Cognitive Change Strategies Research Articles

Does Emotion Regulation Flexibility Work? Investigating the Effectiveness of Regulatory Selection Flexibility in Managing Negative Affect

Regulatory selection flexibility—the ability to flexibly choose emotion regulation strategies that are appropriate to dynamic contextual demands—has been theorized as a critical component of adaptive emotional functioning. Despite this, little research has investigated whether individual differences in regulatory selection flexibility influence real-time emotional experiences. The current study aimed to test the effectiveness of regulatory selection flexibility in reducing negative affect while exposed to emotion-eliciting stimuli. Using a behavioral regulatory selection task, participants viewed negative images that differed in emotional intensity and selected between engagement cognitive change (reappraisal) or attentional disengagement (distraction) strategies to manage their emotional responses. Negative affect was rated immediately before and after the regulatory period, to index emotional experience. Greater regulatory selection flexibility was associated with greater reductions in negative affect. Our findings offer preliminary evidence for the immediate psychological benefit of regulatory selection flexibility and highlight some promising avenues for future research.

REGULAÇÃO EMOCIONAL NO LOCAL DE TRABALHO: UM ESTUDO QUALITATIVO COM PROFESSORES

ABSTRACT: This study aimed to characterize the emotional labor of the professional and technological education teacher by examining the emotions and the emotion regulation strategies teachers adopt. Eight focus groups were held, with the participation of forty-one teachers to collect the data. For the data analysis, we adopted the inductive and deductive categorization methods. The results showed that different emotions are activated in the face of specific emotional demands and that teachers use a variety of strategies, either in isolation or in chains, to regulate them. However, cognitive change strategies and situation modification of the procedural model of emotional regulation were more frequently reported. The results suggest differences in the regulatory preferences of the teachers based on the career period and the training /performance area. Future research could use varied methods (e.g., observation diary) to investigate the regulation’s dynamic, context, and outcomes and develop a contextual scale of teacher emotion regulation. The findings have implications for teacher training programs, educational management, and future research.

Working with Black vs. White patients: an experimental test of therapist decision-making in cognitive behavioral therapy for depression

ABSTRACT Whether and how therapists’ delivery of cognitive behavioral therapy (CBT) for depression differs by patients’ ethnicity or race remains unclear. In this study, 218 therapists were randomized to clinical vignettes that involved the same text but varied in whether the accompanying image depicted a Black or White patient. Therapists exhibited three key differences in their views of clinical strategies for working with Black as compared to White patients. They viewed cognitive change strategies as less therapeutic and validation strategies as more therapeutic for Black patients. They reported similar differences for the time they would spend on each kind of strategy. When asked to compare the relative importance of cognitive change vs. validation strategies specifically, therapists rated validation as more important for Black than White patients. Among therapists presented with Black patients, positive racial attitudes were associated with viewing cognitive change and validation strategies as more therapeutic. These results suggest therapists tend to believe it is desirable to incorporate cognitive methods more limitedly when working with Black patients. Whether such adaptations enhance or detract from the care of Black patients is an important issue that merits future investigation.

When Are Therapists' Efforts to Bring about Cognitive Change Effective? Considering Interpersonal Vulnerabilities as Contextual Factors.

We examined interpersonal variables as moderators of the relation between therapists' use of cognitive change (CC) strategies and CC in a sample of 125 adults who participated in cognitive behavioral therapy for depression. We measured self-reported maladaptive personality characteristics, interpersonal problems, and social skills at intake. Observers rated therapist adherence to cognitive methods for the first five sessions. Patients reported in-session CC following each session. Cognitive methods predicted greater CC. The relation between cognitive methods and CC was moderated by maladaptive personality traits; this relation was stronger for patients with greater maladaptive personality traits. We encourage future research investigating moderators of therapist interventions of putative therapeutic mechanisms.

Emotion malleability beliefs and event intensity and importance predict emotion regulation in daily life

Emotion malleability beliefs facilitate adaptive emotion regulation and, in turn, well-being. We aimed to develop a more nuanced understanding of how emotion malleability beliefs, event intensity, and event importance predict emotion regulation. Participants (N = 107) rated their emotion malleability beliefs before completing 5–7 daily diaries, rating the intensity and importance of a negative event and their use of 22 emotion regulation strategies in response to each event. Emotion malleability beliefs positively predicted use of cognitive change strategies, especially for more important events. Malleability beliefs interacted with importance and intensity to predict expressive suppression. There were limited associations between malleability beliefs and other strategies. The findings suggest that emotion malleability beliefs are tied to the use of specific strategies rather than emotion regulation overall and highlight the importance of considering how individual differences predict intra-individual variation in emotion regulation across different emotional events.

Review and Analysis of thought Records: Creating a Coding System

Background: Thought records are a core component of Cognitive Behavior Therapy. Over time, thought records have been modified to suit various needs or preferences. A diversity of thought records have been developed, which include differing components and cognitive change strategies. Yet, due to a lack of specificity in the literature and field, different thought records are often treated as though they are interchangeable. Limited extant literature suggests that differing thought records may have unique clinical effects. However, meta-analyzing the comparable or differing effects of the distinct extant thought records is impeded by the lack of a coding system for thought records. Objective: The current study sought to prepare a way for further understanding the differential utility and effectiveness of different iterations of thought records by creating a coding system, which is described in detail. This coding system will be used to guide future research into which thought records work best for which problems. Method: Thought records were gathered from seminal texts and solicited from the certified members of the Academy of Cognitive Therapy and the American Board of Behavioral and Cognitive Psychology. Results: In total, 110 non-identical thought records were gathered and coded into 55 unique combinations. These results demonstrate that the variability of thought records used by qualified therapists extends well beyond those found in seminal CBT texts. Conclusion: This broad diversity justifies the need for a coding system to inform future lines of research.

Keep your cool and win the game: Emotion regulation and performance in table tennis

People often feel anxious prior to performance situations, and this can lead to performance decrements. Thus, applying effective emotion regulation strategies could be crucial for achieving maximum performance. We investigated the relation between dispositional precompetition emotion regulation and competition performance. Participants were 310 table tennis players (240 men, Mage =39.07, SD=15.99). Self-reported emotion regulation behavior was matched with objective performance data. We found that positive cognitive change strategies were positively related and negative cognitive change strategies were negatively related to winning in competitions. Furthermore, athletes with a higher performance status more often used situation modification, positive cognitive change, and response modulation strategies. Our findings contribute to personality research by providing evidence for the (non)effectiveness of certain emotion regulation strategies.

Getting fit for hip and knee replacement: a protocol for the Fit-Joints pilot randomized controlled trial of a multi-modal intervention in frail patients with osteoarthritis

BackgroundJoint replacement provides significant improvements in pain, physical function, and quality of life in patients with osteoarthritis. With a growing body of evidence indicating that frailty can be treated, it is important to determine whether targeting frailty reduction in hip and knee replacement patients improves post-operative outcomes.ObjectivesThe primary objective is to examine the feasibility of a parallel group RCT comparing a preoperative multi-modal frailty intervention to usual care in pre-frail/frail older adults undergoing elective unilateral hip or knee replacements. The secondary objectives areTo explore potential efficacy of the multi-modal frailty intervention in improving frailty and mobility between baseline and 6 weeks post-surgery using Fried frailty phenotype and short performance physical battery (SPPB) respectively.To explore potential efficacy of the multi-modal frailty intervention on post-operative healthcare services use.Methods/DesignIn a parallel group pilot RCT, participants will be recruited from the Regional Joint Assessment Program in Hamilton, Canada. Participants who are (1) ≥ 60 years old; (2) pre-frail (score of 1 or 2) or frail (score of 3–5; Fried frailty phenotype); (3) having elective unilateral hip or knee replacement; and (4) having surgery wait times between 3 and 10 months will be recruited and randomized to either the intervention or usual care group. The multi-modal frailty intervention components will include (1) tailored exercise program (center-based and/or home-based) with education and cognitive behavioral change strategies; (2) protein supplementation; (3) vitamin D supplementation; and (4) medication review. The main comparative analysis will take place at 6 weeks post-operative. The outcome assessors, data entry personnel, and data analysts are blinded to treatment allocation. Assessments: feasibility will be assessed by recruitment rate, retention rate, and data collection completion. Frailty and healthcare use and other clinical outcomes will be assessed. The study outcomes will be collected at the baseline, 1 week pre-operative, and 6 weeks and 6 months post-operative.DiscussionThis is the first study to examine the feasibility of multi-modal frailty intervention in pre-frail/frail older adults undergoing hip or knee replacement. This study will inform the planning and designing of multi-modal frailty interventional studies in hip and knee replacement patients.Trial registrationClinicalTrials.govNCT02885337

Cognitive behavioral therapy for pregnancy loss.

Cognitive-behavioral therapy (CBT) is a system of psychotherapy in which an individualized case formulation drives the strategic delivery of therapeutic interventions that target cognition, emotion, behavior, and the therapeutic relationship. It has the potential to be effective for women who have experienced pregnancy loss, as pregnancy loss often carries profound meaning that disrupts many layers of a woman's belief system, and the associated emotional consequences cannot always be managed using their typical repertoire of coping skills. The distinctive features of CBT are described, as well as 3 typical intervention strategies (i.e., behavioral activation, cognitive restructuring, and mindfulness and acceptance) that are often delivered during the course of CBT with patients who have experienced pregnancy loss. Throughout the article, emphasis is placed on balancing attention to the therapeutic relationship and affective experiencing with the implementation of cognitive and behavioral change strategies. (PsycINFO Database Record

Helping Yourself to Help Others: How Cognitive Change Strategies Improve Employee Reconciliation with Service Clients and Positive Work Outcomes

ABSTRACTThis qualitative study examined the paradox of difficult, yet meaningful, helping as part of employees’ jobs in a social services organization. Incorporating an emergent design using employee interviews the study identified how employees alter their understanding of workplace challenges, such as emotional distress and unsafe client behaviours, in order to find new meaning in the other-oriented value of their work. The resulting framework of employees’ experiences through challenging, yet meaningful, helping extends the research in customer service by proposing the reconciliation process, achieved through cognitive change strategies (i.e. visualization techniques, cognitive reframing and mindfulness of experience) serves as a conceptual bridge that helps the management of this apparent paradox. We first describe the workplace challenges and then outline the distinct cognitive change strategies that engendered the reconciliation process. Implications for practice and future researchers are then discussed.

Impaired cognitive reappraisal in panic disorder revealed by the late positive potential.

According to the cognitive model of panic disorder (PD), panic attacks are triggered and maintained by catastrophic misappraisals of bodily sensations. Clinically, PD is associated with impaired cognitive emotion regulation strategies involving cognitive reappraisal. To investigate the neural correlates and time course of cognitive reappraisal in patients with PD, event-related potentials were recorded from patients with PD and demographically matched control group during passive viewing of affective images under three conditions: (a) neutral pictures preceded by neutral descriptions, (b) unpleasant pictures preceded by negative descriptions, and (c) unpleasant pictures preceded by neutral descriptions. The late positive potential (LPP), an event-related potential component sensitive to cognitive change strategies, was examined as an index of cognitive reappraisal. Consistent with previous results, the unpleasant pictures preceded by negative descriptions had decreased valence ratings, increased arousal ratings, and increased LPP amplitudes compared with the unpleasant pictures preceded by neutral descriptions in the control group. In contrast, no reliable effect of description condition was observed for valence ratings in the PD group. The patients demonstrated differing response patterns from the control participants, with higher arousal ratings and larger LPPs during the 1000-2000 ms window when unpleasant pictures were preceded by a neutral description than when unpleasant pictures were preceded by a negative description. The present study suggests that emotion regulation is impaired in patients with PD. These findings describe the first electrophysiological correlates of abnormal cognitive reappraisal in patients with PD.

Integrating lifestyle approaches into osteoarthritis care.

As the lifetime risk, societal cost, and overall functional impact of osteoarthritis (OA) is imposing, it is imperative that clinicians provide an individualized care model for patients. Patients must be offered a multiplicity of care strategies and encouraged to embrace lifestyle approaches for self-managing the effects and symptoms of OA. Certainly, the attitude of the clinician and patient will directly influence receptivity and implementation of lifestyle approaches. This work proposes how the use of structured and routine assessments and cognitive therapy ideologies may complement a comprehensive treatment plan. Assessments described herein include objective and/or self-report measures of physical function, pain, attitude about social support, and sleep quality. Baseline assessments followed by systematic monitoring of the results may give patients and clinicians valuable insight into the effectiveness of the care plan. Empirical evidence from randomized trials with OA patients highlights the effectiveness of cognitive behavioral change strategies for addressing salient concerns for OA (pain control, mobility performance, and sleep quality). Cognitive restructuring can provide patients with renewed power in managing their disease. Cognitive therapy topics discussed presently include: 1) what is OA?, 2) effectiveness of exercise and FITT (frequency, intensity, time, and type) principles for OA patients, 3) goal-setting and barriers, and 4) translating to independent care. Woven within the discussion about cognitive therapy are ideas about how the results from baseline assessments and group-mediated dynamics might assist more favorable outcomes. There are a plethora of assessments and cognitive therapy topics that could be utilized in the care strategy that we are promoting, but the present topics were selected for their low clinician and patient burden and promising results in trials with OA patients. Clinicians who are comfortable and knowledgeable about a wider range of management tools may serve more effectively in the critical, central management process and help patients embrace personal care more successfully.

Electrophysiological Correlates of Aberrant Motivated Attention and Salience Processing in Unaffected Relatives of Schizophrenia Patients.

Patients with schizophrenia (SCZ) exhibit debilitating deficits in attention and affective processing, which are often resistant to treatment and associated with poor functional outcomes. Impaired orientation to task-relevant target information has been indexed by diminished P3b event-related potentials in patients, as well as their unaffected first-degree relatives, suggesting that P3b may be a vulnerability marker for schizophrenia. Despite intact affective valence processing, patients are unable to employ cognitive change strategies to reduce electrophysiological responses to aversive stimuli. Less is known about the attentional processing of emotionally salient task-irrelevant information in patients and unaffected first-degree relatives. The goal of the present study was to examine the neural correlates of salience processing, as indexed by the late positive potential (LPP), during the processing of emotionally salient distractor stimuli in 31 patients with SCZ, 28 first-degree relatives, and 47 control participants using an oddball paradigm. Results indicated that despite intact novelty detection (P3a), both SCZ and first-degree relatives demonstrated deficiencies in attentional processing, reflected in attenuated target-P3b, and aberrant motivated attention, with reduced early-LPP amplitudes for aversive stimuli relative to controls. First-degree relatives revealed a unique enhancement of the late-LPP response, possibly underlying an exaggerated evaluation of salient information and a compensatory engagement of neural circuitry. Furthermore, reduced early-LPP and target-P3b amplitudes were associated with enhanced symptom severity. These findings suggest that, in addition to P3b, LPP may be useful for monitoring clinical state. Future studies will explore the value of P3 and LPP responses as vulnerability markers for early detection and prediction of psychopathology.

Positive interventions: An emotion regulation perspective.

The rapid growth of the literature on positive interventions to increase "happiness" has suggested the need for an overarching conceptual framework to integrate the many and apparently disparate findings. In this review, we used the process model of emotion regulation (Gross, 1998) to organize the existing literature on positive interventions and to advance theory by clarifying the mechanisms underlying their effectiveness. We have proposed that positive emotions can be increased both in the short- and longer-term through 5 families of emotion regulation strategies (i.e., situation selection, situation modification, attentional deployment, cognitive change, and response modulation), showing how these emotion regulation strategies can be applied before, during, and after positive emotional events. Regarding short-term increases in positive emotions, our review found that attentional deployment, cognitive change, and response modulation strategies have received the most empirical support, whereas more work is needed to establish the effectiveness of situation selection and situation modification strategies. Regarding longer-term increases in positive emotions, strategies such as situation selection during an event and attentional deployment before, during, and after an event have received strong empirical support and are at the center of many positive interventions. However, more work is needed to establish the specific benefits of the other strategies, especially situation modification. We argue that our emotion regulation framework clarifies existing interventions and points the way for new interventions that might be used to increase positive emotions in both nonclinical and clinical populations.

Self-Control in School-Age Children

Conflicts between immediately rewarding activities and more enduringly valued goals abound in the lives of school-age children. Such conflicts call upon children to exercise self-control, a competence that depends in part on the mastery of metacognitive, prospective strategies. The process model of self-control organizes these strategies into five families corresponding to sequential phases in the process by which undesired and desired impulses lose or gather force over time. Situation selection and situation modification strategies involve choosing or changing physical or social circumstances. Attentional deployment and cognitive change strategies involve altering whether and how objective features of the situation are mentally represented. Finally, response modulation strategies involve the direct suppression or enhancement of impulses. The process model of self-control predicts that strategies deployed earlier in the process of impulse generation and regulation generally will be more effective than those deployed later. Implications of this self-control perspective for school-age children are considered.

Emotion regulation, physiological arousal and PTSD symptoms in trauma-exposed individuals

ObjectivesRetrospective studies suggest a link between PTSD and difficulty regulating negative emotions. This study investigated the relationship between PTSD symptoms and the ability to regulate negative emotions in real-time using a computerised task to assess emotion regulation. MethodTrauma-exposed ambulance workers (N = 45) completed self-report measures of trauma exposure, PTSD symptoms and depression. Participants then completed a computer task requiring them to enhance, decrease or maintain their negative emotions in response to unpleasant images. Skin conductance responses (SCR) were recorded and participants also made ratings of emotion intensity. Immediately after the computer task, participants were asked to describe the strategies they had used to regulate their negative emotions during the task and recorded spontaneous intrusions for the unpleasant images they had seen throughout the following week. ResultsPTSD symptoms were associated with difficulty regulating (specifically, enhancing) negative emotions, greater use of response modulation (i.e., suppression) and less use of cognitive change (i.e., reappraisal) strategies to down-regulate their negative emotions during the task. More intrusions developed in participants who had greater reductions in physiological arousal whilst decreasing their negative emotions. LimitationsPTSD was measured by self-report rather than by a clinician administered interview. The results suggest a relationship between emotion regulation ability and PTSD symptoms rather than emotion regulation and PTSD. ConclusionsDifficulty regulating negative emotions may be a feature of trauma-exposed individuals with PTSD symptoms, which may be linked to the types of strategies they employ to regulate negative emotions.

Emotion regulation abnormalities in schizophrenia: cognitive change strategies fail to decrease the neural response to unpleasant stimuli.

Contrary to early conceptualizations of emotional experience in schizophrenia (SZ), recent research indicates that patients do not self-report less in-the-moment pleasure than controls (CN). Rather, patients report experiencing elevated levels of negative emotionality in response to a range of evocative stimuli. In this study, we examined the possibility that elevations in negative emotionality in SZ may reflect an underlying emotion regulation abnormality. Event-related potentials (ERPs) were recorded from outpatients with SZ (n = 25) and demographically matched healthy controls (n = 21) during passive viewing of unpleasant and neutral photographs. Unpleasant images were preceded by an audio description that described the image as being either negative or neutral. Neutral images were preceded by neutral audio descriptions. The late positive potential (LPP), an ERP component sensitive to cognitive change strategies, was examined as an index of emotion regulation. Both CN and SZ showed an increased LPP to negatively described unpleasant images compared with neutral images. In addition, CN showed evidence of emotion regulation, as reflected by a smaller LPP for unpleasant images preceded by a neutral descriptor, relative to a negative descriptor. In contrast, SZ patients showed an inability to downregulate emotional response, as evidenced by no difference in the amplitude of the LPP for unpleasant images preceded by negative or neutral descriptors. Findings provide neurophysiological evidence for an emotion regulation abnormality in SZ and suggest that failures in cognitive change may underlie increased negative emotionality in SZ.

Internet-based interventions for disordered gamblers: study protocol for a randomized controlled trial of online self-directed cognitive-behavioural motivational therapy

BackgroundGambling disorders affect about one percent of adults. Effective treatments are available but only a small proportion of affected individuals will choose to attend formal treatment. As a result, self-directed treatments have also been developed and found effective. Self-directed treatments provide individuals with information and support to initiate a recovery program without attending formal treatment. In previous research we developed an telephone-based intervention package that helps people to be motivated to tackle their gambling problem and to use basic behavioral and cognitive change strategies. The present study will investigate the efficacy of this self-directed intervention offered as a free online resource. The Internet is an excellent modality in which to offer self-directed treatment for gambling problems. The Internet is increasingly accessible to members of the public and is frequently used to access health-related information. Online gambling sites are also becoming more popular gambling platforms.Method/DesignA randomized clinical trial (N=180) will be conducted in which individuals with gambling problems who are not interested in attending formal treatment are randomly assigned to have access to an online self-directed intervention or to a comparison condition. The comparison condition will be an alternative website that offers a self-assessment of gambling involvement and gambling-related problems. The participant’s use of the resources and their gambling involvement (days of gambling, dollars loss) and their gambling problems will be tracked for a twelve month follow-up period.DiscussionThe results of this research will be important for informing policy-makers who are developing treatment systems.Trial registrationISRCTN06220098

Using Session-by-Session Measurement to Compare Mechanisms of Action for Acceptance and Commitment Therapy and Cognitive Therapy

Debate continues about the extent to which postulated mechanisms of action of cognitive behavior therapies (CBT), including standard CBT (i.e., Beckian cognitive therapy [CT]) and acceptance and commitment therapy (ACT) are supported by mediational analyses. Moreover, the distinctiveness of CT and ACT has been called into question. One contributor to ongoing uncertainty in this arena is the lack of time-varying process data. In this study, 174 patients presenting to a university clinic with anxiety or depression who had been randomly assigned to receive either ACT or CT completed an assessment of theorized mediators and outcomes before each session. Hierarchical linear modeling of session-by-session data revealed that increased utilization of cognitive and affective change strategies relative to utilization of psychological acceptance strategies mediated outcome for CT, whereas for ACT the mediation effect was in the opposite direction. Decreases in self-reported dysfunctional thinking, cognitive “defusion” (the ability to see one's thoughts as mental events rather than necessarily as representations of reality), and willingness to engage in behavioral activity despite unpleasant thoughts or emotions were equivalent mediators across treatments. These results have potential implications for the theoretical arguments behind, and distinctiveness of, CT and ACT.

Existential Poverty: Welfare Dependency, Learned Helplessness and Psychological Capital

AbstractBeing in existential poverty means living in a state of, or near, persistent material poverty while also being socially excluded, marginalized, or disadvantaged. It is a life‐disempowering experience, one that privileges both immediacy over the future, and welfare over work. This results in learned helplessness, manifesting as a lack of will to take control of life. The existentialist explanation is that those in this mental state do not have an authentic way of life. Positive Psychology, and its offshoot, Positive Organizational Behavior, provide the cognitive change strategies that focus on building in people their sense of self‐efficacy, optimism, hope, resilience, and subjective well‐being, as well as their emotional intelligence, all of which are mental attributes that have demonstrable positive impacts on human performance. This can enable people to pursue gainful, meaningful, and sustained self‐actualizing vocation, so lifting them out of persistent material poverty. The public policy challenges are (1) to determine whether it is in the public interest to redress the negative agental consequences of welfare dependency; (2) to redesign the features of social assistance programs that exacerbate learned helplessness amongst beneficiaries; and (3) to determine how best to reduce the psychologically incapacitating effects of welfare dependency.