological aggression was associated with somatic symptoms among those who reported medium and high levels of difficulties in emotion regulation, but not those with low levels of difficulties in emotion regulation. Distress tolerance did not moderate the association between aggression and somatic symptoms. The current findings speak to the importance of including the assessment of psychological aggression in health promotion programs and medical visits and identifying emotion regulation as a treatment marker for those with somatic symptoms.

This article describes recent theoretical developments and empirical findings regarding the role of negative affect (NA) and emotion regulation in nicotine dependence and smoking cessation. It begins with a review of affect-based models of addiction that address conditioning, affect motivational, and neurobiological mechanisms and then describes the role of NA and emotion regulation in the initiation and maintenance of cigarette smoking. Next, the role of emotion regulation, coping skill deficits, depression, and anxiety sensitivity in explaining the relationship between NA and smoking relapse are discussed. We then review recent models of affect regulation, including emotional intelligence, reappraisal and suppression, and emotional acceptance, and describe implications for substance abuse and smoking cessation interventions. Finally, we point out the need for further investigations of the moderating role of individual differences in response to NA in the maintenance of nicotine dependence, and controlled randomized trials testing the efficacy of acceptance-based interventions in facilitating smoking cessation and relapse prevention.

Partners' ability to cope together in the face of stress-commonly known as dyadic coping (DC)-can promote individual and couple well-being. However, little is known about the predictors of DC, including partners' emotion regulation. This study examined (a) whether emotion regulation abilities are associated with partners' DC responses, and (b) whether these associations are mediated by partners' engagement in stress communication in a community sample of different-gender couples (N=239). Couples completed self-report measures to assess their stress communication and DC responses (supportive, negative, and common DC) and six dimensions of emotion regulation (emotional awareness, acceptance, clarity, goal-orientation, regulation strategies, and impulse control). Results from structural equation modelling analysis confirmed expected associations between stress communication and partners' supportive and common DC responses. Additionally, only associations with women's emotion regulation emerged significant. First, women's emotional awareness was associated with more supportive DC from men and common DC through increases in women's stress communication. Second, women who endorsed emotional acceptance engaged in less supportive DC towards their partner. Third, women's goal-orientation was associated with less supportive DC from each partner and common DC through decreases in men's stress communication. There were no associations with men's emotion regulation. Collectively, findings suggest that although women may manage their negative emotions in ways that are adaptive for their individual well-being, these benefits may not always affect relationship functioning in the same way. Clinical implications and future research directions are discussed.

Bullying victimization and self-harm in adolescents: The roles of emotion regulation and bullying peer norms.

The Role of Emotion Regulation in Autism Spectrum Disorder

This paper analyzes the role of emotion regulation in patients diagnosed with Generalized Anxiety Disorder (GAD). Although there are various types of emotion regulation, this paper studies cognitive reappraisal and expressive suppression specifically because of their prevalence and imperative role in the behavioral aftermath of emotion. Cognitive reappraisal is studied as an antecedent-focused strategy to control and modify the meaning of a situation, whereas expressive suppression is analyzed as a response-focused strategy that alters behaviors associated with situations that elicit emotion. Patients diagnosed with GAD use emotion regulation as both a defensive strategy and a coping mechanism. Through this understanding, the role of Emotion Regulation Therapy (ERT) in conjunction with Cognitive Behavioral Therapy (CBT) is depicted. Emotion Regulation Therapy is also proposed as an alternative to CBT because of its ability to cater specifically to individuals with anxiety disorders. This paper studies the implications of the usage of emotion regulation both as a coping mechanism that is self-employed and therapeutically used by health professionals.

Posttraumatic distress disorder (PTSD) and posttraumatic growth (PTG) may coexist in trauma survivors, but there are mixed relationships between PTSD and PTG. To elucidate their relationship and constructs, it is necessary to examine simultaneously predictive factors, and to compare their determining factors. The aim of this study was to increasing our understanding the relationship between PTSD and PTG by examining simultaneously the role of social support and emotion regulation in PTSD and PTG among adolescents after the earthquake. Six months after the Ya'an earthquake, 315 middle school students in Lushan county were assessed using measures of trauma exposure, social support, and emotion regulation, as well as Child PTSD Symptom Scale and Posttraumatic Growth Inventory. Social support had significant direct association with PTG but not with PTSD, but social support had a negative indirect prediction on PTSD and a positive indirect prediction on PTG through cognitive reappraisal. Social support, through expressive suppression, had a significant and indirect prediction on PTSD, but a nonsignificant indirect prediction on PTG. This study indicate that the predictive mechanism of PTSD and PTG were different and further suggest that PTSD and PTG are separate, independent dimensions of psychological experiences following adversity. (PsycINFO Database Record

Low-income families are less likely to effectively engage in Behavioral Parent Training (BPT), the standard of care for early-onset (3-8 years old) disruptive behavior disorders (DBDs); however, relatively little is known about predictors of treatment process and outcome within this vulnerable group. Given literature to suggest compromises associated with both low-income status and DBDs, this study examined the role of caregiver emotion regulation and socialization practices in 15 low-income families who participated in one evidence-based BPT program, Helping the Noncompliant Child (HNC). Findings suggest baseline caregiver emotion regulation predicted variability in BPT treatment duration and outcomes, whereas baseline caregiver emotion socialization practices explained variation in the severity of child disruptive behaviors concurrently, as well as BPT treatment outcomes. Furthermore, BPT yielded pre- to posttreatment effect sizes that were equivalent to or better than treatments designed to more explicitly target emotion regulation and socialization processes. Clinical implications and future directions are discussed.

To investigate the role of emotion regulation in the relation between fathers' parenting (specifically warmth, behavioral control and psychological control) and adolescents' emotional and eating disorder symptoms, after adjustment for controls. A total of 203 11-18 year-old students from a school in a socio-economically disadvantaged area in North-East London completed questionnaires assessing emotional symptoms (measured with the Strengths and Difficulties Questionnaire's (SDQ) Emotional Symptoms Scale), eating disorder symptoms (measured with the Eating Attitudes Test (EAT-26)), difficulties in emotion regulation (measured with the Difficulties in Emotion Regulation Scale (DERS)), and fathers' overprotection and warmth, measured with the Parental Bonding Instrument (PBI), as well as behavioral and psychological control. The confounding variables considered were number of proximal (i.e., during the last year) adverse life events experienced, gender, age, and socio-economic status (eligibility for free school meals). Adolescents' difficulties in emotion regulation mediated the link between fathers' psychological control and adolescents' emotional symptoms, but not the link between fathers' parenting and adolescents' eating disorder symptoms, which appeared to be more directly linked to fathers' psychological control and number of proximal adverse life events experienced. Proximal adverse life events experienced were also strongly associated with difficulties in emotion regulation. The study findings have implications for intervention programs which may prove more fruitful in addressing adolescent emotional problems by targeting underlying emotion regulation abilities, and in addressing adolescent eating disorder symptoms by protecting adolescents with a recent experience of multiple adverse life events. Parenting programs also stand to benefit from the evidence presented in this study that paternal psychological control may have uniquely harmful consequences for adolescent development through the hampering or atrophying of emotion regulation abilities and the encouragement of eating disorders.

Cognitive-behavioural (CB) theories that explain Obsessive-Compulsive Disorder (OCD) have largely focused on the role of maladaptive belief biases as drivers of the individual’s experience of anxiety or distress, pathological avoidance behaviours and compulsions. One potential limitation of current CB models is the limited focus on the extent to which deficits in emotion regulation (ER) may account for a reliance on maladaptive regulatory processes (avoidance and neutralising compulsions), which also serve to maintain OCD symptomatology. Recently, researchers have begun to examine the potential role of ER in adult and paediatric OCD. However, of the limited number of studies completed to date most have utilised community rather than clinical samples and there are even fewer studies involving youth with OCD. Moreover, there are no studies to date examining the role of ER strategies in cognitive-behavioural treatment of paediatric OCD. Accordingly, this thesis aimed to elucidate the role of ER in OCD symptom expression and treatment by using a combination of self- and parent-report measures of ER to examine the relationship between ER, symptoms and associations with treatment response in relatively large, well-defined clinical samples of children and youth with a primary diagnosis of OCD. These studies represent the most comprehensive examination of the role of ER in paediatric OCD to date, and aim to inform current theoretical models of OCD, as well as inform treatment advances. The first study of this PhD explored whether youth with OCD who experience deficits in emotional control (as indexed by parental report on the Behaviour Rating Inventory of Executive Function, n = 137) differed in their OCD symptom expression, comorbidity and response to evidence-based treatment, relative to youth with OCD who had greater emotional control (n = 68). The findings indicated that those lower on emotional control (n = 69) had significantly greater OCD severity, famil y accommodation, internalising and externalising symptoms, an d were less likely to respond favourably to treatment. The second study involved a clinical sample of 72 youth (aged 7 to 17 years) with a primary diagnosis of OCD and examined self-reported parent perceptions of child ER and associations with family accommodation (FA), as well as explored potential child and parent variables that predicted negative parental perception of child ER ability. The findings of this study revealed that child externalising symptoms and parental depression uniquely predicted negative parental perception of their child’s ER ability. Furthermore, while negative parental perception of child ER was moderately and positively correlated with FA, it was not found to be a unique predictor of FA after controlling for previously established predictors. The third and final study built on the findings of the first study by examining a wide range of specific adaptive and maladaptive ER strategies among youth with a primary diagnosis of OCD (n = 65, aged 7 to 17 years), both before and after treatment, and the degree to which changes in ER strategies following intensive cognitive-behavioural treatment predicted a treatment response at post-treatment and three months following treatment. The findings of this final study indicated significant improvements in four adaptive and five maladaptive ER strategies. Additionally, pre- to post-treatment increases in Acceptance and decreases in Suppression were significant unique predictors of OCD severity at post-treatment, and increases in Acceptance and decreases in Self-Blame were significant unique predictors of OCD severity 3 months following treatment. Taken together, the findings from the three empirical studies reported herein indicate that deficits in ER form a part of the clinical picture of OCD in youth and may be associated with several clinical correlates known to be associated with a poorer treatment response. For instance, deficits in ER are associated with greater externalising symptoms in youth with OCD, and together with parental self-reported depression may be associated with parents having more negative perceptions of their child’s ability to regulate their emotions. Furthermore, given that Acceptance was found to be a particularly strong predictor of favourable treatment response over time, emphasising Acceptance in evidence-based cognitive-behavioural treatment for OCD or augmenting such treatments with an ER training component may potentially enhance the efficacy of evidence-based treatments and ultimately improve treatment response.

Chapter 10 - Emotion regulation difficulties in PTSD