Evidence of Broad Deficits in Emotion Regulation Associated with Chronic Worry and Generalized Anxiety Disorder

This study examined the relationship between emotion regulation deficits and GAD-related outcomes in an analogue sample. Consistent with hypotheses, general emotion dysregulation was associated with reports of chronic worry and with analogue GAD status. Also, specific regulation deficits, including deficits in emotional clarity, acceptance of emotions, ability to engage in goal directed behaviors when distressed, impulse control, and access to effective regulation strategies, were associated with worry and analogue GAD above and beyond variance contributed by negative affectivity. These findings provide additional preliminary evidence for an emotion regulation deficit model of GAD and are discussed in terms of clinical implications and directions for future research.     

The Relationship Between Emotion Dysregulation and Deliberate Self-Harm Among Inpatients with Substance Use Disorders

Despite the emphasis on the role of emotion dysregulation in deliberate self-harm (DSH), no studies have examined this association among patients with substance use disorders (SUD). This study examined if emotion dysregulation is heightened among SUD inpatients with (vs. without) DSH, and if the association between DSH and emotion dysregulation remains significant when controlling for their shared association with risk factors for both, including borderline personality disorder (BPD), posttraumatic stress disorder (PTSD), childhood abuse, and substance use severity. Findings indicate heightened emotion dysregulation among SUD patients with (vs. without) DSH, and provide evidence of a unique association between emotion dysregulation and DSH when controlling for BPD, PTSD, childhood abuse, and substance use severity. Findings also highlight the particular relevance of three dimensions of emotion dysregulation to DSH among SUD patients: limited access to effective emotion regulation strategies, difficulties engaging in goal-directed behaviors when distressed, and emotional nonacceptance.     

Emotion Dysregulation in Generalized Anxiety Disorder: A Comparison with Social Anxiety Disorder

From an emotion regulation framework, generalized anxiety disorder (GAD) can be conceptualized as a syndrome involving heightened intensity of subjective emotional experience, poor understanding of emotion, negative reactivity to emotional experience, and the use of maladaptive emotion management strategies (including over-reliance on cognitive control strategies such as worry). The current study sought to replicate previous findings of emotion dysregulation among individuals with GAD and delineate which aspects of emotion dysregulation are specific to GAD or common to GAD and another mental disorder (social anxiety disorder). Individuals with GAD reported greater emotion intensity and fear of the experience of depression than persons with social anxiety disorder and nonanxious control participants. Individuals with social anxiety disorder indicated being less expressive of positive emotions, paying less attention to their emotions, and having more difficulty describing their emotions than either persons with GAD or controls. Measures of emotion differentiated GAD, social anxiety disorder, and normal control groups with good accuracy in a discriminant function analysis. Findings are discussed in light of theoretical and treatment implications for both disorders.An earlier version of this paper was presented at the Association for Advancement of Behavior Therapy, Reno, NV, November, 2002     

Individual differences in emotional processing and reactivity to pain among older women with rheumatoid arthritis

The purpose of the current study was to determine whether the relationship between pain and emotion may be better understood by identifying people who are more vulnerable to emotional dysregulation and those who are able to regulate emotion. Data were collected from 81 women diagnosed with rheumatoid arthritis. We assessed affect intensity, emotion regulation, active coping, neuroticism as well as weekly reports of pain, positive affect, and negative affect. Results indicated that the joint effects of emotion regulation and emotional intensity predicted emotional responses to pain. The current study suggests that the emotional impact of pain is related to emotional intensity which can be tempered by the ability to regulate emotion.     

Post-traumatic Stress Disorder and Depressive Symptoms Among Inpatient Adolescents: The Underlying Role of Emotion Regulation

The present study examined emotion regulation as a potential mechanism in the relationship between Post-traumatic Stress Disorder (PTSD) and depression among 50 inpatient adolescents receiving psychiatric care at an inpatient mental hospital. PTSD symptoms were significantly associated with emotion dysregulation and depressive symptoms. Mediation analyses and bias-corrected bootstrapping techniques supported emotion dysregulation as a mechanism underlying the association between PTSD and depression symptoms. These findings support the notion that adolescents with clinical levels of PTSD symptoms may engage in ineffective emotion regulation strategies, such as emotional avoidance and suppression, which may, in turn, be associated with increased depression. Findings and implications are discussed.     

Childhood trauma as a predictor of eating psychopathology and its mediating variables in patients with eating disorders

Aim. The aims of this study were to determine whether specific forms of childhood trauma predict eating psychopathologies and to investigate the mediating effects of the psychological symptoms of depression and obsessive‐compulsion between childhood trauma and eating psychopathologies in patients with eating disorders. Background. The highest probability of poor treatment outcomes in patients with eating disorders has been observed in those who experienced childhood trauma. Therefore, researchers are now examining whether childhood trauma should be considered a risk factor for eating psychopathology, but childhood traumatic experiences as predictors of eating psychopathology and their mediating variables has not been investigated sufficiently with this clinical population. Design. Survey. Methods. The subjects were 73 Korean patients with eating disorders. The Childhood Trauma Questionnaire, Eating Disorder Inventory‐2, Beck Depression Inventory and Maudsley Obsessional‐Compulsive Inventory were used to assess self‐reported childhood trauma in five domains (emotional abuse, physical abuse, sexual abuse, emotional neglect and physical neglect), eating psychopathology, depression and obsessive‐compulsion. Stepwise multiple regression analyses were used to explore whether these childhood traumatic experiences predict eating psychopathology and mediation analyses were conducted according to Baron and Kenny’s guidelines. Results. Emotional abuse, physical neglect and sexual abuse were found to be significant predictors of eating psychopathology. We also found that depression fully mediated the association between some forms of childhood trauma and eating psychopathology, while obsessive‐compulsion did not mediate this association. Conclusions. Future interventions for patients with eating disorders should focus on assessing the possibility of childhood trauma, especially in those patients with poor treatment outcomes. In addition, whether or not traumatised individuals exhibit depression is a more important predictor of eating psychopathology than the traumatic experience itself. Relevance to clinical practice. Early intervention for childhood trauma and depression might contribute to preventing eating disorders in traumatised individuals.     

Changes in Explanatory Flexibility Among Individuals with Generalized Anxiety Disorder in an Emotion Evocation Challenge

Seventy-eight undergraduates, 39 with self-reported generalized anxiety disorder (GAD), completed measures of mood and explanatory flexibility (the capacity to assign causes to negative events with a balance of historical and contextual factors) prior to and directly after a musical priming challenge that consisted of listening to negatively-valenced emotional music and thinking about a personally relevant negative event. After the emotion evocation, participants also completed a measure of state emotion regulation. Despite comparable increases in negative affect, GAD analogues evidenced drops in explanatory flexibility whereas non-GAD Controls did not. Drops in explanatory flexibility among GAD analogues covaried significantly with lack of emotional clarity. Findings suggest that for individuals with GAD, emotionally evocative experiences may result in a constricted perspective when apprehending the causes for negative events. This perspective may serve to dampen arousal, but perhaps at the cost of failing to inform one’s actions with important emotional information.     

Diagnostic and Symptom-Based Predictors of Emotional Processing in Generalized Anxiety Disorder and Major Depressive Disorder: An Event-Related Potential Study

The delineation of specific versus overlapping mechanisms in generalized anxiety disorder (GAD) and major depressive disorder (MDD) could shed light on the integrity of these diagnostic categories. For example, negative emotion generation is one mechanism that may be especially relevant to both disorders. Emotional processing abnormalities were examined among 97 outpatients with GAD or MDD and 25 healthy adults, using the late positive potential (LPP), an event-related potential that is larger for emotional versus neutral stimuli. GAD and MDD were also assessed dimensionally across all participants. Both MDD diagnosis and dimensional depression scores were associated with reduced ΔLPP. When controlling for MDD diagnosis/dimension, both the diagnosis and dimension of GAD were associated with increased ΔLPP. Both MDD and GAD dimensions, but not diagnoses, were associated with increased ΔRT to targets that followed emotional pictures. Therefore, MDD and GAD have distinguishable and opposing features evident in neural measures of emotion processing.     

Childhood Maltreatment and Migraine (Part II). Emotional Abuse as a Risk Factor for Headache Chronification

(Headache 2010;50:32‐41) Objectives.— To assess in a headache clinic population the relationship of childhood abuse and neglect with migraine characteristics, including type, frequency, disability, allodynia, and age of migraine onset. Background.— Childhood maltreatment is highly prevalent and has been associated with recurrent headache. Maltreatment is associated with many of the same risk factors for migraine chronification, including depression and anxiety, female sex, substance abuse, and obesity. Methods.— Electronic surveys were completed by patients seeking treatment in headache clinics at 11 centers across the United States and Canada. Physician‐determined data for all participants included the primary headache diagnoses based on the International Classification of Headache Disorders‐2 criteria, average monthly headache frequency, whether headaches transformed from episodic to chronic, and if headaches were continuous. Analysis includes all persons with migraine with aura, and migraine without aura. Questionnaire collected information on demographics, social history, age at onset of headaches, migraine‐associated allodynic symptoms, headache‐related disability (The Headache Impact Test‐6), current depression (The Patient Health Questionnaire‐9), and current anxiety (The Beck Anxiety Inventory). History and severity of childhood (<18 years) abuse (sexual, emotional, and physical) and neglect (emotional and physical) was gathered using the Childhood Trauma Questionnaire. Results.— A total of 1348 migraineurs (88% women) were included (mean age 41 years). Diagnosis of migraine with aura was recorded in 40% and chronic headache (≥15 days/month) was reported by 34%. Transformation from episodic to chronic was reported by 26%. Prevalence of current depression was 28% and anxiety was 56%. Childhood maltreatment was reported as follows: physical abuse 21%, sexual abuse 25%, emotional abuse 38%, physical neglect 22%, and emotional neglect 38%. In univariate analyses, physical abuse and emotional abuse and neglect were significantly associated with chronic migraine and transformed migraine. Emotional abuse was also associated with continuous daily headache, severe headache‐related disability, and migraine‐associated allodynia. After adjusting for sociodemographic factors and current depression and anxiety, there remained an association between emotional abuse in childhood and both chronic (odds ratio [OR] = 1.77, 95% confidence intervals [CI]: 1.19‐2.62) and transformed migraine (OR = 1.89, 95% CI: 1.25‐2.85). Childhood emotional abuse was also associated with younger median age of headache onset (16 years vs 19 years, P = .0002). Conclusion.— Our findings suggest that physical abuse, emotional abuse, and emotional neglect may be risk factors for development of chronic headache, including transformed migraine. The association of maltreatment and headache frequency appears to be independent of depression and anxiety, which are related to both childhood abuse and chronic daily headache. The finding that emotional abuse was associated with an earlier age of migraine onset may have implications for the role of stress responses in migraine pathophysiology.     

Fear of Criticism and Rejection Mediates an Association Between Childhood Emotional Abuse and Adult Onset of Major Depression

The current study examines whether a particular negative cognitive style, Fear of Criticism and Rejection, a subscale of Sociotropy, mediates an association between perceived childhood emotional abuse and adult onset of major depression. The study was motivated by Rose and Abramson's theory that childhood emotional abuse may be particularly relevant to the development of adult cognitive risk for depression. The case–control sample used in the study (N = 50) was drawn from a larger case–control study examining adult cognitive styles and major depression. Childhood emotional abuse was assessed from retrospective reports using a structured interview. Consistent with expectations, Fear of Criticism and Rejection mediated an association between perceived childhood emotional abuse and major depression in adulthood.     

Differentiating Worry and Rumination: Evidence from Heart Rate Variability During Spontaneous Regulation

Worry is the defining feature of generalized anxiety disorder (GAD), and rumination is a central process in depression. GAD and depression are highly comorbid, and worry and rumination reflect similar perseverative cognitive processes. Prior studies have largely assessed these emotion regulation strategies at the trait level, which has resulted in a limited understanding of their phasic characteristics, including associated physiological processes. We addressed this limitation by examining the relationship between spontaneous state-level worry and rumination and heart rate variability (HRV)—a physiological measure of emotion regulation—in response to emotion-eliciting film clips. We found differential associations between worry and rumination in relation to HRV, such that, worry was more consistently associated with HRV across emotional contexts than rumination was. Findings highlight functional distinctions between worry and rumination that have implications for understanding their associations with mood and anxiety disorders and, more broadly, for theories of emotion regulation and psychopathology.     

Neural substrates of the interaction of emotional stimulus processing and motor inhibitory control: an emotional linguistic go/no-go fMRI study

Neural substrates of behavioral inhibitory control have been probed in a variety of animal model, physiologic, behavioral, and imaging studies, many emphasizing the role of prefrontal circuits. Likewise, the neurocircuitry of emotion has been investigated from a variety of perspectives. Recently, neural mechanisms mediating the interaction of emotion and behavioral regulation have become the focus of intense study. To further define neurocircuitry specifically underlying the interaction between emotional processing and response inhibition, we developed an emotional linguistic go/no-go fMRI paradigm with a factorial block design which joins explicit inhibitory task demand (i.e., go or no-go) with task-unrelated incidental emotional stimulus valence manipulation, to probe the modulation of the former by the latter. In this study of normal subjects focusing on negative emotional processing, we hypothesized activity changes in specific frontal neocortical and limbic regions reflecting modulation of response inhibition by negative stimulus processing. We observed common fronto-limbic activations (including orbitofrontal cortical and amygdalar components) associated with the interaction of emotional stimulus processing and response suppression. Further, we found a distributed cortico-limbic network to be a candidate neural substrate for the interaction of negative valence-specific processing and inhibitory task demand. These findings have implications for elucidating neural mechanisms of emotional modulation of behavioral control, with relevance to a variety of neuropsychiatric disease states marked by behavioral dysregulation within the context of negative emotional processing.     

Childhood Maltreatment and Psychopathology: Prospective Tests of Attachment,Cognitive Vulnerability,and Stress as Mediating Processes

A childhood history of maltreatment is a distal risk factor for depression, although less research has examined the proximal mechanisms for this relation. To address this question, three theoretically derived mechanisms were tested as mediators: an insecure attachment style, a negative cognitive style, and negative life events. These mediating processes were examined in two prospective studies. In the first, young adults (n = 652) completed a detailed self-report measure assessing a childhood history (before age 14) of physical, sexual, and emotional abuse. In the second, an independent sample of young adults (n = 75) were interviewed with a well-validated, objective, contextual threat interview that assesses a childhood history (before age 14) of physical, sexual, and psychological abuse as well as the surrounding familial context of emotional neglect, antipathy, discipline, and discord. In both studies, participants completed measures of the proposed mediators as well as anxiety and depressive symptoms at 2 time points (10-week interval in Study 1 and 2-year interval in Study 2). Across both studies, a childhood history of emotional maltreatment and adversity specifically predicted prospective elevations of depressive symptoms, whereas no specific form of childhood maltreatment predicted anxiety symptoms after controlling for initial symptoms and overlap among forms of maltreatment. Further, support was found for the proposed mediating processes. An insecure attachment style, a negative cognitive style, and negative events helped to account for the link between childhood maltreatment and later depressive symptoms in young adulthood.     

人格特质及情绪调节自我效能感对房颤患者焦虑的影响研究：心理灵活性的调节效应

目的：探讨情绪调节自我效能感在房颤患者人格特质与焦虑的中介作用以及心理灵活性对中介效应的调节作用。方法：采用大五人格量表、情绪调节自我效能感量表、心理灵活性综合评估量表以及焦虑自评量表对天津市某三甲综合医院心律失常门诊的309名房颤患者进行调查。通过Pearson相关分析确定变量间的关联,并通过PROCESS V3.0对中介效应以及调节效应进行检验。结果：在控制性别的情况下,开放性人格特质对焦虑情绪具有正向预测作用;情绪调节自我效能感在开放性人格特质与焦虑情绪的关系中起部分中介作用,中介效应占总效应的71.2%;情绪调节自我效能感对焦虑情绪的中介作用受到心理灵活性水平的调节。结论：开放性人格特质可通过改变情绪调节自我效能感进而影响房颤患者焦虑情绪发展,提高心理灵活性可以加强情绪调节自我效能感对焦虑的中介作用。     

心理创伤、共情缺陷与反社会人格障碍

目的:考察童年期心理创伤经历与反社会人格障碍,共情缺陷之间的关系。方法:对2690名服刑人员运用人格障碍问卷(PDQ)进行人格障碍筛查,对其中182名反社会人格障碍筛查阳性者运用个性障碍访谈(PDI)进行半结构访谈,运用人际关系指数(IRI)对反社会人格障碍的4个维度共情进行测量。结果:①服刑人员报告童年期遭受性虐待阳性率最高(47.10%),其次为躯体忽视(39.10%),情感忽视(23.4%),躯体虐待(14.20%),情感虐待最低(11.4%)。②童年创伤经历高分组在各型人格障碍上得分均明显高于低分组。③多元逐步回归分析发现童年期创伤经历对自身体验的困扰和观点采择有明显影响。结论:童年创伤经历对共情能力的形成和发展产生明显影响,并对人格障碍的形成有明显影响。共情缺陷在反社会人格障碍发生中起重要作用。     

Mediators of the link between childhood sexual abuse and emotional distress: a critical review

A history of childhood sexual abuse (CSA) is a risk factor for adult emotional distress, including symptoms of depression, anxiety, dissociation, and trauma. However, CSA is likely associated with adult distress indirectly through an impact on mediating variables. In a review of the empirical literature, the authors found support for the roles of shame or self-blame, interpersonal difficulties, and avoidant coping strategies as mediators. In addition, emotional distress appears to mediate links between CSA and other adverse outcomes, such as alcohol abuse and revictimization. The authors conclude with a number of methodological and conceptual recommendations.     

Childhood Abuse and Adulthood IPV,Depression, and High-Risk Drinking in Latinas

Little is known about relationships between child maltreatment and adulthood intimate partner violence (IPV), depression, and risky drinking in Latinas. 548 Latinas in a sexual health randomized control trial (RCT) self-reported childhood physical, sexual, and emotional abuse, IPV, depression, and risky drinking. Childhood abuse was related to adulthood IPV, OR?=?1.27, depression, OR?=?2.02, and high-risk drinking, OR?=?2.16. Childhood emotional abuse was linked to depression, OR?=?2.19; childhood physical abuse to risky drinking, OR?=?2.62; and childhood sexual abuse to depression, OR?=?2.78 and risky drinking, OR?=?2.38. Results may inform prevention/intervention efforts for mental health nurses.     

Childhood Maltreatment and Migraine (Part I). Prevalence and Adult Revictimization: A Multicenter Headache Clinic Survey

(Headache 2010;50:20‐31) Objectives.— To examine the prevalence of childhood maltreatment and adult revictimization in migraineurs and the association with sociodemographic factors, depression and anxiety. Background.— Population and practice‐based studies have demonstrated an association of childhood abuse and headache in adults, although further details on headache diagnoses, characteristics, and comorbid conditions are lacking. There are mounting data suggesting substantial impact of early maltreatment on adult physical and mental health. Methods.— Electronic surveys were completed by patients seeking treatment in 11 headache centers across the United States and Canada. Physicians determined the primary headache diagnoses based on the International Classification of Headache Disorders‐2 criteria and average monthly headache frequency. Self‐reported information on demographics (including body mass index), social history, and physician‐diagnosed depression and anxiety was collected. The survey also included validated screening measures for current depression (Patient Health Questionnaire‐9) and anxiety (The Beck Anxiety Inventory). History and severity of childhood (<18 years) abuse (sexual, emotional, and physical) and neglect (emotional and physical) was gathered using the Childhood Trauma Questionnaire. There were also queries regarding adult physical and sexual abuse, including age of occurrence. Analysis includes all persons with migraine with aura, and migraine without aura. Results.— A total of 1348 migraineurs (88% women) were included (mean age 41 years). Diagnosis of migraine with aura was recorded in 40% and chronic headache (≥15 days/month) was reported by 34%. The prevalence of childhood maltreatment types was as follows: physical abuse 21%, sexual abuse 25%, emotional abuse 38%, physical neglect 22%, and emotional neglect 38%. Nine percent reported all 3 categories of childhood abuse (physical, sexual, and emotional) and 17% reported both physical and emotional neglect. Overlap between maltreatment types ranged between 40% and 81%. Of those reporting childhood abuse, 43% reported abuse in adulthood, but infrequently (17%) over the age of 30 years. In logistic regression models adjusted for sociodemographic variables, current depression was associated with physical (P = .003), sexual (P = .007), and emotional abuse (P < .001), and physical and emotional neglect (P = .001 for both). Current anxiety was also associated with all childhood abuse and neglect categories (P < .001 for all). A graded relationship was observed between the number of childhood maltreatment types and remote or current depression and anxiety. In adjusted logistic regression analysis, migraineurs reporting 3 or more categories of childhood trauma were more likely to have received diagnoses of both depression and anxiety (odds ratios [OR] = 6.91, 95% confidence interval [CI]: 3.97‐12.03), or either depression or anxiety (OR = 3.66, 95% CI: 2.28‐5.88) as compared with those without childhood abuse or neglect. Conclusion.— Reports of childhood maltreatment, especially emotional abuse and neglect, are prevalent in outpatients with migraine. There is extensive overlap of maltreatment types and a high rate of revictimization in adulthood. All types of childhood abuse and neglect are strongly associated with remote and current depression and anxiety, and the relationship strengthens with an increasing number of maltreatment types.     

Childhood Maltreatment Exposure and Disruptions in Emotion Regulation: A Transdiagnostic Pathway to Adolescent Internalizing and Externalizing Psychopathology

Child maltreatment is a robust risk factor for internalizing and externalizing psychopathology in children and adolescents. We examined the role of disruptions in emotion regulation processes as a developmental mechanism linking child maltreatment to the onset of multiple forms of psychopathology in adolescents. Specifically, we examined whether child maltreatment was associated with emotional reactivity and maladaptive cognitive and behavioral responses to distress, including rumination and impulsive behaviors, in two separate samples. We additionally investigated whether each of these components of emotion regulation were associated with internalizing and externalizing psychopathology and mediated the association between child maltreatment and psychopathology. Study 1 included a sample of 167 adolescents recruited based on exposure to physical, sexual, or emotional abuse. Study 2 included a sample of 439 adolescents in a community-based cohort study followed prospectively for 5 years. In both samples, child maltreatment was associated with higher levels of internalizing psychopathology, elevated emotional reactivity, and greater habitual engagement in rumination and impulsive responses to distress. In Study 2, emotional reactivity and maladaptive responses to distress mediated the association between child maltreatment and both internalizing and externalizing psychopathology. These findings provide converging evidence for the role of emotion regulation deficits as a transdiagnostic developmental pathway linking child maltreatment with multiple forms of psychopathology.     

The No Worries Trial: Efficacy of Online Dialectical Behaviour Therapy Skills Training for Chronic Pain (iDBT-Pain) Using a Single Case Experimental Design

Emotion dysregulation frequently co-occurs with chronic pain, which in turn leads to heightened emotional and physical suffering. This cycle of association has prompted a recommendation for psychological treatment of chronic pain to target mechanisms for emotion regulation. The current trial addressed this need by investigating a new internet-delivered treatment incorporating emotional skills training from dialectical behavioral therapy (DBT). Using a single-case experimental design that is suited to heterogeneous populations and can demonstrate efficacy with a small sample, three participants with chronic pain were recruited. Participants received four weeks of online DBT skills training (iDBT-Pain intervention) which incorporated one-on-one sessions over Zoom and a web app. Results revealed compelling evidence for the intervention on the primary outcome of emotion dysregulation and were promising for the secondary outcome of pain intensity. Improvement was also identified on pre-and post-measures of depression, coping behaviors, sleep problems, wellbeing, and harm avoidance, indicating that the intervention may positively influence other factors related to chronic pain. Overall, the trial provides preliminary efficacy for the intervention to improve chronic pain. However, we recommend further investigation of the iDBT-Pain intervention, either in single case trials, which when conducted with scientific rigor may be aggregated to derive nomothetic conclusions, or in a group-comparison trial to compare with usual modes of treatment.PerspectiveThis trial advances understanding of emotion-focused treatment for chronic pain and provides evidence for a viable new technological treatment. Importantly, as an internet-delivered approach, the iDBT-Pain intervention is accessible to those with restricted mobility and remote communities where there are often limited psychological services for people with chronic pain.