The Association between Self-Reported Difficulties in Emotion Regulation and Heart Rate Variability: The Salient Role of Not Accepting Negative Emotions

Difficulties in emotion regulation are associated with development and maintenance of psychopathology. Typically, features of emotion regulation are assessed with self-report questionnaires. Heart rate variability (HRV) is an objective measure proposed as an index of emotional regulation capacity. A limited number of studies have shown that self-reported difficulties in emotion regulation are associated with HRV. However, results from prior studies are inconclusive, and an ecological validation of the association has not yet been tested. Therefore, further exploration of the relation between self-report questionnaires and psychophysiological measures of emotional regulation is needed. The present study investigated the contribution of self-reported emotion regulation difficulties on HRV in a student sample. We expected higher scores on emotion regulation difficulties to be associated with lower vagus-mediated HRV (vmHRV). Sixty-three participants filled out the Difficulties in Emotion Regulation Scale and their resting HRV was assessed. In addition, a subsample of participants provided ambulatory 24-h HRV data, in order to ecologically validate the resting data. Correlation analyses indicated that self-reported difficulties in emotion regulation was negatively associated with vmHRV in both resting HRV and 24-h HRV. Specifically, when exploring the contribution of the different facets of emotion dysregulation, the inability to accept negative emotions showed the strongest association with HRV. The results are discussed and need for future research is described

Krevjande situasjonar i psykisk helsevern for born og unge – behandlarar si erfaring med og haldning til målretta trening og virtuell røyndom

Objective: Explore experiences of and attitudes towards deliberate practice and virtual reality (VR) among therapists in child and adolescent psychiatry, and what clinical situations are perceived as particularly relevant for practice. Methods: 59 therapists completed an anonymous online survey. Results: Participants had limited experience with deliberate practice and VR, but were generally very positive to trying this framework to develop therapeutic skills. Situations where caregivers were angry were perceived as the most challenging, while situations where clients were quiet and passive were the most frequent. The perceived challenge of different situations varied widely among participants. Implications: The results are used to reflect upon development of therapeutic skills among licensed therapists in general, and within mental health care in particular.publishedVersio

Dispositional Mindfulness and Attentional Control: The Specific Association Between the Mindfulness Facets of Non-judgment and Describing With Flexibility of Early Operating Orienting in Conflict Detection

Background: A state of mindfulness refers to a present-centered attentional awareness without judging. Being mindful seems to increase the ability to be flexible and adaptive in attention focus according to situational contingencies. The way mindfulness affects such attentional control is often measured with three different but interacting attentional networks of alerting (preparedness), orienting (selection of stimulus), and conflict detection (suppression of irrelevant stimuli). In the current study, the aim was to study the effects of dispositional mindfulness on these attention networks, and specifically the effects on the interactions between these attention networks.Methods: Fifty participants between 19 and 29 years old filled out the questionnaire Five Facet Mindfulness Questionnaire (FFMQ) and performed the revised version of the Attention Network Test (ANT-R). The five FFMQ facets of Describing, Non-Judgment, Orienting, Non-Reactivity, and Acting with Awareness were included as predictors in multiple linear regression analyses with the ANT-R scores of alerting, orienting, conflict detection, and the interaction scores of alerting by conflict detection and orienting by conflict detection as outcome variables, respectively.Results: Higher dispositional mindfulness as measured with the five FFMQ facets predicted interaction scores (faster reaction times) of orienting by conflict detection, but none of the other ANT-R scores. It was specifically the FFMQ facets of Describing and non-judgment that predicted this lower interaction score of orienting by conflict detection.Conclusion: Our findings indicate that being mindful is associated with a more flexible and efficient orienting attention. It is associated with a higher ability to disengage from salient stimuli that is irrelevant to pursue goal-directed behavior (conflict detection)

Validation of a brief version of the Difficulties in Emotion Regulation Scale (DERS-16) with an older Norwegian population

Emotion regulation is proposed to have a salient role in optimal aging. However, currently used measures of emotion regulation have not been validated for older adults. Therefore, we evaluated the psychometric properties of the Difficulties in Emotion Regulation Scale—short form (DERS-16) in a large Norwegian sample consisting of individuals between 70 and 95 years (n = 2525). Tests of internal consistency, reliability, assessment of intra-domain correlations, and confirmatory factor analyses were performed. Construct validity was further investigated by assessing concurrent associations between DERS-16 and well-established measures of psychological disorders, psychological health, and well-being (five-item version of Geriatric Depression Scale, Geriatric Anxiety Inventory—short form, and OECD guidelines on measuring subjective well-being). All subscales derived from the instrument showed adequate internal consistency. Furthermore, we obtained a theoretically consistent factor structure, in which a bifactor model combining a general emotion regulation factor and five additional domain-specific facet-factors had superior model fit. As expected, difficulties in emotion regulation correlated positively with symptoms of depression and anxiety, and negatively with psychological health and well-being. Associations were generally of moderate strength. We can thus conclude that the DERS-16 demonstrates excellent psychometric properties when used in samples with older adults and may safely be employed in studies of emotion regulation difficulties in the older segment of our population.publishedVersio

The effects of mindfulness-based cognitive therapy on risk and protective factors of depressive relapse – a randomized wait-list controlled trial

Background The aim of this randomized wait-list controlled trial was to explore the effects of Mindfulness–Based Cognitive Therapy (MBCT) on risk and protective factors for depressive relapse within the domains of cognition, emotion and self-relatedness. Methods Sixty-eight individuals with recurrent depressive disorder were randomized to MBCT or a wait-list control condition (WLC). Results Completers of MBCT (N = 26) improved significantly on measures assessing risk and protective factors of recurrent depression compared to WLC (N = 30) on measures of rumination (d = 0.59, p = .015), emotion regulation (d = 0.50, p = .028), emotional reactivity to stress (d = 0.32, p = .048), self-compassion (d = 1.02, p < .001), mindfulness (d = 0.59, p = .010), and depression (d = 0.40, p = .018). In the Intention To Treat sample, findings were attenuated, but there were still significant results on measures of rumination, self-compassion and depression. Conclusions Findings from the present trial contribute to evidence that MBCT can lead to reduction in risk factors of depressive relapse, and strengthening of factors known to be protective of depressive relapse. The largest changes were found in the domain of self-relatedness, in the form of large effects on the participants’ ability to be less self-judgmental and more self-compassionate.publishedVersio

Is Dispositional Self-Compassion Associated With Psychophysiological Flexibility Beyond Mindfulness? An Exploratory Pilot Study

Background: Dispositional mindfulness and self-compassion are shown to associate with less self-reported emotional distress. However, previous studies have indicated that dispositional self-compassion may be an even more important buffer against such distress than dispositional mindfulness. To our knowledge, no study has yet disentangled the relationship between dispositional self-compassion and mindfulness and level of psychophysiological flexibility as measured with vagally mediated heart rate variability (vmHRV). The aim was thus to provide a first exploratory effort to expand previous research relying on self-report measures by including a psychophysiological measure indicative of emotional stress reactivity. Methods: Fifty-three university students filled out the “Five Facet Mindfulness Questionnaire” (FFMQ) and the “Self-Compassion Scale” (SCS), and their heart rate was measured during a 5 min resting electrocardiogram. Linear hierarchical regression analyses were conducted to examine the common and unique variance explained by the total scores of the FFMQ and the SCS on level of resting vmHRV. Results: Higher SCS total scores associated significantly with higher levels of vmHRV also when controlling for the FFMQ total scores. The SCS uniquely explained 7% of the vmHRV. The FFMQ total scores did not associate with level of vmHRV. Conclusion: These results offer preliminary support that dispositional self-compassion associates with better psychophysiological regulation of emotional arousal above and beyond mindfulness.publishedVersio

Self-Compassion and Its Association With Ruminative Tendencies and Vagally Mediated Heart Rate Variability in Recurrent Major Depression

Background: Recurrent Major Depressive Disorder (MDD) is one of the most disabling mental disorders in modern society. Prior research has shown that self-compassion protects against ruminative tendencies, a key feature of recurrent MDD. In addition, self-compassion has been found to be positively related to higher psychophysiological flexibility (indexed by a higher vagally mediated heart rate variability; vmHRV) in young, healthy adults. To our knowledge, there is a lack of studies on how self-compassion relates to vmHRV in patients with recurrent MDD. The aim of the current study was to investigate whether higher self-compassion would associate with (1) lower ruminative tendencies and (2) higher vmHRV in a sample of adults with recurrent MDD. Methods: We included a sample of 63 patients (46 females) between 20 and 71 years old (M = 40.24, SD = 12.8) with a history of three or more depressive episodes. They filled out the Self-Compassion Scale (SCS), Beck Depression Inventory (BDI), and Rumination Rating Scale (RRS). ECG (used to derive vmHRV) was acquired while resting and the square root of the mean squared differences of successive RR interval values (RMSSD) was calculated as measure of vmHRV. Results: As hypothesized, self-compassion was associated with lower ruminative tendencies. However, self-compassion was not associated with level of vmHRV. Several confounding variables were controlled for in the statistical analyses, and higher age predicted lower vmHRV across all statistical analyses. Conclusion: The results confirmed our hypothesis that higher self-compassion would be associated with lower ruminative tendencies in recurrent MDD. Contrary to our expectation, we did not find that the tendency to be more self-compassionate was associated with higher vmHRV. As such, higher self-compassion seems to relate with a lower tendency to ruminate about past mistakes and events but does not seem to relate to a flexible autonomic stress response (as indexed by higher vmHRV). Other potential explanatory factors for lower vmHRV in recurrent MDD is suggested as focus for exploration in future studies.publishedVersio

Emotion Regulation in Current and Remitted Depression: A Systematic Review and Meta-Analysis

Background: Major Depressive Disorder (MDD) is a highly prevalent, recurrent, and potentially chronic disorder. Identifying risk factors and underlying mechanisms to inform preventive and therapeutic interventions is therefore imperative. Emotion regulation is a proposed factor in the development and maintenance of MDD. The aim of the present review was to summarize and synthesize research on self-reported emotion regulation strategy use and emotion regulation abilities in adults diagnosed with current and remitted MDD.Methods: Seventy-two eligible studies were retrieved from databases through a systematic literature search. Group differences between individuals with current MDD, remitted MDD, and healthy controls were calculated using meta-analytic procedures. Meta-regression analyses investigated potential moderator effects on emotion regulation difficulties.Results: Results indicated that individuals with current MDD report higher maladaptive emotion regulation strategy use for avoidance (Hedges' g = 1.3), rumination (g = 2.1), and suppression (g = 1.1) compared to healthy controls. Also, they reported lower adaptive emotion regulation strategy use for acceptance (g = −1.0), problem solving (g = −1.0), and reappraisal (g = −0.7). Individuals with current MDD reported limited general emotion regulation abilities, indicated by higher alexithymia (g = 1.45), lower emotional awareness (g = −0.95), emotional clarity (g = −1.50) and emotional tolerance (g = −1.89). Similar results were found in individuals with remitted MDD for avoidance (g = 1.0), rumination (g = 1.1), suppression (g = 0.6), and general emotion regulation abilities. However, no difference was found between individuals with remitted MDD and healthy controls for adaptive emotion regulation strategies. Meta-regression analyses suggest that age of illness onset, comorbid anxiety and duration of remission influence emotion regulation.Conclusion: The present review and meta-analysis indicates that individuals with current and remitted MDD have difficulties with emotion regulation compared to individuals who have never been depressed. Although depressive symptoms improve, emotion regulation difficulties may continue, and could be a contributing factor to relapse. Our findings inform future research on emotion regulation and psychotherapeutic interventions

Depression, anxiety, PTSD, and OCD after stillbirth: a systematic review

Background: This systematic review aimed to provide an updated summary of studies investigating depression, anxiety, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD) in parents after stillbirth (from 20 weeks gestational age until birth). Methods: A literature search was conducted in the databases Web of Science and PsychINFO. Main inclusion criteria were 1) peer-reviewed, quantitative, English-language articles published from 1980; (2) studies investigating depression, anxiety, PTSD, or OCD among parents following stillbirth; and (3) studies defining stillbirth as equal to or after 20 weeks of gestation. Results: Thirteen quantitative, peer-reviewed articles were eligible for inclusion. Selected articles investigated depression, anxiety, and PTSD, while no studies on OCD met our inclusion criteria. The majority of studies investigated women, while only two studies included men. The results indicated heightened short- and long-term levels of depression, anxiety, and PTSD in parents after stillbirth compared to those of parents with live birth. Studies investigating predictors found that social support, marital status, negative appraisals, and variables related to care and management after stillbirth affected levels of symptoms. Conclusions: Parents who experience stillbirth have a considerably higher risk of reporting symptoms of depression, anxiety, and PTSD compared with parents with live births. More longitudinal studies are needed to increase our knowledge of how symptoms develop over time, and more research on fathers, transgender, non-binary and gender fluid individuals is needed. Research on the association between stillbirth and OCD is also warranted. Knowledge of the severity of anxiety, depression, and PTSD after stillbirth, and predictors associated with symptom severity could provide healthcare professionals with valuable information on how to provide beneficial postpartum care.publishedVersio

Emotion regulation in current and remitted depression: A systematic review and meta-analysis

Background: Major Depressive Disorder (MDD) is a highly prevalent, recurrent, and potentially chronic disorder. Identifying risk factors and underlying mechanisms to inform preventive and therapeutic interventions is therefore imperative. Emotion regulation is a proposed factor in the development and maintenance of MDD. The aim of the present review was to summarize and synthesize research on self-reported emotion regulation strategy use and emotion regulation abilities in adults diagnosed with current and remitted MDD. Methods: Seventy-two eligible studies were retrieved from databases through a systematic literature search. Group differences between individuals with current MDD, remitted MDD, and healthy controls were calculated using meta-analytic procedures. Meta-regression analyses investigated potential moderator effects on emotion regulation difficulties. Results: Results indicated that individuals with current MDD report higher maladaptive emotion regulation strategy use for avoidance (Hedges' g = 1.3), rumination (g = 2.1), and suppression (g = 1.1) compared to healthy controls. Also, they reported lower adaptive emotion regulation strategy use for acceptance (g = −1.0), problem solving (g = −1.0), and reappraisal (g = −0.7). Individuals with current MDD reported limited general emotion regulation abilities, indicated by higher alexithymia (g = 1.45), lower emotional awareness (g = −0.95), emotional clarity (g = −1.50) and emotional tolerance (g = −1.89). Similar results were found in individuals with remitted MDD for avoidance (g = 1.0), rumination (g = 1.1), suppression (g = 0.6), and general emotion regulation abilities. However, no difference was found between individuals with remitted MDD and healthy controls for adaptive emotion regulation strategies. Meta-regression analyses suggest that age of illness onset, comorbid anxiety and duration of remission influence emotion regulation. Conclusion: The present review and meta-analysis indicates that individuals with current and remitted MDD have difficulties with emotion regulation compared to individuals who have never been depressed. Although depressive symptoms improve, emotion regulation difficulties may continue, and could be a contributing factor to relapse. Our findings inform future research on emotion regulation and psychotherapeutic interventions