Determinism, “Freedom,” and Psychotherapy†

Objective: Childhood abuse is associated with a wide range of negative outcomes, including increased risk for development of emotion dysregulation and psychopathology, such as posttraumatic stress disorder (PTSD). The goal of the present study was to examine associations between child abuse, PTSD symptoms, and performance on an emotional conflict regulation task that assesses implicit emotion regulation abilities. Method: The sample consisted of 67 (94% African American) females recruited from a public, urban hospital. Childhood abuse was measured using the Childhood Trauma Questionnaire, and PTSD was measured using the modified PTSD Symptom Scale. Task accuracy and implicit emotion regulation were measured through an emotional conflict regulation behavioral task. Results: A multivariate analysis of covariance showed that exposure to moderate to severe childhood abuse was significantly related to worse emotional conflict regulation scores independent of current PTSD symptoms, depressive symptoms, and adult trauma exposure, suggesting a deficit in implicit emotion regulation. We also found an interaction between PTSD symptoms and abuse exposure in predicting accuracy on the behavioral task; high levels of PTSD symptoms were associated with poorer task accuracy among individuals who reported moderate to severe exposure to childhood abuse. However, no relationship between implicit emotion regulation abilities and overall PTSD symptom severity was found. Conclusions: This study provides preliminary evidence of an implicit emotion regulation deficit for individuals exposed to significant childhood abuse and further supports the growing evidence that addressing various aspects of emotion dysregulation, such as awareness of emotions and strategies to manage strong emotions, in the context of treatment would be valuable.     

PTSD,emotion dysregulation,and dissociative symptoms in a highly traumatized sample

Exposure to multiple traumas has been shown to result in many negative mental health outcomes, including posttraumatic stress disorder (PTSD). Dissociation, which involves disruptions in memory, identity, and perceptions, may be a component of PTSD, particularly among individuals who have experienced childhood trauma. Emotion regulation difficulties are also strongly associated with childhood trauma and emotion dysregulation may be a particularly important factor to consider in the development and maintenance of dissociative symptoms.The goal of the present study was to determine whether emotion dysregulation mediated the relationship between PTSD symptoms and dissociation in a sample of 154 (80% female, 97% African-American) adults recruited from a public, urban hospital. PTSD was measured using the Clinician Administered PTSD Scale, emotion dysregulation was measured using the Difficulties in Emotion Regulation Scale, and dissociation was measured using the Multiscale Dissociation Inventory. A linear regression analysis showed that both PTSD and emotion dysregulation were statistically significant predictors of dissociation even after controlling for trauma exposure. Alexithymia and an inability to use emotion regulation strategies in particular were predictive of dissociation above and beyond other predictor variables. Using bootstrapping techniques, we found that overall emotion dyregulation partially mediated the effect of PTSD symptoms on dissociative symptoms. Our results suggest that emotion dysregulation may be important in understanding the relation between PTSD and dissociative symptoms. Treatment approaches may consider a focus on training in emotional understanding and the development of adaptive regulation strategies as a way to address dissociative symptoms in PTSD patients.     

Emotion dysregulation across the spectrum of pathological eating: Comparisons among women with binge eating,overeating, and loss of control eating

ABSTRACT

Emotion regulation difficulties influence the etiology and maintenance of binge eating and eating disorders, but differential associations between emotion dysregulation and objective binge eating (OBE) components have not been examined. We compared emotion dysregulation dimensions in women with OBEs (n = 27), overeating only (n = 25), loss of control (LOC) only (n = 32), or no pathological eating (n = 137). Women with OBEs had significantly more difficulty with overall emotion dysregulation, access to strategies, and impulse control when upset than other groups. Women with OBEs and women with overeating did not differ on poor emotional clarity, whereas women with OBEs and women with LOC did not differ on non-acceptance of emotions. The combination of overeating and LOC eating is associated with the greatest emotion dysregulation, but certain emotion regulation facets may differentially relate to overeating and LOC. Identifying emotion-related treatment targets for core eating disorder symptoms is important.     

An examination of the incremental contribution of emotion regulation difficulties to health anxiety beyond specific emotion regulation strategies

Given the potential transdiagnostic importance of emotion dysregulation, as well as a lack of research examining emotion dysregulation in relation to health anxiety, the present study sought to examine associations among specific emotion regulation strategies (cognitive reappraisal and expressive suppression), emotion regulation difficulties, and health anxiety in a physically healthy sample of adults (N = 482). As hypothesized, results of a series of hierarchical multiple regression analyses showed that emotion regulation difficulties provided a significant incremental contribution, beyond the specific emotion regulation strategies, in predicting each of the three health anxiety variables. Among the six dimensions of emotion regulation difficulties, the dimension representing perceived access to effective emotion regulation strategies was the only emotion regulation difficulty dimension that predicted all three health anxiety variables beyond the effects of the specific emotion regulation strategies. Results indicate that emotion regulation difficulties, and particularly one's subjective appraisal of his/her ability to effectively regulate emotions, may be of importance to health anxiety. Clinical implications are discussed.     

A multimodal assessment of the relationship between emotion dysregulation and borderline personality disorder among inner-city substance users in residential treatment

The concept of emotion dysregulation has been integrated into theory and treatment for borderline personality disorder (BPD), despite limited empirical support. Expanding upon existing research on the relationship between emotion dysregulation and BPD, the present study utilized a multimodal approach to the assessment of emotion dysregulation (including two behavioral measures of the willingness to tolerate emotional distress, and a self-report measure of emotion dysregulation broadly defined) to examine the relationship between emotion dysregulation and BPD among inner-city substance users in residential treatment (n = 76, with 25 meeting criteria for BPD). Results provide laboratory-based evidence for heightened emotion dysregulation in BPD, extending extant research on BPD to underserved clinical populations. Specifically, the presence of a BPD diagnosis among a sample of inner-city inpatient substance users was associated with both higher scores on the self-report measure of emotion dysregulation and less willingness to tolerate emotional distress on the behavioral measures of emotion dysregulation. Moreover, both self-report and behavioral measures of emotion dysregulation accounted for unique variance in BPD status, suggesting the importance of utilizing comprehensive assessments of emotion dysregulation within studies of BPD. Findings suggest the need to further explore the role of emotion dysregulation in the development and maintenance of BPD among inner-city substance users in residential treatment.     

Emotion regulation and impulsivity in young adults

Past research has linked both emotion regulation and impulsivity with the development and maintenance of addictions. However, no research has investigated the relationship between emotion regulation and impulsivity within young adults. In the present study, we analyzed 194 young adults (27.8% female; 21.3 ± 3.32 years old; 91.8% single; 85.1% Caucasian), grouping them as low, average, or high emotionally dysregulated, and compared self-reported impulsivity, impulsive behaviors (such as alcohol and substance use and gambling) and cognitive impulsivity. We hypothesized that those with high levels of emotion dysregulation would score higher on self-reported and cognitive impulsivity, and report more impulsive behaviors. Analysis indicated that compared to low, the high emotion dysregulation group scored significantly higher on two self-report measures of impulsivity, harm avoidance, and cognitive reasoning. No significant differences were found between groups in impulsive behaviors and cognitive impulsivity. Overall, this study highlights the relationship between emotion dysregulation and impulsivity, suggesting that emotion regulation may be an important factor to consider when assessing individuals at a higher risk for developing an addiction.     

Emotion dysregulation and hypersexuality: review and clinical implications

There is a long and varied history of research on hypersexuality, but no consensus on either etiology or therapeutic interventions. In an effort to advance understanding of hypersexuality, we review the largely separate literatures on hypersexuality and emotion dysregulation, which has recently been suggested to be a critical factor in the development and maintenance of mental health problems. Unfortunately, there is also a lack of consensus on the various primary and intervening factors involved in development of emotion regulation or emotion dysregulation. First, we review theories and empirical evidence to try to explain how emotion dysregulation could contribute to the onset of hypersexuality or other inappropriate sexual behavior. Next, an attachment-theory perspective is used to develop a common etiological model for both emotion dysregulation and hypersexuality. Finally, we address the issue of hypersexual behavior in the context of couple relationships, taking an interpersonal perspective on emotion and emotion regulation. We refer to different age categories, ranging from adolescence to elderly, as emotion regulation skills are likely to change throughout the lifespan.     

The Emotion Dysregulation Model of Anxiety: A preliminary path analytic examination

Both temperamental (e.g., behavioral inhibition) and environmental (e.g., family emotional environment) factors are associated with etiology and maintenance of anxiety; however, few studies have explored mechanisms through which these risk factors operate. The present study investigation of a developmental model of anxiety (i.e., the Emotion Dysregulation Model of Anxiety; EDMA) that hypothesizes that emotion dysregulation is the mechanism through which temperamental and emotion parenting variables relate to anxiety. Emerging adults (N = 676, M age = 19.5) retrospectively reported on behavioral inhibition and emotion parenting factors in childhood, and current emotion regulation skills and symptoms of anxiety. Results of path analyses provide initial support for the EDMA. Emotion dysregulation fully mediated the relationship between behavioral inhibition and anxiety and partially mediated the relationship between family emotional environment and anxiety.     

Emotion dysregulation as a maintenance factor of borderline personality disorder features

We examined within-individual changes in emotion dysregulation over the course of one year as a maintenance factor of borderline personality disorder (BPD) features. We evaluated the extent to which (1) BPD symptom severity at baseline predicted within-individual changes in emotion dysregulation and (2) within-individual changes in emotion dysregulation predicted four BPD features at 12-month follow-up: affective instability, identity disturbances, negative relationships, and impulsivity. The specificity of emotion dysregulation as a maintaining mechanism of BPD features was examined by controlling for a competing intervening variable, interpersonal conflict. BPD symptoms at baseline predicted overall level and increasing emotion dysregulation. Additionally, increasing emotion dysregulation predicted all four BPD features at 12-month follow-up after controlling for BPD symptoms at baseline. Further, overall level of emotion dysregulation mediated the association between BPD symptom severity at baseline and both affective instability and identity disturbance at 12-month follow-up, consistent with the notion of emotion dysregulation as a maintenance factor. Future research on the malleability of emotion dysregulation in laboratory paradigms and its effects on short-term changes in BPD features is needed to inform interventions.     

Emotion dysregulation and anxiety in late adulthood

Recent research has highlighted the important role of emotion dysregulation in the occurrence and maintenance of anxiety symptoms. The purpose of the present study was to investigate the relationship between anxiety symptoms and older adults’ ability to regulate emotional experiences. A total of 167 community dwelling older adults completed self-report measures of affect and were asked to report how often they use specific emotion regulation strategies. Consistent with previous theories older adults experiencing increasing levels of anxiety reported greater difficulties in regulating emotional responses. Present results provide support for previous findings demonstrating that experiencing anxiety symptoms affects the ability to regulate emotional experiences. Current findings are likely to be informative in terms of understanding emotion dysregulation in older adults at risk of experiencing clinical symptoms of anxiety.     

Reconsidering Emotion Dysregulation

This article aims to review the concept of emotion dysregulation, focusing on issues related to its definition, meanings and role in psychiatric disorders. Articles on emotion dysregulation published until May 2016 were identified through electronic database searches. Although there is no agreement about the definition of emotion dysregulation, the following five overlapping, not mutually exclusive dimensions of emotion dysregulation were identified: decreased emotional awareness, inadequate emotional reactivity, intense experience and expression of emotions, emotional rigidity and cognitive reappraisal difficulty. These dimensions characterise a number of psychiatric disorders in various proportions, with borderline personality disorder and eating disorders seemingly more affected than other conditions. The present review contributes to the literature by identifying the key components of emotion dysregulation and by showing how these permeate various forms of psychopathology. It also makes suggestions for improving research endeavours. Better understanding of the various dimensions of emotion dysregulation will have implications for clinical practice. Future research needs to address emotion dysregulation in all its multifaceted complexity so that it becomes clearer what the concept encompasses.     

Relating empathy and emotion regulation: Do deficits in empathy trigger emotion dysregulation?

Emotion regulation is a crucial skill in adulthood; its acquisition represents one of the key developmental tasks in early childhood. Difficulties with adaptive emotion regulation increase the risk of psychopathology in childhood and adulthood. This is, for instance, shown by a relation between emotion regulation and aggressive behavior in childhood age, indicating emotion dysregulation as an important risk factor of aggressive behavior and potential precursor of psychopathology. Based on (1) interrelations between emotion processes and social information processing (maladaptive emotion regulation and social information processing are associated with higher levels of aggression) and (2) recent neuroscientific findings showing that empathy deficits might not only result in difficulties labeling others' emotions but one's own emotions too, we suggest that empathy deficits might serve as potential trigger of emotion dysregulation. Different studies investigating the relation between empathy and emotion regulation are presented and discussed. Discussions are based on the assumed potential of empathy deficits triggering emotion dysregulation. Furthermore, developmental neuroscientific findings on empathy and emotion regulation are highlighted which provide further insights on how these processes might relate. Finally, possible directions for future research are presented.     

Implicit emotion regulation affects outcome evaluation

Efficient implicit emotion regulation processes, which run without awareness, are important for human well-being. In this study, to investigate the influence of implicit emotion regulation on psychological and electrophysiological responses to gains and losses, participants were required to select between two Chinese four-character idioms to match the meaning of the third one before they performed a monetary gambling task. According to whether their meanings were related to emotion regulation, the idioms fell into two categories. Event-related potentials and self-rating emotional experiences to outcome feedback were recorded during the task. Priming emotion regulation reduced subjective emotional experience to both gains and losses and the amplitudes of the feedback-related negativity, while the P3 component was not influenced. According to these results, we suggest that the application of implicit emotion regulation effectively modulated the subjective emotional experience and the motivational salience of current outcomes without the cost of cognitive resources. This study implicates the potential significance of implicit emotion regulation in decision-making processes.     

Characterizing emotional dysfunction in borderline personality,major depression,and their co-occurrence

This research aimed to characterize patterns of emotional reactivity and dysregulation in borderline personality, depression, and their co-occurrence. In study 1, 488 young adult women from the community were categorized into four groups based on self-reported major depressive disorder (MDD) and borderline personality disorder (BPD) symptoms (Low BPD/Low MDD; Low BPD/High MDD; High BPD/Low MDD; High BPD/High MDD). Immediate and prolonged subjective emotional reactivity to a laboratory stressor were assessed, and participants completed self-report and behavioral measures of emotion dysregulation. Study 2 extended these findings, examining emotional reactivity and dysregulation in a clinical population of 176 substance dependent patients with diagnoses of BPD and MDD and including a biological index of emotional reactivity. Results revealed greater prolonged fear reactivity in the High BPD/High MDD (vs. Low BPD/Low MDD) group in study 1, and greater prolonged anxiety and negative affect reactivity in both High BPD groups (vs. Low BPD/Low MDD and Low BPD/High MDD groups) in study 2 (but no differences in cortisol reactivity). Results also demonstrated greater subjective (but not behavioral) emotion dysregulation in the High BPD/High MDD (vs. Low BPD/Low MDD) group in study 1 and both High BPD groups (vs. both Low BPD groups) in study 2. Finally, the High BPD/High MDD group reported greater difficulties controlling impulsive behaviors compared with all other groups in study 1 and the Low BPD groups in study 2. Findings suggest that BPD pathology (but not MDD pathology alone) is characterized by greater prolonged emotional (especially anxiety/fear-related) reactivity and heightened emotion dysregulation.     

Evidence for an emotion maintenance deficit in schizophrenia

Research has indicated that people with schizophrenia have deficits in reward representation and goal-directed behavior, which may be related to the maintenance of emotional experiences. Using a laboratory-based study, we investigated whether people with schizophrenia were able to maintain an emotional experience when given explicit instructions to do so. Twenty-eight people with schizophrenia and 19 people without completed a behavioral task judging their emotional experience of pictures held over a three second delay. This emotion maintenance task was compared to a subsequent in-the-moment emotion experience rating of each picture. In addition, all participants completed an analogous brightness experience maintenance and rating task, and patients completed a standardized visual working memory task. Participants with schizophrenia showed normal in-the-moment emotion experience of the emotion pictures; however, they showed decreased performance on emotion maintenance (for both positive and negative emotion) compared to participants without schizophrenia, even after controlling for brightness maintenance. The emotion maintenance deficit was not associated with visual brightness performance nor with performance on the visual working memory task; however, negative emotion maintenance was associated with an interview-based rating of motivation. These findings suggest that some aspects of impaired emotion maintenance in schizophrenia may be related to deficits in motivated behavior.     

Neural correlates of positive and negative emotion regulation

The ability to cope adaptively with emotional events by volitionally altering one's emotional reactions is important for psychological and physical health as well as social interaction. Cognitive regulation of emotional responses to aversive events engages prefrontal regions that modulate activity in emotion-processing regions such as the amygdala. However, the neural correlates of the regulation of positive emotions remain largely unexplored. We used event-related functional magnetic resonance imaging to examine the neural correlates of cognitively increasing and decreasing emotional reactions to positive and negative stimuli. Participants viewed negative, positive, and neutral pictures while attempting to increase, decrease, or not alter their emotional reactions. Subjective reactions were assessed via on-line ratings. Consistent with previous studies, increasing negative and positive emotion engaged primarily left-lateralized prefrontal regions, whereas decreasing emotion activated bilateral prefrontal regions. Different activations unique to increasing versus decreasing emotion were observed for positive and negative stimuli: Unique increase-related activations were observed only for positive stimuli, whereas unique decrease-related activations were observed only for negative stimuli. Regulation also modulated activity in the amygdala, a key emotion-processing region. Regulation effects on amygdala activity were larger for positive than for negative stimuli, potentially reflecting a greater malleability of positive emotional reactions. Increasing and decreasing positive and negative emotion can thus increase and decrease subjective reactions and associated amygdala activity in line with regulatory goals, and is associated with different patterns of prefrontal activation as a function of emotional valence and regulatory goal.     

Emotional intelligence modulates cortisol awakening response and self-reported health in caregivers of people with autism spectrum disorders

Caring for people with autism spectrum disorders (ASDs) has negative consequences for caregivers’ health. Specifically, caregivers of people with ASDs have been observed to have more somatic symptoms, poorer self-perceived general health, poorer social functioning and altered immune and endocrine systems. Various positive variables including emotional intelligence (EI) have been found to protect health in several populations, but no studies have previously analyzed the effect of EI in caregivers of people with ASDs. The present study aimed to analyze the association of the three components of EI (attention, clarity and repair) with self-reported health and cortisol awakening response (CAR) in caregivers of offspring with ASD. Attention was negatively associated and clarity positively associated with self-reported health. Clarity and repair were associated with a lower magnitude of CAR, estimated by the area under the curve with respect to ground (AUC_g). Moreover, CAR AUC_g was a mediator in the association of clarity and repair with self-perceived general health. These results confirm that EI components have different effects on health in caregivers of people with ASDs. EI should be included as a target of interventions to improve health in this population.     

The neural correlates of regulating positive and negative emotions in medication-free major depression

Depressive cognitive schemas play an important role in the emergence and persistence of major depressive disorder (MDD). The current study adapted emotion regulation techniques to reflect elements of cognitive behavioural therapy (CBT) and related psychotherapies to delineate neurocognitive abnormalities associated with modulating the negative cognitive style in MDD. Nineteen non-medicated patients with MDD and 19 matched controls reduced negative or enhanced positive feelings elicited by emotional scenes while undergoing functional magnetic resonance imaging. Although both groups showed significant emotion regulation success as measured by subjective ratings of affect, the controls were significantly better at modulating both negative and positive emotion. Both groups recruited regions of dorsolateral prefrontal cortex and ventrolateral prefrontal cortex (VLPFC) when regulating negative emotions. Only in controls was this accompanied by reduced activity in sensory cortices and amygdala. Similarly, both groups showed enhanced activity in VLPFC and ventral striatum when enhancing positive affect; however, only in controls was ventral striatum activity correlated with regulation efficacy. The results suggest that depression is associated with both a reduced capacity to achieve relief from negative affect despite recruitment of ventral and dorsal prefrontal cortical regions implicated in emotion regulation, coupled with a disconnect between activity in reward-related regions and subjective positive affect.     

Exploring Anger Among Offenders: The Role of Emotion Dysregulation and Alexithymia

This study tests whether specific dimensions of emotion dysregulation predict maladaptive anger expression among offenders from Italy and Australia. In particular, it examines the unique associations among emotion dysregulation dimensions and different aspects of anger expression and control, in both inmates and offenders on parole. Multiple regression analyses reveal that difficulties controlling impulsive behaviour when distressed are related to state anger, trait anger, and chronic anger expression. On the other hand, alexithymia predicts the maladaptive expression of anger inwardly directed. Finally, lack of emotional awareness and limited access to emotion regulation (ER) strategies are negatively related to anger control, suggesting that they may represent useful treatment targets. Interestingly, incarcerated offenders reported significantly higher levels of state anger and lower levels of anger control out (i.e. seeking support from others) than offenders living on parole in the community, highlighting the importance of contextual influences in the emotional life of offenders.