ABSTRACT
BACKGROUND: Severe shame is a distressing negative emotion, accompanied by intense feelings of worthlessness that contributes to a broad panoply of psychological disorders. This study aimed to compare the effects on shame dysregulation of two transdiagnostic treatments, the Unified Protocol (UP) and Self-Acceptance Group Therapy (SAGT). We additionally addressed the question of whether borderline personality disorder (BPD) can properly be regarded as an emotional disorder. The focus was on outcome measures, primarily shame that cut across individual diagnostic categories and capture emotional dysfunction broadly conceived. METHODS: Individuals suffering from a range of emotional disorders (including BPD) and high levels of shame were randomly allocated to treatment by either UP (N = 280) or SAGT (N = 282). Outcomes were measures of emotion dysfunction-shame, loneliness, neuroticism, emotional dysregulation, positive and negative affect-measured pre-treatment, post-treatment and at 3- and 6-month follow-ups. RESULTS: UP was superior to SAGT in showing better post-treatment retention of therapeutic gains on all outcome measures over the 6-month follow-up period. Compared with those without a BPD diagnosis, those diagnosed with BPD showed significantly higher neuroticism and emotion dysregulation at baseline and a similar post-treatment reduction in almost all outcomes. CONCLUSIONS: The results support the use of both the UP and SAGT in the treatment of severe shame. The superiority of the UP over SAGT in reducing negative emotionality is interpreted in terms of the specific mechanisms targeted by the UP. The results provide support for the theoretical rationale for the UP as a treatment for dysregulated shame and for emotional dysfunction generally.
Subject(s)
Borderline Personality Disorder , Psychotherapy, Group , Shame , Humans , Female , Male , Adult , Psychotherapy, Group/methods , Borderline Personality Disorder/therapy , Borderline Personality Disorder/psychology , Middle Aged , Treatment Outcome , Young AdultABSTRACT
This study investigated the relative efficacy of Mentalization-based therapy (MBT) and United Protocol (UP) in reducing symptoms of psychopathy and emotion dysregulation in a sample of Iranian community residents with concurrent diagnoses of antisocial and borderline personality disorders (PDs). Interpersonal, affective, and lifestyle features of psychopathy were measured post-treatment and at 6-, 12-, 18-, 24-, and 36-months follow-up using the 13-item version of the Psychopathy Revised-Checklist (PCL-R), which excluded, by design, criminal history features. Emotion dysregulation was measured using the Deficits in Emotion Regulation Scale (DERS) developed by Gratz and Roemer (2004). After treatment, both UP- and MBT-treated individuals showed significantly fewer features of psychopathy and significantly less emotion dysregulation. Compared with those treated with MBT, UP-treated individuals showed significantly less emotion dysregulation in all DERS subscales and a greater reduction in psychopathy features, particularly affective features. It is suggested that this likely reflected the particular emphasis placed by UP on improving emotional self-regulation and facilitating the therapeutic alliance. These results suggest that, despite the traditional pessimism that surrounds psychopathic individuals' treatability, they can be successfully treated.
Subject(s)
Antisocial Personality Disorder , Criminals , Humans , Iran , Antisocial Personality Disorder/therapy , Antisocial Personality Disorder/psychology , Criminals/psychology , Life Style , EmotionsABSTRACT
Harmful consequences of COVID-19, such as prolonged quarantine, lack of social contact, and especially loss of parents or friends, can negatively impact children and adolescents' mental health in diverse ways, including engendering posttraumatic stress symptoms. Our study is the first to compare the transdiagnostic Unified Protocol for the Treatment of Emotional Disorders in Adolescents (UP-A; Ehrenreich et al., 2009; Ehrenreich-May et al., 2017) with Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) in terms of outcomes related to PTSD symptoms (COVID-19-related vs. COVID-19 unrelated PTSD) and comorbid symptoms (i.e., anxiety, depression) and other measures (i.e., emotion regulation, self-injury, anger). Individuals diagnosed with PTSD were randomly assigned to the UP-A (nâ¯=â¯46) or TF-CBT group (nâ¯=â¯47), administered the SCID-5 and a battery of measures and followed up posttreatment and then after 3, 6, and 9 months. Ninety-three adolescents with PTSD were enrolled, 45% boys and 61% COVID-19-related PTSD. We adopted an intention-to-treat approach. At the initial post-intervention assessment, except for emotion regulation and unexpressed angry feelings, in which UP-A participants reported greater reductions, no significant differences in other variables were secured between the UP-A and TF-CBT. However, at follow-up assessments, the UP-A evidenced significantly better outcomes than TF-CBT. We found support for the UP-A compared with TF-CBT in treating adolescents with PTSD, regardless of COVID-19-related PTSD status, in maintaining treatment effectiveness over time.
Subject(s)
COVID-19 , Cognitive Behavioral Therapy , Stress Disorders, Post-Traumatic , Male , Child , Humans , Adolescent , Female , Stress Disorders, Post-Traumatic/therapy , COVID-19/therapy , Anger , AnxietyABSTRACT
BACKGROUND: Body dysmorphic disorder (BDD) is a common disorder which is associated with a high rate of comorbidity and functional impairment. Although research shows that cognitive-behavioral therapy can be an efficacious treatment for BDD, there is growing evidence that dysregulated emotion is a core deficit. The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP) is a transdiagnostic, emotion focused cognitive-behavioral therapy protocol that has been developed to target emotion regulation processes that play an important role in the development and maintenance of many emotional disorders METHODS: : In the present study, 128 patients meeting criteria for BDD were randomized to either the UP (nâ¯=â¯64) or waitlist/treatment-as-usual (WL/TAU) condition. Diagnoses were determined using semi-structural interviews and patients also completed the Brown Assessment of Beliefs Scale (BABS), the Appearance Anxiety Inventory (AAI), the Difficulties in Emotion Regulation Scale (DERS), the Beck Depression Inventory (BDI) and the Clinical Global Impression (CGI). RESULTS: Repeated measure ANOVA indicated that the UP significantly decreased depression, BDD symptoms and body-related anxiety, as well as significantly improving emotional regulation all with large effect sizes compared to the TAU/WL condition. Treatment gains as well as remission of comorbid conditions were maintained at the three-month follow-up. LIMITATIONS: Our study limitations include restricted follow-up periods and excluding participants who were actively suicidal. CONCLUSIONS: To our knowledge, this is the first examination of the UP for BDD, and results suggest that this disorder shares common mechanisms with other disorders of emotion, and that the UP may be an additional efficacious treatment for this condition.
Subject(s)
Affective Symptoms/therapy , Body Dysmorphic Disorders/therapy , Cognitive Behavioral Therapy/methods , Adult , Affective Symptoms/psychology , Analysis of Variance , Anxiety/psychology , Anxiety/therapy , Body Dysmorphic Disorders/psychology , Clinical Protocols , Comorbidity , Depression/psychology , Depression/therapy , Female , Humans , Male , Middle Aged , Psychiatric Status Rating Scales , Treatment OutcomeABSTRACT
BACKGROUND: Substance use and affective disorders frequently co-occur, but the role of affective dysregulation in addiction is often overlooked. There is evidence shows that substance - dependent individuals have more problems in regulating their emotions. OBJECTIVES: This study compared two commonly used emotional regulation strategies, cognitive reappraisal and suppression, in opioids and methamphetamine dependents. MATERIALS AND METHODS: One hundred forty men with substance dependence (70 Opioids, 70 Methamphetamine) were selected by accessible sampling, and they responded to Emotion Regulation Questionnaire (Gross & John) and Clinical drug addiction profile (CDAP) questionnaire. SPSS software was used to analyze the results, and descriptive statistics such as frequency tables and inferential statistics including independent t-test were used. RESULTS: Opioids and methamphetamine dependent patients differ in reappraisal strategy (P < 0.01). These groups differ not only in reappraisal strategy, but also in the suppression (P < 0.001). CONCLUSION: Opioids and methamphetamine dependent individuals used different strategies for regulating their emotions. The key finding was that opioids dependents prefer suppression, and methamphetamine dependents usually use reappraisal for this purpose.