Heterogeneity of emotion regulation strategies in patients with alcohol use disorder during the first year of abstinence: a clustering analysis.

AIMS: Studies examining the use of specific emotion regulation (ER) strategies in patients with severe alcohol use disorder (AUD) are mainly focused on intergroup comparisons to the detriment of intragroup variability. Yet, these patients are in fact characterized by emotional deficits of varying severity, and we seek to identify different patterns of ER strategies in people with AUD during their first year of abstinence. METHODS: Based on the ER strategies used by a large sample of patients with AUD, we applied cluster analysis to identify the existence of subgroups using distinct patterns of adaptive and nonadaptive strategies. To characterize these groups, we compared their clinical characteristics and then their emotional regulation strategies to those of control consumers. RESULTS: A first cluster, representing 61% of the sample, is constituted by individuals with high adaptive strategy scores and high nonadaptive strategy scores; a second cluster, representing 39% of the sample, corresponds to individuals with low adaptive strategy scores and high nonadaptive strategy scores. The individuals in these two clusters differed in terms of anxiety level and abstinence time. Compared with control consumers, the use of nonadaptive ER strategies remained lower for the two clusters, while the use of adaptative strategies differed. CONCLUSIONS: Our results support the idea of considering the heterogeneity of emotional capacities in individuals with AUD during the first year of abstinence. The identification of these profiles suggests either the existence of different adaptive ER capacities at baseline or a specific recovery of adaptive strategies over this period.

Monitoring the emotional facial reactions of individuals with antisocial personality disorder during the retrieval of self-defining memories.

While a deficit in the recognition of facial expression has been demonstrated in persons with antisocial personality disorder (ASPD), few studies have investigated how individuals with ASPD produce their own emotional facial expressions. This study examines the production of facial emotional expressions of male inpatients with ASPD in a forensic hospital compared with a control group as they retrieve autobiographical memories. This design constitutes a specific ecological experimental approach fostering the evocation of personal feelings. Two indicators characterizing the activation of facial expression were used: activation of emotional action units and emotional dominance. The results showed that individuals with ASPD 1) activated angrier facial expressions than control participants for both indicators, 2) displayed a higher dominance of angry facial expressions during the retrieval of positive self-defining memories than control participants and 3) recalled significant memories that were less associated with neutral facial states than the control sample, regardless of the valence of their memories. These findings highlight the core role of anger in ASPD and the possible development of pathological anger, which would distinguish trajectories toward anxious or mood disorders and trajectories characterized by external disorders.

Specificity and wealth of autobiographical memories in restrictive and mixed anorexic patients.

The reduced specificity of positive and negative autobiographical memories observed in anorexic (AN) patients may reflect a global disturbance in their emotional information processing. However, their emotional difficulties may differ according to the subtype of AN, implying possible differences in the manifestation of autobiographical memory impairments. The aims of the study were (1) to confirm the autobiographical memory deficits in AN patients in terms of specificity and wealth of memories, and (2) to compare autobiographical deficits according to the AN subtype: restrictive type (AR) or binge/purging type (AB). Ninety-five non-clinical (NC) individuals and 95 AN patients including 69 AR and 22 AB patients were administered the Williams' and Scott's Autobiographical Memory Test. The results confirmed a lack of specificity regardless of emotional valence in the overall AN patient group without any distinction of subtype, which was linked to the number of hospitalizations. When the AN subtype was considered, AR patients demonstrated reduced specificity for negative memories only, suggesting differences in emotional functioning or in the mechanisms underlying reduced specificity between AR and AB patients. Furthermore, the overall AN group demonstrated lower variability and complexity in their memory content than the NC group. However, this difference in the complexity of recalled memories was only found in response to negative cues. When AN subtypes were considered, AR patients showed fewer complex memories than NC individuals. Beyond a reduced specificity, AN patients also depict a poverty in the range of event recall and a difficulty in developing narrative content. The clinical implications of such autobiographical memory deficits need to be further investigated.

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.

Training emotion regulation processes in alcohol-abstinent individuals: A pilot study.

The study aimed to assess whether abstinent individuals with alcohol use disorders (AUD) would benefit from enhanced emotional regulation (ER) strategies using the affect regulation training (ART) program based on weekly sessions comprising psycho-education, muscle and respiratory relaxation, awareness, acceptance and tolerance, compassionate personal support, emotion analysis and modification. Seventy-two participants with AUD benefited from ART and were compared on their ER ability, mindfulness, and their experience of abstinence to 40 participants not receiving the program, before it, at the end, and 6 months after. Improvements in ER were observed, particularly in positive centration, action centration or self-blame and in mindfulness abilities after the program and six months later. In addition, by comparing participants who received the program with a short (<18 months) or long (>18 months) abstinence duration, the results showed a greater decrease in the use of non-adaptive strategies, a greater increase in adaptive strategies and mindfulness abilities in short-term abstinent individuals. These results demonstrate improvement in ER skills after training in people who were abstinent from alcohol. ART is effective for consolidating abstinence and should be used especially at the beginning of withdrawal to promote the rapid implementation of new ER strategies.

Characterisation of self-defining memories in criminals with antisocial personality disorder.

Early aversive events are key factors in the development of antisocial personality disorder (ASPD) and are known to impact the ability to produce specific autobiographical memories and to modify self-construction. The present study assessed identity construction in forensic inpatients suffering from ASPD by comparing the characteristics (specificity, integration, valence, topic and period) of self-defining memories (SDM) of persons with ASPD hospitalised in a forensic hospital to those of control participants. Offenders with ASPD had difficulty in retrieving purely specific single events and tended to recall memories comprising multiple events. In addition, they produced significantly less meaning-making from their past experiences (low integration). These characteristics of SDM could be due to a defensive process used by offenders with ASPD in which they do not integrate aversive experiences, thereby creating a vicious circle where maladjustment of their personality is maintained.

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.

Decreased emotional eating behavior is associated with greater excess weight loss five years after gastric banding.

While significant weight loss has been observed in the first two years following adjustable gastric banding (AGB), research on the long-term effectiveness of gastric restriction (e.g., 5 years) both on weight loss and eating behavior changes is scarce. The present study examined obese patients' changes in eating behavior preoperatively and 5 years after AGB and examined their associations with excess weight loss (EWL). Specifically, we focused on the association between the modification of three eating behavior profiles (i.e., restrained eating, emotional eating and external eating) and %EWL at 5 years. Among the 197 participants who underwent AGB, 136 completed the clinical assessments (weight, depression with the BDI, eating behavior with the DEBQ) before surgery, and after 5 years. Resultsshowed that the mean percentage of EWL was 47% after 5 years. Moreover, patients reported lower emotional eating and external eating after 5 years in comparison to the baseline, whereas there were no differences concerning restrained eating. Importantly, patients who presented higher %EWL at 5 years also reported a greater decrease in emotional eating between the two sessions than those with low %EWL. Our study underlines that eating behaviors are major variables involved in weight loss after gastric restriction. Results showed that emotional and external eating decreased significantly at 5 years whereas restrained eating behaviors did not vary between the pre- and postoperative stages. Moreover, the data suggest that a decrease in emotional eating accounts for the extent of EWL.

What effort is required in retrieving self-defining memories? Specific autonomic responses for integrative and non-integrative memories.

Self-defining memories (SDM) are autobiographical memories associated with the construction and maintenance of identity, and which play a core role in establishing and achieving goals in life. The aim of this study was to evaluate the effort required in retrieving SDM as reflected by physiological activity. We examined the neurovegetative responses associated with three dimensions of SDM: specificity, integrative meaning and emotional valence. Electrodermal activity (skin conductance response frequency, phasic driver) and the high frequency component of heart rate variability (HF-HRV) were recorded during the retrieval of SDM in 36 healthy participants to assess the activation of the sympathetic and parasympathetic systems, respectively. SDM were characterized by three independent investigators with satisfactory inter-rater reliability. Linear mixed effects analyses showed that only the integrative meaning dimension led to a main effect on electrodermal activity. In addition, an interaction effect showed that the retrieval of non-integrative and specific memories was associated with a higher level of electrodermal activity than the retrieval of integrative specific memories. No effects were obtained regarding the HRV indicators. The higher activation of the sympathetic nervous system associated with the retrieval of non-integrative SDM suggests that the ability to derive meaning from personal experiences plays a regulatory role and is a fundamental component in personal adjustment.

Difficulties in emotion regulation and deficits in interoceptive awareness in moderate and severe obesity.

PURPOSE: Difficulties in emotion regulation and deficits in interoceptive awareness may be responsible for overeating and weight gain in obesity by increasing the risks of problematic eating behaviors. This study aimed to: (1) examine emotion regulation difficulties and interoceptive deficits in obesity; (2) compare the emotion regulation and interoceptive abilities of moderately and severely obese patients. METHODS: Participants were recruited through the university, diabetology centers and bariatric surgery departments. A total of 165 participants were categorized in three groups, matched by age and gender, according to their Body Mass Index (BMI). The severely obese (SO), moderately obese (MO) and normal weight (NW) groups were constituted of 55 participants each. Self-report questionnaires were used to assess emotion regulation difficulties (CERQ-DERS) and interoceptive awareness (MAIA-FFMQ). RESULTS: Overall, obese participants reported more emotion regulation difficulties and less interoceptive awareness than NW participants did. They also reported a lack of planning strategies and emotional awareness, as well as less ability to observe, notice and trust body sensations. No differences in emotion regulation and interoceptive abilities were found between MO and SO participants. CONCLUSIONS: Emotion regulation and interoceptive awareness should be targeted in the psychotherapeutic care of obese people, regardless of their BMI. LEVEL OF EVIDENCE: Level III, case-control analytic study.

Compromises of integration, specificity and emotional content of self-defining memories in patients with opioid-use disorder.

Autobiographical memory plays a major role in the construction of identity. A particular type of memory has been described as more relevant in pursuit of personal goals: self-defining memory (SDM). In patients with opioid-use disorder (OUD), SDM recall has not yet been investigated despite deficits in the retrieval of autobiographical memories. This study aims to characterise SDM recall in OUD patients. Patients (N = 25) and non-dependent individuals (N = 25) were told to recall five SDM and to rate the emotion (valence and arousal) triggered during the retrieval. Specificity, valence, theme, integration and distance in time of the SDM were analysed while controlling for anxiety and depression levels. The SDM construction of the OUD patients was characterised by a lower specificity, more neutral memories and a lower integration, while emotions triggered during retrieval did not differ between the two groups. This may reflect an unsuccessful attempt to disconnect from one's own emotions in the OUD patients. This emotional disconnection and the difficulty of addressing meaning of past events may be due to substance use history coupled with the use of emotional strategies of avoidance. The implications for substance abuse relapse are discussed.

Effects of olfactory stimulation on autobiographical memory in Alzheimer's disease.

BACKGROUND: A body of research showed positive effects of olfactory stimulation on autobiographical memory. However, no research has evaluated the influence of such stimulation on autobiographical memory in Alzheimer's disease. OBJECTIVE AND METHODS: We invited participants with Alzheimer's disease and controls to retrieve autobiographical memories when exposed to odor and in a control condition without odor. RESULTS: Compared to memories evoked without odors, olfactory-evoked autobiographical memories were more specific and accompanied by more subjective experience of reviviscence in patients with Alzheimer's disease. However, no such benefit was observed in control participants. Interestingly, when compared to memories evoked without odors, olfactory-evoked autobiographical memories were retrieved faster in all participants. CONCLUSION: Our findings demonstrate positive effects of olfactory stimulation on two components (specificity and reviviscence) of autobiographical retrieval in Alzheimer's disease. This study offers solid foundations for the adaptation of olfactory stimulation in nursing homes in the framework of reminiscence therapy in order to preserve the sense of identity in patients with Alzheimer's disease as long as possible.

Tell about yourself to improve your autobiographical memory: A study of Korsakoff's syndrome.

Korsakoff's syndrome (KS) has been associated with a difficulty to retrieve specific autobiographical memories. We investigated whether this difficulty can be alleviated after the retrieval of statements describing self-images. KS patients and control participants were recruited and asked to retrieve autobiographical memories after providing statements to the question "Who am I?" and after a control condition consisting of verbal fluency. Analysis showed higher autobiographical specificity in the "Who am I?" than in verbal fluency condition in both patients with KS and control participants. At a theoretical level, our findings demonstrate how retrieval of information related to conceptual self may influence autobiographical memory in KS. At a clinical level, our procedures are important as they demonstrate how a simple task (i.e., "Who am I?" statements) may serve as a tool to cue specific autobiographical memories in patients with KS.

Mind reading abilities in opiate-dependent patients: An exploratory study.

OBJECTIVES: Impairments in social cognition have been described as playing a major role in the maintenance of addictive behavior in substance abusers. This study aimed to investigate the Theory of Mind (ToM) ability of opiate-dependent (OD) patients and to explore whether TOM ability was correlated with length of substance abuse, age at onset of substance abuse and length of abstinence. METHODS: OD patients (N = 29) and non-dependent individuals (NDI) (N = 29) were submitted to the Theory of Mind Assessment Scale (Th.o.m.a.s.), a semi-structured interview, and to the Versailles-Lecture Intentionnelle en Situation (V-LIS), a movie paradigm in which participants have to infer the characters' intentions. RESULTS: The results confirmed a deficit in ToM ability in OD patients, with OD patients demonstrating poorer performance than NDI on both the V-LIS and the Th.o.m.a.s. The combination of perspective taking and reflecting on others' mental states was particularly difficult for OD patients. Furthermore, impairments in ToM abilities were not correlated with the age at onset of substance abuse or to the duration of substance abuse or abstinence. CONCLUSIONS: The results suggest OD patients may have impaired social cognition, demonstrating deficits in even basic social interaction skills, which may constitute a risk factor for addiction. These findings underline the importance of developing interventions to improve social cognition ability during the rehabilitation of OD patients.

Positive facial expressions during retrieval of self-defining memories.

In this study, we investigated, for the first time, facial expressions during the retrieval of Self-defining memories (i.e., those vivid and emotionally intense memories of enduring concerns or unresolved conflicts). Participants self-rated the emotional valence of their Self-defining memories and autobiographical retrieval was analyzed with a facial analysis software. This software (Facereader) synthesizes the facial expression information (i.e., cheek, lips, muscles, eyebrow muscles) to describe and categorize facial expressions (i.e., neutral, happy, sad, surprised, angry, scared, and disgusted facial expressions). We found that participants showed more emotional than neutral facial expressions during the retrieval of Self-defining memories. We also found that participants showed more positive than negative facial expressions during the retrieval of Self-defining memories. Interestingly, participants attributed positive valence to the retrieved memories. These findings are the first to demonstrate the consistency between facial expressions and the emotional subjective experience of Self-defining memories. These findings provide valuable physiological information about the emotional experience of the past.

Autobiographical memory compromise in Alzheimer's disease: a cognitive and clinical overview.

Autobiographical memory refers to memory for personal information. The compromise of autobiographical memory in Alzheimer's disease (AD) results in a loss of knowledge about events and facts that defined the patients' life, and consequently, degradation of their self-knowledge and sense of identity. The compromise of autobiographical memory in AD can be attributed to a diminished subjective experience of memory and a diminished sense of the self. Our review provides a comprehensive overview of cognitive and clinical processes that may be involved in difficulties to retrieve autobiographical memories in Alzheimer's disease. Our review also proposes a theoretical model according to which, the diminished ability to retrieve contextual information and the overgenerality of recall result in a diminished subjective experience of past and future thinking. Besides its theoretical contribution, our review proposes clinical applicability for evaluation and rehabilitation of autobiographical memory in AD.

From Nose to Memory: The Involuntary Nature of Odor-evoked Autobiographical Memories in Alzheimer's Disease.

Research suggests that odors may serve as a potent cue for autobiographical retrieval. We tested this hypothesis in Alzheimer's disease (AD) and investigated whether odor-evoked autobiographical memory is an involuntary process that shares similarities with music-evoked autobiographical memory. Participants with mild AD and controls were asked to retrieve 2 personal memories after odor exposure, after music exposure, and in an odor-and music-free condition. AD participants showed better specificity, emotional experience, mental time travel, and retrieval time after odor and music exposure than in the control condition. Similar beneficial effects of odor and music exposure were observed for autobiographical characteristics (i.e., specificity, emotional experience, and mental time travel), except for retrieval time which was more improved after odor than after music exposure. Interestingly, regression analyses suggested executive involvement in memories evoked in the control condition but not in those evoked after music or odor exposure. These findings suggest the involuntary nature of odor-evoked autobiographical memory in AD. They also suggest that olfactory cuing could serve as a useful and ecologically valid tool to stimulate autobiographical memory, at least in the mild stage of the disease.

Autobiographical memory compromise in individuals with alcohol use disorders: Towards implications for psychotherapy research.

It has been found that Autobiographical memory (i.e., memory for personal experiences and facts about the self) are not properly maintained in people with alcohol-use disorders (AUD). The present paper offers a comprehensive overview of findings regarding the consequences of AUD on autobiographical memory. More specifically, we offer a theoretical model (the AMAUD Autobiographical Memory and Alcohol Use Disorders model) according to which chronic alcohol consumption compromises emotion regulation as well as executive control, which maintains the construction of autobiographical memory. Compromises in emotional regulation and executive functioning can be linked to a weak aspiration to construct detailed memories (i.e., autobiographical overgenerality), compromises of subjective reliving, anterograde amnesia, negative self-defining memories, and a difficulty to mentally project oneself forward in time to generate complex autobiographical representations and self-images. By gathering cognitive and clinical aspects of autobiographical decline in AUD, this model constitutes a theoretical foundation that may lead to a better understanding of this decline. Different clinical perspectives are proposed for developing personalized autobiographical memory rehabilitation programs for individuals with AUD.

Characterization of Self-Defining Memories in Individuals with Severe Alcohol Use Disorders After Mid-Term Abstinence: The Impact of the Emotional Valence of Memories.

BACKGROUND: Self-defining memories (SDM) are distinguished from other autobiographical memory (AM) processes to delineate those associated with the sense of personal identity and continuity in one's individual history. With chronic alcohol consumption, the construction of such memories may be modified in terms of specificity, valence, meaning-making, and evoked topics. This study sought to characterize SDM in a population of 27 patients with alcohol use disorder (AUD) who had been abstinent for at least 2 months compared with 28 control participants. METHODS: Besides cognitive and clinical assessment, participants were told to describe verbally and date 5 SDM and their narratives were recorded. For each memory, 5 dimensions were evaluated: level of specificity, emotional valence, integration of meaning, topics, and distance of memory in time. RESULTS: Overall, SDM of participants with AUD were specifically characterized by (i) low specificity, (ii) low integration, (iii) a predominance of memories with negative emotional valence and a low frequency of positive memories, and (iv) a low frequency of topics related to success. When different dimensions of the SDM were crossed, their characteristics depended mainly on the valence of the memory. Negative memories were more frequent, more specific and more integrated, while positive SDM were less frequent, less specific and less integrated. CONCLUSIONS: The results underline the construction of a form of SDM with drinking problems that is mainly characterized by the disruption of positive memory and the presence of highly specific and integrated negative experiences. A disruption of the integration process modulated by the valence of memories could have repercussions on maintaining a sense of personal identity, the pursuit of personal goals and on social adaptability, and could constitute one of the main risks associated with persistent drinking problems. These results highlight the relevance of developing AM training programs for patients with AUD.