Impaired Emotion Regulation Research Articles

Influence of Comorbid Social Anxiety Disorder on Symptomatology and Social Functioning in Female Military Sexual Trauma Survivors with PTSD

Military sexual trauma (MST) is a common experience in veterans and associated with numerous negative outcomes, such as posttraumatic stress disorder (PTSD), diagnostic comorbidity, and impairments in multiple domains, including social functioning. Comorbid social anxiety disorder (SOC) may represent a particularly challenging presentation due to added difficulties with social functioning and treatment response. The present study investigated severity, emotion regulation, and perceived support and functioning of comorbid SOC in female MST survivors with PTSD. Participants were recruited for a randomized clinical trial that compared telehealth and in-person delivery of evidence-based psychotherapy for PTSD. Of the 112 participants with PTSD, 30 participants (27%) also met criteria for comorbid SOC on a diagnostic interview. Participants with comorbid PTSD-SOC endorsed poorer emotion regulation, less positive affect, and greater negative affect compared to participants with PTSD without SOC comorbidity. Participants with comorbid PTSD-SOC also were less likely to be involved in a romantic relationship and evidenced increased difficulties in sharing thoughts and feelings with family members and friends. Together, these findings suggest that SOC comorbidity in patients with MST-related PTSD is associated with increased impairments in emotion regulation and social functioning.

Heart rate variability: a novel biomarker for agitation propensity in Alzheimer’s disease?

AbstractBackgroundAgitation, a common symptom in Alzheimer’s disease (AD), may be related to impaired emotion regulation capacity with involvement of autonomic networks. Heart rate variability (HRV), an index of integrity of neural networks involved in autonomic function and emotion regulation, could be a potential marker of agitation propensity. We investigated the cross‐sectional and longitudinal association between HRV and agitation prevalence in AD using the Atherosclerosis Risk in Communities (ARIC) Study cohort that followed up participants from 1987–2013.MethodParticipants at ARIC visit 5 who were clinically diagnosed with dementia (or MCI that subsequently progressed to dementia) primarily or wholly attributed to AD were included. Agitation at visit 5 was defined based on the Neuropsychiatric Inventory agitation/aggression subscale alone, or a composite score comprising agitation/aggression, irritability, disinhibition, and aberrant motor behavior subscales. HRV measures at visits 1–5 were the root mean square of successive differences in R‐R intervals (RMSSD) and standard deviation of normal‐to‐normal R‐R intervals (SDNN) obtained from resting, supine, standard twelve‐lead electrocardiograms. The associations between agitation and visit 5 HRV or visit 1–5 change in HRV (defined as individual slope coefficients from mixed effects models) were assessed using simple regression models.ResultsAmong 456 participants who had dementia during the study, N = 302 received a primary diagnosis of AD, of whom N = 120 were classified with pure AD (see Flowchart). In the pure AD subgroup, a 0.1 log‐unit higher RMSSD (odds ratio = 1.14 [1.03‐1.29]) and positive RMSSD change over the preceding two decades (odds ratio = 2.23 [1.24‐4.38]) were associated with agitation point prevalence after accounting for heart rate (change), age, sex, cognitive status, study site and race. A 0.1 log‐unit change in HRV approximated the observed difference in HRV with each decade of age. The associations persisted after accounting for use of medications with autonomic effects.ConclusionThe finding that higher HRV was associated with agitation point prevalence in N = 120 participants clinically diagnosed with dementia solely due to AD supports the potential use of HRV as a biomarker of agitation propensity, and autonomic dysfunction as a target of treatment. Future studies are needed to explore this relationship alongside measures of emotion regulation and locus coeruleus‐noradrenergic system integrity.

Lack of amygdala habituation to negative emotional faces in alcohol use disorder and the relation to adverse childhood experiences.

Aberrant limbic circuit reactivity to negative stimuli might be related to alterations in emotion processing and regulation in alcohol use disorder (AUD). The current study tested for the first time in AUD the hypothesis of aberrant amygdala habituation to repeated aversive stimuli-a robust and reliable neuroimaging marker for emotion processing. We explored the link between deficits in habituation to adverse childhood experience (ACE), a common risk factor for impaired emotion regulation and AUD. AUD individuals (N= 36) and healthy controls (HC; N= 26) participated in an observational case-control functional magnetic resonance imaging (fMRI) study. An established habituation index was used to investigate processing of aversive emotional faces of the amygdala. AUD individuals showed an overall deficit in amygdala habituation (right: t = 4.26, pFWE =0.004; left: t = 4.79, pFWE ≤0.001). Amygdala habituation was significantly related to increased exposure to ACE in HC (t = 3.88, pFWE =0.012), whereas this association was not observed in AUD individuals (T = 1.80, pFWE =0.662). Further, a significant association between higher alcohol consumption and reduced amygdala habituation (right: R2 = -0.356, F= 8.736, p= 0.004; left: R2 = -0.309, F= 6.332, p= 0.015) was observed. We found novel evidence for neural alterations in emotion processing in AUD individuals, indexed by deficient amygdala habituation to negative emotional content. We replicated a prior report on a link between ACE and amygdala habituation, a well-established environmental risk factor for mental disorders and emotion dysregulation, in our control sample. Additionally, deficient amygdala habituation related to the amount of alcohol consumption in the overall sample might indicate a short-term substance effect.

The longitudinal trajectory of emotion regulation and associated neural activity in patients with bipolar disorder: A prospective fMRI study.

Impaired emotion regulation is a key feature of bipolar disorder (BD) that presents during acute mood episodes and in remission. The neural correlates of voluntary emotion regulation seem to involve deficient prefrontal top-down regulation already at BD illness onset. However, the trajectory of aberrant neuronal activity during emotion regulation in BD is unclear. We investigated neural activity during emotion regulation in response to aversive pictures from the International Affective Picture System in patients with recently diagnosed BD (n=43) in full or partial remission and in healthy controls (HC) (n=38) longitudinally at baseline and 16 months later. Patients with BD exhibited stable hypo-activity in the left dorsomedial prefrontal cortex (DMPFC) and right dorsolateral prefrontal cortex (DLPFC) and impaired emotion regulation compared to HC over the 16 months follow-up time. More DLPFC hypo-activity during emotion regulation correlated with less successful down-regulation (r=0.16, p=0.045), more subsyndromal depression (r=-0.18, p=0.02) and more functional impairment (r=-0.24, p=0.002), while more DMPFC hypo-activity correlated with less efficient emotion regulation (r=0.16, p=0.048). Finally, more DMPFC hypo-activity during emotion regulation at baseline was associated with an increased likelihood of subsequent relapse during the 16 months follow-up time (β=-2.26, 95% CI [0.01; 0.99], p=0.048). The stable DLPFC and DMPFC hypo-activity during emotion regulation represents a neuronal trait-marker of persistent emotion regulation difficulties in BD. Hypo-activity in the DMPFC may contribute to greater risk of relapse.

Supportive Emotion Socialization Mitigates Risk Between Maternal Emotion Regulation Difficulties and Preschooler Emotion Regulation.

Few studies have examined protective maternal factors that may mitigate the intergenerational transmission of risk of maternal emotion regulation difficulties on child outcomes. The current study tested whether supportive maternal emotion socialization moderated the association between maternal emotion regulation difficulties and child emotion regulation behaviors. Participants were 68 mother-preschooler (aged 36-60 months) dyads that were oversampled for maternal symptoms of borderline personality disorder, in order to achieve greater variability in the range of maternal emotion regulation difficulties. Maternal emotion regulation difficulties and supportive emotion socialization behaviors were measured using self-report questionnaires, and child emotion regulation was coded during a frustration-eliciting blocked goal task. Results partially supported study hypotheses, such that trait maternal emotion regulation difficulties were associated with child displays of sadness at low levels of supportive maternal emotion socialization, but not when mothers engaged in higher levels of supportive emotion socialization. These findings suggest that maternal emotion regulation and emotion socialization are distinctly related to child emotion expression and regulatory actions, and that adaptive maternal emotion socialization may mitigate some of the adverse transgenerational impacts of impaired emotion regulation.

The role of cognitive reappraisal and expectations in dealing with social feedback.

Whereas emotion regulation (ER) in response to distressing events is widely studied, the mechanisms underlying adaptive ER while anticipating these events are still unknown. In this study, we investigated how ER strategies and expectation influence (a) individuals' anticipatory and online processing of self-relevant events, and (b) their affective response to them. Sixty-one healthy female participants were exposed to bogus positive and negative social feedback under reappraisal (regulation) and watch (no regulation) instructions. During the anticipatory period, participants were either expecting negative feedback or they had no expectation regarding the valence of the upcoming self-relevant feedback. Hence, negative feedback was, respectively, expected or unexpected. Participants' affective responses were collected via self-report and electromyographic (EMG) activity over the corrugator muscle. Results showed that participants' negative affect (based on both self-reports and EMG) was reduced by the instructions to reappraise as compared to the watch condition. Yet, such beneficial effect of reappraisal was: (a) not observed during the anticipation phase, and (b) less effective when social feedback was expected (as compared to not expected) prior to its presentation. Possibly, cognitive reappraisal might be less able to overcome the influence of negative forecasting of self-relevant negative emotional stimuli. Research findings are discussed in light of potential mechanisms underlying impaired adaptive ER in patients vulnerable for mood disorders. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Dysfunction of Emotion Regulation in Mild Cognitive Impairment Individuals Combined With Depressive Disorder: A Neural Mechanism Study.

Depression increases the risk of progression from mild cognitive impairment (MCI) to dementia, where impaired emotion regulation is a core symptom of depression. However, the neural mechanisms underlying the decreased emotion regulation in individuals with MCI combined with depressive symptoms are not precise. We assessed the behavioral performance by emotion regulation tasks and recorded event-related electroencephalography (EEG) signals related to emotion regulation tasks simultaneously. EEG analysis, including event-related potential (ERP), event-related spectral perturbation (ERSP), functional connectivity and graph theory, was used to compare the difference between MCI individuals and MCI depressed individuals in behavioral performance, the late positive potential (LPP) amplitudes, neural oscillations and brain networks during the processing of emotional stimuli. We found that MCI depressed individuals have negative preferences and are prone to allocate more attentional resources to negative stimuli. Results suggested that theta and alpha oscillations activity is increased, and gamma oscillations activity is decreased during negative stimulus processing in MCI depressed individuals, thus indicating that the decreased emotion regulation in MCI depressed individuals may be associated with enhanced low-frequency and decreased high-frequency oscillations activity. Functional connectivity analysis revealed a decrease in functional connectivity in the left cerebral hemisphere of the alpha band and an increase in functional connectivity in the right cerebral hemisphere of the alpha band in MCI depressed individuals. Graph theory analysis suggested that global network metrics, including clustering coefficients and disassortative, decreased, while nodal and modular network metrics regarding local nodal efficiency, degree centrality, and betweenness centrality were significantly increased in the frontal lobe and decreased in the parieto-occipital lobe, which was observed in the alpha band, further suggesting that abnormal alpha band network connectivity may be a potential marker of depressive symptoms. Correlational analyses showed that depressive symptoms were closely related to emotion regulation, power oscillations and functional connectivity. In conclusion, the dominant processing of negative stimuli, the increased low-frequency oscillations activity and decreased high-frequency activity, so as the decrease in top-down information processing in the frontal parieto-occipital lobe, results in the abnormality of alpha-band network connectivity. It is suggested that these factors, in turn, contribute to the declined ability of MCI depressed individuals in emotion regulation.

Altered MRI Diffusion Properties of the White Matter Tracts Connecting Frontal and Thalamic Brain Regions in First-Episode, Drug-Naïve Patients With Postpartum Depression.

Although progress has been made in exploring postpartum depression (PPD), the involvement of cerebral structure connectivity in PPD patients keeps unclear. To explore structural connectivity alternations in mothers with PPD, diffusion tensor imaging (DTI) and automated fiber quantification (AFQ) were used to calculate brain white matter microstructure properties. Cross-sectional. A total of 51 women with first-episode, treatment-näive PPD, and 49 matched healthy postpartum women (HPW) controls. A 3.0 T; single-shot echo-planar imaging sequence. DTI measurements of fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD) and mean diffusivity (MD) were obtained for 18 specific white matter tracts. The relationship between PDD symptoms, hormone levels, and postpartum days was also investigated. Two sample t test and Pearson's correlation analysis. The analysis was performed by using a permutation-based multiple-comparison correction approach, with the threshold of P < 0.05 (family wise error corrected [FWE-corrected]) separately across the four different outcome measures. Women with PPD showed significantly increased FA and AD in right anterior thalamic radiation (ATR) tract and significantly increased FA and significantly reduced RD in the cingulum tract, compared to women without PPD. The RD values of right cingulum were significantly positively correlated with postpartum days in HPW (r=0.39). There were no significant relationships between brain measures and hormone levels in either patients or controls. DTI measures have revealed altered integrity in the white matter of the cortical-thalamic circuits in women with PPD compared to HPW. Damage to these circuits may be a structural basis for the impaired emotional regulation and blunted mother-infant bonding in mothers with PPD and a potential target for the development of new treatments. 2 TECHNICAL EFFICACY: Stage 3.

Body Emotional Investment and Emotion Dysregulation in a Sample of Adolescents with Gender Dysphoria Seeking Sex Reassignment

Adolescents with gender dysphoria (GD) often have internalizing symptoms, but the relationship with affective bodily investment and emotion dysregulation is actually under-investigated. The aims of this study are: (1) the comparison of Self-Administrated Psychiatric Scales for Children and Adolescents’ (SAFA), Body Investment Scale’s (BIS), and Difficulties in Emotion Regulation Scale’s (DERS) scores between GD adolescents (n = 30) and cisgenders (n = 30), (2) finding correlations between body investment and emotion regulation in the GD sample, (3) evaluating the link between these dimensions and internalizing symptomatology of GD adolescents. In addition to the significant impairment in emotion regulation and a negative body investment in the GD sample, Spearman’s correlation analyses showed a relationship between worse body protection and impaired emotion regulation, and binary logistic regressions of these dimensions on each SAFA domain evidenced that they may have a role in the increased probability of pathological scores for depression. Our results focused on the role played by emotion regulation and emotional investment in the body in the exacerbating and maintenance of internalizing symptoms, in particular depression, and self-harming behaviors in GD adolescents.

LGG-24. Neurocognitive impairment and functional independence in adult survivors of childhood glioma: A report from the Childhood Cancer Survivor Study (CCSS)

PURPOSE: Survivors of pediatric glioma are at risk of developing physical and neurocognitive sequelae secondary to their tumor and its treatment. The contribution of these conditions to attainment of functional independence has not previously been examined. METHODS: 1,284 adult survivors of pediatric glioma (48% male, median [range] 30 [18-51] years at assessment, 22 [15-34] years since diagnosis) completed the CCSS Neurocognitive Questionnaire with impairment defined as scores > 90th %ile of sibling norms. Treatment exposures were categorized as surgery only, chemotherapy (± surgery), or cranial radiation (± chemotherapy/surgery). Self-reported chronic health conditions (CHCs) were graded by organ system using NCI’s CTCAE v4.3. Latent class analysis utilized six factors (employment, marital status, independent living, driver’s license, assistance with routine needs, assistance with personal care needs) to identify classes of functional independence. Multivariable modified Poisson regression evaluated relative risk (RR) of neurocognitive impairment between the classes, adjusting for sex, race, age at assessment, and age at diagnosis. Path analysis explored the impact of treatment exposures on functional independence, mediated by Grade 2-4 CHCs and neurocognitive impairment. RESULTS: Three latent classes of functional independence were identified: independent (58%), moderately independent (20%), and non-independent (22%). Compared to the independent class, non-independent survivors were at elevated risk for impaired task efficiency (RR=3.86, 95% CI, 2.97-5.01), memory (RR=2.39, 95% CI, 1.91-2.98), organization (RR=2.04, 95% CI, 1.64-2.54), and emotional regulation (RR=1.67, 95% CI, 1.30-2.15). Path analysis revealed significant direct paths from cranial radiation (β=0.14), impaired task efficiency (β=0.42), and sensorimotor (β=0.22) and endocrine conditions (β=0.24) to non-independence. Cranial radiation also was indirectly associated with non-independence through impaired task efficiency (β=0.06), and sensorimotor (β=0.06) and endocrine conditions (β=0.10). CONCLUSIONS: Neurocognitive impairment and chronic health conditions partially mediate the association between treatment exposures and attainment of independence in adulthood, identifying potential intervention targets to promote independence in long-term survivors.

Affective Brain-Computer Music Interface in Emotion Regulation and Neurofeedback: A Research Protocol

Introduction: Emotion regulation is an integral part of mental health, dynamically impacting brain function as one’s emotions change continuously throughout the day. Impairments in emotion regulation are associated with a range of psychiatric disorders. Although the implications of emotion regulation are crucial to mental health, few studies have examined training emotion regulation strategies with respect to the brain. Thus, this manuscript will propose an affective brain-computer music interface (aBCMI) prototype for emotion regulation that continuously generates music by estimating emotions from real-time electroencephalography (EEG) signals. Methods: In this proposal, we describe our prototype consisting of an emotion classifier that detects the expression of emotions from EEG signals, and a music generator that generates music reflective of those emotions. We evaluate the prototype in three separate studies. In study 1, the accuracy of the music generator is tested. In study 2, the accuracy of the emotion classifier is tested by assessing its correlation with real-time, self-reported emotions. In study 3, the generative music algorithm is assessed to explore emotion regulation strategies. Discussion: The proposed BCMI is expected to accurately estimate emotions, provide musical feedback of participants’ emotions, and enable users to intentionally modulate their emotions from musical feedback. This involves capturing the listener’s emotions in real-time using EEG signals, providing the opportunity to regulate one’s emotional state with musical feedback. Thus, in addition to enabling greater neurofeedback training of emotions, our prototype can enhance the understanding of affective computing and emotions with EEG and machine learning. Conclusion: Clinical applications of this prototype may have a tremendous impact as a neurofeedback tool in music therapy for training emotion regulation. Future research may benefit from using the proposed BCMI as a neurofeedback treatment in mood disorders.

Differential trajectory of cognitive functions in neurocognitive subgroups of newly diagnosed patients with bipolar disorder and their unaffected first-degree relatives — A longitudinal study

BackgroundCognitive impairments exist in a large proportion of remitted patients with bipolar disorder (BD). However, no study has investigated the cognitive trajectories across neurocognitive subgroups of patients or their unaffected first-degree relatives (UR). MethodsNewly diagnosed BD patients, UR and healthy controls (HC) underwent comprehensive cognitive testing at baseline and at 16-months follow-up. Hierarchical cluster analysis was conducted to identify homogeneous subgroups of patients based on their neurocognitive profile at baseline. Cognitive change across subgroups of patients and UR was assessed with linear mixed-model analyses. ResultsData from baseline and follow-up were collected from 152 patients, 53 UR and 135 HC. Patients were clustered into three discrete neurocognitive subgroups: ‘cognitively normal' (43%), ‘mild-moderately impaired’ (33%) and ‘globally impaired’ (24%). While ‘mild-moderately impaired’ patients and HC showed normative cognitive improvement over time in global cognition (p < .001), ‘globally impaired’ patients showed greater improvement than all groups (p < .001), whereas ‘cognitively normal' patients showed a lack of normative improvement (p = .17). UR of impaired patients showed a lack of normative improvement in executive functions (p = .01). ‘Globally impaired’ patients also presented with stable impairments in facial expression recognition and emotion regulation. LimitationsFollow-up data was available for 62% of participants, possibly reflecting a selection bias. ConclusionsThe greater cognitive improvement in ‘globally impaired’ patients partly speaks against neuroprogression. However, the lack of normative improvement in ‘cognitively normal' patients could indicate negative effects of illness. Further follow-up assessments are warranted to clarify whether lack of normative improvement in executive function in UR represents an illness risk-marker.

Post-traumatic stress disorder as moderator of other mental healthconditions.

Post-traumatic stress disorder as moderator of other mental healthconditions.

Prefrontal-amygdala emotion regulation and depression in multiple sclerosis.

Depression is among the most common comorbidities in multiple sclerosis and has severe psychosocial consequences. Alterations in neural emotion regulation in amygdala and prefrontal cortex have been recognized as key mechanism of depression but never been investigated in multiple sclerosis depression. In this cross-sectional observational study, we employed a functional MRI task investigating neural emotion regulation by contrasting regulated versus unregulated negative stimulus perception in 16 persons with multiple sclerosis and depression (47.9 ± 11.8 years; 14 female) and 26 persons with multiple sclerosis but without depression (47.3 ± 11.7 years; 14 female). We tested the impact of depression and its interaction with lesions in amygdala-prefrontal fibre tracts on brain activity reflecting emotion regulation. A potential impact of sex, age, information processing speed, disease duration, overall lesion load, grey matter fraction, and treatment was taken into account in these analyses. Patients with depression were less able (i) to downregulate negative emotions than those without (t = −2.25, P = 0.012, β = −0.33) on a behavioural level according to self-report data and (ii) to downregulate activity in a left amygdala coordinate (t = 3.03, PFamily-wise error [FWE]-corrected = 0.017, β = 0.39). Moreover, (iii) an interdependent effect of depression and lesions in amygdala-prefrontal tracts on activity was found in two left amygdala coordinates (t = 3.53, pFWE = 0.007, β = 0.48; t = 3.21, pFWE = 0.0158, β = 0.49) and one right amygdala coordinate (t = 3.41, pFWE = 0.009, β = 0.51). Compatible with key elements of the cognitive depression theory formulated for idiopathic depression, our study demonstrates that depression in multiple sclerosis is characterized by impaired neurobehavioural emotion regulation. Complementing these findings, it shows that the relation between neural emotion regulation and depression is affected by lesion load, a key pathological feature of multiple sclerosis, located in amygdala-prefrontal tracts.

Psychoanalytical Considerations of Emotion Regulation Disorders in Multiple Complex-Traumatized Children-A Study Protocol of the Prospective Study MuKi.

Studies in adults with mental disorders suggest that the experience of early and chronic trauma is associated with changes in reward expectancy and processing. In addition, severe childhood trauma has been shown to contribute to the development of mental disorders in general. Data on effects of early childhood trauma on reward expectancy and processing in middle childhood currently appear insufficient. The present study aims to fill this research gap by examining the effects of developmental trauma disorder (DTD) on reward expectancy and processing in children aged 8–12 years, testing the hypothesis that children with multiple complex traumas exhibit altered reward processing as a result of prior disappointing reward experiences. One main feature of developmental trauma disorder is early experiences of multiple separation from important and close relationships alongside other experiences of emotional or physical harm. In the sequel children often show affect regulation disorders. To investigate this, we have developed an adapted version of the Monetary Incentive Delay (MID) Task, which examines children’s expectation of reward or frustration. In this first study, behavioral data will be collected from N = 40 children (n = 20 experimental group and n = 20 healthy controls) using this adapted version of the MID Task. Children in the experimental group will be recruited from youth welfare centers in Frankfurt a.M., Germany. Healthy control subjects will be recruited from after-school-care facilities. A brief trauma screening will be conducted for both groups, experimental and control. If children show signs of trauma, the presence of a developmental trauma disorder will be further delineated by a German translation of the Developmental Trauma Disorder Structured Interview for Children (DTDSI-C) which was translated the first time in German by our research group. We hypothesize that children in the experimental group will be less accurate in performing the Monetary Incentive Delay Task because of their impaired emotion regulation skills due to emotional avoidance following developmental trauma. If the results of our initial behavioral study are promising, the MID task will be used in a future study to elucidate the relationship between trauma developmental disorder, reward expectancy and processing, and neurobiological processes in middle childhood.

Visual attention during cognitive reappraisal in adolescent major depression: Evidence from two eye-tracking studies

Adolescent major depression (MD) is associated with impaired emotion regulation. However, results on cognitive reappraisal (CR) are mixed. Investigation of gaze behavior during CR allows a more thorough understanding of intact and deviant CR processes in MD. These studies examined for the first time the role of visual attention during CR in MD. We applied an established CR paradigm in two separate studies, with each study focusing on a different CR strategy. In Study 1, we investigated “distancing” in 39 adolescents with MD and 44 healthy controls (HCs). In Study 2, we applied “reinterpretation” in an independent sample of 37 HCs and 19 adolescents with MD. In both studies, adolescents either down-regulated negative affect to negative pictures via CR or attended them, while eye-movements were continuously recorded. Results of both studies showed that adolescents with MD and HCs did not differ in self-reported ER success. The groups showed comparable gaze behaviour patterns for emotional interest areas and entire pictures. Findings suggest that adolescents with MD are capable of applying CR when instructed and show intact visual attention processes. Future studies should examine whether repeatedly instructing adolescents with MD to apply CR might lead to improved emotion regulation in daily life.

Shades of Rage: Applying the Process Model of Emotion Regulation to Managing Anger After Brain Injury.

Uncontrollable anger is common following an acquired brain injury (ABI), with impaired emotion regulation (ER) being one of the main contributors. Existing psychological interventions appear moderately effective, though studies typically include limitations such as small sample sizes, issues of long-term efficacy, and standardization of content. While ER has been a popular research field, the study of ER for anger management after ABI is less well investigated, and contains few interventions based on the widely used Process Model of ER. This review surveys the efficacy of ER strategies in individuals with ABI, and proposes a novel research design for future interventions. Recommendations are made about: strategy number and type, shared decision-making, approaches to data analysis, and mode of delivery.

Binge eating disorder.

Binge eating disorder (BED) is characterized by regular binge eating episodes during which individuals ingest comparably large amounts of food and experience loss of control over their eating behaviour. The worldwide prevalence of BED for the years 2018-2020 is estimated to be 0.6-1.8% in adult women and 0.3-0.7% in adult men. BED is commonly associated with obesity and with somatic and mental health comorbidities. People with BED experience considerable burden and impairments in quality of life, and, at the same time, BED often goes undetected and untreated. The aetiology of BED is complex, including genetic and environmental factors as well as neuroendocrinological and neurobiological contributions. Neurobiological findings highlight impairments in reward processing, inhibitory control and emotion regulation in people with BED, and these neurobiological domains are targets for emerging treatment approaches. Psychotherapy is the first-line treatment for BED. Recognition and research on BED has increased since its inclusion into DSM-5; however, continuing efforts are needed to understand underlying mechanisms of BED and to improve prevention and treatment outcomes for this disorder. These efforts should also include screening, identification and implementation of evidence-based interventions in routine clinical practice settings such as primary care and mental health outpatient clinics.

Neural and self-report indices of cognitive reappraisal moderate the association between sensitivity to uncertain threat and problem alcohol use

Exaggerated reactivity to threats that are uncertain (U-threat) is a risk factor for problem alcohol use. Data suggest that exaggerated reactivity to U-threat is associated with chronic anxiety and motivation for coping-oriented drinking. Not all individuals with high U-threat reactivity engage in excessive drinking and theory and research suggest that individual differences in emotion regulation, particularly frequency and effectiveness of cognitive reappraisal, are potential moderators of this well-established link. The aim of the current study was to test this hypothesis using a multimodal laboratory design. A total of 83 volunteers with depression and/or anxiety completed a well-validated threat sensitivity task and two complimentary assessments of cognitive reappraisal. Threat sensitivity was measured using startle eyeblink potentiation during threat-of-electric shock. Cognitive reappraisal was measured using self-report and estimates of prefrontal cortex activation (PFC; i.e., ventrolateral, dorsolateral and dorsomedial) during instructed reappraisal during functional magnetic resonance imaging. Results revealed self-reported and PFC indices of reappraisal were correlated within-subjects. Additionally, self-reported and ventrolateral (vlPFC) activation during reappraisal moderated the association between reactivity to U-threat and problem alcohol use. Across both measures, at low engagement in reappraisal, greater startle reactivity to U-threat was associated with greater problem alcohol use. At high engagement in reappraisal, there was no association between U-threat reactivity and problem alcohol use. Together, the findings reveal that exaggerated reactivity to U-threat may be a particularly robust risk factor for problem alcohol use in the context of impaired or ineffective emotion regulation.

Depressive symptoms in youth with ADHD: the role of impairments in cognitive emotion regulation

Youth with attention-deficit/hyperactivity disorder (ADHD) are at increased risk to develop co-morbid depression. Identifying factors that contribute to depression risk may allow early intervention and prevention. Poor emotion regulation, which is common in adolescents, is a candidate risk factor. Impaired cognitive emotion regulation is a fundamental characteristic of depression and depression risk in the general population. However, little is known about cognitive emotion regulation in youth with ADHD and its link to depression and depression risk. Using explicit and implicit measures, this study assessed cognitive emotion regulation in youth with ADHD (N = 40) compared to demographically matched healthy controls (N = 40) and determined the association with depressive symptomatology. As explicit measure, we assessed the use of cognitive emotion regulation strategies via self-report. As implicit measure, performance in an ambiguous cue-conditioning task was assessed as indicator of affective bias in the processing of information. Compared to controls, patients reported more frequent use of maladaptive (i.e., self-blame, catastrophizing, and rumination) and less frequent use of adaptive (i.e., positive reappraisal) emotion regulation strategies. This pattern was associated with the severity of current depressive symptoms in patients. In the implicit measure of cognitive bias, there was no significant difference in response of patients and controls and no association with depression. Our findings point to depression-related alterations in the use of cognitive emotion regulation strategies in youth with ADHD. The study suggests those alterations as a candidate risk factor for ADHD-depression comorbidity that may be used for risk assessment and prevention strategies.