Capacity For Affect Regulation Research Articles

Personality Functioning Improvement during Psychotherapy Is Associated with an Enhanced Capacity for Affect Regulation in Dreams: A Preliminary Study.

Clinical case illustrations of patients with an impairment of personality functioning (IPF) have repeatedly reported that progress during psychotherapy is reflected by alterations in dream content. However, quantitative studies based on samples of psychotherapy patients are scarce. As a core component of both personality functioning and contemporary psychodynamic dream theory, the construct of affect regulation is of specific significance in this context. To test if improvement in personality functioning in the course of psychotherapy is associated with an increasing ability to regulate affects in dreams. In a longitudinal design, affect regulation was compared in N = 94 unsolicited dream reports from the first vs. last third of long term psychotherapy of ten patients with initial IPF. Dream reports were transcribed from recordings of the sessions. Expert ratings of the level of personality functioning were obtained using the Scales of Psychological Capacities. The capacity for affect regulation was assessed using the Zurich Dream Process Coding System. Group differences were assessed using linear mixed models, controlling for dream length as well as the nested structure of this data set. Patients demonstrated an increased capacity for affect regulation in dreams that was primarily evident in three core features: the complexity of dream elements (cf., e.g., parameter attributes, p = 0.024); the extent of affective involvement in the dream ego (cf., e.g., parameter subject feeling, p = 0.014); and the flexibility to regulate the dynamics of safety/involvement processes (p ≤ 0.001). This pattern was especially prominent in a subgroup (n = 7) of patients with more pronounced improvements in personality functioning. These findings support the hypotheses that decreasing IPF during psychotherapy is associated with increases in the capacity for affect regulation in dreams. Thus, researchers and therapists can utilize dream reports to illuminate the important aspects of treatment progress in clinical practice.

Culture and psychopathology: An attempt at reconsidering the role of social learning

This paper proposes a model for developmental psychopathology that is informed by recent research suggestive of a single model of mental health disorder (the p factor) and seeks to integrate the role of the wider social and cultural environment into our model, which has previously been more narrowly focused on the role of the immediate caregiving context. Informed by recently emerging thinking on the social and culturally driven nature of human cognitive development, the ways in which humans are primed to learn and communicate culture, and a mentalizing perspective on the highly intersubjective nature of our capacity for affect regulation and social functioning, we set out a cultural-developmental approach to psychopathology.

Examining the role of therapists’ empathy and clients’ attachment styles on changes in clients’ affect regulation and outcome in the treatment of depression

Objective: The purpose of this study was to test whether changes in clients’ affect regulation capacity (AR) mediated the impact of therapists’ empathy on outcome and whether this relationship was stronger for more insecurely than securely attached clients. Method: The data set included 66 clients, who had participated in 16 weeks of either CBT or EFT for depression. Clients’ AR was assessed using an observer and a self-report measure. Results: Changes in AR significantly mediated the relationship between therapists’ empathy and outcome for depression, dysfunctional attitudes and self-esteem but not interpersonal problems, and changes in AR were moderated by clients’ insecure attachment styles. Conclusions: The findings provide support for therapists’ empathy as an active ingredient of change contributing to changes in clients’ affect regulation capacities and emphasize the importance of assessing clients’ attachment styles so that therapists can be more responsive and effectively tailor their treatments to fit the needs of individual clients.

Alcoholics Anonymous: A Vehicle for Achieving Capacity for Secure Attachment Relationships and Adaptive Affect Regulation

This paper examines similarities between the empirically based concepts of attachment theory and the principles and philosophy of Alcoholics Anonymous (AA). It is argued that AA can function as a caregiving system, a vehicle for neurobiological restructuring and developing the capacity for affect regulation, self-reflection and mentalization. Attachment-focused interventions as well as an understanding of how AA works can be instrumental for clinicians in making appropriate referrals to 12-step programs. Composite case material, in the form of vignettes, illustrates how participation in the program of Alcoholics Anonymous can help create the capacity for secure attachment relationships and adaptive affect regulation.

A Randomized Controlled Study of Neurofeedback for Chronic PTSD.

IntroductionBrain/Computer Interaction (BCI) devices are designed to alter neural signals and, thereby, mental activity. This study was a randomized, waitlist (TAU) controlled trial of a BCI, EEG neurofeedback training (NF), in patients with chronic PTSD to explore the capacity of NF to reduce PTSD symptoms and increase affect regulation capacities.Study Design52 individuals with chronic PTSD were randomized to either NF (n = 28) or waitlist (WL) (n = 24). They completed four evaluations, at baseline (T1), after week 6 (T2), at post-treatment (T3), and at one month follow up (T4). Assessment measures were:1. Traumatic Events Screening Inventory (T1); 2. the Clinician Administered PTSD Scale (CAPS; T1, T3, T4); 3. the Davidson Trauma Scale (DTS; T1-T4) and 4. the Inventory of Altered Self-Capacities (IASC; T1-T4). NF training occurred two times per week for 12 weeks and involved a sequential placement with T4 as the active site, P4 as the reference site.ResultsParticipants had experienced an average of 9.29 (SD = 2.90) different traumatic events. Post-treatment a significantly smaller proportion of NF (6/22, 27.3%) met criteria for PTSD than the WL condition (15/22, 68.2%), χ2 (n = 44, df = 1) = 7.38, p = .007. There was a significant treatment condition x time interaction (b = -10.45, t = -5.10, p< .001). Measures of tension reduction activities, affect dysregulation, and affect instability exhibited a significant Time x Condition interaction. The effect sizes of NF (d = -2.33 within, d = - 1.71 between groups) are comparable to those reported for the most effective evidence based treatments for PTSD.DiscussionCompared with the control group NF produced significant PTSD symptom improvement in individuals with chronic PTSD, as well as in affect regulation capacities. NF deserves further investigation for its potential to ameliorate PTSD and to improve affect regulation, and to clarify its mechanisms of action.

Dissociation in individuals denying trauma exposure: findings from two samples.

A number of studies suggest that dissociation is reliably related to trauma exposure, and that inadequate regulation of posttraumatic distress may be a significant factor. We examined whether affect dysregulation predicts dissociation in those denying any lifetime exposure to trauma. These relationships were evaluated in a general population sample and a second sample of nontraumatized university students. In the first study, multivariate analyses indicated that, along with gender, affect dysregulation was a relatively strong predictor, accounting for 27% of the variance in dissociation. In the replication study, dissociation was associated with affect dysregulation, but not gender. Affect dysregulation seems to predict dissociative symptomatology in nontraumatized individuals. It is hypothesized that emotional distress, whether from trauma or other etiologies, motivates dissociation to the extent that it challenges the individual's compromised capacity for affect regulation. Treatment implications may include the potential helpfulness of interventions that increase emotion regulation skills.

Somatoform pain: a developmental theory and translational research review.

Somatoform pain is a highly prevalent, debilitating condition and a tremendous public health problem. Effective treatments for somatoform pain are urgently needed. The etiology of this condition is, however, still unknown. On the basis of a review of recent basic and clinical research, we propose one potential mechanism of symptom formation in somatoform pain and a developmental theory of its pathogenesis. Emerging evidence from animal and human studies in developmental neurobiology, cognitive-affective neuroscience, psychoneuroimmunology, genetics, and epigenetics, as well as that from clinical and treatment studies on somatoform pain, points to the existence of a shared neural system that underlies physical and social pain. Research findings also show that nonoptimal early experiences interact with genetic predispositions to influence the development of this shared system and the ability to regulate it effectively. Interpersonal affect regulation between infant and caregiver is crucial for the optimal development of these brain circuits. The aberrant development of this shared neural system during infancy, childhood, and adolescence may therefore ultimately lead to an increased sensitivity to physical and social pain and to problems with their regulation in adulthood. The authors critically review translational research findings that support this theory and discuss its clinical and research implications. Specifically, the proposed theory and research review suggest that psychotherapeutic and/or pharmacological interventions that foster the development of affect regulation capacities in an interpersonal context will also serve to more effectively modulate aberrantly activated neural pain circuits and thus be of particular benefit for the treatment of somatoform pain.

“My Brakes Are Broken”: Case Presentation of a Latency-Age Boy Struggling with Affect Regulation

Parental pathology and environmental stress impacts children and can derail the developmental achievement of affect regulation, an essential ego function that has its genesis in the early relationship between the infant and his caregiver. When parents are unable to provide consistent empathic care, articulate emotions, label feelings, and put words to experiences and behaviors, it leaves a child unable to understand his internal and external world. This clinical article demonstrates the link between the function of verbalization and the development of affect regulation in a latency boy growing up in a family suffering from multiple problems. Using the clinical material from the initial and middle phases of his analysis, the process of expanding his ego capacity for affect regulation is discussed as well as the therapeutic techniques that facilitated change.

Attentional processes and responding to affective faces in youth with borderline personality features

This study examined attentional biases for emotional faces in borderline personality disorder (BPD). Twenty-one outpatient youth (aged 15–24 years) meeting three or more DSM-IV BPD criteria and 20 community-derived participants (aged 15–24 years) with no history of psychiatric problems and not meeting any BPD criteria completed a modified dot-probe task that tested automatic (30ms) and controlled (500ms) stages of information processing. The findings indicate that, compared with healthy controls, youth with borderline features were faster to respond to congruent rather than incongruent fear stimuli. This effect was independent of state anxiety and was observed during the 30ms presentation of fearful faces. There was no significant effect for happy or angry faces. Youth with borderline features were also slower to respond to incongruent rather than paired neutral trials, indicating difficulties in disengaging attention from the perceived threat. Such differences were not found for the healthy controls. Thus, youth with borderline features had an attentional bias for fearful faces that reflected difficulty in disengaging attention from threatening information during pre-conscious stages of attention. This finding extends previous research highlighting the diminished capacity for affect regulation and subsequent engagement in behavioural strategies to avoid distress in BPD. Future research should explore the relationship between information processing, emotion regulation in adult BPD samples.

Systematic review of parenting programs for preterm and low birthweight infants on enhancing parent-infant interaction by improving parental sensitivity

Background and AimsParental sensitivity has been identified as being important to the infant's developing central nervous system and capacity for affect regulation. However, this can be compromised in parents of...

Childhood emotional abuse and eating symptoms in bulimic disorders: An examination of possible mediating variables

We sought to estimate prevalences of childhood emotional abuse (CEA) in bulimic and normal-eater control groups, and to replicate previous findings linking CEA to severity of eating symptoms in BN. We also examined potential mediators of the link between CEA and disordered eating. Women diagnosed with a bulimic disorder (n = 176) and normal-eater women (n = 139) were assessed for childhood traumata, eating-disorder (ED) symptoms and psychopathological characteristics (ineffectiveness, perfectionism, depression, and affective instability) thought to be potential mediators of interest. CEA was more prevalent in the bulimic than in the nonbulimic group, and predicted severity of some eating-symptom indices. Ineffectiveness and affective instability both mediated relationships between CEA and selected ED symptoms. We found CEA to predict eating pathology through mediating effects of ineffectiveness and affective instability. CEA might influence severity of ED symptoms by impacting an individual's self-esteem and capacity for affect regulation.

Fear is only as deep as the mind allows

Humans have the ability to control negative affect and perceived fear. Nevertheless, it is still unclear whether this affect regulation capacity relies on a common neural mechanism in different experimental domains. Here, we sought to identify commonalities in regulatory brain activation in the domains of fear extinction, placebo, and cognitive emotion regulation. Using coordinate-based activation-likelihood estimation meta-analysis we intended to elucidate concordant hyperactivations and the associated deactivations in the three experimental domains, when human subjects successfully diminished negative affect. Our data show that only one region in the ventromedial prefrontal cortex (VMPFC) controlled negative affective responses and reduced the degree of subjectively perceived unpleasantness independent of the experimental domain. This down-regulation of negative affect was further accompanied by a concordant reduction of activation in the left amygdala. Finally, the soothing effect of placebo treatments and cognitive reappraisal strategies, but not extinction retrieval, was specifically accompanied by a coherent hyperactivation in the anterior cingulate and the insular cortex. Collectively, our data strongly imply that the human VMPFC may represent a domain-general controller of perceived fear and aversiveness that modulates negative affective responses in phylogenetically older structures of the emotion processing system. In addition, higher-level regulation strategies may further engage complementary neural resources to effectively deal with the emotion-eliciting events.

Mums 4 Mums: structured telephone peer-support for women experiencing postnatal depression. Pilot and exploratory RCT of its clinical and cost effectiveness

BackgroundPostnatal depression (PND) can be experienced by 13% of women who give birth, and such women often exhibit disabling symptoms, which can have a negative effect on the mother and infant relationship, with significant consequences in terms of the child's later capacity for affect regulation. Research has shown that providing support to mothers experiencing PND can help reduce their depressive symptoms and improve their coping strategies. The Mums4Mums study aims to evaluate the impact of telephone peer-support for women experiencing PND.Methods/DesignThe study design adopts the MRC framework for the development and evaluation of complex interventions. Health visitors in Warwickshire and Coventry Primary Care Trusts are screening potential participants at the 8-week postnatal check using either the Edinburgh Postnatal Depression Scale (EPDS > = 10) or the three Whooley questions recommended by NICE (http://guidance.nice.org.uk/CG45). The Mums4Mums telephone support intervention is being delivered by trained peer-supporters over a period of four months. The primary outcome is depressive symptomatology as measured by the Edinburgh Postnatal Depression Scale. Secondary outcomes include mother-child interaction, dyadic adjustment, parenting sense of competence scale, and self-efficacy. Maternal perceptions of the telephone peer-support are being assessed using semi-structured interviews following the completion of the intervention.DiscussionThe proposed study will develop current innovative work in peer-led support interventions and telecare by applying existing expertise to a new domain (i.e. PND), testing the feasibility of a peer-led telephone intervention for mothers living with PND, and developing the relationship between the lay and clinical communities. The intervention will potentially benefit a significant number of patients and support a future application for a larger study to undertake a full evaluation of the clinical and cost effectiveness of telephone based peer-support for PND.Trial registrationISRCTN: ISRCTN91450073. The study has received a major funding grant from National Institute for Health Research (NIHR) (UK) - Research for Patient Benefit (RfPB) programme (ref: PB-PG-0407-13232).

An examination of the relationships among clients' affect regulation, in-session emotional processing, the working alliance, and outcome

The objectives were to examine the relationships among clients' affect regulation capacities, in-session emotional processing, outcome, and the working alliance in 66 clients who received either cognitive–behavioral therapy or process-experiential emotion-focused therapy for depression. Clients’ initial level of affect regulation predicted their level of emotional processing during early and working phases of therapy. Clients’ peak emotional processing in the working phase of therapy mediated the relationship between their initial level of affect regulation and their level of affect regulation at the end of therapy; and clients' level of affect regulation at the end of therapy mediated the relationship between their peak level of emotional processing in the working phase of therapy and outcome. Clients’ affect regulation at the end of therapy predicted outcome independently of the working alliance. The findings suggest that clients' level of affect regulation early in therapy has a significant impact on the quality of their in-session processing and outcome in short-term therapy. Limitations of the study and future directions for research are discussed.

Correlates of adult attachment avoidance: Men's avoidance of intimacy in romantic relationships.

The authors examined associations among 266 undergraduate men’s perceptions of parental bonding, gender role conflict, affect regulation capacity, and adult attachment avoidance. Partial support for the hypothesized mediation effects was found, with results suggesting that emotion regulation suppression and reappraisal helped explain the association between men’s memories of maternal bonding care and adult attachment avoidance. Furthermore, results identified potential mechanisms of influence underlying the development of men’s avoidance of intimacy. Clinical implications and suggestions for further research are provided.

Traumatic stress, affect dysregulation, and dysfunctional avoidance: A structural equation model

The multivariate relationship between interpersonal trauma, posttraumatic stress, affect dysregulation, and various avoidance behaviors was examined in a sample of 418 trauma-exposed participants from the general population. Structural equation modeling indicated that (a) suicidality, substance abuse, dissociation, and problematic activities such as self-injury and dysfunctional sexual behaviors were all indicators of a robust latent variable, named dysfunctional avoidance, (b) accumulated exposure to various types of interpersonal trauma was associated with this avoidance factor, and (c) the relationship between trauma and dysfunctional avoidance was independently mediated by both posttraumatic stress and diminished affect regulation capacity.

An fMRI study of the interface between affective and cognitive neural circuitry in pediatric bipolar disorder

The pathophysiology of pediatric bipolar disorder (PBD) impacts both affective and cognitive brain systems. Understanding disturbances in the neural circuits subserving these abilities is critical for characterizing developmental aberrations associated with the disorder and developing improved treatments. Our objective is to use functional neuroimaging with pediatric bipolar disorder patients employing a task that probes the functional integrity of attentional control and affect processing. Ten euthymic unmedicated pediatric bipolar patients and healthy controls matched for age, sex, race, socioeconomic status, and IQ were scanned using functional magnetic resonance imaging. In a pediatric color word matching paradigm, subjects were asked to match the color of a word with one of two colored circles below. Words had a positive, negative or neutral emotional valence, and were presented in 30-s blocks. In the negative affect condition, relative to the neutral condition, patients with bipolar disorder demonstrated greater activation of bilateral pregenual anterior cingulate cortex and left amygdala, and less activation in right rostral ventrolateral prefrontal cortex (PFC) and dorsolateral PFC at the junction of the middle frontal and inferior frontal gyri. In the positive affect condition, there was no reduced activation of PFC or increased amygdala activation. The pattern of reduced activation of ventrolateral PFC and greater amygdala activation in bipolar children in response to negative stimuli suggests both disinhibition of emotional reactivity in the limbic system and reduced function in PFC systems that regulate those responses. Higher cortical cognitive areas such as the dorsolateral PFC may also be adversely affected by exaggerated emotional responsivity to negative emotions. This pattern of functional alteration in affective and cognitive circuitry may contribute to the reduced capacity for affect regulation and behavioral self-control in pediatric bipolar disorder.

Sustained Empathic Focus, Intersubjectivity, and Intimacy in the Treatment of Couples

Theory should provide a focus for clinical work. A self psychological/intersubjective model provides a particular emphasis that can guide listening and intervention. Sustaining a focus on an individual's subjective/affective experience, and on emerging vulnerability, invites the processing of previously walled-off painful affect. This article underscores how a sustained empathic focus can be instrumental in the development of an increased capacity for affect regulation and the building of psychic structure in the context of couples treatment. This focus, particularly in working with couples, highlights, and often begins to heal, intersubjective differences and ruptures, leading to a deepening of intimacy in both individuals. La teoría tiene que suministrar un foco para el trabajo clínico. El modelo self-psicológico e intersubjetivo suministra un énfasis particular que puede guiar la escucha y las intervenciones. Manteniendo el foco en la experiencia subjetiva/afectiva del individuo, y en la vulnerabilidad que emerge, facilita que se procesen afectos dolorosos que previamente habían sido dejados de lado. Este artículo subraya como el mantenimiento continuado de un foco empático puede ser decisivo en el desarrollo de una capacidad para la regulación de los afectos y la construcción de estructura psíquica en el contexto del tratamiento de parejas. Este foco, particularmente al trabajar con parejas, destaca, y a menudo empieza a curar, diferencias y rupturas intersubjetivas, lo que conduce a profundizar en la intimidad de ambos miembros de la pareja. La théorie devrait définir le centre de l'attention du travail clinique. Un modèle de psychologie du soi/théorie de intersubjectivité fournit une telle centration particulière, qui peut guider l'écoute et l'intervention. Le fait de soutenir une centration sur l'expérience subjective/affective de l'individu, et sur la vulnérabilité émergente, ouvre la porte au traitement de l'affect douloureux préalablement séquestré. Cet article souligne comment une centration empathique soutenue peut être instrumentale dans le développement d'une capacité accrue de régulation affective et de la structuration psychique dans le contexte du traitement des couples. Cette centration, particulièrement dans le travail avec les couples, éclaire, et souvent commence à guérir, les différences et les ruptures intersubjectives, menant à un approfondissement de l'intimité chez chaque individu. La teoria dovrebbe fornire un focus per il lavoro clinico. Un modello orientato dalla psicologia del sé/intersoggettività offre un accento particolare che può guidare l'ascolto e gli interventi. Sostenere l'attenzione sull'esperienza soggettivo/affettiva dell'individuo, e sulla vulnerabilità che emerge, invita all'elaborazione di affetti dolorosi prima inaccessibili. Questo articolo sottolinea come un focus empatico continuativo possa essere utile nello sviluppo di una crescente capacità di regolazione affettiva e nella costruzione di struttura psichica nel contesto della terapia di coppia. Questo focus, specialmente nel lavoro con le coppie, mette in luce, e spesso inizia a curare, le differenze e le rotture intersoggettive, portando a un approfondimento dell'intimità in entrambi gli individui. Eine Theorie sollte eine Ausrichtung für die klinische Arbeit liefern. Ein selbstpsychologisches-intersubjektives Konzept stellt eine besondere Betonung dar, die das Zuhören und die Interventionen leitet. Die Aufrechterhaltung der Aufmerksamkeit auf die subjektiven und affektiven Erfahrungen eines Menschen und auf die auftauchende Vulnerabilität ermöglicht die Bearbeitung von zuvor wie durch eine Mauer abgeschotteten schmerzlichen Affekten. Dieser Aufsatz unterstreicht, wie ein fortwährend empathischer Fokus bei der Entwicklung einer zunehmenden Fähigkeit zur Affektregulation und für den Aufbau psychischer Struktur im Kontext einer Paarbehandlung förderlich sein kann. Dieser Fokus, insbesondere bei der Arbeit mit Paaren, betont—und beginnt damit oft zu heilen—intersubjektive Unterschiede und Beziehungsbrüche und führt dadurch zu einer Vertiefung der Intimität der beiden Beteiligten.

Personality disorders as disorganisation of attachment and affect regulation

If personality disorder is no longer to be a diagnosis of exclusion it needs a conceptual framework that fits both the symptoms of the illness and the behavioural problems that constitute its current diagnostic criteria. In this article, we suggest that personality disorder is best understood as disorganisation of the capacity for affect regulation, mediated by early attachments. We present evidence for this argument based on both developmental and neurobiological research.

Posttraumatic Shame and Guilt

Posttraumatic shame and guilt are important dimensions of posttraumatic syndromes, including simple and complex post-traumatic stress disorder (PTSD). The concepts of posttraumatic shame and guilt have received little theoretical or empirical investigation in the field of traumatology. It is proposed that there are acute and prolonged states of posttraumatic shame and guilt that can be compared in their consequences across eight psychosocial dimensions: (a) self-attribution processes, (b) emotional states and capacity for affect regulation, (c) appraisal and interpretation of actions, (d) the impact of states of shame and guilt on personal identity, (e) suicidality, (f) defensive patterns, (g) proneness to psychopathology and PTSD, and (h) the dimensions of the self-structure adversely affected by states of posttraumatic shame and guilt. The experience of posttraumatic states of shame and guilt are associated with compounded affective processesin PTSD, depression, and substance use disorders.