Emotion-related impulsivity across transdiagnostic dimensions of psychopathology.

OBJECTIVE: Several dimensions have received attention for their potential role in explaining shared variance in transdiagnostic symptoms of psychopathology. We hypothesized emotion-related impulsivity, the trait-like tendency toward difficulty restraining responses to emotion, would relate to symptoms of psychopathology, with two separable dimensions of emotion-related impulsivity relating distinctly to internalizing and externalizing symptoms. METHOD: Across two studies, we tested hypotheses using structural equation models of emotion-related impulsivity and multiple indicators of internalizing, externalizing, and thought symptoms. RESULTS: In Study 1 (658 undergraduates), emotion-related impulsivity was highly correlated with the general psychopathology (p) factor. In study 2 (421 Mechanical Turk participants), models did not support a general p factor; however, we replicated the hypothesized associations of emotion-related impulsivity dimensions with internalizing and externalizing factors. Across both studies, forms of emotion-related impulsivity uniquely and differentially related to internalizing and externalizing symptoms. CONCLUSIONS: Findings indicate emotion-related impulsivity may help explain transdiagnostic dimensions of psychopathology, such as the p factor.

Disability self-worth relates to lower anxiety and depression in people with visual impairment.

OBJECTIVE: Visual impairment (VI) has been associated with depression and anxiety. Although researchers have identified several relevant individual differences associated with risk for depression and anxiety, researchers have not considered the role of personal disability identity (PDI) in depression and anxiety for people with VI. The purpose of this study is to examine the association between two aspects of PDI, perceived self-worth and personal meaning, and depression and anxiety among people with VI. METHOD: Hierarchical linear regressions assessed the relative contribution of PDI and disability characteristics to anxiety and depression in an international sample of adults with VI (N = 390). RESULTS: Lower disability self-worth, but not lower personal meaning, was significantly associated with higher depression and anxiety, explaining more variance than demographic or disability-related factors. CONCLUSION: By introducing disability self-worth as a correlate of depression and anxiety in VI, study findings suggest that considering and cultivating PDI for people with VI may be useful for improving clinical outcomes.

Emotion-related impulsivity and risky decision-making: A systematic review and meta-regression.

Emotion-related impulsivity, the trait-like tendency toward regrettable behavior during states of high emotion, is a robust predictor of internalizing and externalizing psychopathology. Despite substantial evidence that emotion-related impulsivity is important transdiagnostically, relatively little is known about its cognitive correlates. This systematic review and meta-regression investigates one such candidate, risky decision-making. We analyzed 195 effect sizes from 51 studies of 14,957 total participants, including 105 newly calculated effect sizes that were not reported in the original publications. The meta-regression demonstrated evidence for a small, positive relationship of emotion-related impulsivity with behavioral indices of risky decision-making (ß = 0.086). Effects generalized across sample age, gender, Positive versus Negative Urgency, and clinical versus nonclinical samples. The average effect size varied by task type, with stronger effects for the Iowa Gambling Task and Delay Discounting Task. Experimental arousal manipulation was nearly a significant moderator, with stress and pharmacological manipulations yielding significant effect sizes. Analyses indicated that publication bias did not skew the current findings. Notwithstanding limitations, the data suggest that risky decision-making is a cognitive domain that relates to emotion-related impulsivity. We conclude with recommendations regarding the specific types of tasks and arousal inductions that will best capture emotion-related impulsivity in future experimental research.

Who disengages from emotion and when? An EMA study of how urgency and distress intolerance relate to daily emotion regulation.

Overreliance on disengagement emotion regulation strategies (e.g., emotion avoidance, emotion suppression) has been shown to relate to poor clinical outcomes. Two traits characterized by difficulties in goal-directed responses to emotion-urgency and distress intolerance-may help explain who is likely to disengage from emotion and when. These traits are associated with diverse forms of psychopathology and greater reliance on disengagement strategies. Gaps remain about how these traits relate to emotion regulation in daily life. The present study uses ecological momentary assessment (EMA) to determine the associations of urgency and distress intolerance with momentary high arousal negative affect and momentary attempts to regulate negative emotions. Participants (N = 101) were college students who endorsed at least weekly behaviors often characterized by emotion dysregulation (e.g., self-harm, binging/purging, alcohol/drug use). Participants completed trait measures at baseline and EMA surveys of momentary affect and emotion regulation, six times daily for 4 days. Results indicated that at certain levels, urgency and distress intolerance moderated the relationship between high arousal negative affect and disengagement from emotion: low urgency scores related to relatively greater disengagement from emotion following reported high arousal negative affect, whereas high distress intolerance scores related to relatively greater disengagement following high arousal negative affect. Findings support the role of both urgency and distress intolerance in the relationship between high arousal negative affect and disengagement, which implicates the utility of clinical interventions that focus on emotion regulation, especially during high arousal states. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Emotion-related impulsivity: Testing a model of arousal effects on cognitive control.

The trait-based tendency to respond rashly to emotions is robustly tied to many forms of psychopathology and poor behavioural outcomes, including aggression and suicidality. Researchers have found associations between response inhibition and emotion-related impulsivity; however, effect sizes are often small. Because emotion-related impulsivity emerges in the context of heightened positive and negative emotions, arousal is a candidate trigger of impulsivity. The goals of the present study were to (1) replicate the association between emotion-related impulsivity and response inhibition, and (2) test whether emotion-related impulsivity is associated with arousal-induced decays in response inhibition performance. Participants (N = 55) completed a self-report measure of emotion-related impulsivity, and then completed a computer-based response inhibition task (the antisaccade task, in which participants must make a rapid saccadic eye movement away from a cue rather than toward it) before and after a well-validated stress induction (the Trier Social Stress Test). Psychophysiological indices of arousal were measured throughout the session. Findings provide partial support for the association between emotion-related impulsivity and pre-stress response inhibition. Contrary to hypotheses, emotion-related impulsivity did not interact with arousal to predict post-stress response inhibition performance after controlling for pre-stress response inhibition performance. Future research is needed to consider clinical samples and to assess whether emotion-related impulsivity is related to deficits in other facets of cognitive control and decision-making.

Guidelines to Address Barriers in Clinical Training for Trainees with Sensory Disabilities.

Disability is an important facet of diversity. Although diversity in clinical training in health service psychology has improved considerably, training often neglects accessibility and inclusion for individuals with sensory disabilities. The limited research to date documents that trainees with sensory disabilities (TSD) report extensive barriers and are consistently under-represented in clinical settings. Further, few resources have been developed to guide accommodating TSD in clinical training. Accordingly, our goals in this article are two-fold: (1) to highlight the barriers in clinical training faced by TSD and (2) to provide recommendations for trainees, supervisors, clinical leadership, and directors of clinical training to improve accessibility and inclusion for TSD. We offer vignettes to illustrate barriers faced by TSD and suggest guidelines to improve access for TSD.

Momentary Emotion Goals and Spontaneous Emotion Regulation in Daily Life: An Ecological Momentary Assessment Study of Desire for High Versus Low Arousal Positive Emotion.

Recent research has highlighted that emotion regulation strategy use varies both between and within people, and specific individual and contextual differences shape strategy use. Further, use of specific emotion regulation strategies relates to a wide array of differential outcomes, including mental health and behavior. Emotion goals (desire for a given emotion state) are thought to play a particularly important role in shaping people's use of emotion regulation strategies; yet, surprisingly little is known about whether and how momentary emotion goals predict spontaneous strategy use in daily life. In the present investigation, we examined whether ideal desire for high versus low arousal positive affect was associated with subsequent use of specific emotion regulation strategies. Undergraduate participants (final N = 101) completed ecological momentary assessments (final ks = 1,932 for contemporaneous analyses, 1,386 for time-lagged analyses) of their momentary experienced affect, momentary desire for high versus low arousal positive affect, and emotion regulation. Desire for higher arousal predicted greater use of three disengagement strategies: distraction, expressive suppression, and experiential suppression. None of these strategies, though, were associated with sustained enhancement of high arousal (or low arousal) positive affect. These findings point to a possible disconnect between the strategies that people tend to use when they want to feel more arousal and the affective outcomes associated with use of those strategies.

Emotion-related impulsivity predicts increased anxiety and depression during the COVID-19 pandemic.

INTRODUCTION: Emotion-related impulsivity, defined by poor constraint in the face of emotion, is related to internalizing symptoms, cross-sectionally and longitudinally. Internalizing symptoms, though, are profoundly tied to stress reactivity, and little is known about how emotion-related impulsivity relates to stress reactivity. METHOD: Taking advantage of a sample that had completed measures of depression, anxiety, suicidal ideation, and two forms of emotion-related impulsivity before the pandemic, we asked participants to complete three weekly follow-up internalizing assessments early in the pandemic. RESULTS: Among the 150 participants, pre-pandemic emotion-related impulsivity scores predicted higher depression, anxiety, general distress, and suicidal ideation during the COVID-19 pandemic. Controlling for pre-pandemic scores, one form of emotion-related impulsivity (Feelings Trigger Action) predicted increased anxiety and general distress. We also examined how pre-pandemic emotion-related impulsivity was moderated by weekly COVID-related stress. One form of emotion-related impulsivity (Pervasive Influence of Feelings) predicted internalizing symptoms at low stress levels, and a different form (Feelings Trigger Action) predicted internalizing symptoms at higher stress levels. LIMITATIONS: Limitations include the small sample size, the absence of repeat measures of impulsivity, the attrition of individuals with more internalizing symptoms, and the reliance on self-rated measures. CONCLUSIONS: Forms of emotion-related impulsivity predict increases in anxiety and distress over time, but the interactions with stress levels appear to vary. Emotion-related impulsivity can be addressed with accessible intervention tools, suggesting the promise of broader screening for those at risk for internalizing symptoms during periods of high stress.

Immune response to stress induction as a predictor of cognitive-behavioral therapy outcomes in adolescent mood disorders: A pilot study.

Cognitive-behavioral therapy (CBT) alleviates symptoms of depression in youth with bipolar disorder (BD) and major depressive disorder (MDD). Empirical research has linked inflammatory markers to depressive symptoms and acute psychosocial stress; however, a gap remains as to whether immune response to stress may serve as a putative mechanism of treatment. This preliminary pilot study determined the modest feasibility of assessing psychobiological response to stress as a predictor of CBT outcomes for youth with mood disorders. We evaluated whether participation in a 10-session group-CBT intervention for mood disorders altered inflammatory response to a laboratory psychosocial stress induction and if this alteration in immune stress responsivity was related to a decrease in depressive symptoms. Thirty-four youth (age M = 15.03, SD = 1.91) diagnosed with BD or MDD participated in a 10-session CBT group and pre- and post-group assessments; twenty-eight participants who completed the group had usable cytokine data. Pre- and post-group assessments included stress induction with the Trier Social Stress Test (TSST) during which inflammatory cytokines were measured at baseline (time 0) and after the TSST at 30, 60, and 90 min. Results suggest it is modestly feasible to measure immune response to stress alongside CBT treatment for adolescent mood disorders. Our findings were mixed; across seven cytokines, hierarchical linear models indicated two cytokines, IL6 and IL12, were sensitive to acute laboratory stress. We also found significant correlations between life stress, inflammation, and depression both pre- and post- CBT group. Inflammation pre-group, as measured by IL12 and IL1 ß predicted depressive symptoms following treatment. Although we did not find significant within-subject reductions in inflammation, chronic stress predicted changes in IL ß, signaling the central role of chronic stress. This study offers preliminary evidence that immune responsivity to stress induction could serve as a mechanism of treatment for mood disorders in youth, indicating a potential marker for more personalized model of healthcare.

Maladaptive behavior and affect regulation: A functionalist perspective.

Clinical science has benefited tremendously from taking seriously the proposition that putatively maladaptive behaviors serve psychological functions, prominently among these affect regulation (AR). These functionalist accounts have not only advanced basic clinical science, but also formed the bedrock for the development of effective treatments. Drawing heavily on reinforcement learning theory, we aim to elucidate functional relationships between maladaptive behavior and AR. Specifically, we take the view that maladaptive behaviors are frequently motivated and reinforced by hedonic AR functions (i.e., decreasing negative affect and increasing positive affect) but are also susceptible to becoming stimulus-bound habits. We review empirical evidence related to one such behavior, nonsuicidal self-injury. We close with a brief reflection on future directions. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

A brief online intervention to address aggression in the context of emotion-related impulsivity for those treated for bipolar disorder: Feasibility, acceptability and pilot outcome data.

Although aggression is related to manic symptoms among those with bipolar disorder, new work suggests that some continue to experience elevations of aggression after remission. This aggression post-remission appears related to a more general tendency to respond impulsively to states of emotion, labelled emotion-related impulsivity. We recently developed the first intervention designed to address aggression in the context of emotion-related impulsivity. Here, we describe feasibility, acceptability, and pilot data on outcomes for 21 persons who received treatment for bipolar disorder and endorsed high levels of aggression and emotion-related impulsivity. As with other interventions for aggression or bipolar disorder, attrition levels were high. Those who completed the intervention showed large changes in aggression using the interview-based Modified Overt Aggression Scale that were sustained through three months and not observed during wait list control. Although they also showed declines in the self-rated Buss-Perry Aggression Questionnaire and in self-rated emotion-related impulsivity as assessed with the Feelings Trigger Action Scale, these self-ratings also declined during the waitlist control. t Despite the limitations, the findings provide the first evidence that a brief, easily disseminated intervention could have promise for reducing aggression among those with bipolar disorder.

Multivariate associations of ideal affect with clinical symptoms.

Prior research has indicated that ideal affect (i.e., the affective states that people value and would ideally like to experience) may be relevant to mental health outcomes. Studies to date, however, have not used comprehensive multivariate models that account for covariation among facets of ideal affect and incorporate multiple clinical outcomes. In the present studies, we used structural equation modeling to examine the multivariate effects of ideal affect on symptoms of depression, anxiety, and alcohol abuse in 2 moderately large samples of undergraduates (N = 293 and N = 146). Exploratory results of Study 1 indicated that valuation of high arousal positive affective states was significantly associated with lower depression symptoms but higher anxiety and alcohol abuse symptoms and that valuation of high arousal negative states was specifically associated with greater anxiety symptoms. These results were shown to be structurally invariant across samples and ethnicities in Study 2, which also found that ideal-actual affect discrepancies were significantly associated with symptoms of depression and anxiety. These findings support and extend the hypothesis that ideal affect is implicated in clinical outcomes by highlighting the importance of jointly considering multiple facets of ideal and actual affect as they relate to a range of clinical syndromes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Neurocognitive mechanisms of emotion-related impulsivity: The role of arousal.

Prior research suggests that a traitlike tendency to experience impulsivity during states of high emotion is robustly associated with many forms of psychopathology. Several studies tie emotion-related impulsivity to response inhibition deficits, but these studies have not focused on the role of emotion or arousal within subjects. The present study tested whether arousal, measured by pupil dilation, amplifies deficits in response inhibition for those high in emotion-related impulsivity. Participants (N = 85) completed a measure of emotion-related impulsivity, underwent a positive mood induction procedure that reduced heterogeneity in mood states, and completed a response inhibition task. Pupil dilation was used to index arousal during the response inhibition task. Generalized linear mixed effect modeling yielded the hypothesized interaction between arousal (pupil dilation) and emotion-related impulsivity in predicting response inhibition performance at the trial level. Emotion-related impulsivity relates to more difficulties with response inhibition during moments of high arousal.

A positive emotion regulation intervention for bipolar I disorder: Treatment development and initial outcomes.

OBJECTIVE: Dysfunction in positive affect is a defining symptom of bipolar I disorder (BD), both during and between mood episodes. We hypothesize that helping people with BD learn skills to create balance in their affective experiences by engaging in strategies that increase low activation positive emotion (LAP; e.g., relaxation) could help to improve well-being during periods of symptom remission. We discuss the development and preliminary outcomes of a positive emotion regulation (PER) group treatment for people with BD, designed as a supplement to pharmacological treatment. METHOD: The Learning Affective Understanding for a Rich Emotional Life (LAUREL) intervention is a group-based intervention covering 10 empirically supported skills designed to increase LAP. Sixteen people with BD enrolled in the LAUREL intervention and twelve completed baseline and post-intervention assessments. RESULTS: Participants who completed the study (n = 12) attended the majority of groups (87.96%) and reported practicing skills, on average, 16 times a week. We were unable to detect significant differences in mania symptoms following engagement in this PER intervention. Finally, participants reported increases in several areas associated with well-being post-intervention, including mindfulness, reappraisal, and self-compassion. CONCLUSION: This study provides a theoretical framework and preliminary support for a PER intervention for BD.

Simplifying profiles of comorbidity in bipolar disorder.

BACKGROUND: Comorbid psychiatric symptoms in bipolar disorder (BD) predict poorer course of illness and treatment outcome. The sheer number of comorbid symptoms has thwarted developing treatments to address these comorbid concerns. The goal of this study was to develop a more parsimonious approach to understanding clusters of comorbid symptoms within BD. METHOD: Data were collected as part of the National Epidemiologic Survey on Alcohol and Related Conditions. Structured diagnostic interviews were conducted with 43,093 participants using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV (AUDADIS-IV). Analyses were conducted on lifetime symptom counts for the most common 14 comorbid disorders among the 1411 persons who met lifetime criteria for bipolar I disorder. RESULTS: An exploratory factor analysis with promax rotation as well as confirmatory factor analyses revealed a three-factor solution of Externalizing, Anxiety, and Mood syndromes, with a higher order Internalizing factor comprised of the Mood and Anxiety factors. LIMITATIONS: Further research is needed in a clinical sample. CONCLUSIONS: Comorbid symptoms in BD tend to cohere into Internalizing and Externalizing disorders, which could simplify research and treatment on comorbidity in BD.