Childhood trauma and posttraumatic stress symptoms in adolescents and young adults: The mediating role of mentalizing and emotion regulation strategies.

OBJECTIVES: Childhood trauma (physical, emotional, sexual abuse and/or physical and emotional neglect) represents a specific risk for developmental perturbations and long-term negative outcomes. Adolescents and young adults with childhood trauma have rarely experienced a single type of traumatic event but rather multiple traumatic experiences. However, studies on adolescent PTSD are sparse. This study examines the possible mediating role of mentalizing, cognitive and interpersonal emotion regulation strategies between multiple types of childhood trauma exposure and PTSD in adolescents and young adults. METHODS: The sample consisted of 456 adolescents and young adults aged 15 and 25, recruited from four high schools and one university. Participants completed self-report questionnaires assessing childhood trauma, mentalizing, cognitive and interpersonal strategies of emotion regulation and PTSD. RESULTS: Structural Equation Modeling revealed that multiple types of childhood trauma exposure have a significant indirect effect on PTSD symptoms through its association with hypomentalizing and maladaptive cognitive strategies of emotion regulation (i.e. self-blame, rumination, catastrophizing). Results also showed a significant indirect effect between multiple types of childhood trauma exposure and PTSD symptoms through its association with hypomentalizing and maladaptive interpersonal strategies of emotion regulation (i.e. emotional reactivity and tendency to avoid emotional connection). Indirect paths were also run in reverse to control for the direction of the effect. CONCLUSION: Our findings show that exposure to multiple types of childhood trauma contributes to severe PTSD through several complex pathways including both hypomentalizing and maladaptive emotion regulation strategies in adolescence and young adulthood.

Hypnosis Intervention for Couples Confronted with Alzheimer's Disease: Promising Results of a First Exploratory Study.

BACKGROUND: Dementia has a negative impact on the quality of life of the person with dementia and their spouse caregivers, as well as on the couple's relationship, which can lead to high levels of distress for both partners. Hypnosis has been shown to be effective in managing distress and increasing the quality of the relationship. OBJECTIVE: The aim was to develop a standardized hypnosis intervention for couples confronted with Alzheimer's disease and evaluate its feasibility, acceptability, and helpfulness in managing the distress of both partners and increasing the quality of the relationship. METHODS: In a single-arm study, sixteen couples received the 8-week intervention. Qualitative and quantitative assessments were conducted pre- and post-intervention as well as three months after. RESULTS: 88.9% of couples (n = 16) of the final sample (n = 18) completed the intervention. Despite the negative representations of hypnosis, several factors led couples to accept to participate in this study: positive expectations, professional endorsement, medical application, non-drug approach, home-based, free, flexible, and couple-based intervention. The results showed a significant decrease in distress for both partners. These effects were maintained three months after the intervention. Couples felt more relaxed, had fewer negative emotions, accepted difficulties more easily, were more patient, and reported better communication and more affection in the relationship. CONCLUSION: Overall, this pilot study shows the feasibility and acceptability of hypnosis with couples confronted with Alzheimer's disease. Although measures of the preliminary pre- and post-intervention effects are encouraging, confirmatory testing with a randomized controlled trial is needed.

How do maternal emotional regulation difficulties modulate the mother-infant behavioral synchrony?

Mother-infant synchrony is one of the most important processes in the development of socio-affective competencies in children. While maternal abilities and psychopathology are related to maladaptive mother-infant synchrony, it is as yet unclear how maternal emotion regulation difficulties contribute to it. Based on a panel of behavioral indicators (i.e., gaze, vocal, and motor), the present study examined mother-infant synchrony at 6 months of age in a modified version of Ainsworth's Strange Situation (n = 72 dyads). Mother-infant interaction sequences were characterized by indicators of complexity (LZ complexity of joint behavioral sequences) and of synchronization quality (cross-recurrence plot quantification). Results showed that mothers' touch was greater in the reunion condition than in the initial condition. Mothers' motor behaviors were associated with the global levels of infants' behavioral involvement in the reunion condition, unlike the symmetrical influence observed between mothers and infants in the initial condition. Results show that maternal anxiety mediates the relationships between mothers' emotion regulation difficulties and gaze, vocal, and motor synchrony between mothers and infants in the initial and reunion conditions. This study emphasizes the central role of maternal emotion regulation difficulties in the establishment of maladaptive synchrony and in the adjustments of maternal physical contacts with infants.

Modeling the Distress of Adult-Child Caregivers of People with Dementia: The Mediating Role of Self-Efficacy.

BACKGROUND: The increased tasks and responsibilities involved in supporting a parent with dementia (PWD) can induce distress in adult-child caregivers. Previous studies have shown that distress can be influenced by PWD and caregiver determinants, but few studies have considered the associations between these variables. OBJECTIVE: This study tested a complex model of adult-child caregiver distress in which PWD and caregiver determinants and their associations are considered. METHODS: 159 adult-child caregivers participated in this online study. PWD and caregiver determinants were assessed using questionnaires and their associations were investigated using the partial least squares path method. RESULTS: The model showed a significant partial mediation through self-efficacy (confidence in one's ability to organize and manage caregiving situations) between poor self-rated health and distress. Self-efficacy was a significant mediator of the relationship between informal social support and distress, and between preparedness and distress. The direct path between parental overprotection and distress was significant. The association between care and distress was significantly stronger for adult-child caregivers not living with their PWD. CONCLUSION: The model revealed the important mediating role of self-efficacy. Clinical interventions should improve the preparedness of adult-child caregivers and the quality of social support. The positive perception of their self-rated health may thus be promoted.

Characterizing the determinants of sexual dissatisfaction among heterosexuals: The specific role of dyadic coping.

Sexual satisfaction is the most frequently studied sexual component of human sexuality related to its link with relationship satisfaction and stability (S. Sprecher & R. M. Cate, 2004. The handbook of sexuality in close relationships, pp. 235-256. Mahwah, NJ: Taylor & Francis). Previous studies have shown that sexual satisfaction is affected by personal, interpersonal, social and cultural variables, but few studies have considered the associations between these variables. The aim of this study was to evaluate a complex model of sexual satisfaction considering these various levels of variables and their associations. The study was conducted online and comprised 457 individuals in the final sample. The French version of the index of sexual satisfaction evaluated the level of sexual dissatisfaction. Personal, interpersonal, social and cultural variables were assessed with questionnaires and their associations were investigated with the partial least squares-path method. The association between dyadic coping (positive and negative) and sexual dissatisfaction was mediated by relationship satisfaction. The model also showed three sequential mediations through dyadic coping and relationship satisfaction: first between intra-individual vulnerability and sexual dissatisfaction, second between intra-individual resources and sexual dissatisfaction, and third between conjugal characteristics and sexual dissatisfaction. The simple and sequential mediations were stronger for positive dyadic coping. The relationship between intra-individual resources and positive dyadic coping was significantly stronger in women, while the relationship between conjugal characteristics and positive dyadic coping was stronger in men. Dyadic coping plays a key role in sexual dissatisfaction. Clinical interventions should reinforce positive self-image (particularly in women), support emotional and physical vulnerabilities, and promote more supportive dyadic coping (particularly in men in a long-term relationship).

Interoceptive reliance as a major determinant of emotional eating in adult obesity.

This study examined the association between emotional eating, emotion dysregulations, and interoceptive sensibility in 116 patients with obesity by distinguishing an "awareness" and a "reliance" component of interoceptive sensibility. Deficits in interoceptive awareness were only associated with more emotional eating in obesity through less interoceptive reliance and more emotion dysregulations. The results suggest that good interoceptive awareness can increase the risk of emotional eating if not supported by good interoceptive reliance. Interoceptive reliance, like the ability to trust, positively consider, and positively use inner sensations, should be a privileged target of psychotherapeutic interventions in obesity.

Eating in case of emotion dys-regulation, depression and anxiety: Different pathways to emotional eating in moderate and severe obesity.

Emotion dys-regulation is thought to be involved in the development and maintenance of emotional eating (EE), notably through its links with anxious and depressive symptoms. AIM: The aims of the study were to: (a) examine the mediating effect of depressive and anxious symptoms on the relationship between emotion dys-regulation and EE in obesity and (b) compare those links with various degrees of obesity severity. One hundred and twenty patients with obesity, including 60 with "n" (MO) (30 ≤ BMI < 40) and 60 with "severe obesity" (SO) (BMI > 40), completed self-report measures of emotion dys-regulation, depression, anxiety and EE. Partial least square structural equation modelling and multi-group analyses were performed. Emotion dys-regulation was found to be significantly associated with EE only when the severity of obesity was taken into account. In addition, although the MO and SO groups reported similar levels of emotional and eating disorders, significant differences were found between the groups in pathways leading to EE. In MO, emotion dys-regulation was only associated with more EE through more anxiety. In SO, emotion dys-regulation was both directly and indirectly associated with more EE, but only through more depression in the latter. Emotion dys-regulation, anxiety and depression do not have the same impact on EE depending on the severity of obesity. Psychotherapeutic interventions should aim at reducing emotion dys-regulation in obesity from MO onwards, but the focus should be on the management of anxiety-related affects in MO and depression-related affects in SO.

The influence of attachment styles on autonomic correlates of perspective-taking.

This study examined the effects of attachment styles on physiological responses during a perspective-taking task. Sixty-eight participants were selected according to attachment styles. Physiological responses were assessed using skin conductance responses (SCRs) in the three attachment groups (secure, insecure-anxious and insecure-avoidant) during the presentation of attachment-based pictures (distress, comfort or neutral) in two different perspective-taking conditions: self perspective-taking (i.e. imagine how you would feel in the given situation) or other perspective-taking (i.e. imagine how that person could feel in this situation). In the self perspective-taking condition, insecure-anxious individuals displayed higher SCRs than secure individuals for distress pictures. In the other perspective-taking condition, insecure-anxious individuals showed higher SCRs than secure individuals for comfort pictures. The results also showed a strong negative association between self-reported perspective-taking tendencies and SCRs in secure individuals. The findings suggest that perspective-taking plays an important role in the modulation of physiological responses in reaction to attachment-related pictures, which varies according to attachment styles.

Cognitive and Emotional Empathy in Anorexia Nervosa: The Role of Attachment Insecurity, Intrapersonal, and Interpersonal Emotional Competences.

The present research examined a model that evaluates the mediating role of both intrapersonal and interpersonal emotional competences (ECs) between attachment insecurity and the cognitive and emotional dimensions of empathy in patients with anorexia nervosa (AN). Women with AN completed the Experiences in Close Relationships Scale, the Profile of Emotional Competence, the Interpersonal Reactivity Index, the State-Trait Anxiety Inventory, and the Beck Depression Inventory. The results revealed that intrapersonal EC mediated the relationships between attachment insecurity (i.e., attachment anxiety and attachment avoidance) and emotional empathy in patients with AN. Importantly, a high emotional empathy in AN was associated with increased depression and anxiety symptoms. The results also indicated that a high level of attachment avoidance was indirectly associated with lower cognitive empathy through lower levels of interpersonal EC in AN. The present study emphasizes the importance of differentiating affective empathy from cognitive empathy and suggests clinical interventions in patients with AN.

Effect of intrapersonal emotional competences on the relationship between attachment insecurity and severity of eating disorder symptoms in patients with restrictive anorexia.

OBJECTIVE: Attachment insecurity and emotional competences (EC) form a key part of conceptual models of anorexia nervosa (AN). We explored the relationship between attachment dimensions and EC on the severity of eating disorders in patients diagnosed with restrictive AN. METHOD: Sixty-three female patients with restrictive AN and 63 healthy participants completed self-report measures (eating symptoms, EC, attachment, depression, and anxiety). RESULT: Patients with restrictive AN used fewer adaptive and more maladaptive regulation strategies and showed low levels of intrapersonal EC. The partial least squares path modeling analysis showed that high levels of attachment anxiety or avoidance lead to a decrease in intrapersonal EC, which in turn contributes to greater severity of eating symptoms in anorexic patients. CONCLUSIONS: Lower intrapersonal EC played an important mediating role in the effects of attachment insecurity on the severity of eating disorders. The joint use of therapeutic programs that target both EC and attachment processes constitutes a promising approach.

Emotion Regulation Processes and Psychoform and Somatoform Dissociation in Adolescents and Young Adults with Cumulative Maltreatment.

The relationship between childhood trauma and dissociative experiences is widely acknowledged. However, the association between emotion regulation difficulties (ERD), anxiety/depression and dissociation in adolescents and young adults with cumulative maltreatment (CM) remains unclear. The present study examined the role of ERD at both intrapersonal and interpersonal levels and anxiety/depression symptoms in the development of psychoform or somatoform dissociation in adolescents and young adults with CM. We assessed 58 participants with CM and 55 participants without childhood trauma history between the age of 12 and 22 years old. Participants completed self-reports of ERD, anxiety/depression, psychoform dissociation and somatoform dissociation. The results revealed that adolescents and young adults exposed to CM displayed high levels of psychoform and somatoform dissociation, ERD and anxiety/depression symptoms. It was also found that intrapersonal and interpersonal ERD predicted psychoform dissociation, whereas anxiety/depression predicted somatoform dissociation in adolescents and young adults with CM. Intrapersonal and interpersonal ERD and anxiety/depression are therapy targets for clinical interventions in adolescents and young adults with CM and dissociative symptoms.

Self-differentiation and eating disorders in early and middle adolescence: A cross-sectional path analysis.

This study examines the impact of self-differentiation, alexithymia and psychological distress on eating disorder symptoms in young and middle adolescence. Four hundred fifty-one adolescents completed self-report measures. Early and middle adolescents were categorized into two groups (12-14 years and 15-17 years) to represent distinct developmental stages. Significant differences were found between younger and older adolescents. The association between low self-differentiation and both eating disorders symptoms and psychological dimensions related to eating attitudes was stronger in early adolescence than in middle adolescence. The association between low self-differentiation and eating disorder symptoms was mediated by alexithymia and psychological distress in middle adolescence. Taken together, these findings suggest that self-differentiation could be useful in understanding psychological distress and alexithymia in eating disorders.

Living as a couple with anorexia nervosa: A dyadic interpretative phenomenological analysis.

This study examined the difficulties couples face in relation to anorexia nervosa. Using interpretative phenomenological analysis, five couples in which one of the partners lives with anorexia nervosa were interviewed separately. The findings are conceptualized into three areas: first, the encounter 'at the crossroads between remission and relapse'; second, the way that 'anorexia reveals itself'; and finally, the way the 'ménage à trois' works, including the illness fully as part of the couple. Psychotherapists should take into account the context of the couple and the complex interaction between the couple and the illness to support both partners' development of appropriate responses.

Quantifying the dynamics of emotional expressions in family therapy of patients with anorexia nervosa.

Emotional interactions have been considered dynamical processes involved in the affective life of humans and their disturbances may induce mental disorders. Most studies of emotional interactions have focused on dyadic behaviors or self-reports of emotional states but neglected the dynamical processes involved in family therapy. The main objective of this study is to quantify the dynamics of emotional expressions and their changes using the family therapy of patients with anorexia nervosa as an example. Nonlinear methods characterize the variability of the dynamics at the level of the whole therapeutic system and reciprocal influence between the participants during family therapy. Results show that the variability of the dynamics is higher at the end of the therapy than at the beginning. The reciprocal influences between therapist and each member of the family and between mother and patient decrease with the course of family therapy. Our results support the development of new interpersonal strategies of emotion regulation during family therapy. The quantification of emotional dynamics can help understanding the emotional processes underlying psychopathology and evaluating quantitatively the changes achieved by the therapeutic intervention.

Is there a family profile of addictive behaviors? Family functioning in anorexia nervosa and drug dependence disorder.

OBJECTIVES: The objective of the study was to determine whether family profiles differ between patients with anorexia nervosa or drug dependence disorder. METHOD: 25 families of patients with anorexia nervosa and 26 families of patients with drug dependence disorder responded to a battery of self-reports (Interpersonal Dependence Inventory, Family Adaptability and Cohesion Evaluation Scales, and Family Questionnaire). RESULTS: A lack of social self-confidence was observed in patients with anorexia nervosa or drug dependence disorder and their parents. Family disturbances characterized by low cohesion and emotional reliance on another person were observed in the families of patients with anorexia nervosa or drug dependence disorder. CONCLUSIONS: The present study suggests that there are differing levels of severity of family disturbances among fathers, mothers, and patients in both anorexia nervosa and drug dependence disorder.

Affiliative behaviour and conflictual communication during brief family therapy of patients with anorexia nervosa.

OBJECTIVE: Although patients with anorexia nervosa (AN) present positive responses to family therapy, the key features of therapeutic changes still require identification. This study explores the role of conflictual communication and affiliative nonverbal behaviour in therapeutic change in brief strategic family therapy (BSFT) for AN patients. METHODS: Ten female AN patients and their parents were included in the sample and took part in a 6-month follow-up of BSFT. The durations of conflictual communication and of affiliative nonverbal behaviour estimated by eye contact were compared between the first and the last sessions of family-based treatment using nonparametric statistical tests. RESULTS: An increase of the Body Mass Index associated with an increase in the conflictual communication expressed during BSFT sessions were observed. Moreover, affiliative nonverbal behaviour expressed by the father and the patient decrease, after a BSFT follow-up, in conflictual situations only. By contrast, no significant difference was observed in affiliative nonverbal behaviour expressed by the mother. CONCLUSION: The present study demonstrates that the impact of the BSFT differs between members of a family: the AN patient and the father have established a new form of emotional functioning with a decrease in emotional involvement. The study of the combination between verbal and nonverbal communication can represent an important step in the understanding of the mechanisms of therapeutic change.

Dynamics of emotional expression in autobiographic speech of patients with anorexia nervosa.

Emotional disturbances in persons with anorexia nervosa have mainly been documented using static descriptions. This study presents the temporal organisation of emotional expression in autobiographical speech of anorexic patients and thereby provides a first attempt to quantify the dynamics of emotions in patients' speech. The temporal pattern of emotional expression for persons with anorexia nervosa was studied after transforming the autobiographical narratives of 14 patients and 13 matched controls into symbolic sequences of positive, negative, and neutral emotional expressions. These symbolic sequences of emotional states and silences were analyzed using static and dynamic indices. Static indices showed that patients with anorexia nervosa expressed more negative emotions and fewer neutral states than control participants. Dynamic indices showed in patients' speech a cycle of negative emotions and silence. These results showed specific dynamics of emotional expression in persons with anorexia nervosa characterised by the presence of negative emotional perseveration. The possible clinical implications of these findings are discussed.

Autobiographical memory deficit in anorexia nervosa: emotion regulation and effect of duration of illness.

Emotional deficits in anorexia nervosa can be expressed in autobiographical memory recall. The aim of this study is to test whether deficits in autobiographical memory exist in anorexic patients and concern specifically negative or positive emotional valence. Moreover, it is unclear whether these deficits are dependent upon comorbid aspects (depression, alexithymia, and anxiety) or upon illness duration. Anorexic patients (n=25) were compared to healthy volunteers based on their clinical assessment, explicit memory test score, and autobiographical memory test score. The study makes use of the autobiographical test of Williams and Scott, which involves specific emotional cues to elicit memory. Anorexic patients recalled more general memories than controls in autobiographical memory test, but had no deficit in explicit memory test. This pattern, observed both for negative and positive cues, was neither related to depression or alexithymia, nor to anxiety severity, but increased significantly with illness duration. These results show that anorexic patients are characterized by relative difficulty in the integration of both negative and positive emotional experiences, and that this impairment is reinforced by illness duration.