Self-guided imagery rescripting for worry images: A preliminary experimental investigation.

BACKGROUND: Mental images of feared events are overactive and intrusive in generalized anxiety disorder (GAD). Imagery rescripting involves integration of positive or neutral imagery and corrective information into images to facilitate emotional processing, reduce imagery intrusions, and re-structure underlying schema. Yet only one known study has applied the technique to treatment of worry. The present study aimed first to examine the relationship between trait worry and properties of future-oriented worry images, and second to examine the efficacy of a self-guided imagery rescripting intervention in improving individuals' response to their worries. METHODS: Participants recruited through Amazon Mechanical Turk (N = 365) identified their major worry and wrote the script of a worst-case scenario mental image. Participants were randomized to three conditions: re-writing the same worry image script (exposure), or writing scripts of either one or three positive alternative future-oriented images (rescripting conditions). RESULTS: In preliminary analyses, trait worry negatively predicted participants' ratings of worry images, including valence and ability to cope, and positively predicted distress, anticipated cost, and belief in their negative meaning. In experimental analyses, linear mixed-effects models revealed anxious response and cognitive appraisal of the threat were significantly lower among participants allocated to rescripting relative to exposure. There was no effect of rescripting type. CONCLUSIONS: This investigation demonstrated the impact of a future-oriented imagery rescripting task on anxiety and cognitive biases associated with real worries in an unselected sample. Results may contribute to the development of imagery rescripting interventions for GAD.

Imagery-enhanced v. verbally-based group cognitive behavior therapy for social anxiety disorder: a randomized clinical trial.

BACKGROUND: Cognitive behavior therapy (CBT) is effective for most patients with a social anxiety disorder (SAD) but a substantial proportion fails to remit. Experimental and clinical research suggests that enhancing CBT using imagery-based techniques could improve outcomes. It was hypothesized that imagery-enhanced CBT (IE-CBT) would be superior to verbally-based CBT (VB-CBT) on pre-registered outcomes. METHODS: A randomized controlled trial of IE-CBT v. VB-CBT for social anxiety was completed in a community mental health clinic setting. Participants were randomized to IE (n = 53) or VB (n = 54) CBT, with 1-month (primary end point) and 6-month follow-up assessments. Participants completed 12, 2-hour, weekly sessions of IE-CBT or VB-CBT plus 1-month follow-up. RESULTS: Intention to treat analyses showed very large within-treatment effect sizes on the social interaction anxiety at all time points (ds = 2.09-2.62), with no between-treatment differences on this outcome or clinician-rated severity [1-month OR = 1.45 (0.45, 4.62), p = 0.53; 6-month OR = 1.31 (0.42, 4.08), p = 0.65], SAD remission (1-month: IE = 61.04%, VB = 55.09%, p = 0.59); 6-month: IE = 58.73%, VB = 61.89%, p = 0.77), or secondary outcomes. Three adverse events were noted (substance abuse, n = 1 in IE-CBT; temporary increase in suicide risk, n = 1 in each condition, with one being withdrawn at 1-month follow-up). CONCLUSIONS: Group IE-CBT and VB-CBT were safe and there were no significant differences in outcomes. Both treatments were associated with very large within-group effect sizes and the majority of patients remitted following treatment.

How technology can enhance treatment: A scoping review of clinical interventions for anxiety and obsessive-compulsive spectrum disorders.

OBJECTIVES: Researchers are increasingly investigating how technology could be used to improve the efficacy of treatment for anxiety and obsessive-compulsive (OC) spectrum disorders. A broad range of technologies, disorders and therapeutic processes have been examined in the literature. This review summarizes the evidence for using technology in clinical interventions for anxiety and OC-spectrum disorders and highlights research gaps that should be addressed to improve the evidence base. METHODS: A scoping review was conducted based on systematic searches of three databases. Broadly, the criteria included interventions that had integrated technology into clinical contexts to enhance treatment for anxiety and OC-spectrum disorders. All records were double-screened by two reviewers, and data were extracted on the characteristics of interventions, symptom outcomes, and implementation factors. RESULTS: Searches returned 2,475 studies, of which 117 were eligible for inclusion in this review. Although almost all studies reported pre-post-symptom reductions, only one quarter of the controlled studies demonstrated additive effect of technology-based interventions in between-group analyses. We noted a trend in underreporting implementation factors. CONCLUSIONS: Technology-based interventions can improve the efficacy of treatment for anxiety and OC-spectrum disorders, but there are challenges to achieving this goal. Based on a review of the included studies, we provide four specific recommendations to improve the quality and likelihood of success of future research projects. PRACTITIONER POINTS: Technology-based adjuvants are unlikely to improve the efficacy of treatment for anxiety or OC-spectrum disorders based on their novelty or convenience alone. A subset of studies gives hope that specific innovations can improve treatment when targeting a therapeutic process that has been problematic. Clinicians seeking to improve the efficacy of their treatment should first define client-specific therapeutic factors (e.g., homework compliance) that could be leveraged, then apply a specific innovation to address this factor.

Object attachment and emotions in hoarding disorder.

BACKGROUND AND AIMS: Object attachment is a core feature of hoarding disorder (HD), but it also occurs in people without HD. It is therefore critical to clarify differences between normal and abnormal object attachment. Although previous studies show that HD is associated with high emotional reactivity, no study to date has examined the nature and intensity of discrete emotions in people with and without HD in relation to object attachment. METHOD: Individuals with HD (n = 93) and matched controls (n = 93) were recruited via MTurk. They identified and described a possession of low monetary value that they were emotionally attached to and found difficult to discard. Participants rated their object attachment and the intensity of emotions when imagining being with the object (Scenario A) and irretrievably losing the same object (Scenario B). RESULTS: Unexpectedly, there were no significant between-group differences on object attachment; however, the HD group experienced more incongruent emotions about their possessions; they reported significantly higher disgust, anxiety and anger than controls when they imagined being with their chosen object (Scenario A) and were more relaxed compared to controls when the object was lost (Scenario B). There were no significant differences between groups on congruent emotions (i.e., positive emotions in Scenario A or negative emotions in Scenario B). CONCLUSION: People with and without HD experience similar emotional attachment for sentimental items but people with HD experience more mixed emotions, consistent with an insecure object attachment.

Obsessive-compulsive disorder and the risk of subsequent mental disorders: A community study of adolescents and young adults.

BACKGROUND: Comorbidity of obsessive-compulsive disorder (OCD) with other mental disorders has been demonstrated repeatedly. Few longitudinal studies, however, have evaluated the temporal association of prior OCD and subsequent mental disorders across the age period of highest risk for first onset of mental disorders. We examined associations between prior OCD and a broad range of subsequent mental disorders and simulated proportions of new onsets of mental disorders that could potentially be attributed to prior OCD, assuming a causal relationship. METHODS: Data from 3,021 14- to 24-year-old community subjects were prospectively collected for up to 10 years. DSM-IV OCD and other DSM-IV mental disorders were assessed with the Munich-Composite International Diagnostic Interview. We used adjusted time-dependent proportional hazard models to estimate the temporal associations of prior OCD with subsequent mental disorders. RESULTS: Prior OCD was associated with an increased risk of bipolar disorders (BIP; [hazard ratio, HR = 6.9, 95% confidence interval, CI, (2.8,17.3)], bulimia nervosa [HR = 6.8 (1.3,36.6)], dysthymia [HR = 4.4 (2.1,9.0)], generalized anxiety disorder (GAD; [HR = 3.4 (1.1,10.9)], and social phobia [HR = 2.9 (1.1,7.7)]). Of these outcome disorders, between 65 and 85% could be attributed to OCD in the exposed group, whereas between 1.5 and 7.7% could be attributed to OCD in the total sample. CONCLUSIONS: This study provides strong evidence that prior OCD is associated with an increased risk of subsequent onset of BIP, bulimia nervosa, dysthymia, GAD, and social phobia among adolescents and young adults. Future studies should evaluate if early treatment of OCD can prevent the onset of these subsequent mental disorders.

Scrupulosity and hoarding.

OBJECTIVE: Recent evidence suggests that avoiding waste may be a prominent motive to save in hoarding disorder. Such beliefs are reminiscent of scrupulosity obsessions in OCD. This paper reports on three studies examining scrupulosity-like beliefs in hoarding and the development and validation of a measure of material scrupulosity. METHODS: Study one examined the reliability and validity of a measure of material scrupulosity (MOMS) and its relationship to hoarding in a college student sample, as well as the relationship between hoarding and OCD-base scrupulosity. Study 2 examined the psychometric properties of the MOMS in a replication of study 1 with a sample of people with hoarding problems. Study 3 examined the reliability and validity of the MOMS in a large nonclinical/community sample. RESULTS: Findings across the studies provided evidence for the reliability and validity of the MOMS. It was highly correlated with hoarding symptoms, especially difficulty discarding, and hoarding related beliefs, especially responsibility beliefs. It accounted for significant variance in hoarding symptoms independent of other correlates, including other hoarding beliefs. OCD-based scrupulosity was correlated with hoarding in sample 1, but not in the hoarding sample in study 2. CONCLUSIONS: Material Scrupulosity refers to an exaggerated sense of duty or moral/ethical responsibility for the care and disposition of possessions to prevent their being harmed or wasted. It appears to be distinct from other hoarding-related beliefs and a significant predictor of hoarding symptoms. The MOMS appears to possess good reliability and validity in both clinical and nonclinical samples.

Body dysmorphic disorder and its associated psychological and psychopathological features in an Italian community sample.

OBJECTIVE: Body Dysmorphic Disorder (BDD) is a psychiatric condition characterized by preoccupation with perceived defects in physical appearance that are not observable or appear slight to others, along with low self-esteem, high perfectionism, and high comorbidity. Little is known about BDD prevalence and phenomenology in the Italian context, and no data are currently available on BDD prevalence using DSM-5 criteria in the Italian context. The aims of the current study were to explore the prevalence and the phenomenology of BDD and its associated psychological and psychopathological features such as self-esteem, perfectionistic traits, social anxiety, depressive, and obsessive-compulsive symptoms in a community sample. METHODS: Six hundred and fifteen community individuals completed a battery of self-report questionnaires. RESULTS: 10 (1.63%) individuals met DSM-5 diagnostic criteria for BDD; hair, nose and teeth were the most common areas of concern. Individuals with BDD reported also lower levels of self-esteem, more severe social anxiety symptomatology, general distress, depression and obsessive-compulsive features than people without BDD. CONCLUSIONS: BDD is not a rare condition in the Italian context and it emerged to be associated with significant morbidity.

Psychological need satisfaction, control, and disordered eating.

OBJECTIVES: Unfulfilled basic psychological needs have been associated with disordered eating behaviours, but the mechanisms underlying that associations are not well understood. This study examined a two-stage path model linking basic psychological need satisfaction to disordered eating behaviours via issues of control. METHODS: Female university students (N = 323; Mage  = 19.61), community participants (N = 371; Mage  = 29.75), and women who self-reported having been diagnosed with an eating disorder (ED; N = 41; Mage  = 23.88) completed measures of psychological need satisfaction (i.e., autonomy and competence), issues of control (i.e., feelings of ineffectiveness and fear of losing self-control [FLC]), and ED pathology. RESULTS: Path analysis revealed that unsatisfied needs of autonomy and competence were indirectly related to disordered eating behaviours through feelings of ineffectiveness and FLC. CONCLUSIONS: The results indicate that issues of control might be one of the mechanisms through which lack of psychological need satisfaction is associated with disordered eating. Although the model was constructed using cross-sectional data, these findings suggest potential targets for prevention and treatment efforts aimed at reducing disordered eating in young females. PRACTITIONER POINTS: Our results indicate that young women with chronically unfulfilled basic psychological needs might be vulnerable to developing disordered eating behaviours. The observed patterns suggest that persistent experience of need frustration may engender an internal sense of ineffectiveness and lack of control, which then compels individuals to engage in disordered eating behaviours in an attempt to regain autonomy and competence. Interventions for eating disorders may be most effective when emphasizing the promotion of people's needs for autonomy and competence. Limitations The model was constructed using cross-sectional data. Future experimental and longitudinal studies are needed to confirm the temporal sequence from basic psychological needs to issues of control. The sample only consisted of young women. Further research should explore how thwarting of psychological need satisfaction functions in men. Our clinical sample was small and diagnosis was not confirmed through clinical interview; therefore, those data should be interpreted with caution.

Cognitive and psychophysiological correlates of disgust in obsessive-compulsive disorder.

OBJECTIVES: Evidence suggests that obsessive-compulsive disorder (OCD) is characterized by heightened self-reported disgust, however, it is unclear if this extends to physiology. The relationship between obsessive beliefs and disgust also remains poorly understood. Therefore, we examined whether the heightened trait and self-reported disgust observed in individuals with OCD is reflected in heightened physiological disgust responses. We also examined whether obsessive beliefs are associated with disgust responding. DESIGN: A 3 (group) × 6 (stimulus) repeated measures design was used to examine disgust responses in individuals with OCD to six categories of image stimuli: body waste, contamination, injury, sociomoral, neutral, negative non-disgust. METHODS: Individuals with OCD (n = 25) were compared to individuals with non-OCD anxiety disorders (n = 21) and healthy participants (n = 25) with respect to trait, self-reported, facial electromyographic and electrodermal disgust responses. RESULTS: Individuals with OCD showed greater disgust propensity and self-reported disgust to images of body waste compared to healthy and anxious participants, however, there were no group differences in physiological responses. After controlling for trait disgust, obsessive beliefs positively correlated with increased self-reported disgust to neutral images and increased levator labii activity to negative non-disgusting images. CONCLUSIONS: Although individuals with OCD showed elevated disgust propensity and self-reported ratings of body waste stimuli, there was little evidence that OCD is characterized by an abnormal physiological disgust response. The intensity of obsessive beliefs was associated with a tendency to respond with disgust in contexts that are non-disgusting, indicating that obsessive beliefs may be implicated in pathological disgust. PRACTITIONER POINTS: Individuals with OCD display greater levels of disgust propensity and self-reported disgust to images of body waste compared to healthy control participants and individuals with non-OCD anxiety disorders. The abnormalities in self-reported disgust observed in those with OCD do not extend to abnormalities in electrodermal activity or facial electromyographic responses. Maladaptive obsessive beliefs commonly associated with OCD predict heightened disgust in contexts where objective sources of disgust are absent, even after controlling for trait disgust. Maladaptive obsessive beliefs may therefore be implicated in pathological disgust. This study used a heterogeneous OCD sample and future research is needed to determine whether the observed effects are greater for those with primarily washing and contamination symptoms. Although group differences emerged in self-reported disgust, further replications using measures of state anxiety are needed to rule out the possibility that heightened self-reported disgust was confounded with co-occurring fear or general negative affect.

Testing an Imagery Rescripting Exercise Targeting Fear of Self.

A feared possible self refers to the unwanted characteristics that a person may possess or develop. We tested an experimental paradigm to target fear of possible self using imagery rescripting. A student sample (n = 91), with moderate obsessive-compulsive disorder symptoms, engaged in written and audio-guided exercises to evoke episodic future mental imagery that represented their feared possible self. Participants were then randomized between imagery rescripting or neutral imagery control tasks. The results revealed no difference between conditions in fear of self or general obsessional beliefs following the manipulation. State anxiety and the urge to neutralize the imagery reduced more in the control condition than in the rescripting condition. These findings suggest that the current paradigm is emotionally engaging but not effective at addressing fear of self as measured. Methodological improvements such as removing a written component of the rescripting task and idiosyncratic measuring of fear of self are proposed.

Basic processes and clinical applications of mental imagery in worry: A systematic review.

BACKGROUND: In this systematic review, we aimed to synthesise existing research on the phenomenology of mental imagery among high worriers compared to healthy individuals, and to characterise the nature and effectiveness of existing imagery-related interventions in treatment of worry. METHODS: PsycInfo, CENTRAL, EMBASE, Medline, Medline Epub, and PubMed were searched for studies examining the relationship between worry/GAD and mental imagery, or interventions using imagery in treatment of worry/GAD. We assessed study quality and used qualitative narrative synthesis to comprehensively map study results. RESULTS: The search yielded 2589 abstracts that were assessed for eligibility independently by two authors. From this, 183 full texts were screened and 50 qualitatively synthesised. Twenty-seven reported an association between worry/GAD and an aspect of mental imagery. Here, overactive negative and worry imagery, and diminished positive future imagining, were associated with worry/GAD. Twenty-three studies reported an intervention. This literature suggested mixed findings regarding efficacy, including for imaginal exposure as an independent technique for GAD. CONCLUSIONS: Findings support dysfunctional negative imagining and diminished positive prospective imagery in GAD. General imagining abilities remain intact, which is promising for efforts to utilise imagery in treatment. Further research is warranted to develop innovative clinical applications of imagery in treatment of GAD.

A phase II randomised controlled trial of intranasal oxytocin in anorexia nervosa.

BACKGROUND: Anorexia nervosa (AN) is an eating disorder (ED) with high mortality rates and limited response to existing treatments, prompting the need to identify effective agents and adjuncts. There is evidence for an emerging role for the neuropeptide oxytocin (OT) in the pathophysiology of AN, with studies showing a perturbed oxytocinergic system in patients with AN. Preliminary evidence has demonstrated that intranasal OT (IN-OT) can produce anxiolytic effects in AN, as well as reducing concern about eating, and dysfunctional attentional biases related to the disorder. IN-OT is a non-invasive treatment option for AN that requires investigation as an adjunct to nutritional rehabilitation. METHODS: This multi-site study (Trial Registration:ACTRN1261000897460) sought to replicate and extend a previous randomised placebo-controlled pilot trial of repeated dose IN-OT in patients with AN hospitalised for nutritional rehabilitation. Patients with AN (N=61) received daily IN-OT (18 IU twice per day) or placebo for four weeks, whilst undergoing inpatient hospital treatment. Outcome measures included ED psychopathology (primary) as measured by the Eating Disorder Examination (EDE) and Body Mass Index (BMI; secondary). Participants were assessed pre- and post-treatment, and at six months following the intervention. The effects of the first and last doses of IN-OT on responses (anxiety ratings and salivary cortisol) to a high-energy snack were also examined. RESULTS: Sixty-one female inpatients (Mage=24.36,SD=7.87) with an average BMI of 16.24 (range: 11.43-18.55), were recruited into the study. No significant differences were found between placebo and OT groups at any of the time points on the outcomes of interest, but significant improvements in almost all psychological parameters in both groups were evident over time. IN-OT did not significantly reduce anxiety nor salivary cortisol in response to a high-calorie snack. CONCLUSION: This is the largest randomised placebo-controlled trial of repeated dose intranasal OT in people with AN, during refeeding. The therapeutically promising findings of the pilot study were not replicated. Limitations and reasons for the non-replication included relatively large variance, baseline psychopathology scores being higher in this patient group, potential ceiling effects in BMI and ED psychopathology as well as differing comorbidities.

Cognitive Bias Modification (CBM) of obsessive compulsive beliefs.

BACKGROUND: Cognitive bias modification (CBM) protocols have been developed to help establish the causal role of biased cognitive processing in maintaining psychopathology and have demonstrated therapeutic benefits in a range of disorders. The current study evaluated a cognitive bias modification training paradigm designed to target interpretation biases (CBM-I) associated with obsessive compulsive disorder (OCD). METHODS: We evaluated the impact of CBM-I on measures of interpretation bias, distress, and on responses to three OC stressor tasks designed to tap the core belief domains of Importance of Thoughts/Control, Perfectionism/Intolerance of Uncertainty, and Contamination/Estimation of Threat in a selected sample of community members reporting obsessive compulsive (OC) symptoms (N = 89). RESULTS: Participants randomly assigned to the Positive condition evidenced a change in interpretation bias towards more positive and less negative OC-relevant interpretations following CBM-I compared to participants assigned to the Control condition. Importantly, a positivity bias was not observed for foil scenarios unrelated to the core OC belief domains. Further, participants in the Positive condition reported less distress and urge to neutralize following an OC stressor task designed to tap Importance of Thoughts/Control. No significant difference emerged on the indices of behavioural response to the OC stressor tasks. Severity of OC symptoms did not moderate the effects of positive CBM-I training. CONCLUSIONS: CBM-I appears effective in selectively targeting OC beliefs. Results need to be replicated in clinical samples in order for potential therapeutic benefit to be demonstrated.

Evaluating the effects of a brief motivational interviewing protocol on excessive acquisition.

BACKGROUND AND OBJECTIVES: Individuals with hoarding disorder, especially those with problems around acquiring, typically demonstrate a lack of motivation and awareness of their problematic behaviours. Since acquiring behaviours are important targets in interventions for hoarding, effective strategies for increasing motivation in this population are required to enhance the acceptability and efficacy of these interventions. METHODS: The aim of the current study was to evaluate the ability of a brief online motivational intervention to reduce acquiring in a community sample of high acquirers (N = 159). Participants were randomly assigned to either a motivational interviewing protocol (n = 73) or progressive muscle relaxation control condition (n = 86). Readiness to change and motivation to acquire was measured via self-report, and acquiring behaviour was measured using a modified version of the Preston Acquisition Decision Making Task (to increase ecological validity). RESULTS: In both conditions, participants' readiness and motivation to change increased over time. Contrary to hypotheses, the magnitude of this improvement did not significantly differ between conditions. Furthermore, conditions did not perform differently on the behavioural measure of acquiring. LIMITATIONS: Insufficient dose of the intervention may have precluded any differences being observed between conditions. CONCLUSIONS: Results underscore the need to better address the problem of lowered motivation in this population.

Pilot mental health during the COVID-19 pandemic: prevalence rates from semi-structured interviews, and associated vulnerability and protective factors.

Introduction: Pilots are a unique occupational group who perform a specialised job and face significant stressors. Pilot mental health has received increased attention since Germanwings Flight 9525; however, this research has largely focused on general anxiety, depression, and suicide and relied on a questionnaire-based methodology. This approach is likely to miss various mental health issues that may affect pilot wellbeing, leaving the prevalence of mental health issues in aviation unclear. In addition, the COVID-19 pandemic is likely to have a particular impact on the mental health and wellbeing of pilots, who experienced the devastating effect of COVID-19 on the industry. Method: In the present study, we conducted a comprehensive assessment of 73 commercial pilots during the COVID-19 pandemic, using the DIAMOND semi-structured diagnostic interview and explored possible associated vulnerability and protective factors, including life event stressors, personality, passion, lifestyle factors, and coping strategies. Results: The COVID-19 pandemic had a significant impact on aviation during the time of this study, affecting 95% of participants. The diagnostic results revealed over one third of pilots had symptoms of a diagnoseable mental health disorder. Anxiety disorders were the most commonly found disorders, followed by Attention Deficit Hyperactivity Disorder (ADHD), Adjustment Disorder, and Depressive Disorders. Pilots' high life event scores placed them at an increased risk for the development of stress-related illness, though did not explain which pilots had mental health difficulties in this study. Regression analysis supported a diathesis-stress model for pilot mental health, with disagreeableness and obsessive passion contributing to pilots' development of mental health issues, and nutrition as the most important protective factor. Discussion: This study, though limited to the COVID-19 pandemic, provides a valuable precedent for a more thorough assessment of pilot mental health, and contributes to the broader understanding of pilot mental health, including suggestions to target factors associated with the development of mental health issues.

Closing the Gap for Children with OCD: A Staged-Care Model of Cognitive Behavioural Therapy with Exposure and Response Prevention.

Childhood obsessive-compulsive disorder (OCD) is among the most prevalent and disabling mental health conditions affecting children and adolescents. Although the distress and burden associated with childhood OCD are well documented and empirically supported treatments are available, there remains an unacceptable "treatment gap" and "quality gap" in the provision of services for youth suffering from OCD. The treatment gap represents the large number of children who never receive mental health services for OCD, while the quality gap refers to the children and young people who do access services, but do not receive evidence-based, cognitive behavioural therapy with exposure and response prevention (CBT-ERP). We propose a novel staged-care model of CBT-ERP that aims to improve the treatment access to high-quality CBT-ERP, as well as enhance the treatment outcomes for youth. In staged care, patients receive hierarchically arranged service packages that vary according to the intensity, duration, and mix of treatment options, with provision of care from prevention, early intervention, through to first and second-line treatments. Based on a comprehensive review of the literature on treatment outcomes and predictors of treatments response, we propose a preliminary staging algorithm to determine the level of clinical care, informed by three key determinants: severity of illness, comorbidity, and prior treatment history. The proposed clinical staging model for paediatric OCD prioritises high-quality care for children at all stages and levels of illness, utilising empirically supported CBT-ERP, across multiple modalities, combined with evidence-informed, clinical decision-making heuristics. While informed by evidence, the proposed staging model requires empirical validation before it is ready for prime time.

Don't look back in anger: neural correlates of reappraisal, analytical rumination, and angry rumination during recall of an anger-inducing autobiographical memory.

Despite the enormous costs associated with unrestrained anger, little is known about the neural mechanisms underlying anger regulation. Behavioral evidence supports the effectiveness of reappraisal in reducing anger, and demonstrates that rumination typically maintains or augments anger. To further understand the effects of different anger regulation strategies, during functional magnetic resonance imaging 21 healthy male and female undergraduates recalled an anger-inducing autobiographical memory. They then engaged in three counterbalanced anger regulation strategies: reappraisal, analytical rumination, and angry rumination. Reappraisal produced the least self-reported anger followed by analytical rumination and angry rumination. Rumination was associated with increased functional connectivity of the inferior frontal gyrus with the amygdala and thalamus. Understanding how neural regions interact during anger regulation has important implications for reducing anger and violence.

Deficits in emotion regulation associated with pathological gambling.

OBJECTIVES: The concept of emotion regulation features in many models of psychopathology and it has been proposed that individuals with poorly regulated emotions often engage in maladaptive behaviours to escape from or down-regulate their emotions, creating risk for a range of disorders. One such disorder may be pathological gambling. To our knowledge, no study had assessed the use of emotion-regulation strategies in this population. The goal of the present study was therefore to examine emotion-regulation difficulties among a sample of pathological gamblers (n= 56), a mixed clinical comparison group (n= 50), and a sample of healthy community controls (n= 49). DESIGN: Multivariate analysis of variance controlling for age. METHODS: Participants were recruited from the community and a gambling treatment unit in Australia and completed clinical diagnostic interviews (ADIS-IV; SCIP), self-report measures of psychopathology (DASS-21), substance use (AUDIT), and emotion-regulation difficulties (DERS; ERQ). RESULTS: Pathological gamblers and the clinical comparison group reported significantly less use of reappraisal as an adaptive emotion-regulation strategy, and reported a greater lack of emotional clarity and more impulsivity than individuals in the healthy community comparison group. Pathological gamblers reported a greater lack of emotional awareness compared to the healthy control group and reported differences in access to effective emotion-regulation strategies compared to both comparison groups. CONCLUSIONS: The results support specific deficits of emotion regulation in pathological gamblers and emphasize the need to address these underlying vulnerabilities in addition to directly targeting gambling behaviours in therapy.