Higher emotion regulation flexibility predicts more stable negative emotions and faster affective recovery in early psychosis: an experience sampling study.

BACKGROUND: While evidence shows that people with early psychosis are flexible in using different emotion regulation (ER) strategies to manage the varying contextual demands, no studies have examined the effectiveness of such regulatory flexibility in this population. We addressed this issue by investigating whether and how ER flexibility relate to different dynamic aspects (variability, instability, inertia, and recovery) of negative affect (NA) in a combined early psychosis sample, consisting of both individuals at high clinical risk for psychosis and those diagnosed with first-episode psychosis. METHODS: Participants were 148 individuals from the INTERACT project, a multi-center randomized controlled trial on the efficacy of acceptance and commitment therapy in early psychosis. We utilized data from the baseline assessment, during which all participants completed six days of experience sampling assessment of momentary NA, as well as end-of-day assessments of ER strategy use. RESULTS: Multilevel models of within-person associations showed that greater ER flexibility was associated with more stable NA, and quicker recovery of NA from stressors during the day. Linear regression analyses of between-person associations showed that people who had more variable and unstable NA reported greater ER flexibility generally. No evidence was found for associations with NA inertia. CONCLUSIONS: The current study identified unique within-person and between-person links between ER flexibility and dynamics of NA in early psychosis. These findings further provide evidence for ER flexibility in early psychosis, emphasizing the adaptive nature of regulatory flexibility in relation to reduced instability in NA and faster recovery from NA in everyday life.

The dynamical signature of anhedonia in major depressive disorder: positive emotion dynamics, reactivity, and recovery.

BACKGROUND: Major Depressive Disorder (MDD) is the leading cause of disability worldwide. The cardinal features of MDD are depressed mood and anhedonia. Anhedonia is defined as a "markedly diminished interest or pleasure in all, or almost all, activities of the day", and has generally been investigated on group-level using retrospective data (e.g. via questionnaire/interview). However, inferences based on group-level findings not necessarily generalize to daily life experiences within individuals. METHODS: We repeatedly sampled pleasurable experiences within individuals' daily lives by means of Experience Sampling Methods, and compared how positive affect unfolded in the daily life of healthy controls versus patients diagnosed with MDD and anhedonia. We sampled Positive Affect (PA) and reward experiences on 10 semi-random time points a day, for seven days in the daily lives of 47 MDD patients with anhedonia, and 40 controls. RESULTS: Multilevel models showed that anhedonia was associated with low PA, but not to differences in PA dynamics, nor reward frequency in daily life. In reaction to rewards, MDD patients with anhedonia showed no difference in their increase in PA (i.e., PA reactivity), and showed no signs of a faster return to baseline thereafter (i.e., PA recovery). CONCLUSIONS: Our results suggest that the dynamical signature of anhedonia in MDD can be described best as a lower average level of PA, and "normal" in terms of PA dynamics, daily reward reactivity and reward recovery. Preregistration: https://osf.io/gmfsc/register/565fb3678c5e4a66b5582f67 . Preprint: https://osf.io/cfkts.

The relationship between non-suicidal self-injury and alexithymia in borderline personality disorder: "Actions instead of words".

INTRODUCTION: Borderline personality disorder (BPD) is a serious mental illness that centers on the inability to effectively regulate emotions. A large amount of BPD patients engage in non-suicidal self-injury (NSSI). Given the NSSI contributes to serious health risks, it is important to know why some BPD patients engage in NSSI and others do not. A possible associated factor of NSSI in BPD may be alexithymia, which reflects difficulties in identifying and communicating feelings. Therefore the aim of the present study was to investigate whether NSSI was associated with alexithymia and whether this association still stood when controlling for gender and depression. METHODS: The current study explored the relationship between NSSI and alexithymia in 185 BPD patients by means of the Self-Injury Questionnaire-Treatment Related and the Toronto Alexithymia Scale-20 (TAS). RESULTS: Of the 185 BPD inpatients, 82.7% reported life-time NSSI, of whom 52.9% were still engaging in current NSSI; and 71.3% scored in the alexithymic range (cut-off score≥61). Current NSSI was significantly associated with TAS-total. Additionally, when considering the separate TAS subscales Difficulties Describing Feelings (DDF), Difficulties Identifying Feelings (DIF) and Externally Oriented Thinking (EOT), only DDF was significantly associated with NSSI, even after controlling for gender and depression. CONCLUSION: These results suggest that NSSI in BPD patients is associated with alexithymia. More specific, difficulties describing feelings can lead to NSSI, independently of the depressive status of the BPD patient. The implications for clinical treatment of self-injurious BPD patients will be discussed.

A Comparison of Affective-Cognitive States in Daily Life Between Emerging Adults With and Without Past-Year Nonsuicidal Self-Injury.

Although the literature suggests trait-like differences in affective and cognitive vulnerabilities between individuals with and without a history of nonsuicidal self-injury (NSSI), little is known about how these dispositional differences are experienced in the natural environment. The present study compares the intensity, inertia, interaction, and variability of affective (negative and positive affect) and cognitive states (rumination, self-criticism) in the everyday lives of individuals who do and do not engage in NSSI. Using experience sampling methodology (ESM), 60 emerging adults (ages = 18-22 years) with and without past-year NSSI (equally distributed) completed eight questionnaires per day for 12 days (in total, 96 questionnaires per participant), resulting in 4,587 assessments (median compliance = 83.3%; IQR = 71.9-91.7). In a dynamic structural equation modeling framework, dynamic parameters (i.e., mean intensity, carryover effects, spillover effects, and within-person variability) were evaluated using multilevel vector autoregressive models. Emerging adults who engage in NSSI experience higher intensity and greater variability of negative affect, rumination, and self-criticism, whereas those who do not engage in NSSI experience higher intensity and lower variability of positive affect. In addition, past-year NSSI predicted stronger affective-cognitive interactions over time, with stronger spillover effects of negative and positive affect on subsequent rumination and self-criticism in individuals who engage in NSSI. Depressive symptoms and trait levels of emotion dysregulation and self-criticism partially negated these differences. Our findings provide evidence that emerging adults who self-injure experience more negative affective-cognitive states in daily life and point to the potential relevance of boosting positive emotions to buffer negative cognitions.

A mixed-method investigation into measurement reactivity to the experience sampling method: The role of sampling protocol and individual characteristics.

Since the introduction of the experience sampling method (ESM), there have been concerns that the repeated assessments typically related to this method may alter the behavior, thoughts, or feelings of participants. Previous studies have offered mixed results with some studies reporting reactive changes, while others failed to find such effects. Our aim was to investigate under which circumstances ESM induces reactive effects. Students (N = 151) were randomly assigned to receive a questionnaire containing 30 or 60 items three, six, or nine times per day for 14 days. A random sample of 50 participants took part in qualitative interviews after the end of the data collection. We investigated changes over time in the data, while taking into account the sampling protocol and characteristics of participants, and analyzed qualitative reports of measurement reactivity. Decreases in completion time, within-person variance of ratings and subjective reports of habituation point toward the existence of a habituation period. While participants reported increases in emotional awareness in interviews, ESM measures indicated a decrease in emotional awareness over time. Changes in behavior were rare in quantitative and qualitative reports. Positive affect was decreasing over time in the ESM data, and various changes in affect, emotion regulation, and thoughts were reported in interviews. Individual characteristics and sampling protocol had inconsistent effects on changes over time. The results suggest that ESM induces changes in within-person variability, completion times, affect, or emotional awareness over time. Further research is needed to explore whether observed changes affect the validity of ESM data. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Emotion regulation in daily life in early psychosis: The role of contextual appraisals.

BACKGROUND: Little is known about whether and how contextual appraisals relate to emotion regulation (ER) strategy use across the ultra-high risk and first episode stages of psychosis. The present study extends previous research by investigating the extent to which different appraisal dimensions of the most negative and positive events of the day are associated with ER strategy use in individuals with ultra-high risk (UHR) and first-episode psychosis (FEP). METHOD: Sixty-eight UHR individuals and fifty-five FEP individuals filled out an experience sampling evening questionnaire for six consecutive days, in which their appraisal of intensity, importance and perceived control concerning the most negative or positive event of the day, and the ER strategies they deploy in response to these events were measured. RESULTS: Multilevel mixed effect models showed that intensity appraisal was most closely associated with ER strategy use, as opposed to importance and controllability appraisals. Higher intense negative events were associated with more rumination and social sharing, while less intense negative events were associated with more reappraisal. Higher intense positive events were associated with a greater number of deployed strategies and more efforts in using savoring, expression and social sharing. The UHR and FEP individuals did not significantly differ regarding effects of above-mentioned appraisal dimensions on ER. CONCLUSIONS: These results provide evidence supporting ER flexibility in early psychosis, and event intensity emerged as the dimension most strongly associated with ER. Future research should better account for other situational factors (such as social context) that might affect ER use in psychosis.

The Effects of Sampling Frequency and Questionnaire Length on Perceived Burden, Compliance, and Careless Responding in Experience Sampling Data in a Student Population.

Currently, little is known about the association between assessment intensity, burden, data quantity, and data quality in experience sampling method (ESM) studies. Researchers therefore have insufficient information to make informed decisions about the design of their ESM study. Our aim was to investigate the effects of different sampling frequencies and questionnaire lengths on burden, compliance, and careless responding. Students (n = 163) received either a 30- or 60-item questionnaire three, six, or nine times per day for 14 days. Preregistered multilevel regression analyses and analyses of variance were used to analyze the effect of design condition on momentary outcomes, changes in those outcomes over time, and retrospective outcomes. Our findings offer support for increased burden and compromised data quantity and quality with longer questionnaires, but not with increased sampling frequency. We therefore advise against the use of long ESM questionnaires, while high-sampling frequencies do not seem to be associated with negative consequences.

Why do my thoughts feel so bad? Getting at the reciprocal effects of rumination and negative affect using dynamic structural equation modeling.

Rumination means to perseveratively think about one's negative feelings and problems. It is a response to affective distress that is often referred to as maladaptive emotion regulation. According to the response styles theory and control theory, rumination may further prolong and exacerbate affective distress. This means that rumination can be viewed as both an antecedent and an outcome of negative affect (NA), and vice versa. However, at the level of short-term dynamics, state rumination and NA have previously mainly been examined as two separate outcomes. To model the reciprocal within-person effects and hence, to match theoretical assumptions, we combined the two interrelated time series in one model using dynamic structural equation modeling (DSEM). Both effects (NA on subsequent rumination and rumination on subsequent NA) were modeled simultaneously while acknowledging the autoregressive nature of both states (inert properties). We used data from two experience sampling studies (NStudy 1 = 200 Belgian university students; NStudy 2 = 70 German university students). Participants were paged on smartphones several times a day (Study 1: 10; Study 2: 6) for several days (Study 1: 7; Study 2: 9-12). In both studies, we found evidence for reciprocal effects of NA and rumination, and both processes showed autoregressive relationships. Aside from central findings, higher levels of rumination were also associated with higher rumination inertia, pointing toward more habitual rumination also being associated with prolonged rumination. Together, using DSEM, we found reciprocal associations between rumination and NA, while providing new insights into the dynamics between the two processes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Short-Term Psychological Impact of the COVID-19 Pandemic in Psychiatric Patients: Evidence for Differential Emotion and Symptom Trajectories in Belgium.

The spread of COVID-19 and the implementation of various containment strategies across the world have seriously disrupted people's everyday life, and it is especially uncertain what the psychological impact of this pandemic will be for vulnerable individuals, such as psychiatric (ex-)patients. Governments fear that this virus outbreak may prelude a major mental health crisis, and psychiatrists launch critical calls to flatten an upcoming mental ill-health surge. Here, we aim to add nuance to the idea that we are heading towards a mental health pandemic and that psychiatric populations will unavoidably (re)develop psychopathology. Despite being subjected to the same challenges posed by COVID-19, we argue that people with a history of psychiatric illness will psychologically deal with this adversity in different ways. To showcase the short-term differential impact of COVID-19 on patients' mental health, we present the day-to-day emotion and symptom trajectories of different psychiatric patients that took part in an experience sampling study before, during, and after the start of the first wave of the COVID-19 pandemic in March 2020 and associated lockdown measures in Belgium. Piecewise regression models show that not all patients' psychological well-being is affected to a similar degree. As such, we argue that emphasizing human resilience, also among the more vulnerable in society, may be opportune in these unsettling times.

The Statistical Specificity of Emotion Dynamics in Borderline Personality Disorder.

Persons with borderline personality disorder (BPD) experience heightened emotional instability. Different components underlie instability, and the relation between instability and well-being could be confounded by average emotionality and within-person standard deviation across emotional states, reflecting variability. Therefore, the goal was to examine which pattern of emotion dynamics parsimoniously captures the emotional trajectories of persons with BPD. Forty persons with BPD, 38 clinical controls in a major depressive episode, and 40 healthy controls rated the intensity of their emotions 10 times a day for 1 week. After correction for differences in average emotionality, persons with BPD showed heightened emotional instability compared to both control groups. When additionally correcting for emotional variability, the authors found that instability indices did not differ between groups anymore. This shows that persons with BPD differ from control groups in the magnitude of emotional deviations from the emotional baseline, and not necessarily in the degree of abruptness of these deviations.

Self-criticism and dependency predict affective variability in borderline personality disorder: An ecological momentary assessment study.

Affective variability is a defining feature of borderline personality disorder (BPD). We hypothesize that patients with BPD who score higher on self-criticism and/or dependency-patients with a relative emphasis on self-definition and interpersonal relatedness, respectively-are characterized by more affective variability in positive and negative emotions. To examine this hypothesis, a sample of 32 patients with BPD reported their momentary feelings of anger, depression, anxiety, cheerfulness, and relaxation in an experience sampling study with 10 random signals scheduled per day for 8 days. Using heterogeneous linear mixed models, results indicate that patients with BPD who score higher on self-criticism show more within-person variance (WPV) in anger, depression, anxiety, cheerfulness, and feeling relaxed, whereas patients who score higher on dependency show more WPV in anger but less WPV in anxiety and feeling relaxed. Consequently, individual differences in affective variability in BPD are, after adjustment for the confounding between the mean and WPV of affect, related to personality vulnerabilities like self-criticism and dependency. These results add evidence to two-polarities models of personality and the existing view that there is substantial heterogeneity in BPD. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Complex affect dynamics add limited information to the prediction of psychological well-being.

Over the years, many studies have demonstrated a relation between emotion dynamics and psychological well-being1. Because our emotional life is inherently time-dynamic2-6, affective scientists argue that, next to how positive or negative we feel on average, patterns of emotional change are informative for mental health7-10. This growing interest initiated a surge in new affect dynamic measures, each claiming to capture a unique dynamical aspect of our emotional life, crucial for understanding well-being. Although this accumulation suggests scientific progress, researchers have not always evaluated (a) how different affect dynamic measures empirically interrelate and (b) what their added value is in the prediction of psychological well-being. Here, we address these questions by analysing affective time series data from 15 studies (n = 1,777). We show that (a) considerable interdependencies between measures exist, suggesting that single dynamics often do not convey unique information, and (b) dynamic measures have little added value over mean levels of positive and negative affect (and variance in these affective states) when predicting individual differences in three indicators of well-being (life satisfaction, depressive symptoms and borderline symptoms). Our findings indicate that conventional emotion research is currently unable to demonstrate independent relations between affect dynamics and psychological well-being.

Emotional reactivity to appraisals in patients with a borderline personality disorder: a daily life study.

BACKGROUND: Emotional instability, consisting of patterns of strong emotional changes over time, has consistently been demonstrated in daily life of patients with a borderline personality disorder (BPD). Yet, little empirical work has examined emotional changes that occur specifically in response to emotional triggers in daily life, so-called emotional reactivity. The goal of this study was to examine emotional reactivity in response to general emotional appraisals (i.e. goal congruence or valence, goal relevance or importance, and emotion-focused coping potential) and BPD-specific evaluations (trust and disappointment in self and others) in daily life of inpatients with BPD. METHODS: Thirty inpatients with BPD and 28 healthy controls participated in an experience sampling study and repeatedly rated the intensity of their current emotions, emotional appraisals, and evaluations of trust and disappointment in self and others. RESULTS: Results showed that the BPD group exhibited stronger emotional reactivity in terms of negative affect than healthy controls, however only in response to disappointment in someone else. BPD patients also showed weaker reactivity in positive affect in response to the appraised importance of a situation; the more a situation was appraised as important, the higher the subsequent positive affect for healthy controls only, not the patient group. CONCLUSIONS: These findings show that appraisals can trigger strong emotional reactions in BPD patients, and suggest that altered emotional reactivity might be a potential underlying process of emotional instability in the daily life.

Are emotional action tendencies and attentional bias related to temperament dimensions in patients with borderline personality disorder?

Disturbances in emotion regulation have been identified as a core feature of patients with a borderline personality disorder (BPD). Findings of studies using experimental measures of emotion processing are mixed, which may be partially explained by the heterogeneity of the BPD population. To address this issue, we investigated differences in experimental measures of emotional action tendencies (approach-avoidance behaviour) and attentional bias to emotional stimuli in BPD subtypes. Data of the Approach-Avoidance Task (AAT) and the Emotional Stroop Task (EST) were collected in 140 BPD patients, previously clustered into four BPD subtypes based on temperament dimensions. We investigated (1) the relationship between temperament dimensions and the performance on the AAT and EST and (2) compared performance on these tasks in previous defined BPD subtypes. The results of the present study demonstrated a positive relationship between effortful control (EC) and AAT effect-scores. A higher level of EC was positively associated with a general emotional action tendency towards faces with directed gaze, even when controlling for gender, age and BPD severity. Preliminary results on the comparison of the BPD subtypes demonstrated no significant differences in AAT and EST performance. These findings emphasize the relevance of EC in emotional action tendencies in BPD patients.

Why I don't always know what I'm feeling: The role of stress in within-person fluctuations in emotion differentiation.

Emotion differentiation, the ability to make fine-grained distinctions between emotional states, has mainly been studied as a trait. In this research, we examine within-person fluctuations in emotion differentiation and hypothesize that stress is a central factor in predicting these fluctuations. We predict that experiencing stress will result in lower levels of emotion differentiation. Using data from a 3-wave longitudinal experience sampling study, we examined the within-person fluctuations in the level of emotion differentiation across days and months and tested if these fluctuations related to changes in stress levels. On the day-level, we found that differentiation of negative emotions varied significantly within individuals, that high stress levels were associated with lower levels of emotion differentiation, and that stress on 1 day negatively predicted the level of differentiation of negative emotions on a next day (but not vice versa). On the wave-level, we found a concurrent, but not a prospective relationship between stress and emotion differentiation. These results are the first to directly demonstrate the role of stress in predicting fluctuations in emotion differentiation and have implications for our theoretical understanding of emotion differentiation, as well as for interventions. (PsycINFO Database Record

The bipolarity of affect and depressive symptoms.

People differ in the extent to which they experience positive (PA) and negative affect (NA) rather independently or as bipolar opposites. Here, we examine the proposition that the nature of the relation between positive and negative affect in a person's emotional experience is indicative of psychological well-being, in particular the experience of depressive symptoms, typically characterized by diminished positive affect (anhedonia) and increased negative affect (depressed mood). In three experience sampling studies, we examine how positive and negative affective states are related within people's emotional experience in daily life and how the degree of bipolarity of this relation is associated with depressive symptom severity. In Study 1 and 2, we show both concurrently and longitudinally that a stronger bipolar PA-NA relationship is associated with, and in fact is predicted by, higher depressive symptom severity, even after controlling for mean levels of positive and negative affect. In Study 3, we replicate these findings in a daily diary design, with the two conceptually related main symptoms of depression, sadness, and anhedonia, as specific manifestations of high NA and low PA, respectively. Across studies, additional analyses indicate these results are robust across different time scales and various PA and NA operationalizations and that affective bipolarity shows particular specificity toward depressive symptomatology, in comparison with anxiety symptoms. Together, these findings demonstrate that depressive symptoms involve stronger bipolarity between positive and negative affect, reflecting reduced emotional complexity and flexibility. (PsycINFO Database Record

The emotion regulation function of nonsuicidal self-injury: A momentary assessment study in inpatients with borderline personality disorder features.

Studies using retrospective self-report or proxies of nonsuicidal self-injury (NSSI) in the lab have shown that NSSI is often preceded by intense negative emotions and followed by a decrease in negative emotions/tension, suggesting an emotion regulation function of NSSI. To investigate this emotion regulation function of NSSI in a more ecologically valid way, we used experience sampling methods to examine the temporal relationship between NSSI behavior and emotional experiences throughout the day in 30 inpatients currently staying in psychiatric hospitals. Because NSSI is especially prevalent and severe in patients with a borderline personality disorder (BPD), we focused on patients with high levels of BPD symptomatology. Results confirmed that high levels of negative emotion prospectively predicted a higher probability of engaging in NSSI in the next time interval. However, the occurrence of NSSI itself was related to concurrent increases in negative emotion and decreases in positive emotion, and even prospectively predicted an increase in negative emotion in the consecutive time interval. These preliminary results show that on a time scale of hours, instead of resulting in emotional relief, NSSI seems to be associated with a further increase in negative emotionality, shedding light on the cyclic nature of NSSI. (PsycINFO Database Record

The affect stabilization function of nonsuicidal self injury in Borderline Personality Disorder: An Ecological Momentary Assessment study.

Nonsuicidal Self-Injury (NSSI) is prominent in individuals with Borderline Personality Disorder (BPD), and there is abundant evidence that affect regulation plays an important role in NSSI in the majority of patients. Affective variability is a core feature of BPD, and thus, we hypothesize that NSSI has an affect stabilization function in BPD. Affect stabilization is a process through which individuals attempt to make their affect more stable by reducing affective variability. We tested this hypothesis in 32 participants with BPD who reported on their NSSI and affect -using a displeasure-pleasure (valence) and activation-deactivation (activation) dimension- in an experience sampling study with 10 random signals scheduled per day for 8 days. Results indicated that individuals who engaged in NSSI show more Within Subject (WS) variance in valence and activation than individuals who did not engage in NSSI. However, within the NSSI patients, individuals who engaged more frequently in NSSI during the study showed less WS variance in valence and activation than patients who engaged less frequently in NSSI. This suggests that NSSI may be reinforced by its affect stabilization function. In the discussion, we explore alternative explanations for the relation between NSSI and affective variability, and consider the clinical implications.

The specificity of emotional switching in borderline personality disorder in comparison to other clinical groups.

In an attempt to better understand the nature of emotion dysregulation in the daily lives of persons with a borderline personality disorder (BPD), Houben et al. (2016) recently identified emotional switching, which refers to the tendency to make large changes between positive and negative emotional states over time, as a possible defining characteristic of the emotion dynamics observed in BPD. The goal of this study was to examine the specificity of these previous findings in 2 samples by comparing BPD patients (N = 43 in sample 1; N = 81 in sample 2) to patients with bulimia nervosa (N = 20), posttraumatic stress disorder (N = 28), or healthy controls (N = 28) in sample 1, and to patients with depressive disorder (N = 50) in sample 2, with respect to measures of emotional switching. Analyses of these 2 experience sampling datasets revealed that contrary to expectations, BPD patients did not differ from the clinical groups regarding their mere tendency to switch between positive and negative emotional states on consecutive moments over time and regarding the magnitude of such changes between positive and negative emotional states over time. However, all clinical groups did differ from healthy controls regarding all switch measures in dataset 1. These results indicate that emotional switching, similar to other more traditional indicators of overall changes in emotional intensity in daily life, might reflect a feature of emotional responding characterizing a range of disorders with mood disturbances.

Emotional switching in borderline personality disorder: A daily life study.

Despite large efforts to understand emotional instability in borderline personality disorder (BPD), it is still unclear exactly how this is manifested in the daily lives of people suffering from the disorder. Building on theoretical and clinical observations of BPD, we propose that the emotional instability in BPD particularly consists of the occurrence of strong changes between positive and negative emotional states from 1 moment to the next, labeled emotional switching. We tested this proposal by means of an experience sampling study in which 30 BPD patients and 28 healthy controls reported in their daily lives the level of pleasantness/unpleasantness of their emotional states 10 times a day for 8 consecutive days using handheld palmtops. Results showed that although BPD patients did not differ from healthy controls regarding their overall tendency to switch from a positive to a negative emotional state or vice versa, the size of such changes between positive and negative states was found to be significantly larger in BPD patients. In contrast, the magnitude of emotional changes that remained within the negative emotional range or positive emotional range was not particularly larger for BPD patients compared with healthy participants. These findings imply that the emotional instability in BPD is particularly characterized by larger changes from positive to negative states and vice versa, rather than overall larger changes in intensity, providing insight into possible processes underlying emotion dysfunction in BPD.