Linguistic measures of psychological distance track symptom levels and treatment outcomes in a large set of psychotherapy transcripts.

SignificanceUsing language to "distance" ourselves from distressing situations (i.e., by talking less about ourselves and the present moment) can help us manage emotions. Here, we translate this basic research to discover that such "linguistic distancing" is a replicable measure of mental health in a large set of therapy transcripts (N = 6,229). Additionally, clustering techniques showed that language alone could identify participants who differed on both symptom severity and treatment outcomes. These findings lay the foundation for 1) tools that can rapidly identify people in need of psychological services based on language alone and 2) linguistic interventions that can improve mental health.

Voluntary pursuit of negatively valenced stimuli from childhood to early adulthood.

Although common sense suggests that we are motivated to pursue positive and avoid negative experiences, previous research shows that people regularly seek out negative experiences. In the current study, we characterized this tendency from childhood to young adulthood. Due to the known increases in risky behavior and sensation seeking in adolescence, we hypothesized that adolescents would show an increased engagement with negatively valenced stimuli compared to children and adults. Participants aged 4-25 (N = 192) completed a behavioral task assessing motivation to engage with negative, positive, and neutral images. On each trial, participants viewed two small images and selected one to view at a larger size for up to 10s. Trials were organized into three valence conditions: negative versus positive images (matched on arousal), negative versus neutral images, and positive versus neutral images. Although participants chose positive images more than neutral or negative images, participants selected negative images frequently, even when given a positive (28% of trials) or neutral (42% of trials) alternative. Contrary to expectations, the tendency to choose negative images was highest in early childhood and decreased linearly with increasing age, and the tendency to choose positive images increased linearly with age. These results provide insight into how motivation to engage with emotional stimuli varies across age. It is possible that the novelty and rarity of negative experiences drives children to pursue these stimuli. Alternatively, children may find negative images less aversive, which would caution against assuming that these stimuli elicit the same motivational states in individuals of all ages.

The Nonlinear Development of Emotion Differentiation: Granular Emotional Experience Is Low in Adolescence.

People differ in how specifically they separate affective experiences into different emotion types-a skill called emotion differentiation or emotional granularity. Although increased emotion differentiation has been associated with positive mental health outcomes, little is known about its development. Participants ( N = 143) between the ages of 5 and 25 years completed a laboratory measure of negative emotion differentiation in which they rated how much a series of aversive images made them feel angry, disgusted, sad, scared, and upset. Emotion-differentiation scores were computed using intraclass correlations. Emotion differentiation followed a nonlinear developmental trajectory: It fell from childhood to adolescence and rose from adolescence to adulthood. Mediation analyses suggested that an increased tendency to report feeling emotions one at a time explained elevated emotion differentiation in childhood. Importantly, two other mediators (intensity of emotional experiences and scale use) did not explain this developmental trend. Hence, low emotion differentiation in adolescence may arise because adolescents have little experience conceptualizing co-occurring emotions.

Emotions in "Black and White" or Shades of Gray? How We Think About Emotion Shapes Our Perception and Neural Representation of Emotion.

The demands of social life often require categorically judging whether someone's continuously varying facial movements express "calm" or "fear," or whether one's fluctuating internal states mean one feels "good" or "bad." In two studies, we asked whether this kind of categorical, "black and white," thinking can shape the perception and neural representation of emotion. Using psychometric and neuroimaging methods, we found that (a) across participants, judging emotions using a categorical, "black and white" scale relative to judging emotions using a continuous, "shades of gray," scale shifted subjective emotion perception thresholds; (b) these shifts corresponded with activity in brain regions previously associated with affective responding (i.e., the amygdala and ventral anterior insula); and (c) connectivity of these regions with the medial prefrontal cortex correlated with the magnitude of categorization-related shifts. These findings suggest that categorical thinking about emotions may actively shape the perception and neural representation of the emotions in question.

Utilization of Chiropractic Care at the World Games 2013.

OBJECTIVE: The purpose of this study was to describe chiropractic care use at the World Games 2013. METHODS: In this retrospective study, we reviewed treatment charts of athletes and non-athletes who sought chiropractic care at The World Games in Cali, Colombia, from July 25 to August 4, 2013. Doctors of chiropractic of the International Federation of Sports Chiropractic provided care. Chart notes included body region treated, treatment modality, and pretreatment and posttreatment pain ratings. RESULTS: Of the participants, 537 of 2964 accredited athletes and 403 of 4131 accredited non-athletes sought chiropractic treatment; these represent utilization rates of 18.1% for athletes and 9.8% for non-athletes. A total of 1463 treatments were recorded for athletes (n = 897) and non-athletes (n = 566). The athletes who were treated represented 28 of 33 sports and 68 of 93 countries that were present at the games. Among athletes, the thoracic spine was the most frequent area of treatment (57.2%), followed by the lumbar spine (48.7%) and the cervical spine (38.9%). Myotherapy was the most frequently used treatment method (80.9%), followed by chiropractic manipulation (78.5%), taping (38.0%), and mobilization (24.6%). Reports of acute injury were higher among athletes (45.4%) compared with non-athletes (23.8%). Reported pain was reduced after treatment (P < .001), and 86.9% patients reported immediate improvement after receiving chiropractic treatment. CONCLUSIONS: The majority of people seeking chiropractic care at an international sporting competition were athletes. For those seeking care, the injury rate was higher among athletes than among non-athletes. The majority of patients receiving chiropractic care reported improvement after receiving care.

Social norms shift behavioral and neural responses to foods.

Obesity contributes to 2.8 million deaths annually, making interventions to promote healthy eating critical. Although preliminary research suggests that social norms influence eating behavior, the underlying psychological and neural mechanisms of such conformity remain unexplored. We used fMRI to investigate whether group norms shift individuals' preferences for foods at both behavioral and neural levels. Hungry participants rated how much they wanted to eat a series of healthy and unhealthy foods and, after each trial, saw ratings that ostensibly represented their peers' preferences. This feedback was manipulated such that peers appeared to prefer each food more than, less than, or as much as participants themselves. After a delay, participants rerated each food. Participants' second ratings shifted to resemble group norms. Initial consensus, as compared to disagreement, with peers produced activity in the nucleus accumbens, a region associated with reward prediction errors. Furthermore, the strength of this activity predicted the extent to which participants' ratings conformed to peer ratings, suggesting that the value associated with consensus drives social influence. Ventromedial prefrontal cortex (vMPFC), a region associated with value computation, initially responded more strongly to unhealthy, as compared to healthy, foods. However, this effect was "overwritten" by group norms. After individuals learned their peers' preferences, vMPFC responses tracked the popularity, but not the healthfulness, of foods. Furthermore, changes in vMPFC activity tracked social influence over behavioral ratings. These data provide evidence that group norms can shift food preferences, supporting the use of norms-based interventions to promote healthy eating.

The Promise of Affective Language for Identifying and Intervening on Psychopathology.

We are in dire need of innovative tools for reducing the global burden of psychopathology. Emerging evidence suggests that analyzing language (i.e., the words people use) can grant insight into an individual's emotional experiences, their ability to regulate their emotions, and even their current experiences of psychopathology. As such, linguistic analyses of people's everyday word use may be a diagnostic marker of emotional well-being, and manipulating the words people use could foster adaptive emotion regulation and mental health. Given the ubiquity of language in everyday life, such language-based tools for measuring and intervening in emotion and mental health can advance how we identify and treat mental illnesses at a large scale. In this paper, I outline the promise of this approach and identify key problems we must solve if we are to make it a reality. In particular, I summarize evidence connecting language, emotion, and mental health for three key constructs: sentiment (i.e., the valence of one's language), linguistic distancing (i.e., using language to separate oneself from distressing stimuli), and emotion differentiation (i.e., using words to specifically identify one's emotions). I also identify open questions in need of attention for each of these constructs and this area of research as a whole. Overall, I believe the future is bright for the application of psycholinguistic approaches to mental health detection and intervention.

Managing fear and anxiety in development: A framework for understanding the neurodevelopment of emotion regulation capacity and tendency.

How we manage emotional responses to environmental threats is central to mental health, as difficulties regulating threat-related distress can blossom into symptoms of anxiety disorders. Given that anxiety disorders emerge early in the lifespan, it is crucial we understand the multi-level processes that support effective regulation of distress. Scholars have given increased attention to behavioral and neural development of emotion regulation abilities, particularly cognitive reappraisal capacity (i.e., how strongly one can down-regulate negative affect by reinterpreting a situation to change one's emotions). However, this work has not been well integrated with research on regulatory tendency (i.e., how often one spontaneously regulates emotion in daily life). Here, we review research on the development of both emotion regulation capacity and tendency. We then propose a framework for testing hypotheses and eventually constructing a neurodevelopmental model of both dimensions of emotion regulation. Clarifying how the brain supports both effective and frequent regulation of threat-related distress across development is crucial to identifying multi-level signs of dysregulation and developing interventions that support youth mental health.

Fluency generating emotion words correlates with verbal measures but not emotion regulation, alexithymia, or depressive symptoms.

How do you feel? To answer this question, one must first think of potential emotion words before choosing the best fit. However, we have little insight into how the ability to rapidly bring to mind emotion words-emotion fluency-relates to emotion functioning or general verbal abilities. In this study, we measured emotion fluency by counting how many emotion words participants could generate in 60 s. Participants (N = 151 in 2011-2012) also completed a behavioral measure of verbal fluency (i.e., how many words starting with "P" or "J" participants could produce in 60 s), a cognitive reappraisal emotion regulation task, and emotion functioning questionnaires. In preregistered analyses, we found that participants produced more negative emotion words than positive words and more positive words than neutral words in the emotion fluency task. As hypothesized, emotion fluency was positively related to verbal fluency, but contrary to hypotheses, emotion fluency was not related to self-reported or task-based emotion functioning (e.g., alexithymia, depression, and emotion regulation ability). As such, in community samples, emotion fluency may reflect general cognitive abilities rather than processes crucial to emotional well-being. While emotion fluency as measured here does not track indices of well-being, future research is needed to investigate potential contexts in which verbal fluency for emotion words may be key to emotion regulation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Affective language spreads between anxious children and their mothers during a challenging puzzle task.

Humans influence each other's emotions. The spread of emotion is well documented across behavioral, psychophysiological, and neuroscientific levels of analysis, but might this influence also be evident in language (e.g., are people more likely to use emotion words after hearing someone else use them)? The current study tests whether mothers and children influence each other's use of affective language. From 2018 to 2020, children aged 6-12 who met diagnostic criteria for anxiety disorders and their mothers (N = 93 dyads) completed a challenging puzzle task while being video recorded. Analyses of transcriptions revealed that mothers and children indeed influenced each other's language. Bidirectional influence was observed for use of negative affect words: Mothers were more likely to use negative affect words if their child had just used negative affect words (over and above mothers' own language on their previous turn), and children were similarly influenced by mother affect word use. A similar bidirectional relation emerged for linguistic distance, a measure related to effective emotion regulation and mental health. However, the significance of the child-to-mother direction of influence for these two variables varied depending on correction threshold and should thus be verified in future research. Nonetheless, these findings extend understanding of emotional influence by showing turn-by-turn relations between the use of affective language. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Linguistic distancing predicts response to a digital single-session intervention for adolescent depression.

Examining the linguistic characteristics of youths' writing may be a promising method for detecting youth who are struggling. In this study, we examined linguistic patterns of adolescent responses to writing prompts in a large, well-powered trial of an evidence-based, digital single-session intervention teaching malleability beliefs about personal traits and symptoms ("growth mindset"). Participants who completed the intervention as part of a larger randomized control trial were included in this preregistered study (n = 638, https://osf.io/zqmxt). Participants' responses were processed using Linguistic Inquiry and Word Count. We tested correlations between linguistic variables (i.e., linguistic distancing, positive affect, negative affect, insight, certainty), baseline outcome variables, post-intervention outcome variables, and 3-month post-intervention outcome variables. We also used Least Absolute Shrinkage and Selection Operator (LASSO) regression models to identify key predictors of treatment outcomes. As hypothesized, greater use of linguistic distancing was associated with lower levels of baseline hopelessness and higher levels of perceived agency. Additionally, per LASSO models including all linguistic variables, greater use of linguistic distancing predicted larger reductions in depressive symptoms from baseline to three-month follow-up. Linguistic distancing appeared to account for 27% of the variance in depression trajectories when also accounting for baseline depression. CLINICAL REGISTRATION NO: NCT04634903.

A Cognitive-Behavioral Formulation of Narcissistic Self-Esteem Dysregulation.

Narcissistic personality disorder (NPD) is a commonly encountered diagnosis, affecting approximately 1%-6% of the population, with no evidence-based treatments. Recent scholarship has focused on self-esteem dysregulation as a key component of NPD: Excessively high expectations for oneself and how one should be treated leads to brittle self-esteem and maladaptive reactions to self-esteem threats. The current article builds on this formulation, introducing a cognitive-behavioral model of narcissistic self-esteem dysregulation that clinicians can use in providing a relatable model of change for their patients. Specifically, symptoms of NPD can be seen as a set of cognitive and behavioral habits that serve to regulate difficult emotions emerging from maladaptive beliefs and interpretations of self-esteem threats. This perspective renders narcissistic dysregulation amenable to cognitive-behavioral therapy (CBT) in which patients learn skills that help them gain awareness around these habitual reactions, reshape cognitive distortions, and engage in behavioral experiments that serve to transform maladaptive belief systems that consequently free them from symptomatic reactions. Here, we provide a precis of this formulation and examples of how CBT skills can be used to treat narcissistic dysregulation. We also discuss future research that could provide empirical support for the model and test the efficacy of CBT approaches to NPD. Conclusions focus on the notion that narcissistic self-esteem dysregulation likely varies continuously in the population and transdiagnostically across disorders. Greater insight into the cognitive-behavioral mechanisms of self-esteem dysregulation could foster tools for ameliorating distress both in people with NPD and the general populace.

Emotion Differentiation and Youth Mental Health: Current Understanding and Open Questions.

A growing body of research identifies emotion differentiation-the ability to specifically identify one's emotions-as a key skill for well-being. High emotion differentiation is associated with healthier and more effective regulation of one's emotions, and low emotion differentiation has been documented in several forms of psychopathology. However, the lion's share of this research has focused on adult samples, even though approximately 50% of mental disorders onset before age 18. This review curates what we know about the development of emotion differentiation and its implications for youth mental health. I first review published studies investigating how emotion differentiation develops across childhood and adolescence, as well as studies testing relations between emotion differentiation and mental health in youth samples. Emerging evidence suggests that emotion differentiation actually falls across childhood and adolescence, a counterintuitive pattern that merits further investigation. Additionally, several studies find relations between emotion differentiation and youth mental health, but some instability in results emerged. I then identify open questions that limit our current understanding of emotion differentiation, including (i) lack of clarity as to the valid measurement of emotion differentiation, (ii) potential third variables that could explain relations between emotion differentiation and mental-health (e.g., mean negative affect, IQ, personality, and circularity with outcomes), and (iii) lack of clear mechanistic models regarding the development of emotion differentiation and how it facilitates well-being. I conclude with a discussion of future directions that can address open questions and work toward interventions that treat (or even prevent) psychopathology.

Emotion Naming Impedes Both Cognitive Reappraisal and Mindful Acceptance Strategies of Emotion Regulation.

Friends and therapists often encourage people in distress to say how they feel (i.e., name their emotions) with the hope that identifying their emotions will help them cope. Although lay and some psychological theories posit that emotion naming should facilitate subsequent emotion regulation, there is little research directly testing this question. Here, we report on two experimental studies that test how naming the emotions evoked by aversive images impacts subsequent regulation of those emotions. In study 1 (N = 80), participants were randomly assigned into one of four between-subjects conditions in which they either (i) passively observed aversive images, (ii) named the emotions that these images made them feel, (iii) regulated their emotions by reappraising the meaning of images, or (iv) both named and regulated their emotions. Analyses of self-reported negative affect revealed that emotion naming impeded emotion regulation via reappraisal. Participants who named their emotions before reappraising reported feeling worse than those who regulated without naming. Study 2 (N = 60) replicated these findings in a within-participants design, demonstrated that emotion naming also impeded regulation via mindful acceptance, and showed that observed effects were unrelated to a measure of social desirability, thereby mitigating the concern of experimenter demand. Together, these studies show that the impact of emotion naming on emotion regulation opposes common intuitions: instead of facilitating emotion regulation via reappraisal or acceptance, constructing an instance of a specific emotion category by giving it a name may "crystalize" one's affective experience and make it more resistant to modification. Supplementary Information: The online version contains supplementary material available at 10.1007/s42761-021-00036-y.

High emotion differentiation buffers against internalizing symptoms following exposure to stressful life events in adolescence: An intensive longitudinal study.

Exposure to stressful life events is strongly associated with internalizing psychopathology, and identifying factors that reduce vulnerability to stress-related internalizing problems is critical for development of early interventions. Drawing on research from affective science, we tested whether high emotion differentiation-the ability to specifically identify one's feelings-buffers adolescents from developing internalizing symptoms when exposed to stress. Thirty adolescents completed a laboratory measure of emotion differentiation before an intensive year-long longitudinal study in which exposure to stress and internalizing problems were assessed at both the moment-level (n=4,921 experience sampling assessments) and monthly-level (n=355 monthly assessments). High negative and positive emotion differentiation attenuated moment-level coupling between perceived stress and feelings of depression, and high negative emotion differentiation eliminated monthly-level associations between stressful life events and anxiety symptoms. These results suggest that high emotion differentiation buffers adolescents against anxiety and depression in the face of stress, perhaps by facilitating adaptive emotion regulation.

Developmental Variation in the Associations of Attention Bias to Emotion with Internalizing and Externalizing Psychopathology.

Attention biases to emotion are associated with symptoms of internalizing and externalizing psychopathology in children and adolescents. It is unknown whether attention biases to emotion and their associations with different symptoms of psychopathology vary across development from early childhood through young adulthood. We examine this age-related variation in the current study. Participants (N = 190; ages: 4-25) completed survey-based psychopathology symptom measures and a dot-probe task to assess attention bias to happy, sad, and angry relative to neutral faces. We tested whether linear or non-linear (e.g., spline-based models) associations best characterized age-related variation in attention to emotion. We additionally examined whether attention biases were associated with depression, anxiety, and externalizing symptoms and whether these associations varied by age. No age-related differences in attention biases were found for any of the emotional faces. Attention biases were associated with psychopathology symptoms, but only when examining moderation by age. Biased attention to angry faces was associated with greater symptoms of anxiety and depression in adolescents and young adults, but not children. Similarly, biased attention to happy faces was associated with externalizing symptoms in adolescents and young adults, but not in children. In contrast, biased attention to happy faces was associated with greater anxiety symptoms in children, but not in adolescents or young adults. Biased attention toward social threat and reward becomes more strongly coupled with internalizing and externalizing symptoms, respectively, during the transition to adolescence. These findings could inform when interventions such as attention bias modification training may be most effective.

A year in the social life of a teenager: Within-person fluctuations in stress, phone communication, and anxiety and depression.

Stressful life events (SLEs) are strongly associated with the emergence of adolescent anxiety and depression, but the underlying mechanisms remain poorly understood, especially at the within-person level. We investigated how adolescent social communication (i.e., frequency of calls and texts) following SLEs relates to changes in internalizing symptoms in a multi-timescale intensive year-long study (N=30; n=355 monthly observations; n=~5,000 experience-sampling observations). Within-person increases in SLEs were associated with receiving more calls than usual at both monthly- and momentary-levels, and making more calls at the monthly-level. Increased calls were prospectively associated with worsening internalizing symptoms at the monthly-level only, suggesting that SLEs rapidly influences phone communication patterns, but these communication changes may have a more protracted, cumulative influence on internalizing symptoms. Finally, increased incoming calls prospectively mediated the association between SLEs and anxiety at the monthly-level. We identify adolescent social communication fluctuations as a potential mechanism conferring risk for stress-related internalizing psychopathology.

Do Patterns and Types of Negative Affect During Hospitalization Predict Short-Term Post-Discharge Suicidal Thoughts and Behaviors?

We still have little understanding of short-term predictors of suicidal thoughts and behaviors (STBs). Prior research links increased negative affect to STBs, but the vast majority of earlier work is limited by measuring negative affect at one time point and aiming to predict STBs months or years in the future. Recently, intensive longitudinal studies have shown that negative affect is associated with suicidal thoughts over relatively short, clinically useful time periods; however, the specific patterns and types of negative affect that predict STBs remain unclear. Using ecological momentary assessment (EMA) data from psychiatric inpatients hospitalized for suicide risk (N = 83), this study sought to test whether the patterns (means and variability) of two types of negative affect (anxiety/agitation and shame/self-hatred, which were derived from a larger EMA battery) during hospitalization predict STBs in the four weeks after discharge: an extremely high-risk time for suicidal behavior. The mean - but not the variability - of both anxiety/agitation and shame/self-hatred during hospitalization predicted the number of days with suicidal thoughts after discharge. The mean and the variability of shame/self-hatred - but not anxiety/agitation - predicted post-discharge suicide attempt. We discuss implications for assessment and treatment of suicidal individuals and propose key directions for future research.

Using Topic Modeling to Detect and Describe Self-Injurious and Related Content on a Large-Scale Digital Platform.

OBJECTIVE: Self-injurious thoughts and behaviors (SITBs) are a complex and enduring public health concern. Increasingly, teenagers use digital platforms to communicate about a range of mental health topics. These discussions may provide valuable information that can lead to insights about complex issues like SITBs. However, the field of clinical psychology currently lacks an easy-to-implement toolkit that can quickly gather information about SITBs from online sources. In the present study, we applied topic modeling, a natural language processing technique, to identify SITBs and related themes online, and we validated this approach using human coders. METHOD: We separately used topic modeling software and human coders to identify themes present in text from a popular online Internet support forum for teenagers. We then determined the degree to which results from the software's topic model aligned with themes identified by human coders. RESULTS: We found that topic modeling detected SITBs and related themes in online discussions in a way that accurately distinguishes between relevant and irrelevant human-coded themes. CONCLUSIONS: This approach has the potential to drastically increase our understanding of SITBs and related issues discussed on digital platforms, as well as our ability to identify those at risk for such outcomes.

Use of linguistic distancing and cognitive reappraisal strategies during emotion regulation in children, adolescents, and young adults.

Regulating one's emotions is an important psychological skill at all ages. Cognitive reappraisal-changing the meaning of a stimulus to alter its emotional impact-is an effective emotion regulation technique. Prior work shows that adults spontaneously reduce their use of present tense verbs and first-person singular pronouns (e.g., I, me, mine) when engaging in cognitive reappraisal, a linguistic shift that is thought to track increased psychological distance. Here, we investigated whether such linguistic distancing during emotion regulation varied across age. Participants aged 10 to 23 (N = 112) spoke aloud their thoughts and feelings while completing a classic cognitive reappraisal task. Participants' verbal responses were recorded, transcribed, and analyzed for linguistic distancing, compliance with reappraisal instructions, and use of 8 different reappraisal strategies identified by prior researchers. Results replicated prior work in a developmental sample: Reappraisal decreased negative affect and increased linguistic distancing, and stronger linguistic distancing during reappraisal was associated with more successful emotion regulation. Contrary to hypotheses, we found no age differences in linguistic distancing or reappraisal success, even after excluding trials on which participants did not comply with reappraisal instructions. However, reappraisal strategy use varied across age. Use of the changing circumstances and separating oneself (i.e., distancing) strategies increased across age whereas changing consequences use decreased across age. Additionally, in adolescence, challenging reality use was elevated and problem-solving use was reduced compared to other ages. Results suggest that linguistic distancing during emotion regulation is stable from age 10 to 23 but use of cognitive reappraisal strategies differs. (PsycInfo Database Record (c) 2020 APA, all rights reserved).