Emotional Clarity Research Articles

Identifying Relationships Between Difficulties with Emotion Regulation and Compulsive Sexual Behavior.

Emotion dysregulation is an associated feature of compulsive sexual behavior disorder (CSBD), now recognized by the World Health Organization. Previous studies have identified associations between trait emotion dysregulation and CSBD. Given that difficulties with emotion regulation (DERS) is comprised of several facets (e.g., difficulty with impulse control and lacking awareness of one's feelings when upset), and that these facets differentially relate to other mental health concerns, the present study aimed to examine how DERS facets relate to compulsive sexual behavior (CSB). The present study also considered interpersonal emotion regulation via attachment avoidance and attachment anxiety. Hierarchical regression was conducted, first accounting for demographic covariates, then adding attachment styles, and finally all DERS subscales. Results indicated that, among a large, diverse, online U.S. sample (N = 915; Mage = 39.21, SD = 0.81; 54.3% men), difficulty controlling impulses when upset, difficulty with clarity of emotions, and non-acceptance of emotions were significantly positively associated with CSB (small to moderate effects). Attachment anxiety and avoidance were also significantly positively associated with CSB, although their effects were minimal when adding DERS facets. Overall, this study supports the theorized impact of emotion dysregulation on CSB. Assessment of individual differences in DERS and intervening on these concerns are important for treating CSB.

Mediation of emotional intelligence in resilient coping and depression in adverse conditions: study in home confinement of the COVID-19 health crisis (Mediación de la inteligencia emocional en el afrontamiento resiliente y la depresión en condiciones adversas: estudio en confinamiento domiciliario durante la emergencia sanitaria COVID-19)

ABSTRACT The COVID-19 pandemic has caused home confinement for three months in Spain. That has had a negative psychological impact. This study aims to determine whether the relationship between resilient coping and depression is mediated by emotional intelligence. An online questionnaire was applied to 179 participants. A mediation analysis was conducted. The results reveal a more significant number of depressive symptoms in women than in men and higher levels of resilient coping in men. Younger participants showed more depressive symptoms than the rest of the analysed population. Finally, the results suggest that emotional intelligence might mediate the relationship between resilient coping and depression, particularly in the emotional clarity dimension. Conclusions: the skills involved in emotional intelligence, especially emotional clarity, may optimize the use of resilient coping strategies to face adversity.

The Kusa manga, a secondary prevention program for cannabis use in adolescence based on emotional regulation: Preliminary data

IntroductionFrance is one of the European countries with the highest prevalence of cannabis use, particularly in adolescence. Emotional regulation (ER) is one of the major risk factor in the etiology and the maintenance of cannabis use disorder and therefore is a key target for prevention programs. ObjectivesThis study aimed to evaluate the feasibility and the impact of a prevention program focusing on ER (especially on various emotional skills like awareness, emotional clarity and reactivity, ER strategies, and the level of emotional awareness) and on cannabis use among adolescents from various institutions. MethodIn total, 87 adolescents from various institutions were included. ER was assessed by the Emotion Regulation Questionnaire, the Difficulties in Emotion Regulation Scale, the Emotion Reactivity Scale and the Adolescent Levels of Emotional Awareness Scale; cannabis use was assess by the Cannabis Abuse Screening Test (CAST). All participants were assess before preventive intervention (T0) and four months after the end of the program (T1). ResultsBetween T0 and T1, for all participants, there was an increase of emotional awareness, a decrease of emotional sensitivity, intensity and persistence, and an increase of the level of emotional awareness (total, self and others). There was no significant difference between T0 and T1 in CAST scores. ConclusionsThe prevention program showed encouraging results with a vulnerable group of adolescents in institutional care, particularly those from the Child Social Care (Aide sociale à l’enfance) and Child Forensic Institution (Protection judiciaire de la jeunesse) by showing an effect on different components of ER but not directly on cannabis use.

Incorporating macro-social contexts into emotion research: Longitudinal associations between structural stigma and emotion processes among gay and bisexual men.

Research into correlates and predictors of emotion regulation has focused almost exclusively on individual differences and the immediate situation. Here, we consider whether features of macro-social contexts may also shape emotion regulation. To test this hypothesis, we conducted a longitudinal study of 502 gay and bisexual men living in 269 U.S. counties that varied in the level of stigma surrounding sexual minorities. We find that gay and bisexual men living in higher- (vs. lower-) stigma counties consistently reported more suppression, which consequently explained longitudinal increases (vs. decreases) in their lack of emotional clarity over 24 months. Results were robust to demographic characteristics, stigma at the interpersonal level (i.e., sexual orientation-related discrimination), and another form of social inequality (i.e., county-level income inequality). These findings suggest that broadening the lens of emotion regulation research to include characteristics of the macro-social environment may yield new insights into determinants of emotion regulation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Youth Dating Violence, Behavioral Sensitivity, and Emotional Intelligence: A Mediation Analysis.

Intimate partner violence is a multidimensional phenomenon encompassing psychological, physical, and sexual components. Violence in young couples is common in our society. This kind of violence is usually bidirectional, which adds to its complexity. This study aimed to explore how victimization (in three dimensions: non-abuse, technical mistreatment, and mistreatment) and perpetration (in two dimensions: non-perpetrator and perpetrator) are related to the BIS (Behavioral Inhibition System)/BAS (Behavioral Approach System), and it also evaluated if the dimensions of emotional intelligence (EI) (emotional attention, clarity, and regulation) mediate this relationship. Violence was evaluated in 272 young volunteer participants, as well as BIS/BAS behavioral sensitivity and perceived emotional intelligence. The correlations between these variables were analyzed, and a mediation analysis was also conducted. The results show that victimization (of the sexual and coercive type) was associated with less BAS activation, while victimization (of the sexual, humiliation, and detachment types) was associated with less BIS activity. All types of victimization were associated with less EI, specifically with less emotional clarity. Aggression (of the sexual, humiliation, detachment, and coercion types) was related to lower BAS and higher BIS sensitivity. Detachment aggression was associated with low emotional clarity. In conclusion, relationships between victimization and perpetration are evidenced in terms of BIS/BAS sensitivity and EI. Specifically, the dimension of EI emotional clarity acts as a mediator of BIS activation in victims of detachment.

Latent profile analysis of emotional clarity and acceptance in school-to-work transition students: association with depression and life satisfaction

Latent profile analysis of emotional clarity and acceptance in school-to-work transition students: association with depression and life satisfaction

Childhood Maltreatment History and Borderline Personality Symptoms: The Role of Mentalization Difficulties Among Vulnerable Women.

Mentalization difficulties may be one reason why individuals who experienced childhood maltreatment (CM) are at increased risk for borderline personality (BP) symptoms. The goal of this study was to identify specific aspects of mentalization associated with CM and determine their role in the short-term course of BP symptoms. A total of 253 mothers with a previous mental health diagnosis completed online surveys at three times over 9 months. A cross-lag panel model was tested to estimate reciprocal effects between mentalization measures and BP symptoms and indirect effects from CM to mentalization to BP symptoms. At baseline, women with more CM endorsed more difficulty with general mentalization, emotional clarity, and reflecting on childhood experiences. Lack of emotional clarity and disorganized responding about childhood served as indirect paths from CM to subsequent BP symptoms and showed bidirectional associations with BP symptoms over time. Thus, these may be particularly important treatment targets in this population.

Emotional regulation and body dissatisfaction: the mediating role of anger in young adult women.

Emotion regulation difficulties have an important role in the presence of negative self-image. These problems in the self-regulation of emotion could lead to negative emotional processes (such as anger) that can lead to body dissatisfaction. Therefore, the aim of the present study was to examine emotion regulation difficulties than can negatively impact self-image and to understand if anger acts as mediator in the relationship between emotion regulation and body dissatisfaction. A cross-sectional study was carried out comprising 565 young adult women aged 18-30 years. The participants were administered the Difficulties in Emotion Regulation Scale (DERS), the State-Trait Anger Expression Inventory 2 (STAXI-2), and the Body Dissatisfaction dimension of the Eating Disorder Inventory-2 (EDI-2). The proposed hypotheses were tested by path analysis in MPlus 8.0. The results indicated that anger had a positive significant effect on body dissatisfaction as well as the non-acceptance of emotional responses, the lack of emotional awareness, and the lack of emotional clarity. Of all the dimensions of emotional regulation difficulties, impulse control difficulty was the dimension which had a positive significant indirect effect on body dissatisfaction explained by increased anger. The present study suggests the importance of emotion regulation in the prevention of body dissatisfaction. Impulse control difficulty may be the key emotion regulation emotion in explaining the increments of anger that lead to body dissatisfaction. Among young adults, the promotion of positive body image can be promoted by helping this population to self-regulate their anger impulses.

Mediation of academic self-efficacy between emotional intelligence and academic engagement in physical education undergraduate students.

The aim of this study was to analyze academic self-efficacy as a mediator between emotional intelligence and academic engagement. A non-experimental, cross-sectional, correlational-causal study was designed in which 1,164 Mexican students participated (Mage = 21.21; SD = 3.26) (30.0% female; 69.6% male; 0.4% other). The scales of emotional intelligence, academic self-efficacy and academic engagement were used, and a structural equation analysis with latent variables was conducted. The results obtained demonstrate that emotional clarity and repair have a positive and direct effect on academic self-efficacy. In addition, emotional repair predicts behavioral and emotional engagement. It was also found that academic self-efficacy is an excellent mediator between emotional clarity and repair, and the dimensions of academic engagement, as it substantially improves behavioral and emotional engagement while decreasing behavioral and emotional disaffection.

Intrinsic Motivation: Knowledge, Achievement, and Experimentation in Sports Science Students-Relations with Emotional Intelligence.

In this paper, we have focused on the Self-Determination Theory, paying special attention to intrinsic motivation, which is understood as the motivation that leads the subject to perform a task without the expectation of obtaining an external reward. In the field of sport, motivation is one of the most studied variables and one of the most researched, since it is closely related to the reasons that lead the athletes to start, maintain, and abandon sports practice. The main objective of this study is to analyze the relationship between intrinsic motivation (IM) and emotional intelligence from the theoretical contributions of the Self-Determination Theory. The specific objectives are to analyze attention, clarity, and emotional regulation, as well as intrinsic motivation to acquire knowledge. Additionally, we aim to explore the relationship between attention, clarity, and emotional regulation and the intrinsic motivation to achieve something. Lastly, we investigate the correspondence between attention, clarity, and emotional regulation and the intrinsic motivation to experience stimuli. The sample consists of 163 undergraduate and master's students related to Physical Activity and Sports Sciences, studying at a Spanish public university, located in the southeast region of Andalusia-specifically, in the city of Almería. The participants had a mean age of 20.33 years. In terms of gender, 70.9% (n = 117) were men and 27.9% (n = 46) women. In terms of degree, 76.7% (n = 147) were undergraduate students and 23.3% (n = 18) were postgraduate students. The Sports Motivation Scale (SMS/EMD) was used to assess intrinsic motivation, and the TMMS-24 was used to assess emotional intelligence. The main findings of this research demonstrate the existence of a relationship between the three dimensions of emotional intelligence (emotional attention, emotional clarity, and emotional regulation) and intrinsic motivation (intrinsic motivation to know something, intrinsic motivation to achieve something, and intrinsic motivation to experience stimulation). These findings emphasize the importance of emotional intelligence for intrinsic motivation.

Does emotion regulation in adolescents in residential care mitigate the association between sexual victimization and poor psychological well-being?

BackgroundChildhood sexual abuse/assault has been linked to mental health problems that affect an individual's psychological well-being. This study explores the facets of emotional regulation as mediating mechanisms in the relationship between sexual victimization and psychological well-being in adolescents in residential care in Eastern Spain. Furthermore, it examines the role of sex assigned at birth and being unaccompanied asylum seeker children as possible moderators of the mediation model. MethodsA total of 346 adolescents (34.1% girls, 65.9% boys) aged between 11 and 19 years old completed a battery of instruments. Parallel multiple mediation paths were tested to determine whether sexual victimization is associated to psychological well-being across emotional regulation dimensions. Moderated mediation models with sex assigned at birth and the condition of unaccompanied asylum seeker children were tested too. ResultsThis study demonstrates that high sexual victimization is associated with poor psychological well-being in adolescents in residential care through the lack of emotional clarity, non-acceptance of emotional responses, and limited access to emotional regulation strategies (β = −0.6, 95%CI = −1.26, −0.09; β = −0.38, 95%CI = −0.9, 0.002; β = −0.39, 95%CI = −0.93, −0.03, respectively). In addition, the latter indirect effect pathway was significantly moderated by the condition of being unaccompanied asylum seeker children (β = 1.46, 95%CI = 0.28, 2.84). Sex assigned at birth was not shown to be a significant moderator. ConclusionsIdentifying which mechanisms of emotional regulation mediate the relationship between sexual victimization and psychological well-being in adolescents in residential care may contribute not only to reducing the psychological distress of these adolescents but also to improving the effectiveness and efficacy of the child welfare system.

The interaction between clinically-elevated maladaptive personality traits and global emotion dysregulation elucidates individual differences in mood disorders: Findings from a non-Western clinical sample

Global emotion dysregulation is a known risk factor for mood disorders; however, less is known about individual differences in global emotion dysregulation in non-Western samples, and whether DSM-5 maladaptive personality traits and global emotion dysregulation interact to influence the severity and diagnosis of mood disorders. The present study aimed to elucidate the interactions between clinically-elevated negative affectivity and detachment traits and global emotion dysregulation dimensions among patients with mood disorders in a predominantly Chinese sample. A total of 200 patients with mood disorders (Mean age = 36.5 years; 54 % females; 77.5 % Chinese ethnicity) were assessed for DSM-5 maladaptive personality traits, global emotion dysregulation, depressive symptoms, and diagnosis of mood disorders. Clinically-elevated negative affectivity (31 %) and detachment (22 %) traits were significantly associated with global emotion dysregulation dimensions (ps < 0.005). Clinically-elevated negative affectivity and detachment traits interacted with poor emotional clarity on depressive symptoms, such that for patients with both clinically-elevated negative affectivity and detachment traits, poor emotional clarity was associated with increased severity of depressive symptoms. Overall, the present study provides preliminary evidence on the clinical utility of screening for maladaptive personality traits to understand pertinent individual differences in global emotion dysregulation and depressive psychopathology in a non-Western context.

Latent profiles of emotion dysregulation among individuals with binge-spectrum eating disorders: Associations with eating disorder pathology.

Emotion dysregulation (i.e., a multi-component term comprising nonacceptance of emotional responses, difficulty engaging in goal-directed behaviour, impulse control difficulties, lack of emotional awareness, limited access to emotion regulation strategies, and lack of emotional clarity) is a well-established transdiagnostic risk and maintenance factor for eating disorders. To date, there is limited information on how varying scores on subdomains of emotion dysregulation may yield distinct profiles in individuals with binge-spectrum eating disorders (B-EDs), and how these emotion dysregulation profiles may inform resultant symptomatology. In the current study, treatment-seeking individuals with B-EDs (n=315) completed the Difficulties in Emotion Regulation Scale (DERS) and Eating Disorder Examination. Latent profile analysis was conducted on the six subscales of the DERS. Identified latent profiles were examined as predictors of eating disorder pathology using linear regression, and a two-class model of emotion dysregulation fit the data. Class 1 (n=113) was low in all of the DERS subscales, while Class 2 (n=202) was high in all of the DERS subscales. Individuals in Class 2 had a significantly higher frequency of compensatory behaviours in the past month (F(1,313)=12.97, p<0.001), and significantly higher restraint scores (F(1,313)=17.86, p<0.001). The classes also significantly differed in terms ofeating concern (F(1,313)=20.89, p<0.001) and shape concern (F(1,313)=4.59, p=0.03), with both being higher for Class 2. We found only two distinct classes of emotion dysregulation in B-ED's such that individuals were simply high or low in emotion dysregulation. These results suggest that it may be more valuable for future research to evaluate emotion dysregulation as a cohesive whole rather than conceptualising the construct as having truly distinct subdomains.

Joyful Stoic Death Writing: An Interpretative Phenomenological Analysis of Newcomers Contemplating Death in an Online Group

Death awareness, which is an integral part of Stoic philosophy, has received little attention in either therapeutic training or empirical psychological research. This study seeks to address this gap by investigating participants’ experiences of completing a Stoic death writing intervention. To understand newcomers’ experiences being in-daily-death-contemplation, in-depth, semi-structured interviews conducted in December 2021 with six adult participants in a UK program, 28 Days Joyful Death Writing with the Stoics, were analyzed using interpretative phenomenological analysis (IPA). Analysis generated two primary themes: Contemplative Context and Death Contemplation Significance. Contemplative Context included the experiences of a temporary, unstable community (called communitas), otherness (called alterity), and the wider world. Death Contemplation Significance included death and other personal losses, and gains such as personal purpose, positive emotions/experiences, and beneficial behaviors/activities. Findings indicate daily death writing in communitas appears to have potential to provoke personal death awareness and undermine death taboos, accompanied by self-reported changes in emotional clarity, psychological flexibility, worry, and rumination. Furthermore, operationalizing open programs like 28 Days could contribute to idiographic approaches emerging in intervention science, including via augmenting practitioner training. Future studies could investigate practitioners, trainees, and more experienced Stoics as well as develop novel assessment means for evaluating death awareness.

Sleep disturbance and suicidality in psychiatrically hospitalized adolescents: The role of specific emotion regulation domains.

Sleep disturbance is associated with broadband measurements of emotion regulation (ER). The linkage between ER, a multidimensional process, and suicidal ideation and suicide attempt is also documented in theoretical and empirical work. Recent research indicates that distinct profiles of ER are associated with psychiatric outcomes, including adolescent suicidal ideation and attempt. The present study examined whether specific domains of ER would explain the association between sleep disturbance, and ideation and attempt among psychiatrically hospitalized adolescents. The sample included 284 adolescents who completed self-report measures on sleep disturbance, ER, suicidal ideation, suicide attempt, and psychiatric symptoms upon inpatient hospitalization. Findings indicated that sleep disturbance was associated with suicidal ideation. Further, a single ER domain (perceived limited access to ER strategies) fully accounted for the significant association between sleep disturbance and suicidal ideation. A reported suicide attempt in the past week was correlated with the nonacceptance of emotional responses, perceived limited access to ER strategies, and emotional clarity, but was not associated with sleep disturbance. The current findings highlight the importance of examining narrowband ER and indicate the presence of differential associations between sleep disturbance, ER, and suicide-related outcomes. Findings further elucidate the possible role of impaired cognitive responses to emotional experiences in the co-occurrence of sleep disturbance and youth psychiatric outcomes.

Prediction of psychopathology during the COVID-19 pandemic using linear and non-linear methodologies: Importance of COVID-19 threat perception, emotional competencies and resilience

The presence of a mental or physical illness prior to the pandemic, the perceived threat from COVID-19, resilience or emotional intelligence may influence the onset or increase of psychopathology during the COVID-19 lockdown. The aim was to assess predictors of psychopathology by comparing two statistical methodologies (one linear and one non-linear). MethodA total of 802 Spanish participants (65.50% female) completed the questionnaires independently after signing informed consent. Psychopathology, perceived threat, resilience and emotional intelligence were assessed. Descriptive statistics, hierarchical regression models (HRM) and fuzzy set qualitative comparative analysis (fsQCA) were conducted. ResultsThe data obtained through the HRM showed that the presence of a previous mental illness, low resilience and emotional clarity, high emotional attention and repair, and COVID-19 threat perception predicted 51% of the variance in psychopathology. Results obtained from QCA showed that different combinations of these variables explained 37% of high levels of psychopathology and 86% of low levels of psychopathology, highlighting how the presence of prior mental illness, high emotional clarity, high resilience, low emotional attention and low perceived COVID-19 threat play a key role in explaining psychopathology. ConclusionsThese aspects will help promote personal resources to buffer psychopathology in lockdown situations.

Consideration of Psychosocial Factors in Acute Low Back Pain by Physical Therapists.

Clinical guidelines consistently recommend screening psychosocial (PS) factors in patients with low back pain (LBP), regardless of its mechanical nature, as recognized contributors to pain chronicity. However, the ability of physiotherapists (PTs) in identifying these factors remains controversial. This study aimed to assess the current identification of psychosocial risk factors by physical therapists (PTs) and which characteristics of PTs are associated with the identification of the main risk for chronicity (physical or psychosocial). A cross-sectional descriptive study surveying Spanish PTs in public and private health services was conducted, including questions on PT characteristics and three low back pain (LBP) patient vignettes with different biopsychosocial (BPS) clinical presentations. From 484 respondents, the majority of PTs agreed regarding the main risk for chronicity for each vignette (PS 95.7% for vignette A, PS and physical 83.5% for vignette B and PS 66% for vignette C). Female PTs were more likely to rate psychosocial compared with males (p < 0.05). PTs with higher levels of social and emotional intelligence (both, p < 0.05) were more likely to identify the main risk for chronicity. However, only gender and social information processing for vignette A (p = 0.024) and emotional clarity for vignette B (p = 0.006) were able to predict the identification of psychosocial and physical risk, respectively. The main risk for chronicity was correctly identified by a large majority of PTs through patient vignettes. Gender, social and emotional intelligence played a relevant role in the recognition of psychosocial risk and biopsychosocial factors.

Can you hear it? Toward conceptual clarity of emotional cost and negative emotions

Research on cost beliefs has surged over the past several years. Though many dimensions of cost have been identified, researchers have often conflated these dimensions with one another. Moreover, some dimensions of cost may actually refer to already established constructs. In the current study, we explore the potential jangle fallacy between emotional cost and negative emotions, including anger, frustration, anxiety, boredom, and confusion, with particular attention to the costs and emotions that students anticipated to be associated with a course, as well as the costs and emotions that students actually experienced during the course. Results of this study provide evidence that emotional cost and negative emotions are distinct constructs in both their anticipated and experienced forms, although some similarities between constructs were also identified. Future directions are discussed for providing more conceptual clarity of emotional cost.

Emotion regulation difficulties and sleep quality in adolescence during the early stages of the COVID-19 lockdown

IntroductionAdolescence is a period of vulnerability for emotion regulation and sleep difficulties, risks that might be compounded by intense COVID-19 lockdowns and challenges. The aim of this study was to investigate how sleep quality related to emotion regulation difficulties in adolescents during lockdown in Perú. MethodsParticipants were 2563 adolescents enrolled in Innova school in Perú (11 – –17 years) in May 2020. Hypotheses were derived from exploring one half of the sample, preregistered at https://osf.io/fuetz/, and then confirmed in the second half of the sample. Participants completed subjective surveys of sleep quality (short PSQI) and the Difficulties in Emotion Regulation Scale Short Form (DERS-SF). ResultsWorse sleep quality was robustly associated with more difficulties in emotion regulation across both samples. The association was found particularly for emotion regulation subscales related to the ability to engage in goal directed behavior in the face of distress, emotional clarity and strategies to deal with feeling distressed. In contrast, there was no robust association between sleep and the ability to regulate impulses in the context of negative emotions, and no association with the ability to accept emotions. Girls and older adolescents robustly endorsed worse sleep quality and more difficulties in emotion regulation. LimitationsThe cross-sectional nature of this study prevents us from determining the direction of the association. Data were collected using adolescent self-report which, while informative of adolescent perceptions, might diverge from objective measures of sleep or emotion regulation difficulties. ConclusionsOur findings with adolescents in Perú contribute to our understanding of the association between sleep and emotion regulation at a broader global scale.

Emotion dysregulation in relation to cannabis use and mental health among young adults

BackgroundEmotion dysregulation (ED) is a transdiagnostic variable that accounts for the onset and maintenance of mental health disorders. The interplay between ED, cannabis use and mental health has not been appraised in the young adult population and whether there are sex-dependent effects has yet to be examined. This study looked at whether ED mediates the association between past-month cannabis use and mental health, while considering sex as a moderator. Methods2,762 (64.2% women) undergraduate Spanish students completed an online battery. Among others, they fulfilled the Depression Anxiety Stress Scale-21 (DASS-21) and the Difficulties in Emotion Regulation Scale (DERS-28). A two-way ANOVA assessed the effects of sex and past-month cannabis use on participants’ DASS-21 scores. A set of moderated mediations tested whether the indirect effect of past-month cannabis use on DASS-21 through DERS differed by sex. ResultsPast-month cannabis female users showed higher levels of depression, anxiety and stress (M = 51.10, SD = 26.72) than did men [(M = 33.76, SD = 20.31); F(1, 2758) = 5.119, p =.024, η2p =.002]. In female young adults only, the effect of past-month cannabis use on mental health was mediated by ED (total score), non-acceptance of emotional responses, lack of emotional control, difficulties in engaging in goal-directed behavior, and lack of emotional clarity (all p’s < 0.005) ConclusionsFindings indicate the importance of considering ED in assessment and intervention practices. Interventions targeting ED may be particularly effective for female young adult cannabis users.