Peggilee Wupperman

Emotion-regulation skills as a treatment target in psychotherapy.

BACKGROUND Deficits in emotion-regulation skills have been shown to be integral to the development and maintenance of a wide range of mental disorders. AIM To evaluate the importance of these skills as a treatment target in psychotherapeutic interventions. METHOD Nine specific emotion-regulation skills were assessed in a sample of 289 inpatients before and after cognitive-behavioural treatment. Self-reports of success in pretreatment skills application were first compared to those of 246 non-clinical controls. Pretreatment skills application and change in skills application during therapy were then related to a variety of outcome measures. Finally, the effects of integrating a brief training of general emotion-regulation skills into the CBT-based treatment were evaluated in a controlled trial. RESULTS Uni- and multivariate analyses identified the skills of acceptance, tolerance, and active modification of negative emotions as particularly important for current mental health and treatment outcome. Replacing parts of the standard CBT treatment with the emotion-regulation training enhanced the effects of the CBT treatment on skills application and on other measures of mental health. CONCLUSION Incorporating interventions that directly target general emotion-regulation skills may improve the effectiveness of psychotherapeutic interventions.

Emotion regulation and mental health: recent findings, current challenges, and future directions.

Purpose of review In recent years, deficits in emotion regulation have been studied as a putative maintaining factor and promising treatment target in a broad range of mental disorders. This article aims to provide an integrative review of the latest theoretical and empirical developments in this rapidly growing field of research. Recent findings Deficits in emotion regulation appear to be relevant to the development, maintenance, and treatment of various forms of psychopathology. Increasing evidence demonstrates that deficits in the ability to adaptively cope with challenging emotions are related to depression, borderline personality disorder, substance-use disorders, eating disorders, somatoform disorders, and a variety of other psychopathological symptoms. Unfortunately, studies differ with regard to the conceptualization and assessment of emotion regulation, thus limiting the ability to compare findings across studies. Future research should systematically work to use comparable methods in order to clarify the following: which individuals have; what kinds of emotion regulation difficulties with; which types of emotions; and what interventions are most effective in alleviating these difficulties. Summary Despite some yet to be resolved challenges, the concept of emotion regulation has a broad and significant heuristic value for research in mental health.

Deficits in emotion-regulation skills predict alcohol use during and after cognitive–behavioral therapy for alcohol dependence.

OBJECTIVE As emotion regulation is widely considered to be a primary motive in the misuse of alcohol, our aim in the study was to investigate whether deficits in adaptive emotion-regulation skills maintain alcohol dependence (AD). METHOD A prospective study investigated whether emotion-regulation skills were associated with AD and whether these skills predicted alcohol use during and after treatment for AD. Participants were 116 individuals treated for AD with cognitive-behavioral therapy. Emotion regulation and severity of AD symptoms were assessed by self-report. Alcohol use during treatment was assessed by Breathalyzer and urine analysis for ethyl glucuronide; alcohol use during the 3-month follow-up interval was assessed by self-report. RESULTS Pretreatment emotion-regulation skills predicted alcohol use during treatment, and posttreatment emotion-regulation skills predicted alcohol use at follow-up, even when controlling for other predictors potentially related to emotion regulation. Among a broad range of specific emotion-regulation skills, the ability to tolerate negative emotions was the only skill that negatively predicted subsequent alcohol consumption when controlling for the other skills. Individuals in the AD sample reported significantly larger deficits in emotion-regulation skills than did those in a nonclinical control sample but significantly less than did those in a sample of individuals exclusively meeting criteria for major depressive disorder. CONCLUSIONS Enhancement of general emotion-regulation skills, especially the ability to tolerate negative emotions, appears to be an important target in the treatment of AD.

Enhancing emotion-regulation skills in police officers: results of a pilot controlled study.

Police officers are routinely exposed to situations that elicit intense negative emotions; thus, officers have a particularly strong need for effective methods of regulating such emotions. The main purpose of this study was to investigate whether a manualized emotion-regulation training (Integrative Training of Emotional Competencies; iTEC; Berking, 2010a) can improve the emotion-regulation skills of police officers. First, self-reports of 9 emotion-regulation skills were assessed in a sample of officers (N=31) and compared to those of a matched community-based control group. Then, the effects of the training on the emotion-regulation skills of officers were evaluated in a time-staggered design with a waitlist control condition. Results indicate that, compared to controls, officers have difficulties in accepting and tolerating negative emotions, supporting themselves in distressing situations, and confronting emotionally challenging situations. The training significantly enhanced successful skill application, especially some skills with which officers reported difficulty applying. These findings suggest that a focus on emotion-regulation skills may be an important component for programs aimed at preventing mental-health problems in police officers.

Prospective effects of emotion-regulation skills on emotional adjustment.

Deficits in emotion-regulation skills have widely been shown to be associated with poor emotional adjustment. However, it is still unclear whether these deficits are a cause or a consequence of poor adjustment. The purpose of the present research was to clarify the reciprocal effects between these 2 concepts. In 2 studies (Ns = 446 and 635), self-reports of emotion regulation and emotional adjustment were assessed twice with a 2-week interval. Cross-lagged regression analyses demonstrated that self-reports of emotion regulation predicted subsequent adjustment, over and above the effects of previous adjustment, whereas emotional adjustment did not predict subsequent emotion regulation. Thus, a focus on emotion-regulation skills may be important in the prevention and treatment of affect-related mental health problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Do deficits in mindfulness underlie borderline personality features and core difficulties

The current study investigated whether deficits in mindfulness (the awareness, attention, and acceptance of the present moment) can account for variability in borderline personality (BPD) features and characteristic difficulties in emotion regulation, interpersonal effectiveness, and impulsivity. Structural equation modeling and hierarchical regressions were utilized to examine the associations of trait mindfulness with BPD features, interpersonal problem-solving, impulsive and passive emotion-regulation strategies, and neuroticism in a sample of young adults (N = 342). As hypothesized, mindfulness was related inversely to BPD features and core areas of difficulty, and these associations continued even when controlling for neuroticism. Additionally, mindfulness deficits continued to predict borderline features even when interpersonal effectiveness, passive and impulsive emotion-regulation, and neuroticism were controlled. It is concluded that deficits in mindfulness may be integral to BPD features. Difficulties with attention, awareness, and acceptance of internal and external experience appear to explain borderline pathology even when controlling for problems with negative affectivity, behavioral dyscontrol, and emotional and interpersonal dysfunction--which have been described as definitional of this disorder. Thus, attention to mindfulness deficits may enhance clinical formulation of BPD symptomatology, as well as provide a vital component of effective BPD treatment.

The role of mindfulness in borderline personality disorder features.

This study investigated whether deficits in mindfulness (attention, awareness, and acceptance of the present moment) underlie variability in borderline personality disorder (BPD) features and related impairments in interpersonal functioning, impulsivity, and emotion regulation. A path analytic approach was used to examine the relationships of trait mindfulness with BPD features, interpersonal effectiveness, impulsive and passive emotion-regulation, and neuroticism in a psychiatric sample of adults (N = 70). As hypothesized, mindfulness was associated inversely with BPD features and core areas of dysfunction, and these associations continued when controlling for neuroticism. Furthermore, mindfulness deficits continued to predict BPD features even when interpersonal effectiveness, passive and impulsive emotion-regulation, and neuroticism were controlled. These findings suggest that mindfulness may be a unique predictor for the expression of BPD pathology. An emphasis on mindfulness may thus be crucial in enhancing the formulation and treatment of BPD.

Mindfulness and modification therapy for behavioral dysregulation: results from a pilot study targeting alcohol use and aggression in women

OBJECTIVES Increasing evidence suggests that deficits in mindfulness (awareness, attentiveness, and acceptance of the present moment) play a role in a range of disorders involving behavioral dysregulation. This paper adds to that literature by describing a transdiagnostic psychotherapy (Mindfulness & Modification Therapy; MMT) developed to target behavioral dysregulation. DESIGN An open-treatment pilot-trial investigated the feasibility, acceptability, and pre-post effects of MMT targeting women (N = 14) court-referred for alcohol abuse/dependence and aggression. RESULTS Pre-post comparisons revealed significant decreases in alcohol use, drug use, and aggression. In addition, the retention rate was 93%. CONCLUSION Preliminary evidence suggests that MMT is a feasible and acceptable treatment that decreases dysregulated behaviors such as substance use and aggression, while also potentially increasing retention.

Is the association between various emotion-regulation skills and mental health mediated by the ability to modify emotions? Results from two cross-sectional studies.

BACKGROUND AND OBJECTIVES In order to clarify mechanisms underlying the association between emotion regulation and psychopathology, we tested whether the ability to modify negative emotions mediates the associations of other emotion-regulation skills with psychopathological symptoms in two studies. METHODS The first study included 151 college students; the second included 121 psychiatric inpatients. Bootstrapping-enhanced mediation analyses were utilized to assess associations between self-reports of emotion-regulation skills and psychopathology, as well as potential mediation effects. RESULTS In both samples, the ability to modify emotions completely mediated the association between symptoms and skills for most skills, but not for the skill of accepting/tolerating negative emotions. LIMITATIONS Major limitations include the use of a cross-sectional design as well as exclusive use of self-report data. CONCLUSIONS The ability to modify negative emotions may be the common pathway by which many emotion-regulation skills exert their influence on mental health; however, the skill of accepting/tolerating negative emotions may be beneficial to mental health regardless of whether or not it facilitates modification of emotions.

Neurocognitive performance among alcohol dependent men with and without physical violence toward their partners: a preliminary report.

Ojective: There are high rates of co-occurring alcohol dependence and intimate partner violence (IPV) among men seeking substance abuse treatment. The authors examined neurocognitive performance among treatment-seeking alcohol dependent men with (IPV +) and without reported physical violence (IPV −). Method: Twenty-five subjects participated in this pilot study. All participants underwent a neurocognitive battery including, Continuous Performance Test (CPT), California Verbal Learning Test (CVLT), Digit Span, Iowa Gambling Test (IGT), Wisconsin Card Sort (WCST), Trail Making Test, Parts A & B, a visuospatial memory (VSWM) task and the Stroop Color Word Test (SCWT). Result: Alcohol dependent participants with IPV (IPV + ; n = 9) had more severe deficits in attention, concentration, cognitive flexibility compared to controls (n = 7). Both the alcohol dependent (IPV − ; n = 9) and IPV + groups had significantly more impairments on tasks of impulsivity than the smoking controls. The IPV − group had significantly more impairments on executive functioning compared to smoking controls, but was not significantly different than the IPV + group. Conclusions: Our preliminary results suggests that IPV + males have more severe neuropsychological impairments compared to the smoking control group than did the IPV − group. The implications of these findings are discussed.