Emotion Dysregulation Symptoms Research Articles

Treating self-harm behaviors in prisons: implementation of the STEPPS program

BackgroundImproving mental health within correctional facilities, specifically to address self-harm behaviors, is a crucial endeavor. However, significant challenges arise when implementing evidence-based programs within this complex setting. Despite these hurdles, the Systems Training for Emotional Predictability and Problem Solving (STEPPS) program has garnered recognition, notably in the United States, for its efficacy in tackling such issues. This study aimed to examine inmate profiles in prisons located in Catalonia, Spain, and to investigate the STEPPS program’s effectiveness and implementation process.MethodForty-one inmates participated in the study and completed measures covering self-harm behaviors, emotion regulation, impulsivity, mental health symptoms, and satisfaction with the intervention. Twenty-four professionals who implemented the STEPPS program completed satisfaction, normalization process, burnout, acceptability, appropriateness, and feasibility measures.ResultsThe results suggest that the STEPPS program significantly reduced symptoms of emotional dysregulation, motor impulsivity, and compulsive symptomatology among inmates. The intervention was well-received by professionals, and perceived as appropriate and feasible. The perception of feasibility decreased after implementation, likely due to contextual factors such as inmate and organization characteristics. Additionally, professionals remained committed to the implementation, dedicating time and effort to the process and engaging in thorough evaluations, without increasing their levels of burnout.ConclusionsThese findings deepen the understanding of self-harm behaviors in prisons, highlighting the program STEPPS as promising approach for addressing self-harm. However, improvements in the STEPPS program are still necessary to enhance its implementation in this setting.Trial RegistrationNCT06297460 (ClinicalTrials.gov, retrospectively registered, 2022/01/01).

Efficacy and Safety of Lithium for Suicide and Suicide-Related Behaviors in Youth: A Review of the Literature.

This systematic review evaluates the anti-suicidal properties of Lithium in children and adolescents with Bipolar Disorder (BD), addressing gaps in evidence regarding its efficacy and safety in reducing suicidality and self-harming behaviors. A comprehensive literature search was conducted across PubMed, Web of Science, and Scopus up to February 2024. Eligible studies were those focusing on patients aged 25 years or younger, examining Lithium therapy and its impact on suicidal ideation and behaviors. The review included randomized controlled trials, longitudinal prospective and retrospective studies, and cross-sectional studies, while excluding expert opinions and case reports. Evidence generally supports the efficacy of Lithium in reducing suicidal ideation and self-harming behaviors in youth with BD, though results are mixed. Randomized controlled trials demonstrated its effectiveness in mitigating suicidal thoughts during acute manic episodes, with effects persisting post-treatment. Longitudinal studies suggested that Lithium might offer superior outcomes compared to other mood stabilizers, although its specific impact on suicidality remains inconclusive. Cross-sectional studies and retrospective analyses reveal associations between Lithium use and reduced self-harming behaviors, but causality remains uncertain. While mood-stabilizing effects of Lithium offer potential benefits for reducing suicidality in youth, evidence on its direct impact on emotional dysregulation (ED) and long-term efficacy is limited. Variability in individual responses and adherence issues underscore the need for further research. Future studies should include larger, diverse samples, focus on ED symptoms, and explore Lithium mechanisms in suicidality prevention. Lithium remains a promising treatment for mood stabilization and reduction in suicidality in youth with BD.

Evaluating the Link between Visual Attention Bias and Emotion Dysregulation of Young Children

The ability to regulate emotions is vital to successful social interactions. This study explores whether visual attention bias is associated with emotion dysregulation (ED) in early childhood. Parental reports of child ED (Child Behaviour Checklist (CBCL) and Temper Tantrum Scale) were examined in relation to child visual attention bias whilst viewing emotional faces. Results indicated that the level of eye gaze fixation towards emotional images and faces was associated with ED when social function (measured with the Social Responsiveness Scale), gender, age, and attention problems (measured from the CBCL subscale), were adjusted. The modifying effect on visual attention bias was evaluated using interaction analysis in the generalized linear model. The level of visual attention bias, indicated by the proportion of eye gaze fixation time on areas of interest (AOIs) in images displaying unpleasant emotions (such as anger), was inversely associated with the level of externalising problem behaviours (p = .014). Additionally, the association of eye gaze fixation time for AOIs displaying negative emotional cues with the level of externalising problem behaviours varied by age (p = .04), with younger children (aged < 70 months) demonstrating a stronger association than older children (aged ≥\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\ge$$\\end{document} 70 months). Findings suggest that young children with greater ED symptoms look less at unpleasant emotional cues. However, this relationship is attenuated as children become older. Further research to identify objective biomarkers that incorporate eye-tracking tasks may support prediction of ED-related mental health issues in the early years.

Hippocampal temporal dynamics and spatial heterogeneity unveil vulnerability markers in the offspring of bipolar patients.

Bipolar disorder (BD) is a highly heritable disorder characterized by emotion dysregulation and recurrent oscillations between mood states. Despite the proven efficacy of early interventions, vulnerability markers in high-risk individuals are still lacking. BD patients present structural alterations of the hippocampus, a pivotal hub of emotion regulation networks composed of multiple subregions with different projections. However, the hippocampal dynamic functional connectivity (dFC) in BD remains unclear. We aim to investigate whether the dFC of hippocampal subdivisions differentiates BD patients, offspring of BD patients (BDoff), and healthy controls (HC); and whether it correlates with symptoms differently between these groups. We studied for the first time the dFC of the hippocampus through a cutting-edge micro-co-activation patterns (μCAPs) analysis of resting-state functional MRI data of 97 subjects (26 BD, 18 BDoff, 53 HC). μCAPs allow a data-driven differentiation within the seed region. dFC between the hippocampal body and a somatomotor-μCAP was lower both in BD patients (p-valueFDR:0.00015) and in BDoff (p-valueFDR:0.020) than in HC. Inversely, dFC between the hippocampal head and a limbic-μCAP was higher in BD patients than in HC (p-valueFDR: 0.005). Furthermore, the correlations between a frontoparietal-μCAP and both depression and emotion dysregulation symptoms were significantly higher in BD than HC (p-valueFDR <0.02). Overall, we observed alterations of large-scale functional brain networks associated with decreased cognitive control flexibility and disrupted somatomotor, saliency, and emotion processing in BD. Interestingly, BDoff presented an intermediate phenotype between BD and HC, suggesting that dFC of hippocampal subregions might represent a marker of vulnerability to BD.

Cariprazine in the management of emotionally unstable personality disorder in female patients: a case series.

Emotionally unstable personality disorder (EUPD) is debilitating psychiatric disorder, particularly common in female and forensic populations. However, appropriate pharmacological treatment to effectively manage symptoms of EUPD remains an unmet clinical need. Dopamine receptor partial agonists (DRPAs), such as aripiprazole, have a favourable tolerability profile and have demonstrated some benefits in targeting symptoms of emotional dysregulation, although, evidence regarding the effects of novel D2/D3 DRPA cariprazine in EUPD patients has been limited. To evaluate the efficacy and tolerability of cariprazine for EUPD in a case series of female forensic inpatients where the diagnosis is more prevalent. Demographic and clinical information of the patients were collected from patient electronic records during their admission in a specialized NHS forensic service. Treatment response was measured using the Positive and Negative Syndrome Scale (PANSS) at baseline, 3 and 6 months and Global Clinical Impression Scale (CGI-scores) at baseline and 6 months. Tolerability and BMI, ECG QTc interval and prolactin levels were recorded prior to initiation and at 6 months. Eight female patients with EUPD (mean age 29.8 years, SD 5.3) were treated with cariprazine (range 3-6mg). Total CGI-scores modestly improved from 5.6 baseline to 5.0 at 6 months. There was a reduction in mean total PANSS scores from baseline to 6 months (92.5, SD 8.1 to 72.4, SD 15.8), general psychopathology (56.1 SD 6.7 to 42.5, SD9.7), positive (21.9 SD 4.6 to 17.1, SD4.8) and negative PANSS scores (14.5 SD 6.3 to 12.8, SD4.6), corresponding to a 21%, 23%, 20% and 3% mean score reduction, respectively. Cariprazine demonstrated a favourable metabolic and hormonal side effect profile with no treatment discontinuation at 6 months follow up. This is the first case series to evaluate the effectiveness of cariprazine in EUPD. Its efficacy in improving PANSS and CGI-S scores was overall modest and highly variable, reflective of an inherently heterogenous and comorbid patient sample but the benefits on treatment perseverance and tolerability were considerable. Cariprazine may be of particular benefit in EUPD where psychotic symptoms are co-morbid, as an augmentation strategy to clozapine, or where previous antipsychotics have caused metabolic or hormonal side effects.

Effectiveness of Dialectical Behavior Therapy (DBT) in a Forensic Psychiatric Hospital.

Dialectical behavior therapy (DBT) has strong evidence in support of its effectiveness in reducing suicide attempts, anger, impulsivity, and substance abuse. It has been implemented in a variety of forensic settings to help with these challenges, despite limited research on the efficacy of DBT within this population. The current study presents treatment outcomes from an established DBT program in a maximum-security forensic facility. Outcomes included self-reported functioning, behavioral outcomes, and assessment of DBT skills knowledge among inpatients who participated in either comprehensive DBT or DBT skills training. Behaviorally, the study found a significant decrease in rates of patient assaults and reduced use of "Pro re nata" (PRN) medication for anxiety or agitation over the course of DBT treatment. During the first six months of treatment, self-reported symptoms of depression, emotional and behavioral dysregulation, and psychological inflexibility significantly decreased. Within this time frame, patients also displayed a significant decrease in the use of dysfunctional coping skills and a significant increase in knowledge pertaining to emotion regulation and interpersonal effectiveness. The results of this study largely support the use of DBT in forensic settings.

(135) CASE REPORT OF SEXUAL VIOLENCE VICTIMS PRESENTING PHYSICAL AND PSYCHOPATHOLOGICAL SYMPTOMS: DO THE LIFETIME OF ABUSE, SOCIAL SUPPORT, AND TIMING OF TREATMENT MATTER?

Abstract Introduction The consequences of experiencing sexual violence (SV) are linked to the time in life when it occurred and the relationship with the perpetrator. The connections among receiving late social support and treatment with worsening of SV outcomes need more clarification. These are three case reports describing SV episodes occurred in childhood or adolescence and their psychological and physical consequences. Objective Description of three case reports of SV occurred in childhood or adolescence and their psychological and physical consequences. Methods Description of sociodemographic data, psychiatric assessment (Mini International Neuropsychiatric Interview (MINI) – Brazilian Version 5.0.0), SV episode and adverse childhood experiences - ACE (Childhood Trauma Questionnaire-CTQ), emotional and stress-related symptoms (Depression Anxiety Stress Scale - DASS-21; Difficulties in Emotion Regulation Scale - DERS; Dissociative Experiences Scale - DES; Posttraumatic Stress Disorder Checklist for DSM-5 - PCL-5; Tonic Immobility Scale -TIS) and physical characteristics regarding pain and muscle rigidity (McGuill Pain Questionaire -SF, Stibor and Schober tests, fleximeter, exploratory palpation) of three victims of SV, enrolled in a referral psychiatric-medical center. Results In these three cases (case A and B female; case C male), the SV occurred at childhood (cases A and B) and adolescence (case C), with a minimum period of five years for SV disclosure, neither one with early medical/social support. In addition to SV, at least one ACE (CTQ) was found: emotional abuse (case A = 19; case B = 15; case C = 16; cutoff = 9), emotional neglect (A = 23; B = 23; C = 10; cutoff = 10), physical abuse (A = 15; B = 13; C = 10; cutoff = 8) and physical neglect (A = 12; B = 11; C = 9; cutoff = 8). Regarding psychopathological aspects we found symptoms of stress (A = 20;B &amp;lt; 10;C = 20;cutoff = 10), depression (A = 22; B = 20; C = 22;cutoff = 10) and anxiety (A = 8; B &amp;lt; 8; C = 12; cutoff = 8) – DASS-21; high scores of PTSD – PCL5 (A = 55; B = 55:C = 57;cutoff = 33); dissociative symptoms - DES (A = 96,5; B = 45,14; C = 156,5; cutoff = 30); moderate (36-65%) to severe (66-90%) difficulties in emotion regulation - DERS (A = 66,45%; B = 44,37%; C = 72,57%). In psychiatric assessment (Case B and C) beyond the classic symptoms of PTSD (guilty, dissociation, dodge, avoidance, and interpersonal harm), symptoms of emotional dysregulation (self-mutilation and dysphoria) characteristic of complex PTSD, dullness and impoverish ideas (Case A), stand out. Regarding physical-somatic symptoms, we found high score of tonic immobility reaction -TIS (A = 29; B &amp;lt; 21:C = 42;cutoff = 21); pain complaints (A = 22; B = 31; C = 25; score = 0-45), muscle rigidity in the axial axis inferred by Stibor test (A = positive; B = negative; C = negative), Schober test (A = positive; B = negative; C = positive) and reduced range of cervical flexion (A = 43°; B = 34°; C ≥ 65°; normal 65°), extension (A ≥ 50°; B = 33°; C = 48°, normal 50°). Through palpatory exploration, the pain was mainly localized in the pelvic (psoas and iliac) and respiratory (diaphragm) muscles. Conclusions The physical and psychopathological findings in these case reports seems to be in line with literature evidence of a higher frequency of pain and psychopathological symptoms in victims of SV in childhood–adolescence. The lack of early medical/social support appears to increase the severity of the outcomes. It highlights the need for more comprehensive therapeutic approach, integrating physiotherapists, clinicians, and mental health professionals, and early investigation by health care providers. Disclosure No.

LGBTQ+ outpatients present to eating disorder treatment earlier and with more severe depressive symptoms than cisgender heterosexual peers

ABSTRACT Community evidence indicates high eating disorder (ED) and comorbid symptom severity among LGBTQ+ compared to cisgender heterosexual (CH) individuals. Little is known about such disparities in ED treatment samples, especially in outpatient treatment. We aimed to descriptively characterize and investigate baseline group differences in symptom severity between LGBTQ+ and CH ED outpatients at treatment intake. Data from 60 (22.3%) LGBTQ+ and 209 (77.7%) CH ED outpatients were used to examine: (1) demographic and diagnostic differences; (2) differences in ED, depressive, and emotion dysregulation symptoms. Objectives were tested using Fisher-Freeman-Halton exact and independent samples t-tests, and analyses of covariance adjusted for age and diagnosis, respectively. Most LGBTQ+ outpatients were bisexual (55.2%), and 6.5% identified as transgender and non-binary. LGBTQ+ outpatients presented to treatment at younger ages (Mean Difference [MD] = -3.39, p = .016) and reported more severe depressive symptoms (MD = 5.73, p = .004) than CH patients, but endorsed similar ED symptom and emotion dysregulation severity. Groups did not differ in other demographic or diagnostic characteristics. LGBTQ+ individuals may develop more severe depression and similarly severe EDs at earlier ages but seek outpatient care sooner than CH peers. Managing depressive symptoms may be particularly important for LGBTQ+ ED patients.

Randomized controlled trial investigating web-based, therapist delivered eye movement desensitization and reprocessing for adults with suicidal ideation.

Promising preliminary evidence suggests that EMDR may reduce suicidal ideation (SI) when used to treat Major Depressive Disorder, Posttraumatic Stress Disorder, and trauma symptoms in the context of acute mental health crises. EMDR has never been tested specifically for treating SI, and there is a lack of data regarding the safety and effectiveness of web-based, therapist-delivered EMDR in populations with known SI. The primary objective of this study was to investigate the impact of web-based, therapist-delivered EMDR, targeting experiences associated with suicidal thinking. Secondary objectives included examining the effect of EMDR treatment on symptoms of depression, anxiety, posttraumatic stress, emotional dysregulation, and dissociation, as well as safety and attrition. This randomized control trial (ClinicalTrials.gov ID number: NCT04181047) assigned adult outpatients reporting SI to either a web-based EMDR intervention or a treatment as usual (TAU) group. TAU included primary and mental health services available within the Canadian public health system. Participants in the EMDR group received up to 12 web-based EMDR desensitization sessions, delivered twice weekly during the COVID-19 pandemic (2021-2023). The Health Research Ethics Board at the University of Alberta approved the protocol prior to initiation of data collection for this study (protocol ID number: Pro00090989). Forty-two adult outpatients received either EMDR (n=20) or TAU (n=22). Participants reported a high prevalence of early onset and chronic SI, and there was a high rate of psychiatric comorbidity. In the EMDR group, median SI, depression, anxiety, and posttraumatic symptom scale scores decreased from baseline to the four month follow-up. In the TAU group, only the median SI and posttraumatic symptom scale scores decreased from baseline to four month follow up. Although sample size precludes direct comparison, there were numerically fewer adverse events and fewer dropouts in the EMDR group relative to the TAU group. Study results provide promising preliminary evidence that web-based EMDR may be a viable delivery approach to address SI. In this complex population, a short treatment course was associated with reductions of SI and other symptoms across multiple diagnostic categories. Further investigation is warranted to verify and extend these results. https://clinicaltrials.gov/study/NCT04181047?id=NCT04181047&rank=1, identifier NCT04181047.

The impact of emotional dysregulation and comorbid depressive symptoms on clinical features, brain arousal, and treatment response in adults with ADHD.

The role of emotional dysregulation (ED) in attention-deficit/hyperactivity disorder (ADHD) has become an important issue. This study, in which we analyzed data from a predictive pharmaco-EEG-trial, aimed to examine whether symptoms of ED in adult ADHD affect ADHD symptom severity, brain arousal regulation as measured by resting EEG, and the response to stimulant medication. ED is defined as having a sex- and age-corrected T-score of >70 on the emotional lability subscale of the German version of Conners' Adult ADHD Rating Scale. A total of 115 participants were included in the study, 56 of whom had ED. Participants with ED were more impaired in terms of the severity of core ADHD symptoms, especially inattentive symptoms, comorbid depressive symptoms, interpersonal relationships, and quality of life. In addition, participants with ED were more likely to report a total score above 13 on the Beck Depression Inventory-II, which was considered to be the cutoff for mild depression. No differences were found between the ED and non-ED groups in response to stimulant medication or in brain arousal regulation. In addition, there was no significant effect of ED with comorbid depressive symptoms on treatment response. There was a trend for subgroups that showed a change in brain arousal regulation associated with symptom improvement. Our findings may support the assumption that ED may be an important feature of ADHD. The use of EEG-based brain arousal regulation as a diagnostic and predictive tool in ADHD in the presence of ED and comorbid depressive symptoms should be further investigated.

Emotional Dysregulation and Post-Traumatic Stress Symptoms: Which Interaction in Adolescents and Young Adults? A Systematic Review.

Emotional dysregulation (ED) has recently been conceptualized as a transnosographic entity in major mental disorders, and increasing evidence has suggested association between ED and post-traumatic stress symptoms (PTSS), though the nature of this association is unclear. The aim of the present review was to examine the possible interplay between ED and trauma exposure in the literature, as well as a possible role for the comorbidity of PTSD or PTSS in adolescents and young adults. In particular, we explored whether ED may represent a risk factor for PTSD or, conversely, a consequence of traumatic exposure. This systematic review was conducted according to PRISMA 2020 guidelines in three databases (PubMed, Scopus, and Embase). The 34 studies included showed a wide heterogeneity in terms of the populations selected and outcomes examined. Most studies used the Difficulties in Emotion Regulation Scale (DERS) and examined the relationship between ED, trauma, and psychopathological manifestations after the occurrence of trauma, with a focus on child abuse. Although current data in the literature are heterogeneous and inconclusive, this research highlights the role of ED as a mechanism that may mediate vulnerability to PTSD, but also as a predictor of severity and maintenance of typical, atypical, or associated PTSD symptoms, suggesting prevention programs for PTSD and other mental disorders should support the development of emotion regulation strategies.

Maladaptive daydreaming, emotional dysregulation, affect and internalized stigma in persons with borderline personality disorder and depression disorder: A network analysis.

Maladaptive daydreaming (MD) manifests through experiences of excessive, long-lasting daydreaming resulting in significant suffering, including isolation, distress and shame. Considering that one of its functions is a distraction from painful feelings, it is linked with escapism and plays a significant role in disorders associated with emotional dysregulation, maintaining negative symptoms, including internalized stigmatization and social withdrawal. The current study aimed to examine cognitive (internalized stigma), affective (affect, anhedonia, emotional dysregulation) and behavioural (escapism) aspects of MD in borderline personality disorder (BPD) and depression groups. The sample consisted of 188 persons, including 102 individuals with BPD. The results showed higher scores in emotional dysregulation, internalized stigma and escapism in the BPD group compared to the depression group; the subgroups did not vary in MD rates. The network analysis revealed significant differences between groups in variables dynamics, with links between MD and self-suppression escapism, negative affect in the BPD group and MD with self-suppression escapism and social withdrawal in the depression group. Emotionally dysregulation and internalized stigma factors posed as the most robust expected influence components in both networks, suggesting that the cognitive and affective factors, not strictly behavioural, are pivotal for one's functioning and regulation strategies in the groups studied. The current study allows for clinical implications in interventions focused on persons developing MD and emotional dysregulation symptoms, including persons with BPD and depression.

A pilot study examining the effectiveness of a short-term, DBT informed, skills group for emotion dysregulation during the perinatal period.

The perinatal period (pregnancy and the first-year postpartum) is a time of increased vulnerability to mental health difficulties including emotion dysregulation. Research conducted on treatments targeting emotion dysregulation during this time is limited. Dialectical behavioral therapy (DBT) skills groups are considered the gold standard for targeting emotion dysregulation. We developed and evaluated the effectiveness of a seven-session DBT informed skills group (perinatal emotion regulation skills [Peri-ERS]) tailored to meet the unique emotion dysregulation experienced by women within the perinatal period. N = 41 perinatal women participated in the Peri-ERS group within the Women's Health Concern's Clinic, St. Joseph's Healthcare Hamilton. Participants completed a semistructured assessment to determine eligibility. They completed self-report symptom measures at baseline, Sessions 1-6, and posttreatment assessments. Paired-samples t tests, Cohen's d, and Friedman's rank tests were run to examine change over time. Reliable and clinical change index (RCI) analysis was conducted on emotion dysregulation. Participants demonstrated significant improvements in all symptom domain measures. Forty-eight percent of participants exhibited reliable clinical change on emotion dysregulation. These findings suggest the Peri-ERS group is effective in reducing emotion dysregulation symptoms for perinatal women. These results are promising as this novel treatment addresses a gap in the literature and may potentially be implemented in women's health clinics as a way of improving overall perinatal care. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Musical experience prior to traumatic exposure as a resilience factor: a conceptual analysis.

Resilience mechanisms can be dynamically triggered throughout the lifecourse by resilience factors in order to prevent individuals from developing stress-related pathologies such as posttraumatic stress disorder (PTSD). Some interventional studies have suggested that listening to music and musical practice after experiencing a traumatic event decrease the intensity of PTSD, but surprisingly, no study to our knowledge has explored musical experience as a potential resilience factor before the potential occurrence of a traumatic event. In the present conceptual analysis, we sought to summarize what is known about the concept of resilience and how musical experience could trigger two key mechanisms altered in PTSD: emotion regulation and cognitive control. Our hypothesis is that the stimulation of these two mechanisms by musical experience during the pre-traumatic period could help protect against the symptoms of emotional dysregulation and intrusions present in PTSD. We then developed a new framework to guide future research aimed at isolating and investigating the protective role of musical experience regarding the development of PTSD in response to trauma. The clinical application of this type of research could be to develop pre-trauma training that promotes emotional regulation and cognitive control, aimed at populations at risk of developing PTSD such as healthcare workers, police officers, and military staffs.

Emotional Regulation and Adolescent Concussion: Overview and Role of Neuroimaging.

Emotional dysregulation symptoms following a concussion are associated with an increased risk for emotional dysregulation disorders (e.g., depression and anxiety), especially in adolescents. However, predicting the emergence or worsening of emotional dysregulation symptoms after concussion and the extent to which this predates the onset of subsequent psychiatric morbidity after injury remains challenging. Although advanced neuroimaging techniques, such as functional magnetic resonance imaging and diffusion magnetic resonance imaging, have been used to detect and monitor concussion-related brain abnormalities in research settings, their clinical utility remains limited. In this narrative review, we have performed a comprehensive search of the available literature regarding emotional regulation, adolescent concussion, and advanced neuroimaging techniques in electronic databases (PubMed, Scopus, and Google Scholar). We highlight clinical evidence showing the heightened susceptibility of adolescents to experiencing emotional dysregulation symptoms following a concussion. Furthermore, we describe and provide empirical support for widely used magnetic resonance imaging modalities (i.e., functional and diffusion imaging), which are utilized to detect abnormalities in circuits responsible for emotional regulation. Additionally, we assess how these abnormalities relate to the emotional dysregulation symptoms often reported by adolescents post-injury. Yet, it remains to be determined if a progression of concussion-related abnormalities exists, especially in brain regions that undergo significant developmental changes during adolescence. We conclude that neuroimaging techniques hold potential as clinically useful tools for predicting and, ultimately, monitoring the treatment response to emotional dysregulation in adolescents following a concussion.

Stage 2 Registered Report: The Bidirectional Relationship Between Brain Features and the Dysregulation Profile: A Longitudinal, Multimodal Approach

Youth with symptoms of emotion dysregulation are at risk for a multitude of psychiatric diagnoses later in life. However, few studies have focused on the underlying neurobiology of emotion dysregulation. This study assessed the bidirectional relationship between emotion dysregulation symptoms and brain morphology throughout childhood and adolescence. A combined total of 8,235 children and adolescents drawn from 2 large population-based cohorts, the Generation R Study and Adolescent Brain Cognitive Development (ABCD) Study, were included. Data were acquired in 3 waves in Generation R (mean [SD] age= 7.8 [1.0] wave 1 [W1]; 10.1 [0.6] W2; 13.9 [0.5] W3) and in 2 waves in ABCD (mean [SD] age= 9.9 [0.6] W1; 11.9 [0.6] W2). Cross-lagged panel models were used to determine the bidirectional relationships between emotion dysregulation symptoms and brain morphology. The study was preregistered before performing analyses. In the Generation R sample, emotion dysregulation symptoms at W1 preceded lower hippocampal (β=-.07, SE= 0.03, p= .017) and temporal pole (β=-.19, SE= 0.07, p= .006) volumes at W2. Emotion dysregulation symptoms at W2 preceded lower fractional anisotropy in the uncinate fasciculus (β=-.11, SE= 0.05, p= .017) and corticospinal tract (β=-.12, SE= 0.05, p= .012). In the ABCD sample, emotion dysregulation symptoms preceded posterior cingulate (β= .01, SE= 0.003, p= .014) and nucleus accumbens volumes (left hemisphere: β=-.02, SE= 0.01, p= .014; right hemisphere: β=-.02, SE= 0.01, p= .003). In population-based samples, with relatively low psychopathology symptoms in the majority of children, symptoms of emotion dysregulation can precede differential development of brain morphology. This provides the foundation for future work to assess to what extent optimal brain development can be promoted through early intervention. The Bidirectional Relationship Between Brain Features and the Dysregulation Profile: A Longitudinal, Multimodal Approach; https://doi.org/10.1016/j.jaac.2022.03.008. We worked to ensure that the study questionnaires were prepared in an inclusive way. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

A randomized controlled trial of mindfulness-based cognitive therapy for body dysmorphic disorder: Impact on core symptoms, emotion dysregulation, and executive functioning

Background and objectivesMindfulness-based cognitive therapy (MBCT) is garnering increasing empirical interest as an intervention for Body Dysmorphic Disorder (BDD), although no studies of mindfulness as a standalone treatment have included a sample composed entirely of patients with BDD or a comparison group. The aim of this study was to investigate the improvement of MBCT intervention on the core symptoms, emotional dysfunction, and executive function of BDD patients, as well as the feasibility and acceptability of MBCT training. MethodPatients with BDD were randomized into an 8-week MBCT group (n = 58) or treatment-as-usual (TAU) control group (n = 58) and were assessed at pre-treatment, post-treatment, and 3-month follow-up. ResultsParticipants who received MBCT showed greater improvement on self-reported and clinician ratings of BDD symptoms, self-reported emotion dysregulation symptoms and executive function compared with TAU participants. Improvement for executive function tasks was partially supported. In addition, feasibility and acceptability of MBCT training were positive. LimitationsThere is no systematic assessment of the severity of key potential outcome variables associated with BDD. ConclusionMBCT may be a useful intervention for patients with BDD, improving patients’ BDD symptoms, emotion dysregulation, and executive functioning.

Amygdala subdivisions exhibit aberrant whole-brain functional connectivity in relation to stress intolerance and psychotic symptoms in 22q11.2DS

The amygdala is a key region in emotional regulation, which is often impaired in psychosis. However, it is unclear if amygdala dysfunction directly contributes to psychosis, or whether it contributes to psychosis through symptoms of emotional dysregulation. We studied the functional connectivity of amygdala subdivisions in patients with 22q11.2DS, a known genetic model for psychosis susceptibility. We investigated how dysmaturation of each subdivision’s connectivity contributes to positive psychotic symptoms and impaired tolerance to stress in deletion carriers. Longitudinally-repeated MRI scans from 105 patients with 22q11.2DS (64 at high-risk for psychosis and 37 with impaired tolerance to stress) and 120 healthy controls between the ages of 5 to 30 years were included. We calculated seed-based whole-brain functional connectivity for amygdalar subdivisions and employed a longitudinal multivariate approach to evaluate the developmental trajectory of functional connectivity across groups. Patients with 22q11.2DS presented a multivariate pattern of decreased basolateral amygdala (BLA)-frontal connectivity alongside increased BLA-hippocampal connectivity. Moreover, associations between developmental drops in centro-medial amygdala (CMA)-frontal connectivity to both impaired tolerance to stress and positive psychotic symptoms in deletion carriers were detected. Superficial amygdala hyperconnectivity to the striatum was revealed as a specific pattern arising in patients who develop mild to moderate positive psychotic symptoms. Overall, CMA-frontal dysconnectivity was found as a mutual neurobiological substrate in both impaired tolerance to stress and psychosis, suggesting a role in prodromal dysregulation of emotions in psychosis. While BLA dysconnectivity was found to be an early finding in patients with 22q11.2DS, which contributes to impaired tolerance to stress.

Associations between trauma and substance use among healthcare workers and public safety personnel during the SARS-CoV-2 (COVID-19) pandemic: the mediating roles of dissociation and emotion dysregulation

ABSTRACT Background: Given the highly stressful environment surrounding the SARS-CoV-2 pandemic, healthcare workers (HCW) and public safety personnel (PSP) are at an elevated risk for adverse psychological outcomes, including posttraumatic stress disorder (PTSD) and alcohol/substance use problems. As such, the study aimed to identify associations between PTSD severity, related dissociation and emotion dysregulation symptoms, and alcohol/substance use problems among HCWs and PSP. Methods: A subset of data (N = 498; HCWs = 299; PSP = 199) was extracted from a larger study examining psychological variables among Canadian HCWs and PSP during the pandemic. Structural equation modelling assessed associations between PTSD symptoms and alcohol/substance use-related problems with dissociation and emotion dysregulation as mediators. Results: Among HCWs, dissociation fully mediated the relation between PTSD and alcohol-related problems (indirect effect β = .133, p = .03) and emotion dysregulation partially mediated the relation between PTSD and substance-related problems (indirect effect β = .151, p = .046). In PSP, emotion dysregulation fully mediated the relation between PTSD and alcohol-related problems (indirect effects β = .184, p = .005). For substance-related problems among PSP, neither emotion dysregulation nor dissociation (ps >.05) had any effects. Conclusion: To our knowledge, this is the first study examining associations between PTSD severity and alcohol/substance use-related problems via mediating impacts of emotion dysregulation and dissociation among HCWs and PSP during the SARS-CoV-2 pandemic. These findings highlight dissociation and emotion dysregulation as important therapeutic targets for structured interventions aimed at reducing the burden of PTSD and/or SUD among Canadian HCWs or PSP suffering from the adverse mental health impacts of the SARS-CoV-2 pandemic.

Emotional and sensory dysregulation as a possible missing link in attention deficit hyperactivity disorder: A review.

Attention Deficit Hyperactivity Disorder (ADHD) is a common developmental disorder affecting 5-7% of adults and children. We surveyed the literature to examine ADHD through three pillars: developmental characteristics, symptomatology, and treatment strategies. Firstly, in terms of developmental characterstics, early life stress may increase the risk of developing ADHD symptoms according to animal models' research. Secondly, the current core symptoms of ADHD are comprised of inattention, hyperactivity, and impulsivity. However, the up-to-date literature indicates individuals with ADHD experience emotional and sensory dysregulation as well, which early-life stress may also increase the risk of. Finally, we discuss the therapeutic benefits of methylphenidate on both the current core ADHD symptoms and the sensory and emotional dysregulation found in those with ADHD. In summation, we surveyed the recent literature to analyze (i) the potential role of early-life stress in ADHD development, (ii) the involvement of emotional and sensory dysregulation in ADHD symptomatology and finally, (iii) the therapeutic intervention with methylphenidate, aiming to reduce the potential effect of early life stress in ADHD, and mainly emotional and sensory dysregulation. The apparent but currently less recognized additional symptoms of emotional and sensory dysregulation in ADHD call for further investigation of these possible causes and thus increasing treatments efficacy in individuals with ADHD.