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Importance: Despite the existence of effective treatments, many individuals with bulimia nervosa (BN) do not receive evidence-based therapies. Integrating digital interventions into routine care might reach more patients and reduce the clinical burden of BN. Objective: To evaluate the effectiveness of a web-based cognitive behavioral self-help intervention for individuals with BN. Design, Setting, and Participants: A 2-group randomized clinical trial without follow-up was conducted between February 2, 2021, and July 9, 2022, in Germany. Participants aged between 18 and 65 years who met the diagnostic criteria for BN were enrolled online via self-referral. Data analyses were conducted from October 24, 2022, to December 23, 2023. Interventions: A web-based cognitive behavioral self-help intervention including 12 weekly modules was compared with a waiting-list control group only having access to routine care. Main Outcomes and Measures: The primary outcome was the change in the number of bulimic episodes between baseline and posttreatment. Secondary outcomes included changes in global eating disorder symptoms, clinical impairment, well-being, work capacity, comorbid symptoms, self-esteem, and emotion regulation complemented by weekly measures and ecological momentary assessment. Intention-to-treat analyses were performed. Results: Participants (N = 154; mean [SD] age, 29.6 [8.6] years; 149 [96.8%] female) receiving the web-based intervention demonstrated a significantly greater decrease in bulimic episodes compared with the control group (Cohen d = -0.48; 95% CI, -0.75 to -0.20; P < .001), representing a significant change in binge-eating episodes (Cohen d = -0.61; 95% CI, -0.89 to -0.33; P < .001), but not in compensatory behaviors (Cohen d = -0.25; 95% CI, -0.51 to 0.02; P = .21). The intervention was superior in improving global eating disorder symptoms (Cohen d = -0.61; 95% CI, -0.89 to -0.32; P < .001) and clinical impairment (Cohen d = -0.62; 95% CI, -0.92 to -0.33; P < .001). No significant effects were found for well-being (Cohen d = -0.08; 95% CI, -0.37 to 0.22; P > .99) and work capacity (Cohen d = -0.01; 95% CI, -0.68 to 0.66; P = .99). Exploratory analyses indicated significant changes in self-esteem and emotion regulation difficulties, but not in comorbid symptoms. Conclusions and Relevance: In this randomized clinical trial, a web-based cognitive behavioral self-help intervention effectively decreased eating disorder symptoms and illness-related burden in individuals with BN, underlining the potential of digital interventions to complement established treatments. Trial Registration: ClinicalTrials.gov Identifier: NCT04876196.
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Bulimia Nerviosa , Terapia Cognitivo-Conductual , Intervención basada en la Internet , Humanos , Bulimia Nerviosa/terapia , Bulimia Nerviosa/psicología , Femenino , Terapia Cognitivo-Conductual/métodos , Adulto , Masculino , Persona de Mediana Edad , Alemania , Adulto Joven , Resultado del Tratamiento , Adolescente , Internet , AutoimagenRESUMEN
Importance: Binge eating disorder (BED) is one of the most frequent eating pathologies and imposes substantial emotional and physical distress, yet insufficient health care resources limit access to specialized treatment. Web-based self-help interventions emerge as a promising solution, offering more accessible care. Objective: To examine the effectiveness of a web-based cognitive behavioral self-help intervention for individuals with BED. Design, Setting, and Participants: This 2-arm, parallel-group randomized clinical trial conducted from January 15, 2021, to August 3, 2022, in Germany and other German-speaking countries enrolled patients aged 18 to 65 years who met the diagnostic criteria for BED (according to the Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]). Data analysis occurred between January 27 and September 4, 2023, following our statistical analysis plan. Interventions: Participants were randomized to a web-based self-help intervention or a waiting-list control condition. Main Outcomes and Measures: The primary outcome was a change in objective binge eating episodes from baseline to after treatment. Secondary outcomes included global eating pathology, clinical impairment, work capacity, well-being, comorbid psychopathology, self-esteem, and emotion regulation. Results: A total of 1602 patients were screened, of whom 154 (mean [SD] age, 35.93 [10.59] years; 148 female [96.10%]) fulfilled the criteria for BED and were randomized (77 each to the intervention and control groups). The web-based intervention led to significant improvements in binge eating episodes (Cohen d, -0.79 [95% CI, -1.17 to -0.42]; P < .001), global eating psychopathology (Cohen d, -0.71 [95% CI, -1.07 to -0.35]; P < .001), weekly binge eating (Cohen d, -0.49 [95% CI, -0.74 to -0.24]; P < .001), clinical impairment (Cohen d, -0.75 [95% CI, -1.13 to -0.37]; P < .001), well-being (Cohen d, 0.38 [95% CI, 0.01 to 0.75]; P = .047), depression (Cohen d, -0.49 [95% CI, -0.86 to -0.12]; P = .01), anxiety (Cohen d, -0.37 [95% CI, -0.67 to -0.07]; P = .02), self-esteem (Cohen d, 0.36 [95% CI, 0.13 to 0.59]; P = .003), and emotion regulation (difficulties: Cohen d, -0.36 [95% CI, -0.65 to -0.07]; P = .01 and repertoire: Cohen d, 0.52 [95% CI, 0.19 to 0.84]; P = .003). Conclusion and Relevance: In this randomized clinical trial of a web-based self-help intervention for patients with BED, the findings confirmed its effectiveness in reducing binge eating episodes and improving various mental health outcomes, highlighting a scalable solution to bridge the treatment gap for this condition. Trial Registration: ClinicalTrials.gov Identifier: NCT04876183.
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Trastorno por Atracón , Terapia Cognitivo-Conductual , Intervención basada en la Internet , Humanos , Trastorno por Atracón/terapia , Trastorno por Atracón/psicología , Femenino , Masculino , Adulto , Persona de Mediana Edad , Terapia Cognitivo-Conductual/métodos , Resultado del Tratamiento , Alemania , Autocuidado/métodos , Adulto Joven , Internet , Autoimagen , Adolescente , AncianoRESUMEN
Emotion regulation strategies are frequently combined within one emotional episode, a phenomenon labeled emotion polyregulation. Nevertheless, there is a scarcity of studies examining which regulatory strategies are commonly combined across different contexts and how effective these combinations are in everyday life. Targeting this research gap, the present ecological momentary assessment study modeled emotion polyregulation and its success for contexts of (a) downregulation, (b) upregulation, and (c) maintenance goals in N = 321 adults. The endorsement and success of 15 different emotion regulation strategies derived from the process model of emotion regulation were measured 5 times a day for 7 days. Multilevel factor analyses revealed that individuals tend to combine different regulatory strategies depending on the activated regulatory goal: When examining downregulation, four factors best described the combined use of regulatory strategies: Situation Modification, Repetitive Processing, Emotional Avoidance, and Interpersonal Regulation. In contrast, three-factor models characterized emotion polyregulation for upregulation (Emotional Acceptance, Repetitive Processing, and Interpersonal Regulation) and maintenance goals (Unspecific Regulation, Emotional Acceptance, and Interpersonal Regulation). Moreover, multilevel structural equation modeling revealed that the success of emotion polyregulation is goal-dependent. While combining interpersonal and situation modification strategies was related to beneficial outcomes for downregulation goals, acceptance-based strategies were most strongly associated with emotion regulation success in situations of upregulation and maintenance. These results add to a more complex understanding of emotion regulation in daily life and highlight the necessity of broadening the focus of emotion regulation research to examine emotion polyregulation. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Regulación Emocional , Adulto , Humanos , Regulación Emocional/fisiología , Objetivos , Emociones/fisiología , Evaluación Ecológica Momentánea , Análisis FactorialRESUMEN
BACKGROUND: Despite the importance of positive emotions for affective psychopathology, prior research primarily focused on negative emotion regulation. To address this gap, this ecological momentary assessment study compared a broad set of emotion regulation strategies in the context of positive versus negative emotions regarding their effectiveness and associations with depressive symptoms. METHODS: We analyzed data from 1066 participants who were notified five times daily for seven consecutive days to complete a smartphone survey assessing their predominant emotions, strategies to regulate them, and subsequent emotional outcomes. RESULTS: Findings show that the effectiveness of most regulation strategies depended on whether the emotional context was positive or negative. While acceptance and savoring predicted improved emotional outcomes across emotional contexts, reappraisal and problem-solving were associated with deteriorated emotional outcomes and increased depressive symptoms when regulating positive but not negative emotions. LIMITATIONS: Future studies should replicate our findings in demographically and culturally diverse clinical samples to improve generalizability. CONCLUSION: These results emphasize that strategies effective for regulating negative emotions may be less helpful in the context of positive emotions. Thus, context-specific interventions may be a promising approach to improve the treatment of affective disorders.
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Depresión , Regulación Emocional , Humanos , Depresión/psicología , Emociones/fisiología , Encuestas y Cuestionarios , Trastornos del Humor , Evaluación Ecológica MomentáneaRESUMEN
Responding to the emotions of the people around us is a phenomenon traversing human lives; however, research has only recently started exploring the predictors of interpersonal emotion regulation (IER). In two ecological momentary assessment studies conducted in 2021 and 2022, we tested whether facets of empathy (i.e., mentalizing, experience sharing, empathic concern, and personal distress) are associated with other-focused IER goals and their attainment in everyday life (Ns = 125 and 204). Study 1 examined associations between mentalizing, experience sharing, and global hedonic and counter-hedonic IER goals (i.e., making others feel better or worse) in a relatively young and predominantly female student sample in Germany. Study 2 expanded these findings to empathic concern, personal distress, and specific types of hedonic and counter-hedonic IER goals (i.e., increasing, decreasing, and/or maintaining others' positive and/or negative emotions) in a more diverse U.S. community sample. Participants primarily endorsed hedonic IER goals, which were associated with higher mentalizing and experience sharing in both studies and higher empathic concern and lower personal distress in Study 2. Counter-hedonic IER goals were positively associated with experience sharing and personal distress in Study 2. Conversely, empathic concern and mentalizing were negatively related to counter-hedonic IER goals. We also found differential associations for state and trait empathy with IER goals. All empathy facets except personal distress were positively associated with goal attainment in Study 2. These findings address a major gap in our knowledge about everyday IER and offer a novel perspective on empathy in social emotion regulation processes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Regulación Emocional , Empatía , Objetivos , Relaciones Interpersonales , Humanos , Empatía/fisiología , Femenino , Masculino , Adulto , Adulto Joven , Alemania , Evaluación Ecológica Momentánea , Mentalización , AdolescenteRESUMEN
Individuals with borderline personality disorder (BPD) have shown a negativity bias, whereas the general population has shown a positivity bias in their trustworthiness appraisal of others. We tested if individuals with BPD are more negative but also more realistic with their appraisals. Trustworthiness was objectified on an external criterion. The influence of childhood trauma was investigated. Facial photographs of peace prize laureates and sentenced murderers were presented. Participants with BPD and healthy controls (HC) rated the trustworthiness of the targets. Bias and sensitivity were measured using signal detection theory. The BPD group was more negatively biased compared to HC, but not more sensitive in discriminating between the two groups. When correcting for experienced childhood abuse and neglect, the authors found that group differences in bias disappeared. Individuals with BPD might not be more sensitive in discriminating between, on average, more or less trustworthy targets, but they have developed a negativity bias to ensure the detection of untrustworthiness.
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Experiencias Adversas de la Infancia , Trastorno de Personalidad Limítrofe , Maltrato a los Niños , Humanos , Niño , Confianza , Trastorno de Personalidad Limítrofe/diagnósticoRESUMEN
BACKGROUND: Generalized anxiety disorder (GAD) is a highly prevalent and severely distressing condition that can lead to functional impairments and is considered one of the most difficult anxiety disorders to treat. Following new technological developments, a highly structured cognitive behavioral therapy (CBT) approach that has already shown success in face-to-face psychotherapy can be implemented: internet-delivered CBT (iCBT). There is now evidence for the efficacy of both guided and unguided iCBT interventions for GAD regarding symptom reduction. OBJECTIVE: To establish the usefulness of such interventions, we plan to evaluate the efficacy of a web-based self-help program (Selfapy) for GAD in a relatively large sample. We aim to assess effects beyond symptom reduction, including effects on well-being, functioning, and mental health literacy, as well as the effect on health care burden, while testing the intervention in conditions comparable to routine care. METHODS: Patients (n=156) who have been diagnosed with GAD, are aged between 18 and 65 years, have internet access, and have sufficient German language skills will be recruited for this study. The intervention group (n=78) will receive access to the 12-week self-help web-based program Selfapy. The waitlist control group (n=78) will receive no intervention in the context of the study. However, both groups will be allowed to access further health care services (eg, psychotherapy, medication), reflecting current routine care in Germany. Outcome measures will be assessed at baseline (T1) and 6 weeks (T2) and 12 weeks (T3) after the start of the intervention. The primary outcome will be generalized anxiety symptoms and quality of life at T3. Additional outcomes include depression, work capacity, therapy-related expenses and burdens, health literacy, and negative effects. RESULTS: By May 2023, all participants had finished the trial and the report was being prepared for publication. CONCLUSIONS: Web-based interventions may be an important addition to the German health care system to reduce barriers to treatment access. Further, they may prove cost-effective for the treatment of GAD. TRIAL REGISTRATION: Deutsches Register Klinischer Studien DRKS00023799; https://tinyurl.com/22bds38x. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/41440.
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The strategy-situation fit hypothesis suggests that emotion regulation strategies are only beneficial to mental health if they meet contextual demands. Previous studies support this assumption but focused on properties of the emotional stimulus and reported cross-sectional associations with mental health, thus neglecting the social context and long-term mental health outcomes. To address these limitations, we examined (1) whether reappraisal, social sharing, and suppression varied depending on the social context (i.e., being alone, among close others, or nonclose others) and (2) whether specific strategy-context associations were linked to current, and (3) long-term mental health. The study consisted of two ecological momentary assessment (EMA) periods, separated by one year, and the second period occurred during COVID-19-related governmentally imposed social restrictions. This design allowed us to examine emotion regulation following social context changes. Our results indicate that emotion regulation varied by the social context. Reappraisal was used more frequently when being alone, suppression occurred more among nonclose others, and social sharing increased with close others. Regarding current mental health, more suppression was linked to higher depressive symptoms only when used in the presence of close others. In contrast, using suppression when being alone was linked to lower depressive symptoms. Finally, analyses with long-term outcomes revealed improved mental health when participants increased their use of reappraisal when being alone, and decreased reappraisal after a higher presence of close others. These findings could reflect the unique regulatory costs and benefits of different social situations and highlight the role of context-specific reappraisal for longer-term adaptiveness. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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COVID-19 , Regulación Emocional , Humanos , Regulación Emocional/fisiología , Estudios Transversales , Emociones/fisiología , Medio SocialRESUMEN
BACKGROUND: Examining predictive biomarkers to identify individuals who will likely benefit from a specific treatment is important for the development of targeted interventions. The late positive potential (LPP) is a neural marker of attention and elaborated stimulus processing, and increased LPP responses to negative stimuli are characteristic of pathological anxiety. The present study investigated whether LPP reactivity would prospectively predict response to cognitive-behavioral therapy (CBT), the first-line treatment for obsessive-compulsive disorder (OCD). METHODS: To this end, the LPP in response to negative as compared to neutral pictures was examined in 45 patients with OCD, who underwent CBT in a naturalistic outpatient setting. LPP amplitudes were used as predictors of symptom reduction after CBT. RESULTS: We found that higher LPP amplitudes to negative relative to neutral stimuli were predictive of lower self-reported OCD symptoms after completion of CBT, controlling for pre-treatment symptoms. Further, LPP reactivity was negatively correlated with self-reported habitual use of suppression in everyday life. LIMITATIONS: Some participants had already begun treatment at the time of study participation. Overall, results need further replication in larger samples and standardized therapy settings. CONCLUSIONS: The current findings suggest that patients with increased emotional reactivity benefit more from CBT, possibly through less avoidance of anxiety-provoking stimuli during exposure with response prevention, a crucial component in CBT for OCD. Although its clinical utility still needs to be evaluated further, the LPP constitutes a promising candidate as a prognostic marker for CBT response in OCD.
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Terapia Cognitivo-Conductual , Trastorno Obsesivo Compulsivo , Ansiedad , Trastornos de Ansiedad , Atención/fisiología , Terapia Cognitivo-Conductual/métodos , Humanos , Trastorno Obsesivo Compulsivo/psicología , Trastorno Obsesivo Compulsivo/terapia , Resultado del TratamientoRESUMEN
Background: Although binge eating disorder (BED) is the most common eating pathology and carries a high mental and physical burden, access to specialized treatment is limited due to patient-related barriers and insufficient healthcare resources. Integrating web-based self-help programs into clinical care for BED may address this treatment gap by making evidence-based eating disorder interventions more accessible. Methods: A two-armed randomized controlled trial will be conducted to evaluate the effectiveness of a web-based self-help intervention for BED in routine care settings. Patients aged 18-65 years fulfilling the diagnostic criteria for BED (N = 152) will be randomly allocated to (1) an intervention group receiving a 12-week web-based self-help program or (2) a waitlist control group with delayed access to the intervention. The primary outcome will be the number of binge eating episodes. Secondary outcomes include global eating pathology, functional impairments, work capacity, well-being, comorbid psychopathology, self-esteem, and emotion regulation abilities. Measurements will be conducted at baseline (study entrance), 6 weeks after baseline (mid-treatment), and 12 weeks after baseline (post-treatment). To capture outcomes and treatment mechanisms in real-time, traditional self-reports will be combined with weekly symptom monitoring and ecological momentary assessment. Discussion: Evaluating the effectiveness of web-based interventions is essential to overcome the treatment gap for patients with BED. When adequately integrated into standard care, these programs have the potential to alleviate the high burden of BED for individuals, their families, and society. Trial registration: https://clinicaltrials.gov/ct2/show/NCT04876183, Identifier: NCT04876183 (registered on May 6th, 2021).
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BACKGROUND: Individuals with bulimia nervosa (BN) experience persistent episodes of binge eating and inappropriate compensatory behavior associated with impaired physical and mental health. Despite the existence of effective treatments, many individuals with BN remain untreated, leading to a high burden and an increased risk of chronicity. Web-based interventions may help facilitate access to evidence-based treatments for BN by reducing barriers to the health care system. METHODS: The present study will investigate the effectiveness of a web-based self-help intervention for BN in a two-armed randomized controlled trial. Individuals diagnosed with BN (N = 152) will be randomly assigned to either (1) an intervention group receiving a 12-week web-based intervention or (2) a waitlist control group with delayed access to the intervention. Further assessments will be scheduled 6 (mid-treatment) and 12 (post-treatment) weeks after baseline. Changes in the number of binge eating episodes and compensatory behaviors will be examined as primary outcomes. Secondary outcomes include global eating pathology, functional impairments, well-being, comorbid psychopathology, self-esteem, and emotion regulation abilities. DISCUSSION: Adding web-based interventions into routine care is a promising approach to overcome the existing treatment gap for patients with BN. Therefore, the current study will test the effectiveness of a web-based intervention for BN under standard clinical care settings. TRIAL REGISTRATION: ClinicalTrials.gov, Identifier: NCT04876196 (registered on May 6th, 2021).
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OBJECTIVE: A history of childhood abuse and neglect (CAN) is significantly associated with psychopathologies in adulthood, including comorbid posttraumatic stress disorder (PTSD) and substance use disorders (SUD). Difficulties in emotion regulation (ER) might influence the association between CAN and PTSD. The aim of this study was to examine the relationship between CAN and PTSD symptom severity in women with SUD and to investigate the mediating role of general difficulties in ER and its specific dimensions. Method: We examined 320 women, with a current diagnosis of at least subsyndromal PTSD and SUD, using self-report measures of CAN, PTSD symptom severity, and ER difficulties. We conducted both simple and multiple bootstrapping-enhanced mediation analysis to investigate whether general difficulties in ER and its specific dimensions mediate the relationship between CAN and PTSD symptom severity. Results: General difficulties in ER mediated the association between CAN and PTSD symptom severity. CAN significantly predicted adult PTSD symptom severity, directly and indirectly, through ER difficulties. Difficulties engaging in goal directed behavior when distressed was the only ER dimension, which mediated the effect of CAN on PTSD symptoms. Conclusions: Our results suggest that difficulties in ER and specifically difficulties engaging in goal directed behavior when distressed might constitute an influential factor in the relationship between CAN and PTSD symptom severity in a sample of SUD patients, and highlight the importance of targeting ER as a potential treatment focus for patients with comorbid PTSD and SUD.
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Maltrato a los Niños , Regulación Emocional , Trastornos por Estrés Postraumático , Trastornos Relacionados con Sustancias , Adulto , Niño , Emociones , Femenino , HumanosRESUMEN
What are the cognitive processes that allow flexible responses to the changing demands of varying emotional contexts? Previous research suggests that higher levels of cognitive control are linked to successful emotion regulation. In particular, the implementation of emotion regulation strategies has been associated with individual differences in cognitive control, including (a) inhibiting prepotent responses, (b) updating information in working memory, and (c) shifting mental sets. Although most of this work has focused on the relationship between cognitive control and the short-term implementation of regulatory strategies, cognitive control may be even more important for understanding the dynamic adaptation to varying emotional contexts, that is, emotion regulation flexibility. However, cognitive control and emotion regulation flexibility have not been investigated in conjunction, resulting in a lack of a coherent understanding. In this article, we describe a framework outlining the importance of cognitive control for understanding three key components of emotion regulation flexibility: (a) strategy stopping or switching, (b) strategy maintenance, and (c) monitoring. We highlight the relevance of studying each of these components through the lens of cognitive control processes, particularly focusing on the tradeoff between shielding versus shifting goals and goal-directed behavior in various emotional contexts. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Cognición/fisiología , Regulación Emocional/fisiología , Adaptación Psicológica , Humanos , Individualidad , Inhibición Psicológica , Memoria a Corto Plazo/fisiologíaRESUMEN
Childhood maltreatment (CM) is a strong risk factor for alcohol dependence (AD) and is associated with a more severe course of the disease. Alterations of the hypothalamic-pituitary-adrenal (HPA) axis may play an important role in this relationship. The aim of the present study was to systematically investigate potential alterations in HPA functioning associated with AD diagnosis and CM. Four study groups were recruited: AD patients with (n = 29; 10â) and without (n = 33; 8â) CM and healthy controls with (n = 30; 20â) and without (n = 38; 15â) CM. Cumulative cortisol secretion was measured by hair cortisol concentration (HCC). To measure HPA axis response to the Trier social stress test (TSST), saliva and blood samples were analysed for adrenocorticotropic hormone (ACTH) and cortisol. In the AD groups, the period of hair growth covered acute alcohol consumption and withdrawal. The TSST was scheduled after completion of withdrawal. Irrespective of CM, higher HCCs and reduced ACTH and cortisol levels before and after TSST were observed in AD patients. The analyses did not reveal any differences between AD patients with and without CM. Healthy controls with CM had lower plasma cortisol levels compared with those without CM. The results suggest that AD is strongly related to HPA axis functioning, which may superimpose possible differences between AD patients with and without CM. Future studies should investigate whether biologically different subtypes of AD with and without CM can be identified in earlier stages or before the development of AD.
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Adultos Sobrevivientes del Maltrato a los Niños/estadística & datos numéricos , Alcoholismo/metabolismo , Hidrocortisona/metabolismo , Sistema Hipotálamo-Hipofisario/metabolismo , Sistema Hipófiso-Suprarrenal/metabolismo , Estrés Psicológico/metabolismo , Adulto , Alcohólicos/estadística & datos numéricos , Femenino , Cabello/metabolismo , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: There is scarce research on the effects of mindfulness in individual therapy. As many practitioners integrate mindfulness exercises into individual therapy, empirical evidence is of high clinical relevance. METHOD: We investigated the effects of a session-introducing intervention with mindfulness elements (SIIME) in a randomized, controlled design. The effects of SIIME on therapeutic alliance and symptomatic outcome were compared with progressive muscle relaxation (PMR) and treatment-as-usual (TAU) control conditions. The sample comprised 162 patients with anxiety and depression. RESULTS: Multilevel modeling revealed a significant symptom reduction and significant increase of alliance over the course of therapy. There were no significant time-condition interactions on outcome and alliance, indicating the comparable efficiency of all three treatment conditions. CONCLUSIONS: We found no advantage of SIIME versus PMR and TAU. Add-on mindfulness might not improve individual therapy related to alliance and outcome.
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Trastornos de Ansiedad/terapia , Entrenamiento Autogénico/métodos , Trastorno Depresivo/terapia , Atención Plena/métodos , Procesos Psicoterapéuticos , Alianza Terapéutica , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
The Heidelberg Form for Emotion Regulation Strategies (HFERST) was developed to complement previous emotion regulation (ER) questionnaires and addresses some of their limitations by measuring eight ER strategies. An initial item pool was developed in German following expert discussions and adaptation of the items from existing ER scales. Following a stepwise selection based on the experts' judgments, 32 items with the best content validity were chosen. Results of an exploratory factor analysis in Study 1 (N = 399) and two confirmatory factor analyses in Studies 2 (N = 715) and 3 (N = 408) supported the eight-factor structure of the HFERST and provided evidence for its internal consistency, construct and criterion validity, and clinical utility. Study 4 supported a 2-week stability of the HFERST and Study 5 showed that, following an ER intervention, the HFERST captured a reduction in dysfunctional and an improvement in functional ER strategies, which again supports the clinical utility of the HFERST.
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Regulación Emocional , Encuestas y Cuestionarios , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Análisis Factorial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Psicometría , Reproducibilidad de los Resultados , Adulto JovenRESUMEN
Cognitive reappraisal of emotion is strongly related to long-term mental health. Therefore, the exploration of underlying cognitive and neural mechanisms has become an essential focus of research. Considering that reappraisal and executive functions rely on a similar brain network, the question arises whether behavioral differences in executive functions modulate neural activity during reappraisal. Using functional neuroimaging, the present study aimed to analyze the role of working memory capacity (WMC) and cognitive flexibility in brain activity during down-regulation of negative emotions by reappraisal in N = 20 healthy participants. Results suggests that WMC and cognitive flexibility were negatively correlated with prefrontal activity during reappraisal condition. Here, results also revealed a negative correlation between cognitive flexibility and amygdala activation. These findings provide first hints that (1) individuals with lower WMC and lower cognitive flexibility might need more higher-order cognitive neural resources in order to down-regulate negative emotions and (2) cognitive flexibility relates to emotional reactivity during reappraisal.
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Amígdala del Cerebelo/fisiología , Cognición/fisiología , Inteligencia Emocional/fisiología , Emociones/fisiología , Función Ejecutiva/fisiología , Memoria a Corto Plazo/fisiología , Adulto , Amígdala del Cerebelo/diagnóstico por imagen , Mapeo Encefálico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
Background: Substance use disorders (SUD) belong to the most frequent behavioural consequences of childhood abuse and neglect (CAN). If parents are concerned, SUD are also an important risk factor for CAN. The relationship between CAN and SUD remains poorly understood. There is a need of adequate treatments for SUD patients suffering from the consequences of CAN, as well as for approaches to prevent CAN by parents with SUD. Objective: To describe the aims and the structure of a German research network on relationships between CAN and SUD (CANSAS network). Method: Descriptive overview of the aims, and the different project clusters of the network. Results: The aims of the CANSAS network are: (1) to examine relationships between SUD and CAN; (2) to examine the effects of an evidence-based treatment for SUD patients with posttraumatic disorders; and (3) to provide SUD services with tools to diagnose CAN, and to assess the risk of maltreatment among parents with SUD. The aims of the network are addressed by six projects in three different project clusters (mediators and risk factors, evidence-based treatment, and improvement of services). Conclusions: It is expected that the CANSAS network will advance the understanding of relationships between early adversity and substance use disorders. It will bring forward the discussion about promising treatments for SUD patients with experiences of CAN. Finally it will provide services with measures to identify patients with CAN, and with tools to break the trans-generational cycle of adversity.
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Background: History of childhood abuse and neglect is considered to be a relevant risk factor for adult psychopathology. A functional emotion regulation (ER) can account for resilience despite of traumatic experiences in childhood. Materials & Methods: This study compares the habitual use of specific ER strategies among mentally healthy individuals with (n=61) and without (n=52) experience of childhood abuse and neglect by using the self-rating instrument Heidelberg Form for Emotion Regulation Strategies (H-FERST). SCID-I, ADP-IV, SCL-27, and BDI-II were used for assessment of psychopathological distress. Results: We found no group difference in the habitual use of ER strategies. Healthy individuals with childhood abuse and neglect showed significantly more subjective distress symptoms. Discussion & Conclusion: Considering the significantly higher psychopathological distress reported by the trauma group, the functional habitual use of ER strategies could serve as a path to explain the resilient development of adult individuals after childhood abuse and neglect.
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Adultos Sobrevivientes del Maltrato a los Niños/psicología , Ajuste Emocional , Trastornos Mentales/psicología , Resiliencia Psicológica , Trastornos por Estrés Postraumático/psicología , Adolescente , Adulto , Niño , Mecanismos de Defensa , Femenino , Humanos , Masculino , Trastornos Mentales/diagnóstico , Persona de Mediana Edad , Psicometría , Psicopatología , Trastornos por Estrés Postraumático/diagnóstico , Encuestas y CuestionariosRESUMEN
RATIONALE: Alcohol-dependent (AD) patients with a history of childhood maltreatment (CM) have shown a more severe clinical profile and a higher risk of relapse than those without CM. It was hypothesized that stress responsivity plays an important role in moderating the relationship between CM and AD. Surprisingly, systematic investigations about the stress responsivity in AD patients with CM are rare. OBJECTIVE: This study compared physiological and subjective stress responses in AD patients with and without CM as well as in healthy controls with and without CM. METHODS: A total of 130 participants performed the Trier Social Stress Test (TSST). Physiological stress reactivity related to the noradrenergic system was assessed by salivary alpha-amylase (sAA) activity. Subjective ratings of anxiety, nervousness, distress, and mood were rated on visual analogue scales. RESULTS: AD patients showed significantly lower stress-related sAA activity than healthy controls (p ≤ 0.024; z ≥ 1.97). A different pattern was found in the subjective ratings. In particular, anticipatory anxiety revealed a clear effect of CM (p ≤ 0.005; z ≥ 2.43) but no difference between AD patients and healthy controls (p > 0.05). After the TSST, distress ratings differed between AD patients with CM and AD patients without CM (p ≤ 0.009; z ≥ 2.61). CONCLUSION: The discrepancy between physiological responsivity and subjective stress experiences may account for an increased inability to cope with stressful situations, which in turn might explain the enhanced risk of relapse in AD patients with a history of CM during early abstinence.