Amy Kranzler

Nonsuicidal self-injury disorder: The path to diagnostic validity and final obstacles.

After decades of researchers calling for the creation of a self-injury syndrome, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders listed Nonsuicidal Self-Injury (NSSI) disorder as a condition for further study. The purpose of this review is to provide information about the current status of research on NSSI disorder, current arguments for and against the disorders creation, and areas that require further research. Specifically, we address the five biggest obstacles to validation: the need for clear delimitation from other psychiatric disorders as well as suicidal behavior, the need to fully explore the developmental course of the disorder, empirically establishing the most appropriate diagnostic criteria, and the potential clinical utility of creating a new disorder. With further research in these key areas, we expect that there will soon be enough evidence for the validity of NSSI disorder to warrant its inclusion in a future edition of the DSM.

Bidirectional-Compounding Effects of Rumination and Negative Emotion in Predicting Impulsive Behavior: Implications for Emotional Cascades.

Influenced by chaos theory, the emotional cascade model proposes that rumination and negative emotion may promote each other in a self-amplifying cycle that increases over time. Accordingly, exponential-compounding effects may better describe the relationship between rumination and negative emotion when they occur in impulsive persons, and predict impulsive behavior. Forty-seven community and undergraduate participants who reported frequent engagement in impulsive behaviors monitored their ruminative thoughts and negative emotion multiple times daily for two weeks using digital recording devices. Hypotheses were tested using cross-lagged mixed model analyses. Findings indicated that rumination predicted subsequent elevations in rumination that lasted over extended periods of time. Rumination and negative emotion predicted increased levels of each other at subsequent assessments, and exponential functions for these associations were supported. Results also supported a synergistic effect between rumination and negative emotion, predicting larger elevations in subsequent rumination and negative emotion than when one variable alone was elevated. Finally, there were synergistic effects of rumination and negative emotion in predicting number of impulsive behaviors subsequently reported. These findings are consistent with the emotional cascade model in suggesting that momentary rumination and negative emotion progressively propagate and magnify each other over time in impulsive people, promoting impulsive behavior.

Rumination in major depressive disorder is associated with impaired neural activation during conflict monitoring

Individuals with major depressive disorder (MDD) often ruminate about past experiences, especially those with negative content. These repetitive thoughts may interfere with cognitive processes related to attention and conflict monitoring. However, the temporal nature of these processes as reflected in event-related potentials (ERPs) has not been well-described. We examined behavioral and ERP indices of conflict monitoring during a modified flanker task and the allocation of attention during an attentional blink (AB) task in 33 individuals with MDD and 36 healthy controls, and whether their behavioral performance and ERPs varied with level of rumination. N2 amplitude elicited by the flanker task was significantly reduced in participants with MDD compared to healthy controls. Level of self-reported rumination was also correlated with N2 amplitude. In contrast, P3 amplitude during the AB task was not significantly different between groups, nor was it correlated with rumination. No significant differences were found in behavioral task performance measures between groups or by rumination levels. These findings suggest that rumination in MDD is associated with select deficits in cognitive control, particularly related to conflict monitoring.

Emotional Awareness: A Transdiagnostic Predictor of Depression and Anxiety for Children and Adolescents

Research increasingly suggests that low emotional awareness may be associated with symptoms of depression and anxiety among children and adolescents. However, because most studies have been cross-sectional, it has remained unclear whether low emotional awareness predicts subsequent internalizing symptoms. The current study used longitudinal data to examine the role of emotional awareness as a transdiagnostic predictor of subsequent symptoms of depression and anxiety. Participants were 204 youth (86 boys and 118 girls) ages 7–16 who completed self-report measures of emotional awareness, depressive symptoms, and anxiety symptoms at baseline, as well as measures of depression and anxiety symptoms every 3 months for a year. Results from hierarchical mixed effects modeling indicated that low baseline emotional awareness predicted both depressive and anxiety symptoms across a 1-year period. These findings suggest that emotional awareness may constitute a transdiagnostic factor, predicting symptoms of both depression and anxiety, and that emotional awareness training may be a beneficial component of treatment and prevention programs for youth depression and anxiety.

A perfect storm: examining the synergistic effects of negative and positive emotional instability on promoting weight loss activities in anorexia nervosa.

Growing evidence indicates that both positive and negative emotion potentially influence the development and maintenance of anorexia nervosa, through both positive and negative reinforcement of weight loss activities. Such reactive emotional experience may be characterized by frequent and intense fluctuations in emotion, a construct known as “emotional instability.” The purpose of this study was to investigate the association between positive emotional instability and weight loss activities in anorexia nervosa, and to investigate the synergistic effects of positive and negative emotional instability on promoting weight loss activities. Using ecological momentary assessment methods, 118 participants with anorexia nervosa reported their emotional experiences and behaviors at least six times daily over 2 weeks using a portable digital device. Using generalized linear modeling, results indicated that high levels of both positive and negative emotional instability, and the interaction between the two, were associated with more frequent weight-loss activities, beyond anorexia subtype and mean levels of emotional intensity. These findings indicate that when women with anorexia exhibit both high levels of both positive and negative emotional instability they are more prone to a variety of weight loss activities. The importance of addressing the role of both positive and negative emotion in anorexia treatment is discussed.

Emotional dysregulation, internalizing symptoms, and self-injurious and suicidal behavior: Structural equation modeling analysis

ABSTRACT This study used structural equation modeling to examine the relationships between emotion dysregulation, internalizing symptoms, nonsuicidal self-injury (NSSI), and suicide. One hundred forty-eight undergraduates completed a brief structured interview and self-report measures of emotion dysregulation, internalizing symptoms, and NSSI and suicidal behaviors. Results indicated a significant indirect effect of emotion dysregulation on NSSI via internalizing symptoms and on suicide attempts via NSSI. Findings provide a more nuanced understanding of the indirect association between emotion dysregulation and NSSI and suicidal behaviors. Implications for the potential utility of targeting internalizing symptoms as well as emotion dysregulation in interventions addressing NSSI and suicidal behaviors are discussed.

Illustrating positive psychology concepts through service learning: Penn teaches resilience

We describe an undergraduate service-learning research course in which undergraduates are trained to disseminate an intervention designed to promote resilience and well-being in middle-school youth. The course provides undergraduates with an opportunity for active and collaborative learning in psychology and serves as a new model for the wide-scale dissemination of evidence-based prevention programs through supervised undergraduates. We provide insights into the strengths and weaknesses of the course, along with some thoughts about ways that readers might implement something similar at their own institutions, using the Penn Resiliency Program or other related interventions.

Development of Emotional Cascades in Borderline Personality Disorder

Turbulent emotional experience and engaging in a wide variety of dysregulated behaviors are essential symptoms of borderline personality disorder (BPD). A new model of BPD, called the Emotional Cascade Model, aims to increase our understanding of the fundamental connection between emotional and behavioral dysregulation in this disorder, by highlight the phenomena of emotional cascades. Emotional cascades do not occur in isolation, however, and are likely influenced by a number of developmental factors, eventually contributing to the emergence of BPD. Furthermore, the experience of emotional cascades is likely to negatively influence developmental trajectory over time, resulting in additional exacerbation of symptoms. Theoretical and empirical considerations for the role of the Emotional Cascade Model in BPD will be discussed, as will important developmental factors that are likely to influence and interact with emotional cascades.