Examining the relationship between subtypes of rumination and non-suicidal self-injury: A meta-analytic review.

INTRODUCTION: Non-suicidal self-injury (NSSI) is a highly prevalent maladaptive behavior, often used to cope with intense negative affect. Rumination is an emotion regulation strategy that leads to fixation on and exacerbation of (typically) negative affective states. However, studies examining the relationship between rumination and NSSI have yielded mixed results, showing high degrees of heterogeneity. METHODS: The present study conducted meta-analyses (k = 50) of the association between overall rumination and NSSI, and independent meta-analyses for each of four subtypes of rumination (general, depressive, brooding, reflection rumination). Potential moderators that may influence the magnitude of these relationships were also examined. RESULTS: A small-to-moderate positive association between rumination and NSSI was found independent of rumination subtype. Moderating effects included NSSI outcome measure and study design for overall rumination and general rumination, respectively. Race was found to moderate the relationships between both brooding and depressive rumination and NSSI, though in inverse directions. An analysis of effect heterogeneity across studies suggested that undetected moderators may be present. CONCLUSION: Results of this study support the relationships between rumination subtypes and NSSI and identify factors that may impact these relationships. Continued research is needed to understand this association, particularly in more varied subtypes of rumination and cognitive-affective moderators.

Personality Disorder Symptoms in Intermittent Explosive Disorder: A Latent Class Analysis.

Intermittent explosive disorder (IED) is characterized by recurrent reactive aggression. IED is associated with significant personality pathology that is suggestive of higher levels of general personality disorder (PD). However, little is known about how personality factors impact the severity and presentation of IED. The present study employed a latent class analysis to assess for distinct PD symptom classes within IED and to evaluate whether these classes differed in terms of severity and behavioral presentation. Statistical and clinical indicators revealed a four-class model, with latent classes distinguished primarily on general levels of PD symptoms (low, moderate, high). However, the two moderate PD symptom classes were distinguished from other classes on avoidant PD. In addition, classes differed in terms of severity and presentation, suggesting important implications for both general PD and avoidant PD comorbidity within IED. Results provide further insight into the heterogeneity within IED and suggest a more nuanced approach in treating this serious condition.

Trait Reward Sensitivity Modulates Connectivity with the Temporoparietal Junction and Anterior Insula during Strategic Decision Making.

Many decisions happen in social contexts such as negotiations, yet little is understood about how people balance fairness versus selfishness. Past investigations found that activation in brain areas involved in executive function and reward processing was associated with people offering less with no threat of rejection from their partner, compared to offering more when there was a threat of rejection. However, it remains unclear how trait reward sensitivity may modulate activation and connectivity patterns in these situations. To address this gap, we used task-based fMRI to examine the relation between reward sensitivity and the neural correlates of bargaining choices. Participants (N = 54) completed the Sensitivity to Punishment (SP)/Sensitivity to Reward (SR) Questionnaire and the Behavioral Inhibition System/Behavioral Activation System scales. Participants performed the Ultimatum and Dictator Games as proposers and exhibited strategic decisions by being fair when there was a threat of rejection, but being selfish when there was not a threat of rejection. We found that strategic decisions evoked activation in the Inferior Frontal Gyrus (IFG) and the Anterior Insula (AI). Next, we found elevated IFG connectivity with the Temporoparietal junction (TPJ) during strategic decisions. Finally, we explored whether trait reward sensitivity modulated brain responses while making strategic decisions. We found that people who scored lower in reward sensitivity made less strategic choices when they exhibited higher AI-Angular Gyrus connectivity. Taken together, our results demonstrate how trait reward sensitivity modulates neural responses to strategic decisions, potentially underscoring the importance of this factor within social and decision neuroscience.

Predictors of treatment outcome in cognitive behavioral therapy for intermittent explosive disorder: A preliminary analysis.

OBJECTIVE: The present study examined potential treatment outcome predictors of a multicomponent cognitive behavioral intervention for intermittent explosive disorder (IED). METHOD: The sample (n = 64; 22 female) consisted of individuals with a current diagnosis of IED that completed treatment across three study trials. Treatment outcome predictors assessed included demographic variables, psychiatric comorbidity, symptom severity, and treatment motivation/engagement. Treatment outcomes were (a) change in number of past-week aggressive acts from pretreatment to posttreatment and (b) presence of IED diagnosis at posttreatment. RESULTS: Results indicated those who endorsed lower trait anger were more likely to remit from IED diagnosis at posttreatment. No other variables were found to significantly predict treatment outcome. CONCLUSIONS: These findings support the notion that cognitive behavioral therapy can be effective for a wide range of individuals with IED, with little variation in efficaciousness based on presence of demographic characteristics, comorbid disorders, or treatment motivation/engagement. This seems to be particularly the case for individuals with lower levels of trait anger. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A systematic review with meta-analysis of cognitive bias modification interventions for anger and aggression.

Aggression and anger are associated with interpretation and attention biases. Such biases have become treatment targets for anger and aggressive behavior in cognitive bias modification (CBM) interventions. Several studies have evaluated the efficacy of CBM for the treatment of anger and aggressive behavior, with inconsistent results. The present study meta-analytically analyzed 29 randomized controlled trial studies (N = 2334) published in EBSCOhost and PubMed between March 2013 and March 2023 assessing the efficacy of CBM for anger and/or aggression. Included studies delivered CBMs that addressed either attention biases, interpretation biases, or both. Risk of publication bias and potential moderating effects of several participant-, treatment- and study-related factors were assessed. CBM significantly outperformed control conditions in the treatment of aggression (Hedge's G = -0.23, 95% CI [-0.35, -0.11], p < .001) and anger (Hedge's G = -0.18, 95% CI [-0.28, -0.07], p = .001) independent of treatment dose, participant demographic characteristics, and study quality, though overall effects were small. Follow-up analyses demonstrated that only CBMs targeting interpretation bias were efficacious for aggression outcomes, but not when baseline aggression was accounted for. Findings suggest that CBM demonstrates efficacy for the treatment aggressive behavior and to a lesser extent, anger.

Laboratory assessment of aggression: The Taylor Aggression Paradigm in adults with and without a disorder of impulsive aggression.

INTRODUCTION: The modified Taylor Aggression Paradigm (TAP) has been used to study impulsive aggression in experimental designs and has been relatively successful in addressing critiques of aggression paradigms; however, little has been done to examine the potential of using the TAP as a direct measure of aggression. This study aimed to explore the psychometric properties of the TAP behavioral indexes as measures of aggression. METHODS: A community sample of 962 adults were divided into three groups based on diagnostic assessments: Intermittent Explosive Disorder; Non-Aggressive Psychiatric Disorder; or healthy controls. Participants then completed the TAP and self-report measures to assess construct validity. A subset of 47 participants completed a second TAP within one year to assess reliability. TAP indexes were based on number of "extreme" shocks selected (high shock index), average shock levels selected (mean shock index), and shocks levels selected without provocation (unprovoked aggression). RESULTS: Overall, TAP indexes were consistent and reliable. IED participants had the highest high shock and mean shock indexes of all groups (X2 = 49.93, p < 0.001). High shock index was related to trait aggression (ß = 0.184, p < 0.001) after including covariates; mean shock index had a trending association with trait anger (ß = 0.102, p = 0.059). CONCLUSION: TAP behavioral indexes demonstrated promising psychometrics as a measure of aggression. High shock index appears to be more strongly associated with aggressive behavior; mean shock index may better measure general hostile responding. Future research might include comparisons specifically with impulse control disorders.

Context-Specific Interpersonal Problem-Solving and Suicidal Thoughts and Behaviors.

Background: Interpersonal problem-solving difficulties constitute a suicide risk factor that may be particularly relevant among college students. Most studies have examined general interpersonal problem-solving; however, context-specific abilities may have greater clinical implications. Aim: This study examined whether individuals with and without a history of suicidal thoughts and behaviors differed in context-specific interpersonal problem-solving. Method: Undergraduate students (n = 112) completed a brief interview and interpersonal problem-solving tasks with positive (e.g., initiating romantic relationship) and negative (i.e., physical revenge) resolutions. Results: Individuals with a history of suicide ideation generated more effective solutions and more alternatives in the negative-resolution scenario; no significant differences were identified for the positive-resolution scenarios. No group differences were found based on suicide attempt status. Limitations: Our results do not account for the mechanisms that influence problem-solving abilities in negative-resolution scenarios. Conclusion: Clinical efforts may benefit from targeting the translation of interpersonal problem-solving abilities to situations with positive resolutions.

Cognition and Non-Suicidal Self-Injury: Exploring Relationships with Psychological Functions.

OBJECTIVE: Non-suicidal self-injury (NSSI) is strongly associated with difficulties in emotion regulation, but its relationships with maladaptive cognitive processes are less clear. METHOD: The current study examined relationships between self-reported NSSI (presence, number of methods, frequency, recency, duration, functions) and negative cognitive processes (rumination, worry, self-criticism, perceived burdensomeness, thwarted belongingness) among 1,357 undergraduates. Cognition variables were submitted to exploratory factor analysis (EFA), and relationships were examined between the resulting factors and NSSI history (among the full sample) and NSSI severity and functions (among those with a history of NSSI). RESULTS: The EFA derived two higher order cognitive factors: repetitive negative thinking (RNT) and negative self-perception (NSP). Both RNT and NSP were significantly higher among participants with than those without a history of NSSI. Among those with NSSI, NSP, but not RNT, was positively related to lifetime NSSI frequency and number of methods, as well as recency (presence in the past 12 months) and total duration (in years) of NSSI engagement. Moreover, RNT and NSP were positively associated with aggregate intrapersonal (but not interpersonal) functions of NSSI. The two cognitive factors demonstrated differential relationships with the individual intrapersonal NSSI functions. CONCLUSIONS: Higher order categories of cognitive risk factors may have unique relationships with functions and severity of NSSI, with possible implications for more targeted approaches to risk assessment and intervention.HighlightsNegative thinking and self-perception were higher in people who engage in NSSI.Negative self-perception was associated with greater NSSI severity.Negative thinking and self-perception had different relations to NSSI functions.

Cognitive-Behavioral Versus Supportive Psychotherapy for Intermittent Explosive Disorder: A Randomized Controlled Trial.

Few clinical trials have evaluated the efficacy of psychotherapy for Intermittent Explosive Disorder (IED). The present study tested the efficacy of a cognitive behavioral intervention (versus supportive psychotherapy) among adults with IED. In this randomized clinical trial, 44 participants with IED (22 men and 22 women) aged 20-55 years completed twelve 50-minute individual sessions of either a multi-component cognitive behavioral intervention for IED (n = 19) or a time equated supportive psychotherapy (n = 25). At baseline, posttreatment, and 3-month follow-up, all participants received the Overt Aggression Scale-Modified, which was conducted by an interviewer who was blind to the participant's study condition. During these visits, participants also completed self-report measures of relational aggression (Self-Report of Relational Aggression and Social Behavior), anger (State-Trait Anger Expression Inventory-2), cognitive biases (e.g., Social Information Processing Questionnaire Attribution and Emotional Response Questionnaire), and associated symptoms (e.g., Beck Depression Inventory). Primary study outcomes were aggressive behavior and anger. Though participants in both treatments tended to improve over time, the cognitive behavioral intervention was superior to supportive psychotherapy in decreasing aggressive behavior and relational aggression. These findings support the efficacy of a multicomponent cognitive behavioral intervention in treating aggression in IED.

The effect of dialectical behavior therapy on anger and aggressive behavior: A systematic review with meta-analysis.

Dysregulated anger, and its common behavioral urge, aggression, pose substantial costs to public health and society. Though some studies have shown DBT to be efficacious in treating aggression and anger dyscontrol, the overall effects of DBT on these outcomes are unknown. To address this limitation, a systematic review with meta-analysis was conducted on 34 studies (N = 2536) published in PsycINFO and PubMed between January 1994 and February 2022 assessing the effect of DBT on anger and/or aggression. Included studies were empirical research articles published in a peer-reviewed journal and assessed the delivery of DBT on quantitative outcome measures of anger or aggression. Included studies delivered the standard outpatient DBT program or DBT adapted for the population and treatment setting, though all studies included the core components of DBT. Risk of publication bias was assessed. Results demonstrated that DBT significantly reduced anger (Hedge's G = -0.21, 95% CI [-0.32, -0.11]) independent of study design and participant variables, though longer treatment duration was associated with greater reductions in anger. There was also a non-significant trend for DBT in reducing aggression (Hedge's G = -0.10, 95% CI [-0.21, 0.00]). Findings from this study suggest that DBT demonstrates efficacy in reducing dysregulated anger transdiagnostically.

Emotion regulation strategies among individuals with borderline personality disorder relative to other groups: A review.

Borderline personality disorder (BPD) is associated with difficulties in emotion regulation (ER) abilities. Investigations of ER strategies in BPD have been less robust. This systematic review identified 55 studies comparing ER strategy use between individuals diagnosed with BPD versus psychiatric and non-psychiatric comparison groups. Individuals with BPD reported more frequent maladaptive and less frequent adaptive ER strategy use than non-psychiatric controls. Results were less consistent relative to psychiatric comparison groups, though individuals with BPD reported greater self-criticism and avoidance. Groups responded comparably to instructed use of adaptive (but not maladaptive) ER strategies. This body of research would benefit from further examination of the roles of psychiatric comorbidity and problematic behaviours in the relationship between BPD and ER strategies.

A latent class analysis of intermittent explosive disorder symptoms.

Intermittent explosive disorder (IED), the sole diagnosis in the DSM-5 for which the cardinal symptom is recurrent affective aggressive outbursts, is a common and substantially impairing disorder. IED is also associated with several cognitive and affective impairments. However, little is known about the heterogeneity of the disorder and how this may correspond to aggression severity and related adverse outcomes. The current study employed a latent class analysis (LCA) among individuals diagnosed with lifetime DSM-5 IED to derive distinct subgroups that differed in the quality and/or frequency of cognitive-affective symptoms. These subgroups were then externally validated on a number of adverse outcomes. Statistical and clinical indicators supported a four-class model. Classes were distinguished mainly by the level of emotion dysregulation participants endorsed, with two moderate emotion dysregulation classes differing on their emotional information processing and impulsive tendencies. The external validation analysis revealed that classes differed in terms of various adverse outcomes (e.g., interpersonal problems, life satisfaction, suicide risk). Overall, the present study suggests distinct cognitiveaffective symptom profiles among those with IED that differ meaningfully with regard to risk for adverse outcomes. These findings provide evidence of the heterogeneity within IED and may suggest a more personalized therapeutic approach to patients with IED.

Analgesic Effect of Alcohol Mediates the Association between Alcohol Intoxication and Deliberate Self-Harm.

We examined whether the analgesic effect of alcohol mediates the association between alcohol and deliberate self-harm (DSH) using data from a larger study on alcohol effects. Men (n = 106) and women (n = 104) low-risk alcohol drinkers (ages M = 26.00, SD = 6.98) recruited from the community who had no suicide attempt or episode of deliberate self-harm within the past year were randomly assigned to either a placebo drink condition or a drink calibrated to reach approximately .050%, .075%, or .100% blood alcohol concentration. Notable within-condition BAC variability, as well as overlap between conditions, suggested that BAC would be a more accurate indicator of intoxication compared to condition assignment. Pain tolerance was assessed by increasingly intense 1-s shocks delivered via fingertip electrodes. Self-reported pain associated with the pain tolerance index was also examined. A laboratory task of DSH, the Self-Aggression Paradigm, was then completed, with DSH operationalized as the number of self-administered shocks the participant was led to believe were twice the intensity of his or her pain tolerance and could cause "minor tissue damage that would quickly heal." A negative binomial parallel mediational model for count data revealed that pain tolerance, but not self-report pain, mediated the effect of alcohol on DSH. As such, the current study provides preliminary experimental evidence that the analgesic effect of alcohol is partially responsible for link between alcohol intoxication and deliberate self-harm.

Gender Differences in the Relationship between Anger and Aggressive Behavior.

Evidence is mixed regarding differences in prevalence of aggressive behavior, with many (though not all) studies suggesting that men are more aggressive than women. Furthermore, while aggression often occurs in response to provocation-induced anger, this relationship may be stronger for men; women may be more likely to engage in non-aggressive (e.g., affiliative) behaviors in response to provocation, particularly at low-level provocation. This study examined gender differences in aggression as well as differences in the relationship between anger and aggression for men and women. Adults (N = 424) participated in a behavioral aggression task, and a subset of participants (n = 304) completed a questionnaire assessing trait levels of anger as part of a larger study at a large midwestern university. Results indicated that while men and women aggressed at similar levels, aggression was significantly associated with trait anger for men only, at low levels of provocation, with only a trending relationship for high provocation. This suggests that while men and women may be equally aggressive in certain situations, this behavior may be differentially associated with anger.

Gender Moderates the Association Between Exposure to Interpersonal Violence and Intermittent Explosive Disorder Diagnosis.

Exposure to interpersonal violence (EIV) is a prevalent risk-factor for aggressive behavior; however, it is unclear whether the effect of EIV on clinically significant aggressive behavior is similar across gender. We examined whether gender moderates the association between experiencing and witnessing interpersonal violence and the diagnosis of intermittent explosive disorder (IED). We also examined potential pathways that might differentially account for the association between EIV and IED in men and women, including emotion regulation and social information processing (SIP). Adult men and women (N = 582), who completed a semistructured clinical interview for syndromal and personality disorders, were classified as healthy controls (HC; n = 118), psychiatric controls (PC; n = 146) or participants with an IED diagnosis (n = 318). Participants also completed the life history of experienced aggression (LHEA) and life history of witnessed aggression (Lhwa) structured interview and self-report measures of emotion regulation and SIP. Men reported more EIV over the lifetime. In multiple logistic regression analysis, experiencing and witnessing aggression within the family and experiencing aggression outside the family were associated with lifetime IED diagnosis. We found that the relationship between EIV and IED was stronger in women than in men. Affective dysregulation mediated certain forms of EIV, and this relation was observed in both men and women. SIP biases did not mediate the relation between EIV and IED. EIV across the lifespan is a robust risk factor for recurrent, clinically significant aggressive behavior (i.e., IED). However, the relationship between EIV and IED appears to be stronger in women. Further, this relation appears partially mediated by affective dysregulation.

An experimental examination of interpersonal problem-solving in nonsuicidal self-injury: A pilot study.

Nonsuicidal self-injury (NSSI) typically occurs in the presence of negative emotions. Prior research has emphasized interpersonal stress as a specific context that may elevate negative emotions in this population and even increase the likelihood of NSSI behavior. However, the factors that contribute to the relationship between interpersonal stress and NSSI have received relatively limited attention. The current pilot study aimed to experimentally examine interpersonal problem-solving as a potential moderator of the interpersonal stress - NSSI risk relationship among those with a NSSI history. Eighty-six participants (52.3% with NSSI history) were randomly assigned to one of three mood induction conditions (interpersonal negative, general negative, interpersonal neutral), after which they completed an interpersonal problem-solving task and a laboratory analogue of self-injurious behavior. Results indicated that NSSI history was associated with poorer interpersonal effectiveness. Further, individuals with a history of NSSI who experienced an interpersonally-focused negative mood and produced less effective interpersonal solutions were more self-harming on a laboratory analogue of self-injurious behavior. While the present findings are preliminary in nature, they offer guidance for research moving forward and, if replicated, suggest interpersonal problem-solving as a potential treatment target among individuals engaging in NSSI.

Relationships between Non-Suicidal Self-Injury and Other Maladaptive Behaviors: Beyond Difficulties in Emotion Regulation.

Non-suicidal self-injury (NSSI) co-occurs with both other maladaptive behaviors (e.g., aggression) and emotion dysregulation. However, the extent to which these maladaptive behaviors are linked to NSSI independent of emotion dysregulation is unclear. The present study examined relationships between NSSI and six other maladaptive behaviors among university undergraduates. When controlling for demographic variables, emotion dysregulation, and other maladaptive behaviors, binge eating, purging, illicit drug use, and physical aggression were each related to lifetime NSSI history and/or severity. No maladaptive behaviors were significantly related to the presence of current diagnostic-level NSSI in these multivariate analyses. Results suggest that some maladaptive behaviors may relate uniquely to NSSI risk independent of emotion dysregulation, highlighting the importance of considering such behaviors in self-injury assessment and treatment.

The Development of a Measure to Assess Social Reactions to Self-Injury Disclosure.

Only approximately half of individuals engaging in nonsuicidal self-injury (NSSI) ever disclose their behavior. Yet there is a dearth of research aimed at understanding NSSI disclosure and the outcomes of choosing to disclose, such as social reactions to NSSI disclosure. The current study aimed to develop and validate a measure of perceived social reactions to the disclosure of NSSI, the Self-Injury Social Reactions Questionnaire (SI-SRQ). Results supported a three-factor structure of the SI-SRQ assessing positive (tangible aid, emotional support) and negative social reactions in undergraduate (n = 269), community (n = 217), and recent NSSI (n = 129) samples. The internal consistencies of the resultant subscales, in addition to the convergent validity, were also supported. The development of the SI-SRQ provides an avenue to enhance our knowledge of the relationship between social reactions to NSSI disclosure and disclosure outcomes, which may help inform educational efforts about responding to NSSI disclosures more effectively.

Characterizing the choice to disclose nonsuicidal self-injury.

OBJECTIVE: Despite nonsuicidal self-injury (NSSI) being a prevalent and problematic behavior, only approximately half of those who engage in NSSI disclose their behavior. Yet, limited research has explored the choice to disclose. This study sought to identify if NSSI characteristics, emotional distress, and perceived interpersonal obstacles discriminated between NSSI disclosure status. Exploratory aims also investigated reasons for one's disclosure decision and disclosure contextual factors. METHOD: Participants included 977 undergraduate students (83% female) with a lifetime history of NSSI. RESULTS: Greater NSSI intrapersonal functions, suicide risk, and significant other support, and lower depression symptoms were associated with NSSI disclosure. Exploratory results highlight perceptions of one's NSSI severity and desire to receive support in disclosure choice; intrapersonal functions and peer support were associated with the timing of disclosure. CONCLUSIONS: Findings underscore the potential importance of individual attitudes toward NSSI, in addition to traditionally measured risk factors, as potential drivers in NSSI disclosure.

The relationship between physiological reactivity to provocation and emotion dysregulation with proactive and reactive aggression.

Biological theories of aggression propose that autonomic nervous system (ANS) hypo-reactivity may be more specific to proactive aggression, whereas ANS hyper-reactivity may be specific to reactive aggression. However, the research findings in this area are mixed. Furthermore, no study to date has examined whether emotion dysregulation moderates the aggression - ANS relationship. The present study examined electrodermal activity (EDA), respiratory sinus arrhythmia (RSA) and heart rate (HR) reactivity in 76-undergraduate participants (29 men, mean age = 21.49) in response to a provocation task relative to baseline. Results showed that blunted HR reactivity was associated with increased proactive aggression. RSA augmentation and blunted EDA reactivity were both associated with increased proactive and reactive aggression, but only among those above the sample mean on emotion dysregulation. Thus, emotion dysregulation may play a key role in the relationship between ANS reactivity and both reactive and proactive aggression.