Disturbances In Emotion Regulation Research Articles

Skills training followed by either EMDR or narrative therapy for posttraumatic stress disorder in adult survivors of childhood abuse: a randomized controlled trial

ABSTRACT Background: Individuals suffering from PTSD following childhood abuse represent a large subgroup of patients attending mental health services. The aim of phase-based treatment is to tailor treatment to the specific needs to childhood abuse survivors with PTSD with a Skills Training in Affective and Interpersonal Regulation (STAIR) phase, in which emotion dysregulation and interpersonal problems are targeted, and a trauma-focused phase. Objective: The purpose of this study was to compare STAIR + Eye Movement Desensitization and Reprocessing (EMDR) vs. STAIR + Narrative Therapy (NT) as treatments for PTSD following childhood-onset trauma in a routine clinical setting. Method: Sixty-eight adults were randomly assigned to STAIR/EMDR (8 STAIR-sessions followed by 12 EMDR-sessions) or STAIR/NT (8 STAIR-sessions followed by 12 NT-sessions). Assessments took place at pre-treatment, after each treatment phase and at 3 and 12 months post-intervention follow-up. Primary outcomes were interviewer-rated and self-reported symptom levels of PTSD. Secondary outcomes included symptom levels of depression and disturbances in emotion regulation and interpersonal skills. Results: Multilevel analyses in the intent-to-treat sample indicated that patients in both treatments improved substantially on PTSD symptom severity (CAPS: d = 0.81 to 1.29; PDS: d = 1.68 to 2.15), as well as on symptom levels of depression, anxiety, emotion regulation, dissociation and interpersonal skills. Effects increased or were maintained until 12-month follow-up. At mid-treatment, after STAIR, patients in both treatments improved moderately on PTSD symptom severity (PDS: d = 1.68 to 2.15), as well as on symptom levels of depression (BDI: d = .32 to .31). Symptoms of anxiety, emotion dysregulation, interpersonal problems and dissociation were not decreased after STAIR. There were no significant differences between the two conditions on any outcome. Conclusion: PTSD in adult survivors of childhood interpersonal trauma can effectively be treated by phase-based interventions using either EMDR or NT in the trauma-processing phase. Trial registration: ClinicalTrials.gov identifier: NCT01443182..

Hormonal status of patients with infertility and post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is a mental disorder that occurs after a psychologically or physically traumatic event, and characterized by three main clusters of posttraumatic symptoms, as well as chronic and significant disturbances in emotion regulation, identity, and relationships. PTSD is more common in women, which suggests a role for the regulation of female sex hormones in its development.The objective: to study the hormonal status of women with infertility and PTSD.Materials and methods. 112 women with infertility were examined, who were divided into groups depending on the PTSD criteria. The I group included 36 women with PTSD criteria, who were diagnosed with infertility before the onset of the traumatic factor, the II group – 31 patients with fertility disorders which were diagnosed on the background of PTSD, the III group – 45 women with infertility and without signs of PTSD, the control group consisted of 50 healthy women who applied for a routine preventive examination.In all patients, on the 3rd–5th day of the menstrual cycle, the concentrations of prolactin, estradiol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone were determined in the blood serum, in the saliva – cortisol, on the 21st day of the cycle – in the blood serum progesterone.Results. It was established that in women with infertility that was developed after the traumatic factor, the prolactin content is significantly higher (59.5±18.9 ng/ml) than in other groups of patients with fertility disorders (36.9±12.3 ng/ml in I group, 34.3±17.9 ng/ml – in the III group) and in the group of healthy women (13.5±5.6 ng/ml). The concentration of estradiol in the I group was within the reference values for the follicular phase of the cycle, but significantly lower (23.4±3.6 pg/ml) than in women of the other groups (from 87.6±14.6 pg/ml in the III group to 103.5±27.8 pg/ml in the group of healthy women). The average concentration of progesterone in the I (3.4±2.7 pg/ml) and II (4.1±2.9 pg/ml) groups was within the reference values, but was probably lower than that of healthy women (23.6±4.9 pg/ml), as well as women with infertility without signs of PTSD (19.4±5.1 pg/ml).In this study the patients with infertility which has developed on the background of PTSD had LH values within the reference normal range (2.0±0.5 U/L), but several times lower than in women with other reasons of infertility (12.0±3.6 U/l – in women with infertility before the development of PTSD, 6.0±1.9 U/l – in women with infertility without PTSD criteria) and in healthy women (9.2±3.4 U/l).An increased level of testosterone beyond the reference values was found only in women of the II group (3.3±1.9 nmol/l), in the other groups the average testosterone concentration ranged from 1.3±0.6 nmol/l in healthy women to 1.5±0.9 nmol/l in the I group and 1.8±0.7 nmol/l in women with infertility without signs of PTSD. Patients with PTSD are characterized by an increased level of cortisol in saliva, which indicates a prolonged reaction of the body to the trauma (8.8±0.3 ng/ml – in the I group, 10.3±0.4 ng/ml – in the II group), in groups without PTSD the level of this hormone in saliva was almost twice as low (5.4±0.2 ng/ml – in the III group and 5.9±0.3 ng/ml – in healthy women).Conclusions. 1. The patients with PTSD and infertility are characterized by high concentrations of cortisol in saliva and a decreased progesterone level in blood serum.2. In patients who had fertility disorders before a stressful event, a decreased estrogen concentration and an increased luteinizing hormone level were found in blood serum, which indicates endocrine disorders as a cause of infertility.3. Prolactin and testosterone levels were found to be higher in the patients with infertility that was developed after a traumatic event than in other women with reproductive function disorders. Both factors are pathogenetically related to the pathological reaction to stress.

Characteristics of Patients in Methadone Maintenance Treatment (MMT) Who Have Difficulties in Emotion Regulation

Disturbances in emotion regulation among opioid users receiving methadone maintenance treatment (MMT) was reported in a few small studies. We aimed to evaluate the prevalence and characteristics of patients in MMT with impaired emotion regulation. We studied a cross-sectional sample of 121 patients by means of the Difficulties in Emotion Regulation Scale (DERS). Data on clinical, sociodemographic and addiction variables were reviewed, including results of random observed urine testing for opioids, alcohol, cocaine, cannabis, and benzodiazepine (BDZ). The prevalence of a high DERS score (> 90) was 39%. Characteristics associated with high DERS scores (logistic regression model) were benzodiazepine misuse and 20 years of opioid use before admission to MMT. Among the subscales, IMPULSE and STRATEGIES were independently related to substance use (logistic regression). Greater cocaine usage was also more prevalent only in univariate analyses. The DERS score correlated inversely with years of education among patients with negative urine test. The DERS subscale score for AWARENESS was lower in females than in males as among patients with suicide attempts or involvement in physical violence. Since the IMPULSE and STRATEGIES scores predict drug use, these aspects of emotional regulation should be targeted first in third-wave cognitive-behavioral intervention in MMT.

Impact of interleukin-1β single nucleotide polymorphisms and depressive symptoms in individuals with chronic viral hepatitis.

Elevated levels of interleukin 1β (IL-1β) have been identified in patients with chronic viral hepatitis and have been associated with depressive symptoms. Given the high prevalence of depression in this patient population, this study sought to explore the potential influence of IL-1β genetic variations on the severity of depressive symptoms. In a cohort of 181 Taiwanese patients with chronic viral hepatitis, we investigated the impact of five common IL-1β single nucleotide polymorphisms (SNPs), including rs16944, rs1143627, rs1143630, rs1143643, and rs3136558, on depressive symptoms using the Beck's Depression Inventory-II. Additionally, we analyzed the primary domains of IL-1β-related depressive symptoms according to Beck's six symptom categories of depression. Our analysis revealed significant associations between depressive symptoms and three intronic IL-1β SNPs. After controlling for age, sex, marital status, and education level, patients with the rs1143630 GG, rs1143643 CC, and rs3136558 AA genotypes demonstrated higher severity of depressive symptoms in the domains of indecision (p = 0.004), agitation (p = 0.001), and feelings of punishment (p = 0.005), respectively, compared to rs1143630 GA+AA, rs1143643 CT, and rs3136558 AG+GG genotypes. According to Beck's categorization, these symptoms can be classified into three dimensions: disturbances in emotion regulation, energy, and cognition. Our findings demonstrate the association between IL-1β polymorphisms and depressive symptoms and suggest a potential underlying mechanism for specific depressive symptoms within the chronic viral hepatitis population. These insights could improve our understanding and treatment of depressive symptoms in individuals with viral hepatitis.

Gender differences in the transactional associations between anxiety sensitivity and emotion regulation over time

Although anxiety sensitivity (AS) and disturbances in emotion regulation (ER) are both transdiagnostic factors thought to predispose toward internalizing pathology, little is known about associations between these constructs over time. Further, no work has examined the modulating impact of gender on these associations, despite previous work identifying gender differences in both AS and ER. Data were collected from 275 adults (Mage = 35.7; 52% women) at two timepoints, six months apart (baseline=March 2021, follow-up=September 2021), using an online crowdsourcing platform. Multigroup cross-lagged analyses showed that, across genders, lower baseline ER predicted higher AS at follow-up (p < .001), over and above baseline AS, but the reverse was not true. Additionally, this association was moderated by gender (∆Wald’s χ2 =8.33, p < .01), such that lower baseline ER predicted higher follow-up AS in men (p < .001), but not women (p = .35). Our findings suggest the presence of gender differences in the longitudinal, transactional associations between transdiagnostic risk factors important for the maintenance and exacerbation of future internalizing pathology. For example, men may be engaging in less adaptive ER strategies (e.g., suppression), resulting in a failure to downregulate future AS. Present results inform etiological models of internalizing disorders.

Internet Addiction: Predictor of Disturbed Emotion Regulation, Sleep quality and General Health in University Students

Excessive practice of using internet may result to behavioral addiction that is associated with detrimental physical, emotional and psychological health in university students by using between-groups correlational research design. The present research explored differences in university students with and without internet addiction regarding disturbed emotion regulation, poor sleep quality and general health issues. Further, the research explored internet addiction as a predictor of disturbed emotion regulation, poor sleep quality and general health issues in university students identified with internet addiction. The sample contained 600 students (375 with &amp; 225 without internet addiction) from different public universities of Lahore. Findings revealed higher mean scores for the students with internet addiction on disturbed emotion regulation, poor sleep quality and general health issues (p &lt; 0.01). Besides internet addiction, gender and nuclear family system emerged as significant predictors of disturbed emotion regulation, poor sleep quality and general health issues (p &lt; 0.01) in university students. Research implications suggest that young adults from universities should be given counselling for appropriate usage of internet rather develop internet addiction so that they can be able to utilize internet rather than deteriorating their health and time

Concealing, Tolerating, and Adjusting to Emotions in Obsessive-Compulsive and Anxiety Disorders: A Cross-Sectional Study.

Although research has shown that mood and anxiety disorders manifest disturbed emotion regulation, it is unclear whether anxiety disorders differ between each other in terms of their emotion regulation strategies. In the present study, we investigated whether patients with anxiety disorders present different affective styles. We assessed affective styles of 32 obsessive-compulsive disorder (OCD) patients, 29 social anxiety disorder (SAD) patients, 29 panic disorder (PD) patients, and 20 healthy controls through the Affective Style Questionnaire (ASQ). A multivariate analysis of covariance (MANCOVA) was performed to compare the affective styles across groups (OCD, SAD, PD and control), while controlling for depression, anxiety symptoms and age. The MANCOVA revealed a significant, small-medium, main effect of diagnostic group on affective styles. The planned contrasts revealed that OCD and SAD patients reported significantly lower scores for "tolerance" (ASQ-T) compared to healthy controls group. There were no differences between PD group and healthy controls. Our findings provide evidence that OCD and SAD have difficulty tolerating strong emotions existing in the present moment in an open and non-defensive way.

Reduced astrocytic mGluR5 in the hippocampus is associated with stress-induced depressive-like behaviors in mice

Major depressive disorder (MDD) is one of the most common and disabling mental disorders that characterized by profound disturbances in emotional regulation, motivation, cognition, and the physiology of affected individuals. Although MDD was initially thought to be primarily triggered through neuronal dysfunction, the pathological alterations in astrocytic function have been previously reported in MDD. We report that chronic restraint stress (CRS) induces astrocyte activation and decreases expression of astrocytic mGluR5 in the hippocampal CA1 of susceptible mice exhibited depressive-like behaviors. Reducing expression of astrocytic mGluR5 in dorsal CA1 simulates CRS-induced depressive-like behaviors and impairs excitatory synaptic function in mice, while overexpression of astrocytic mGluR5 in dorsal CA1 rescues CRS-induced depressive-like traits and excitatory synaptic dysfunction. Thus, we provide direct evidence for an important role of astrocytic mGluR5 in producing the behavioral phenotypes of MDD, supporting astrocytic mGluR5 may serve as an effective therapeutic target for MDD.

Circadian Rhythm Alterations May be Related to Impaired Resilience, Emotional Dysregulation and to the Severity of Mood Features in Bipolar I and II Disorders.

ObjectiveThe study aimed to investigate the possible impact of resilience and emotion dysregulation on the clinical manifestations of bipolar disorders (BDs) focusing on the possible role of circadian rhythm alterations.MethodA sample of 197 inpatients suffering from BD of type I (BDI) or II (BDII) were assessed during a major depressive episode using the Structural Clinical Interview for DSM-5 (SCID-5), the Beck Depression Inventory-II (BDI-II), the Young Mania Rating Scale (YMRS), Resilience Scale for Adults (RSA), Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN), Difficulties in Emotion Regulation Scale (DERS) and the Scale for Suicide Ideation (SSI). Participants with or without circadian rhythm disturbances as measured with Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN), were compared; regression and mediation analyses were computed.ResultsParticipants with circadian rhythms disturbances showed a greater severity of depressive symptoms, of suicidal risk, lower resilience and more disturbances in emotion regulation including impulsivity and regulatory strategies. The logistic regression revealed that circadian rhythm disturbances was related to depressive symptoms (O.R. 4.0), suicidal risk (OR 2.51), emotion dysregulation (OR 2.28) and low resilience (OR 2.72). At the mediation analyses, circadian rhythm alterations showed an indirect effect on depressive symptoms by impairing resilience (Z= 3.17, p=0.0014)/ emotional regulation (Z= 4.36, p<0.001) and on suicidal risk by affecting resilience (Z= 2.00, p=0.045) and favoring impulsivity (Z= 2.14, p=0.032).ConclusionsThe present findings may show that circadian rhythm alterations might play a key role in BD manifestations, as being correlated with more severe clinical presentations of depressive symptoms, suicidal risk, impaired resilience and emotional regulation. Addressing circadian rhythm alterations might potentially promote resilience and emotion regulation hence improving mood symptoms and suicidal risk in BDs.

Emotional Reactivity and Family-Related Factors Associated With Self-Injurious Behavior in Adolescents Presenting to a Child and Adolescent Psychiatric Emergency Service.

Background: Adolescents presenting in a child and adolescent psychiatric emergency service show various psychiatric disturbances, most commonly suicidal ideation, suicide attempts, and non-suicidal self-injury (NSSI). It was postulated that especially disturbed emotion regulation contributes to self-injurious behavior of young people. This study aims to investigate the relevance of emotional reactivity (ER), as part of emotion regulation, during an acute crisis, how it relates to self-injurious behavior reinforcement and how a family as well as peers' history of self-injurious behavior are associated with self-injurious behavior of presenting adolescents. Additionally, crisis-triggering background factors were evaluated from the perspective of patients and their caregivers.Methods: A consecutive sample of 86 adolescents aged 11–18 years presenting to the emergency outpatient department due to self-injurious thoughts and behavior received a pretreatment psychiatric evaluation. Among other psychometric measures and structured clinical interviews, ER was measured via the Emotion Reactivity Scale (ERS). Family-related aspects were collected both through evaluation of history and through questionnaires filled in by custodians or parents.Results: Data analysis revealed that suicidal ideation was significantly related to family history with self-injurious behavior in comparison with a family background without such a history. A significant positive correlation was apparent between the ERS sensitivity score and occurrence of NSSI within the past year. A relationship between the ERS and distinct types of reinforcement as a motivation factor for NSSI was found. Post-hoc tests revealed a significant difference between boys and girls when no positive peers' history is present with boys having lower ERS scores than girls, but no difference when both groups had friends engaging in self-injurious behavior. There was only moderate agreement between parents and their children in naming reasons for the current crisis involving NSSI.Conclusion: Emotional regulation, especially ER, has an influence on patients' acute psychiatric symptomatology and when experiencing an acute crisis should be brought into focus early at psychiatric assessment. A history of self-injurious behavior taken from patient's family members and close circle of friends and agreement on reasons for the crisis should be routinely included in the exploration of a patient presenting with self-injurious behavior.

Emotional regulation in eating disorders and gambling disorder: A transdiagnostic approach.

Background and aimsDifficulties in Emotion Regulation (ER) are related to the etiology and maintenance of several psychological disorders, including Eating Disorders (ED) and Gambling Disorder (GD). This study explored the existence of latent empirical groups between both disorders, based on ER difficulties and considering a set of indicators of personality traits, the severity of the disorder, and psychopathological distress.MethodsThe sample included 1,288 female and male participants, diagnosed with ED (n = 906) and GD (n = 382). Two-step clustering was used for the empirical classification, while analysis of variance and chi-square tests were used for the comparison between the latent groups.ResultsThree empirical groups were identified, from the most disturbed ER profile (Subgroup 1) to the most functional (Subgroup 3). The ER state showed a linear relationship with the severity of each disorder and the psychopathological state. Different personality traits were found to be related to the level of emotion dysregulation.Discussion and conclusionIn this study, three distinct empirical groups based on ER were identified across ED and GD, suggesting that ER is a transdiagnostic construct. These findings may lead to the development of common treatment strategies and more tailored approaches.

Effects of unilateral tDCS over left prefrontal cortex on emotion regulation in depression: Evidence from concurrent functional magnetic resonance imaging.

Major depressive disorder (MDD) is the most common mood disorder and a primary cause of disability worldwide. MDD symptomatology entails disturbances in emotion regulation, namely one's ability to modify the intensity and duration of emotional reactions towards affective events. Transcranial direct current stimulation (tDCS) has emerged as a promising treatment for MDD. Yet, positive tDCS outcomes vary across studies, while the precise effects of the procedure for cortical excitability in MDD during emotion regulation remain largely unexplored. Here, we leveraged functional magnetic resonance imaging (fMRI)-compatible tDCS technology to examine the functional consequences of a unilateral anodal tDCS montage at 1.5 mA over left PFC (area F3; with the reference electrode over an extracephalic location) for brain activity during an emotion-regulation task in MDD patients and age-matched healthy control subjects. Our results revealed down-regulation of negative emotions in the right amygdala and visual cortex of healthy controls but not MDD patients prior to stimulation, the degree of which correlated with the magnitude of the participants' reappraisal scores. TDCS did not elicit significant changes in neural activation patterns for either group. These findings contribute to the literature on the pathophysiology of MDD by showing that a key disturbance in the disorder entails the ineffective down-regulation of activity not only within the amygdala, but also within visual cortical areas in response to negative information. Further, these results suggest that relative to bifrontal tDCS montages, unilateral stimulation of moderate intensity over left PFC may not be sufficient to elicit therapeutic effects for MDD.

Study protocol for a randomised-controlled study on emotion regulation training for adolescents with major depression: the KONNI study

IntroductionMajor depression (MD) often has its onset during adolescence and is associated with significant morbidity and mortality. One important factor for the development and maintenance of adolescent MD are disturbances...

The distinctive neural circuitry of complex posttraumatic stress disorder during threat processing.

There is controversy over the extent to which the new International Classification of Diseases (ICD-11) diagnosis of complex posttraumatic stress disorder (CPTSD) is distinct from posttraumatic stress disorder (PTSD). This study aimed to conduct the first investigation of distinctive neural processes during threat processing in CPTSD relative to PTSD. This cross-sectional functional magnetic resonance study included 99 participants who met criteria for PTSD (PTSD = 32, CPTSD = 28) and 39 trauma-exposed controls. PTSD was assessed with the Clinician-Administered PTSD Scale (CAPS). CPTSD was assessed with an adapted version of the International Trauma Questionnaire. Neural responses were measured across the brain while threat or neutral faces were presented at both supraliminal and subliminal levels. During supraliminal presentations of threat stimuli, there was greater bilateral insula and right amygdala activation in CPTSD participants relative to PTSD. Reduced supraliminal right dorsolateral prefrontal cortex activation and increased subliminal amygdala and insula activation were observed as common dysfunction for both CPTSD and PTSD groups relative to trauma controls. There were no significant differences in terms of subliminal presentations and no differences in functional connectivity. Dissociative responses were positively associated with right insula activation (r = 0.347, p < 0.01). These results provide the first evidence of distinct neural profiles of CPTSD and PTSD during threat processing. The observation of increased insula and right amygdala activation in CPTSD accords with the proposal that CPTSD is distinguished from PTSD by disturbances in emotion regulation and self-concept.

Elucidating the putative link between prefrontal neurotransmission, functional connectivity, and affective symptoms in irritable bowel syndrome

Altered neural mechanisms are well-acknowledged in irritable bowel syndrome (IBS), a disorder of brain-gut-communication highly comorbid with anxiety and depression. As a key hub in corticolimbic inhibition, medial prefrontal cortex (mPFC) may be involved in disturbed emotion regulation in IBS. However, aberrant mPFC excitatory and inhibitory neurotransmission potentially contributing to psychological symptoms in IBS remains unknown. Using quantitative magnetic resonance spectroscopy (qMRS), we compared mPFC glutamate + glutamine (Glx) and γ-aminobutyric acid (GABA+) concentrations in 64 women with IBS and 32 age-matched healthy women (HCs) and investigated their association with anxiety and depression in correlational and subgroup analyses. Applying functional magnetic resonance imaging (fMRI), we explored whether altered neurotransmission was paralleled by aberrant mPFC resting-state functional connectivity (FC). IBS patients did not differ from HCs with respect to mPFC GABA+ or Glx levels. Anxiety was positively associated with mPFC GABA+ concentrations in IBS, whereas Glx was unrelated to psychological or gastrointestinal symptoms. Subgroup comparisons of patients with high or low anxiety symptom severity and HCs revealed increased GABA+ in patients with high symptom severity, and lower mPFC FC with adjacent anterior cingulate cortex (ACC), a crucial region of emotion modulation. Our findings provide novel evidence that altered prefrontal inhibitory neurotransmission may be linked to anxiety in IBS.

The mediating role of difficulties in emotion regulation on attachment styles of adolescents with conduct disorders.

Adolescence is a period of achieving emotion regulation skills. One of the main responsibilities of adolescents is to learn adaptive emotion regulation and personal autonomy. The purpose of this study was to investigate the mediating role of difficulties in emotion regulation in the attachment styles of adolescents with conduct disorders. This was a cross-sectional and correlational study. The study consisted of 105 adolescent residing in detention centers in the southeast of Iran using multi-stage random sampling. Data were collected using various questionnaires such as the Inventory of Parents and Peer Attachment-Revised (IPPA-R), the Difficulties of Emotion Regulation Scale (DERS), and the Strength and Difficulties Questionnaire (SDQ). Information was analyzed using path analysis. The results show parental attachment and difficulties in emotion regulation significantly contribute to the prediction of conduct problems. A sense of alienation causes conduct disorders through disturbance in emotional regulation, but trust and communication with parents are only indirectly related to conduct disorders by disturbances in emotional regulation. As attachment is closely correlated with emotional regulation and difficulties in emotion regulation also lead to the conduct disorders, it is suggested to train emotion regulation in adolescents and their families with the aim of shaping relationships that will lead to the formation of a secure attachment style in the child.

Emotion regulation in patients with somatic symptom and related disorders: A systematic review.

BackgroundSomatic symptoms and related disorders (SSD) are prevalent phenomena in the health-care system. Disturbances in emotion regulation (ER) are commonly observed in patients suffering from SSD.ObjectivesThis review aimed to examine ER processes that characterize SSD by a systematic analysis of the available empirical studies.Data sourcesPsycINFO and PubMed databases for the articles published between January 1985 and June 2018.Search terms“emotion/al regulation” or “affect regulation” and various forms of SSD.Study eligibility criteriaEmpirical studies that a) assigned adolescent or adult patients suffering from SSD based on a clinical diagnosis, and b) examined the relationship between ER and SSD, were included.Study synthesis methodsA tabular summary of the articles was generated according to study characteristics, study quality, variables, and findings. The findings were organized based on ER variables used in the articles and diagnoses of SSD, which were then re-organized under the main constituents of ER (attention, body, and knowledge).ResultsThe findings of the 64 articles largely supported the association between SSD and disturbances in ER, which are usually shared by different diagnoses of SSD. The results indicate that patients show a reduced engagement with cognitive content of emotions. On the other hand, bodily constituents of ER seem to depict an over-reactive pattern. Similarly, the patients tend to encounter difficulties in flexibly disengaging their (spontaneous) attention from emotional material.LimitationsThere is a scarcity of longitudinal designs, randomized controlled trials, experiments, and diary studies suited to investigate the short- and long-term causal relationship between ER and SSD. Symptoms of SSD and measures to assess emotion regulation are heterogeneous.Conclusions and implicationsAssessment of ER processes is potentially useful to understand SSD and for treatment planning. Furthermore, a concurrent investigation of the dynamic interaction of the ER modalities promises insights for better understanding of the role of ER in development, course, and maintenance of SSD.

A research programme to evaluate DBT-PTSD, a modular treatment approach for Complex PTSD after childhood abuse

BackgroundPosttraumatic stress disorder (PTSD) after childhood abuse (CA) is often related to severe co-occurring psychopathology, such as symptoms of borderline personality disorder (BPD). The ICD-11 has included Complex PTSD as a new diagnosis, which is defined by PTSD symptoms plus disturbances in emotion regulation, self-concept, and interpersonal relationships. Unfortunately, the empirical database on psychosocial treatments for survivors of CA is quite limited. Furthermore, the few existing studies often have either excluded subjects with self-harm behaviour and suicidal ideation — which is common behaviour in subjects suffering from Complex PTSD. Thus, researchers are still trying to identify efficacious treatment programmes for this group of patients.We have designed DBT-PTSD to meet the specific needs of patients with Complex PTSD. The treatment programme is based on the rules and principles of dialectical behavioural therapy (DBT), and adds interventions derived from cognitive behavioural therapy, acceptance and commitment therapy and compassion-focused therapy. DBT-PTSD can be provided as a comprehensive residential programme or as an outpatient programme. The effects of the residential programme were evaluated in a randomised controlled trial. Data revealed significant reduction of posttraumatic symptoms, with large between-group effect sizes when compared to a treatment-as-usual wait list condition (Cohen’s d = 1.5).The first aim of this project on hand is to evaluate the efficacy of the outpatient DBT-PTSD programme. The second aim is to identify the major therapeutic variables mediating treatment efficacy. The third aim is to study neural mechanisms and treatment sensitivity of two frequent sequelae of PTSD after CA: intrusions and dissociation.MethodsTo address these questions, we include female patients who experienced CA and who fulfil DSM-5 criteria for PTSD plus borderline features, including criteria for severe emotion dysregulation. The study is funded by the German Federal Ministry of Education and Research, and started in 2014. Participants are randomised to outpatient psychotherapy with either DBT-PTSD or Cognitive Processing Therapy. Formal power analysis revealed a minimum of 180 patients to be recruited. The primary outcome is the change on the Clinician-Administered PTSD Scale for DSM-5.DiscussionThe expected results will be a major step forward in establishing empirically supported psychological treatments for survivors of CA suffering from Complex PTSD.Trial registrationGerman Clinical Trials Register: registration number DRKS00005578, date of registration 19 December 2013.

Distinct temporal brain dynamics in bipolar disorder and schizophrenia during emotion regulation.

Disturbances in emotion regulation (ER) are characteristic of both patients with bipolar disorder (BD) and schizophrenia (SZ). We investigated the temporal dynamics of brain activation during cognitive ER in BD and SZ to understand the contribution of temporal characteristics of disturbed ER to their unique and shared symptomatology. Forty-six participants performed an ER-task (BD, n = 15; SZ, n = 16; controls, n = 15) during functional magnetic resonance imaging, in which they were instructed to use cognitive reappraisal techniques to regulate their emotional responses. Finite impulse response modeling was applied to estimate the temporal dynamics of brain responses during cognitive reappraisal (v. passive attending) of negative pictures. Group, time, and group × time effects were tested using multivariate modeling. We observed a group × time interaction during ER in the ventrolateral prefrontal cortex (VLPFC), supplementary motor area (SMA) and inferior occipital gyrus. Patients with SZ demonstrated initial hyper-activation of the VLPFC and SMA activation that was not sustained in later regulatory phases. Response profiles in the inferior occipital gyrus in SZ showed abnormal activation in the later phases of regulation. BD-patients showed general blunted responsivity in these regions. These results suggest that ER-disturbances in SZ are characterized by an inefficient initialization and failure to sustain regulatory control, whereas in BD, a failure to recruit regulatory resources may represent initial deficits in formulating adequate representations of the regulatory needs. This may help to further understand how ER-disturbances give rise to symptomatology of BD and SZ.

Complex Posttraumatic Stress Disorder in Patients Exposed to Emotional Neglect and Traumatic Events: Latent Class Analysis

The inclusion of a complex posttraumatic stress disorder (CPTSD) diagnosis in the 11th revision of the International Classification of Diseases reflects growing evidence that a subgroup of individuals with PTSD also suffer from disturbances in emotion regulation, interpersonal skills, and self-concept, which together are termed "disturbances in self-organization" (DSO). Although CPTSD is assumed to result from exposure to complex traumatic events, emotional neglect may be an important contributor. This study investigated the presence of CPTSD, defined by endorsement of PTSD and DSO symptoms in a clinical postwar generation sample. The sample consisted of 218 patients who had been exposed to emotional neglect in childhood, a subgroup of whom had also been exposed to potentially traumatic events. Using items from the Harvard Trauma Questionnaire and the Brief Symptom Inventory, a latent class analysis revealed two classes: high endorsement of almost all CPTSD symptoms (n = 83; 38.1%) and low endorsement of all CPTSD symptoms (n = 135; 61.9%). Contrary to our hypothesis, no DSO-only class was found. The R3step method showed gender and number of traumatic events to be significant predictors of class membership. Compared to the low endorsement class, individuals in the CPTSD class were more likely to be female, p = .013, and to report a higher number of traumatic experiences, p < .001. The potential intermediary role of emotional neglect in the development of DSO and CPTSD is discussed.