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Background Existing psychological therapies for bipolar disorders have been found to have mixed results, with a consensus that they provide a significant, but modest, effect on clinical outcomes. Typically, these approaches have focused on promoting strategies to prevent future relapse. An alternative treatment approach, termed ‘Think Effectively About Mood Swings’ (TEAMS) addresses current symptoms, including subclinical hypomania, depression and anxiety, and promotes long-term recovery. Following the publication of a theoretical model, a range of research studies testing the model and a case series have demonstrated positive results. The current study reports the protocol of a feasibility randomized controlled trial to inform a future multi-centre trial. Methods/Design A target number of 84 patients with a diagnosis of bipolar I or II disorder, or bipolar disorder not-otherwise-specified are screened, allocated to a baseline assessment and randomized to either 16 sessions of TEAMS therapy plus treatment-as-usual (TAU) or TAU. Patients complete self-report inventories of depression, anxiety, recovery status and bipolar cognitions targeted by TEAMS. Assessments of diagnosis, bipolar symptoms, medication, access to services and quality of life are conducted by assessors blind to treatment condition at 3, 6, 12 and 18 months post-randomization. The main aim is to evaluate recruitment and retention of participants into both arms of the study, as well as adherence to therapy, to determine feasibility and acceptability. It is predicted that TEAMS plus TAU will reduce self-reported depression in comparison to TAU alone at six months post-randomization. The secondary hypotheses are that TEAMS will reduce the severity of hypomanic symptoms and anxiety, reduce bipolar cognitions, improve social functioning and promote recovery compared to TAU alone at post-treatment and follow-up. The study also incorporates semi-structured interviews about the experiences of previous treatment and the experience of TEAMS therapy that will be subject to qualitative analyses to inform future developments of the approach. Discussion The design will provide preliminary evidence of efficacy, feasibility, acceptability, uptake, attrition and barriers to treatment to design a definitive trial of this novel intervention compared to treatment as usual. Trial registration This trial was registered with Current Controlled Trials (ISRCTN83928726) on registered 25 July 2014.
The present review adopts an action control perspective on emotion regulation, contextualising the gap between emotion control goals (e.g., I want to remain calm) and emotional outcomes (e.g., anger, anxiety, and aggression) in terms of the broader literature on goal pursuit. We propose that failure to effectively regulate emotions can result from difficulties with the self-regulatory tasks of (i) identifying the need to regulate, (ii) deciding whether and how to regulate, and (iii) enacting a regulation strategy. Next we review evidence that a technique traditionally associated with regulating behavioural goals (forming implementation intentions or ‘‘if-then’’ planning) can help to overcome these difficulties. Meta-analysis indicated that forming implementation intentions is effective in modifying emotional outcomes, with a large effect relative to no regulation instructions (k = 21, N = 1306 d = 0.91, 95% CI = 0.61 to 1.20) and a medium-sized effect relative to goal intention instructions (k = 29, N = 1208, d = 0.53, 95% CI = 0.42 to 0.65). Our conclusion is that research on emotion regulation might benefit from an action control perspective and the interventions that this perspective offers. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden.
The present meta-analysis investigated the effectiveness of strategies derived from the process model of emotion regulation in modifying emotional outcomes as indexed by experiential, behavioral, and physiological measures. A systematic search of the literature identified 306 experimental comparisons of different emotion regulation (ER) strategies. ER instructions were coded according to a new taxonomy, and meta-analysis was used to evaluate the effectiveness of each strategy across studies. The findings revealed differences in effectiveness between ER processes: Attentional deployment had no effect on emotional outcomes (d(+) = 0.00), response modulation had a small effect (d(+) = 0.16), and cognitive change had a small-to-medium effect (d(+) = 0.36). There were also important within-process differences. We identified 7 types of attentional deployment, 4 types of cognitive change, and 4 types of response modulation, and these distinctions had a substantial influence on effectiveness. Whereas distraction was an effective way to regulate emotions (d(+) = 0.27), concentration was not (d(+) = -0.26). Similarly, suppressing the expression of emotion proved effective (d(+) = 0.32), but suppressing the experience of emotion or suppressing thoughts of the emotion-eliciting event did not (d(+) = -0.04 and -0.12, respectively). Finally, reappraising the emotional response proved less effective (d(+) = 0.23) than reappraising the emotional stimulus (d(+) = 0.36) or using perspective taking (d(+) = 0.45). The review also identified several moderators of strategy effectiveness including factors related to the (a) to-be-regulated emotion, (b) frequency of use and intended purpose of the ER strategy, (c) study design, and (d) study characteristics.
Two experiments investigated whether forming an if-then plan or implementation intention could break the link between mood and risky behaviour. In Expt 1, participants planned how to deal with unpleasant moods. Next, as part of an ostensibly unrelated experiment, participants underwent a disguised mood induction before rating their willingness to perform a series of risky behaviours. Unpleasant mood increased subsequent risk willingness among participants who did not form a plan but did not influence risk willingness among participants who formed an implementation intention. In Expt 2, mood arousal was manipulated and participants then undertook a gambling task. One-half of the sample formed implementation intentions that focused attention on the odds of winning. Greater arousal led to more risky betting among control participants. However, forming an implementation intention promoted good risk awareness and, consequently, shielded participants' task performance from the effects of arousal. Taken together, the findings suggest that people can strategically avoid the detrimental effect of unpleasant mood and arousal on risk by forming implementation intentions directed at controlling either the experience of mood or the risky behaviour.
Situation selection involves choosing situations based on their likely emotional impact and may be less cognitively taxing or challenging to implement compared to other strategies for regulating emotion, which require people to regulate their emotions "in the moment"; we thus predicted that individuals who chronically experience intense emotions or who are not particularly competent at employing other emotion regulation strategies would be especially likely to benefit from situation selection. Consistent with this idea, we found that the use of situation selection interacted with individual differences in emotional reactivity and competence at emotion regulation to predict emotional outcomes in both a correlational (Study 1; N = 301) and an experimental field study (Study 2; N = 125). Taken together, the findings suggest that situation selection is an effective strategy for regulating emotions, especially for individuals who otherwise struggle to do so.
Emotion regulation (ER) is vital to everyday functioning. However, the effortful nature of many forms of ER may lead to regulation being inefficient and potentially ineffective. The present research examined whether structured practice could increase the efficiency of ER. During three training sessions, comprising a total of 150 training trials, participants were presented with negatively valenced images and asked either to "attend" (control condition) or "reappraise" (ER condition). A further group of participants did not participate in training but only completed follow-up measures. Practice increased the efficiency of ER as indexed by decreased time required to regulate emotions and increased heart rate variability (HRV). Furthermore, participants in the ER condition spontaneously regulated their negative emotions two weeks later and reported being more habitual in their use of ER. These findings indicate that structured practice can facilitate the automatic control of negative emotions and that these effects persist beyond training.
This study examined the relative effort exerted when participants down-regulated their emotional state using different emotion regulation (ER) strategies. N = 70 healthy participants were presented with film clips designed to induce disgust. Participants were asked to regulate their emotions using one of three different ER strategies: (i) instructed suppression, (ii) primed suppression and (iii) implementation intentions to suppress. A fourth group were asked to just watch the presented film clips. Participants responses to presented stimuli were measured through self-reports of their current emotional state. Gross’ (1998) emotional behaviour coding system was also used to assess participants’ emotional state through an examination of their facial expressions. Blood glucose levels (BGL) and heart rate variability (HRV) were used to examine the extent of biological effort exerted during ER. Findings suggested that instructed suppression and implementation intentions were able to help people to down-regulate their feelings of disgust. Primed suppression did not influence feelings of disgust. In terms of the effort associated with regulation, there were no differences between the strategies in blood glucose consumption. However, the use of instructed suppression and implementation intentions led to a significant increase in HRV compared to participants in the ‘watch’ condition. Contrary to expectations, however, there was no difference between implementation intentions and instructed suppression.