Regina Miranda

Beyond PTSD: Emotion regulation and interpersonal problems as predictors of functional impairment in survivors of childhood abuse *

This study sought to determine the relative contribution of problems in emotion regulation and interpersonal functioning compared to PTSD symptoms in predicting functional impairment among women with childhood abuse histories. One hundred sixty-four treatment-seeking women completed measures of emotion regulation, interpersonal problems, PTSD symptoms, and social adjustment. Severity of PTSD symptoms was a significant predictor of functional impairment. In addition, after controlling for the effects of PTSD symptomatology, emotion regulation and interpersonal problems were both significant predictors and together made contributions to functional impairment equal to that of PTSD symptoms. These data indicate that emotion regulation and interpersonal problems play an important role in functional impairment among women with a history of childhood abuse. These factors should be taken into account in treatment planning to ensure successful rehabilitation from the long-term effects of chronic childhood trauma.

Suicide attempt characteristics, diagnoses, and future attempts: Comparing multiple attempters to single attempters and ideators

OBJECTIVE To compare psychiatric diagnoses and future suicide attempt outcomes of multiple attempters (MAs), single attempters (SAs), and ideators. METHOD Two hundred twenty-eight teens who reported recent ideation or a lifetime suicide attempt in a screening of 1,729 high school students completed the Adolescent Suicide Interview, which provided information on attempt number and characteristics and mood, anxiety, and substance use disorder modules of the Diagnostic Interview Schedule for Children; 191 were reinterviewed 4 to 6 years later to ascertain interval attempts and psychiatric disorder. Between screening and follow-up, 33 (17%) teens made an attempt, 12 of whom were previously classified as lifetime MAs (more than one attempt) and six as SAs. RESULTS MAs more often met criteria for any one of the DSM diagnoses assessed at baseline (mood, anxiety, or substance use disorder; 71%), compared with SAs (39%) and ideators (41%), and at follow-up (mood, anxiety, substance use, or disruptive behavior disorder; 69%) compared with SAs (36%) (p <.05). As reported at baseline, MAs (versus SAs) more often wished to die during their attempt (53% versus 23%), less often planned their attempt for intervention (44% versus 76%), and more often regretted recovery (26% versus 7%; p <.05). Baseline MAs had significantly higher odds of making a later attempt compared to ideators (odds ratio 4.0, 95% confidence interval 1.5-10.2) and SAs (odds ratio 4.6, 95% confidence interval 1.0-20.2). No participants committed suicide during follow-up. SAs who made another attempt (versus those who did not) more often met criteria for a baseline anxiety disorder and more often wished to die during their baseline attempt. CONCLUSIONS MAs more strongly predict later suicidality and diagnosis than SAs and ideation. Forms that assess past suicide attempts should routinely inquire about frequency of attempts. The similarity between the present findings and those of clinical samples suggests that screening may yield a representative sample of suicide attempters and ideators.

Brooding and reflective rumination among suicide attempters: Cognitive vulnerability to suicidal ideation

Previous research suggests that the brooding subtype of rumination is associated with increased suicidal ideation, but findings are inconsistent with respect to reflection, considered to be the more adaptive form of rumination. This study investigated the circumstances under which reflective rumination might be associated with increased suicidal ideation by examining whether a suicide attempt history moderated the relationship between the ruminative subtypes and current suicidal ideation. Thirty-seven young adults who reported a past suicide attempt and fifty-nine young adults without a suicide attempt history completed measures of rumination and depression symptoms in an initial study session. They then completed a measure of suicidal ideation and hopelessness during a second study session. Overall, brooding was associated with higher self-reported suicidal ideation, whereas reflection was not significantly associated with ideation. However, reflection - but not brooding - interacted with suicide attempt history to statistically predict suicidal ideation, even after adjusting for symptoms of depression and hopelessness, whereas brooding no longer predicted ideation after adjusting for these symptoms. These findings qualify earlier suggestions that reflection is a more adaptive form of rumination by indicating that among vulnerable individuals - in particular those with a history of a suicide attempt - a higher degree of reflective rumination is associated with increased suicidal ideation.

Depression, Generalized Anxiety Disorder, and Certainty in Pessimistic Predictions about the Future

This study examined whether symptoms of GAD and depression were differentially associated with predictions individuals made about their future. Sixty-five undergraduates completed the BDI-II and GAD-Q-IV, predicted whether positive and negative events would happen to them in the future, and indicated their level of certainty about these predictions. Both higher GAD and depression symptoms were associated with an increased tendency to anticipate that negative events would happen. However, only depression was associated with the tendency to predict that positive events would not occur, even after adjusting for GAD symptoms. In addition, GAD and depression scores were positively associated with pessimistic certainty about negative events, but only depression was associated with increased certainty about both the occurrence of negative outcomes and a lack of positive outcomes, even after adjusting for GAD symptoms.

Cognitive content-specificity in future expectancies: Role of hopelessness and intolerance of uncertainty in depression and GAD symptoms

The present study examined cognitive content-specificity in future-event predictions associated with symptoms of depression and generalized anxiety disorder (GAD). College undergraduates (N=284) completed measures of depression, GAD, and rated their certainty that a given set of positive and negative outcomes were or were not likely to happen in their future. Participants also completed measures of hopelessness and intolerance of uncertainty (IU). Individuals (N=263) completed the same measures again 6 weeks later. Certainty in an absence of positive future outcomes was associated with symptoms of depression but not GAD, and hopelessness mediated this relationship - concurrently and when examining change scores over 6 weeks. Certainty in negative outcomes was concurrently associated with both symptoms of depression and GAD, and hopelessness partially mediated these relationships. IU predicted concurrent increases in depression and GAD symptoms, and negative-outcome certainty partially mediated the IU-depression but not the IU-GAD symptom relationship. Change in certainty did not mediate the relationship between changes in IU and GAD symptoms but partially mediated the relationship between change in IU and depression symptoms over time. Hopelessness appears to play a unique role in the relationship between reduced anticipation of positive future outcomes and depression. Although less clearly suggested by the data, IU may contribute to both depression and GAD symptoms but may do so through different pathways.

Adult attachment, emotion dysregulation, and symptoms of depression and generalized anxiety disorder

Differences in attachment style have been linked to both emotion regulation and psychological functioning, but the emotion regulatory mechanism through which attachment style might impact symptoms of depression and anxiety is unclear. The present study examined the explanatory role of emotion dysregulation in the relation between adult attachment style and symptoms of depression and generalized anxiety disorder (GAD) in a sample of 284 adults. Secure attachment was associated with lower depression and GAD symptoms and lower emotion dysregulation, whereas insecure attachment styles were generally associated with higher depression and GAD scores and higher emotion dysregulation. Perceived inability to generate effective emotion regulation strategies mediated the relation between insecure attachment and both depression and GAD symptoms. Nonacceptance of negative emotions and inability to control impulsive behaviors emerged as additional mediators of the relation between insecure attachment styles and GAD symptoms. The differential contribution of attachment style and emotion regulation to the prediction of depression and GAD symptoms may reflect differences in vulnerability to depression and GAD.

Cognitive inflexibility as a prospective predictor of suicidal ideation among young adults with a suicide attempt history

Previous studies suggest that people attempt suicide because they are cognitively inflexible, but past research suggesting a link between cognitive inflexibility and suicidal thoughts and behavior has been limited by cross‐sectional designs. This study examined whether cognitive inflexibility differentially and prospectively predicted suicidal ideation among young adults with and without a history of a suicide attempt.

Subtypes of Rumination in the Relationship Between Negative Life Events and Suicidal Ideation

The brooding and reflection forms of rumination were examined as mediators of the concurrent relationship between the impact of negative life events (INE), symptoms of depression, and suicidal ideation. An ethnically diverse sample of college undergraduates (N = 1,011) completed measures of negative life events and rumination, and they reported on their symptoms of depression and suicidal ideation. Brooding, but not reflection, partially mediated the INE-ideation relationship. Depression symptoms partially mediated the relationship between INE and suicidal ideation and between brooding and ideation. People who brood in response to negative life events may be vulnerable to thinking about suicide, partly due to symptoms of depression, but also as a result of brooding itself.

Significant Others and the Self

We subscribe to the assumption that the self is fundamentally relational—that is, entangled with significant others—such that key elements of the self are experienced in relation to significant others, even when others are not present. In our socialcognitive model of transference, transference occurs when a mental representation of a significant other is activated by cues in a new person that resemble the other. As a result, the self in relation to this significant other is activated, eliciting changes in affect, expectancies, motivations, and behaviors, as well as in the nature of the working self-concept, all reflecting the version of the self one is when with the significant other. Moreover, when people experience a threat to either a significant other relationship or the self in the context of an encounter with a new person who triggers transference, this sets into motion self-regulatory processes, which play out in relations with the new person. Overall, we argue that the evocation of prior experiences with significant others tells us something about the nature of the self, affect, and self-regulation that has implications for both resiliency and vulnerability.

Ruminative subtypes and coping responses: Active and passive pathways to depressive symptoms

Individuals draw on a variety of cognitive strategies—some active, some passive—as a way of coping with stress and dysphoria. Previous research suggests that the impact of rumination—one such strategy—on depression depends on whether rumination takes the passive form of brooding versus the more active form of reflection. This study tests whether brooding and reflection explain the effects of passive versus active coping responses, respectively, on depressive symptoms. In an undergraduate sample (n=284), brooding partially mediated the relationship between passive coping and depressive symptoms, whereas reflection did not. Reflection moderated the relationship between active coping and symptoms, such that low active copers who were high in reflection endorsed more symptoms than those low in reflection. Brooding and reflection may operate within cognitive–behavioural response pathways characterised by an active/passive distinction. Whether reflection is maladaptive likely depends on the active nature of the surrounding coping response.