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Emotion Regulation Therapy for Generalized Anxiety Disorder

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Abstract

Despite the success of cognitive behavioral therapies (CBT) for emotional disorders, a sizable subgroup of patients with complex clinical presentations, such as patients with generalized anxiety disorder, fails to evidence adequate treatment response. Emotion Regulation Therapy (ERT) integrates facets of traditional and contemporary CBTs, mindfulness, and emotion-focused interventions within a framework that reflects basic and translational findings in affect science. Specifically, ERT is a mechanism-targeted intervention focusing on patterns of motivational dysfunction while cultivating emotion regulation skills. Open and randomized controlled psychotherapy trials have demonstrated considerable preliminary evidence for the utility of this approach as well as for the underlying proposed mechanisms. This article provides an illustration of ERT through the case of “William.” In particular, this article includes a case-conceptualization of William from an ERT perspective while describing the flow and progression of the ERT treatment approach.

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... The above examples of discrimination learning deficits in GAD and PD represent difficulty with differential affective responding to danger and safety information. That said, studies of the clinical phenomenology of these disorders suggest key differences, with GAD (versus PD) associated with more persistent and difficult to reverse deficits in affective discrimination of danger from safety [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. Below, we describe extant evidence for this GAD-PD difference separately for each disorder. ...
... Further support for impaired affective discrimination in GAD derives from studies on exposure therapy [19][20][21][22]. Exposure therapy is an empirically-validated intervention [23] that relies on repeatedly exposing patients to feared stimuli in the absence of negative outcomes. ...
... The result of extinction, as supported by experimental work on extinction, is the inhibition of aversive associations to the feared stimulus and the development of a competing association between the feared stimulus and safety [5,25]. Prior research shows that traditional exposure is typically not effective for those with GAD when compared with other anxiety disorders [20][21][22]. Those with GAD, more than individuals with other anxiety disorders, respond anxiously to their feared stimuli both before exposure therapy (when such stimuli were perceived as danger cues) and after therapy when such stimuli acquired safety value [20,21]. ...
... Two studies examined 20 weekly sessions of emotion regulation therapy (ERT; Mennin et al., 2015; Mennin et al., 2018) that builds upon ACT and mindfulness strategies as well as some traditional cognitive behavioral strategies. This intervention is broken into three phases (Fresco et al., 2013). Phase one, Awareness Skills Training, consists of mindful attention to physical and emotional cues; recognizing antecedents to emotions, emotions, and consequences of emotions; and recognizing what has led to favoring security over reward/the experience of positive emotions. ...
... three, Experiential Exposure, consists of exposure to risky, but possibly rewarding situations and focusing on how the client may live a life aligned with their values, as well as addressing self-critical, negative beliefs about one's emotions (Fresco et al., 2013). An open trial of ERT with 21 adults with GAD (Mennin et al., 2015) indicated large effect sizes for pre-therapy to post-therapy change in GAD symptoms (g = 3.90) and worry (g = 1.40). ...
Chapter
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Generalized anxiety disorder (GAD) is a widespread and debilitating disorder. In this review, we present updated research on worry, along with the emotional, information processing, interpersonal, and biological factors underlying this disorder, through the lens of a comprehensive model of GAD: the Contrast Avoidance Model. This model sheds light on the developmental and maintaining factors of this disorder, and provides new insights for treatment. We also review research on the efficacy of extant treatments of GAD, along with presenting new directions for future research.
... Research on emotion and its relationship with worry in GAD has tended to rely on self-report questionnaires and laboratory experiments (see Fresco, Mennin, Heimberg, & Ritter, 2013;Newman & Llera, 2011;Newman et al., 2019). While highly valuable and informative, these methods also involve relatively "static" measurement that may or may not correspond with the real-life experience of emotion and worry (Newman et al., 2019;Trull & Ebner-Priemer, 2014). ...
... Moreover, theories of GAD indirectly touch on the notion of sustained negative emotion. For example, the emotion dysregulation model posits that people with GAD have difficulty engaging in adaptive emotion regulation strategies to downregulate negative emotion (Fresco et al., 2013;Mennin et al., 2005), whereas the contrast avoidance model suggests that people with GAD endure negative emotional states to avoid negative emotional contrasts (Newman & Llera, 2011). Therefore, both theories touch indirectly on the notion that people with GAD may experience sustained, or inert, negative emotion. ...
Article
Emotion-oriented theories (e.g., emotion dysregulation model, Mennin et al., 2005; contrast avoidance model; Newman & Llera, 2011) posit that people with Generalized Anxiety Disorder (GAD) have disturbances in emotion, experience negative emotion as aversive and in turn use maladaptive strategies, including worry, to regulate their distress. Much of what is known about emotion in the context of GAD is based on studies employing static methodologies. It is proposed that constructs and methodologies from the literature on emotion dynamics offer a complementary perspective. The principal aims of the study were to identify an emotion profile for people with GAD and to examine the direct effect of worry on subsequent negative and positive emotions via the experience sampling method. Participants included people with GAD (GAD group; n = 39) and people without GAD (nonclinical control [NCC] group; n = 41). Relative to the NCC group, the GAD group exhibited an emotion profile characterized by elevated mean intensity, greater instability and greater inertia of negative emotions and lower mean intensity, greater instability of positive emotions, but did not differ on inertia of positive emotions. People with GAD were found to have greater worry inertia and worry was also found to be associated with a subsequent increase in negative emotion, and this was more pronounced for the GAD group relative to the NCC group. The findings inform emotion-oriented models, provide unique insights into the dynamic emotional experiences of those with GAD and reinforce the benefits of the experience sampling methodology to study GAD-relevant processes.
... Consistent with these hypotheses, MBCT may reduce excessive connectivity within the default mode network (Farb, Segal, & Anderson, 2011Taylor et al., 2013), possibly reflecting strengthened present-moment awareness (e.g., Fresco et al., 2007b). Similarly, Fresco et al. (2017) examined the associations between pretreatment neural patterns of intrinsic functional connectivity in hubs within the DMN to treatment-related changes in worry and decentering in generalized anxiety disorder patients (with and without MDD) receiving emotion regulation therapy (e.g., Fresco, Mennin, Heimberg, & Ritter, 2013;Mennin, Fresco, Ritter, & Heimberg, 2015). Findings revealed that treatment linked gains in decentering, as well as reductions in worry were predicted by reduced functional connectivity between the anterior mPFC and a cluster in occipital lobe, as well as by greater connectivity between DMN hubs and regions of the salience network. ...
... Emotion Regulation Therapy (ERT) is mechanism-targeted, experientially-oriented CBT that integrates traditional and contemporary CBT [30] and emotion-focused therapies [31]. Rooted in a framework that draws from basic and translational affect science, ERT was developed to improve treatment for conditions in which PNT is considered a crucial maintaining factor, such as in the case of caregiver distress. ...
Article
Informal caregivers (ICs) are integral to care provided to patients facing life-threatening or incurable illnesses. This responsibility causes considerable burden, as approximately one half of ICs report clinically significant symptoms of depression and/or anxiety that persist when left untreated. Psychosocial interventions containing efficacious treatment principles (e.g., cognitive behavior therapy [CBT]) show disappointing results in reducing anxiety and depression in ICs. This may reflect failure of these interventions to specifically target crucial mechanisms underlying the central feature of distress caused by the patient’s illness—notably, perseverative negative thinking (PNT). Emotion Regulation Therapy (ERT) is an efficacious CBT developed to explicitly target mechanisms underlying PNT and the emotional concomitants that arise in response to stressful situations. This open trial was conducted to evaluate the acceptability and initial efficacy of ERT adapted to the experience of cancer ICs (ERT-C). Thirty-one ICs provided informed consent and completed eight weekly individual sessions of ERT-C. Participants completed self-report measures of depression and anxiety symptoms, PNT, emotion regulation deficits, and caregiver burden before and after treatment. ERT-C was well tolerated as indicated by 22 treatment completers and feedback provided in exit interviews. ICs demonstrated reduced depression and anxiety symptoms, PNT, and emotion regulation deficits with moderate to large effect sizes (Hedge’s g range: 0.36–0.92). Notably, caregiver burden was not reduced but ICs expressed more ability to confront caregiving-related challenges. Findings offer promising but preliminary support for ERT-C as a conceptual model and treatment modality for distressed cancer ICs.
... Emotion regulation deficits have been shown to prospectively predict various forms of psychopathology (Bardeen, Kumpula, & Orcutt, 2013;Kim & Cicchetti, 2010; Tull, Bardeen, DiLillo, Messman-Moore, & Gratz, 2015). As such, treatments have been developed in which deficits in emotion regulation are targeted in the service of reducing psychological distress (e.g., Emotion Regulation Therapy [ERT]; Mennin & Fresco, 2013). To improve our understanding of psychopathology marked by emotion regulation deficits and to evaluate treatment outcomes, there is a critical need for psychometrically sound measures of emotion regulation difficulties. ...
Article
Full-text available
The Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004) is a self-report measure that assesses six facets of emotion dysregulation. A modified version of the DERS (M-DERS) was developed to address psychometric limitations of the original measure (Bardeen et al., 2016). Although the factor structure of the M-DERS (i.e., two models: correlated trait and second-order models) has been supported via confirmatory factor analysis (CFA), the tenability of a bifactor model of the M-DERS has yet to be examined. Preliminary research suggests that a bifactor model of the DERS is tenable. In the present study (Ns of 993 and 578), results from a series of CFAs indicated adequate fit of the M-DERS and poor fit of the original DERS across several tested models (e.g., correlated trait, second-order, bifactor). Although a considerable amount of variance was accounted for by the general factor, statistical indices from the bifactor model supported a multidimensional conceptualization of the M-DERS. The Nonacceptance and Goals subscales evidenced incremental utility, after accounting for the general factor, in predicting general distress (Nonacceptance only) and intolerance of uncertainty. Implications for future use of the DERS and M-DERS are discussed.
... According to ERT model, [20,21] people with anxiety disorders exhibit dysfunction in three different areas. Motivational dysfunction, regulatory dysfunction and resulting disordered contextual learning. ...
Article
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Background: Emotion Regulation therapy (ERT) is an integrative therapy for anxiety disorders. ERT focuses on treating the emotion regulation difficulties found to be common underlying etiological factors across anxiety disorders. Case description: The present case report describes application of Emotion Regulation Therapy (ERT) in a client of social anxiety disorder (SAD) with comorbid depression and anxious avoidant personality disorder (AAPD). Rationale for using ERT in SAD, ERT case conceptualization and therapy process are explained. Client received 16 weekly sessions of ERT. Nature and severity of social anxiety, emotion regulation difficulties, depression, general anxiety and clinical global functioning were assessed at pre intervention, post, one month and three months after the intervention. Conclusion: There was improvement on all the outcome measures with the gains maintained over six month period. Results of the study with reference to the implications of using ERT are discussed. Keywords: Emotion processing and regulation, Anxiety disorders, Transdiagnostic therapy, Emotion Regulation Therapy.
... These results provide suggestions for interventions. They confi rm a universal benefi t of interventions that focus on changing maladaptive emotion regulation [21]. They show that in a country like Bangladesh -just like in other countries-, targets for prevention and intervention of psychopathology could be found in changing maladaptive cognitive strategies like rumination, catastrophizing, and self-blame into more adaptive strategies like positive reappraisal. ...
Article
Full-text available
p> Introduction: Psychopathology of adolescents in developing countries such as Bangladesh is a neglected problem, which should get more attention, especially with a focus on finding targets for prevention and intervention. Aim of the study was to study relationships between cognitive emotion regulation strategies and psychopathology in Bengali adolescents. Methods: The sample consisted of 340 12-to-18-year old adolescents from Bangladesh. The Cognitive Emotion Regulation Questionnaire (CERQ) was used to measure cognitive emotion regulation strategies. The SCL-90 was used to measure symptoms of depression, anxiety and hostility. Relationships between CERQ and SCL-90 scales were studied by Multiple Regression Analysis. Results: With regard to relationships between CERQ strategies and psychopathology: Higher extents of ‘Worry-focused’ cognitive styles appeared to be related to the reporting of more symptoms of psychopathology, while more ‘Reappraisal-focused’ styles were associated with the reporting of less symptoms of psychopathology. Discussion: The results with regard to the relationships between cognitive emotion regulation strategies and psychopathology may provide possible targets for interventions to improve mental health in adolescents in developing countries.</p
... daily life [1], affecting decision-making, perception, human interaction, and human intelligence [2]. Emotion recognition plays an important role in Cognitive Behavioural Therapy (CBT) [3], Emotion Regulation Therapy (ERT)/Emotion-Focused Therapy (EFT) [4] [5] [6], and the evaluation of medical treatment [7] for emotion-related mental disorders, such as Generalized Anxiety Disorder (GAD) [8], and Depression [9]. With the potential applications in CBT and EFT, enabling Artificial Intelligence (AI) to identify human emotions has captured more and more interest from researchers recently [1]. ...
... ej., trastorno de déficit de atención), con dificultades en el control emocional (Walcott & Landau, 2004); la esquizofrenia, donde la preferencia por la utilización de estrategias de supresión emocional respecto a la reevaluación cognitiva genera problemas de ansiedad y adaptación social (Van der Meer, Van't Wout & Aleman, 2009), y el autismo, donde las dificultades en la regulación emocional se han relacionado con incrementos en la ansiedad por la falta de habilidades con las que comprender las interacciones sociales (White, Mazefsky, Dichter, Chiu, Richey & Ollendick, 2014). Diferentes programas se han centrado en el tratamiento de la regulación emocional de manera específica para trastornos como la personalidad límite (Farrell & Shaw, 1994), la anorexia (Money, Genders, Treasure, Schmidt & Tchanturia, 2011), la ansiedad generalizada (Fresco, Mennin, Heimberg & Ritter, 2013), las agresiones sexuales (Gillespie, Mitchell, Fisher & Beech, 2012), el autismo . Otros programas más generales como el de Attwood (2004) (The Exploring Feelings Program), con un enfoque cognitivo-conductual y orientado al tratamiento de emociones concretas como la alegría, la relajación, la ira y la ansiedad. ...
Article
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La capacidad para regular las emociones de manera eficaz facilita la adaptación de las personas al ámbito social y es uno de los elementos fundamentales para entender cómo las personas más resilientes son capaces de afrontar las situaciones adversas y salir reforzadas. El análisis de estas variables permitiría comprender mejor la relación que la literatura científica establece entre el estado afectivo positivo y una mejor salud física y mental. Uno de los aspectos más relevantes en esta relación son las habilidades para reconocer y expresar las emociones, que permiten su fácil integración en programas de prevención y rehabilitación. Además, estas habilidades podrían potenciarse en el contexto clínico a través de la mejora en la interacción emocional entre el personal sanitario y los pacientes, con un enfoque prioritario hacia la regulación de las emociones positivas.
... There are several different contemporary approaches to worry that each have a different emphasis (see Behar et al., 2009 for an excellent review). These have been labelled the Avoidance Model of Worry and GAD (Borkovec et al., 2004;Newman et al., 2011), the Intolerance of Uncertainty Model (Dugas et al., 1998;Dugas and Robichaud, 2007;Wilkinson et al., 2011), the Metacognitive Model (Hjemdal et al., 2013;Wells, 1995), the Emotion Dysregulation Model (Fresco et al., 2013;Mennin et al., 2002) and the Acceptance-Based Model of Generalized Anxiety Disorder (Hayes-Skelton et al., 2013;Orsillo, 2002, 2005). All of these treatment approaches have some empirical support, albeit to varying degrees (see Cuijpers et al., 2014). ...
... Regulacija doživljanja (kontrola v širšem pomenu besede) nastopi šele posredno; gre torej za kontrolo preko sprejemanja, kar navidez predstavlja paradoks. Pretirano anksioznost lahko pojmujemo tudi kot posledico pomanjkljive regulacije emocij (Mennin, 2004), čuječnost pa med drugim poveča posameznikovo zmožnost uravnavanja svojih čustev in razpoloženj (A. M. Hayes inFeldman, 2004). ...
Article
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While the effects and correlates of mindfulness are relatively well studied, much less is known about the mechanisms of mindfulness. A comprehensive model of how mindfulness works is presented in this article, with the model encompassing five mechanisms: (a) attenuation of responding automaticity, (b) increased objectivity towards experience, (c) widening of attentional focus, (d) attenuation of experiential avoidance, and (e) exposure and desensitization. The first three mechanisms are related to the mindfulness dimension of awareness of experience, and the last two mechanisms are related to the dimension of experiential acceptance. For greater clarity, these five mechanisms of action are presented through the example of the effects of mindfulness on anxiety and its disorders. It is assumed that the model is also valid for explaining the effects of mindfulness in other areas (such as stress and depression), which should be investigated in further research.
... Research has shown that emotion regulation is an important indicator of psychological health in childhood and adolescence [6][7][8][9][10][11][12][13][14][15][16][17]. Although several clinical programs already focus on emotion regulation skills [20][21][22][23][24], the successful application of these techniques in young age groups requires that clinicians have knowledge on the normative use of emotion regulation strategies over age. Specifically, such knowledge allows practitioners to focus their efforts on emotion regulation strategies that are adjusted to the age of the individual. ...
Article
Full-text available
Dysfunctional emotion regulation is an important predictor of psychopathology. Although many clinical programs focus on emotion regulation skills, the successful application of these programs in children and adolescents requires knowledge on the normative use of emotion regulation strategies over age. To this end, the current cross-sectional study examined changes in emotion regulation throughout childhood and adolescence. The use of seven adaptive and five maladaptive emotion regulation strategies was measured with the FEEL-KJ in a representative sample (N = 1397) of Dutch children and adolescents between 8 and 18 years old. Overall, the results indicated reduced use of adaptive strategies and increased use of maladaptive strategies in participants between 12 and 15 years old compared with younger or older participants. The findings of the current study indicate that adolescence is characterized by a maladaptive shift in emotion regulation. Given that the continued use of dysfunctional emotion regulation plays an important role in the development and maintenance of psychopathology, these results highlight the importance of prevention and treatment programs focused on emotion regulation to shield vulnerable adolescents against mental illness. Full text is available at http://rdcu.be/pccS.
... As a whole, these studies have demonstrated the feasibility and efficacy of providing children and adolescents with guided practice in using coping resources or emotion regulation strategies that can be effective in dealing with many stressors or helpful in alleviating distress (Compas et al., , 2010(Compas et al., , 2014Fresco, Mennin, Heimberg, & Ritter, 2013;Kovacs et al., 2006;Suveg, Sood, Comer, & Kendall, 2009;Tein, Sandler, Ayers, & Wolchik, 2006;Weisz, Hawley, & Jensen Doss, 200;Weisz, Thurber, Sweeney, Proffitt, & LeGagnoux, 1997). Other interventions have shown success in increasing coping efficacy (Gonzales et al., 2012;Wolchik et al., 2000). ...
Chapter
The goal of this chapter is to review conceptual and empirical progress in the study of the development of coping and to identify important ways in which this work may be useful to researchers studying the development of psychopathology and resilience. We first summarize perspectives that identify coping as a transactional process, reviewing theory and research on how individual differences in stress appraisals, coping, and emotional responses are linked to psychopathology and adaptive functioning. Then, in the normative developmental perspectives section, we describe coping as a fundamental human adaptive process that involves the regulation of multiple subsystems (like emotion and attention) that are activated by stress. We consider age-graded developments in multiple ways of coping in order to bring structure to research on the negative and positive outcomes of coping for human adaptation, psychopathology, and resilience. In the developmental systems section, we consider coping as an integral part of developmental cascades that contribute to psychopathology and resilience. We review research on how coping is associated with temperament, attachment, and parenting to identify examples of underlying risk and protective factors. These factors likely play a role in developmental cascades that mark and contribute to psychopathology and resilience. We end with suggestions for future research and highlight some translational implications of research.
... Preponderancia de meta preocupaciones: en pacientes con intensa meta preocupación, pareciera más apropiada la terapia metacognitiva por su foco central en reestructurar las meta preocupaciones y desactivar la supresión de pensamientos asociada (86). 8. Resistencia o rechazo a ejercicios de exposición: en aquellos pacientes con TAG que no hayan presentado una respuesta favorable a tratamientos basados en técnicas de exposición; o que directamente se opongan a ellas, la terapia de relajación aplicada y la terapia de regulación emocional podrían resultar la alternativa más conveniente ya que la fase inicial de entrenamiento en relajación presente en ambos abordajes disminuye la ansiedad y preocupación del paciente, aumentando su autoeficacia, y animándolo posteriormente a exponerse a situaciones de ansiedad durante la fase aplicada o guiada por valores, respectivamente (17,37). (ver figuar 6) ...
Article
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EN ESPAÑOL: El objetivo del presente estudio fue caracterizar el abordaje clínico de la preocupación en el Trastorno de Ansiedad Generalizada (TAG), a partir de cómo terapeutas Cognitivo Conductuales de Buenos Aires la incluyeron en sus intervenciones. Se realizó un análisis secundario sobre entrevistas a 10 terapeutas. Los participantes escucharon un material estímulo cuasi clínico, e intervinieron como si estuviesen con un paciente real. Las entrevistas fueron audiograbadas y transcriptas. Para el análisis de los datos, en el presente estudio se categorizaron las respuestas utilizando el método de investigación cualitativo consensual. Asimismo, se analizó cuantitativamente la proporción de intervenciones enfocadas en la preocupación, utilizando la clasificación multidimensional de intervenciones psicoterapéuticas. Los resultados sugieren la existencia de un bajo grado de acuerdo entre los terapeutas locales respecto a cómo abordar la preocupación en pacientes con estas características. Se discuten potenciales criterios basados en la evidencia que faciliten la toma de decisión clínica al proveer tratamiento a pacientes con TAG. IN ENGLISH: The goal of the present study was to characterize the clinical approach to worry in Generalized Anxiety Disorder (GAD), based on how Cognitive-Behavioral Therapists from Buenos Aires included it in their interventions. A secondary analysis was conducted with inter- views of 10 therapists. Participants were asked to listen to a quasi-clinical material, and to intervene as if they were with a real patient. Interviews were audio-recorded and transcribed. For the data analysis in the present study, responses were categorized using Consensual Qualitative Research methodology, and the proportion of interventions targeting worry was also analyzed using the Multidimensional Classi cation of Psychotherapeutic Interventions. Results suggest the existence of a low degree of agreement among local therapists on how to address worryness in patients with these characteristics. Potential evidence-based criteria to facilitate clinical decision making when treating patients with GAD are discussed.
... Indeed, a number of studies show that mindfulness training is effective at improving emotion regulation and research has also shown that the SART is linked to affective outcomes, including negative affect (Mrazek et al., 2012;Smallwood et al., 2009), so we posit that acceptance may be a critical skill for these effects of mindfulness on emotion related outcomes (Lindsay & Creswell, 2015). Acceptance, the embracing of present experience without judgment or attempts to change the experience (Hayes, Luoma, Bond, Masuda, & Lillis, 2006), has been linked to positive outcomes in previous studies of Acceptance Commitment Therapy (ACT) and Emotion Regulation Therapy (ERT), including effects on emotion outcomes (Arch et al., 2012;Bond & Bunce, 2003;Forman et al., 2007;Fresco et al., 2013). The orientation of acceptance is theorized to allow one to attend to negative affective states from a nonreactive perspective (Bieling et al., 2012), which may foster better task performance than an emotionally reactive or judgmental state; and indeed, previous findings suggest that greater negative affect is associated with greater SART errors (Mrazek et al., 2012). ...
Article
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Mindfulness meditation programs, which train individuals to monitor their present-moment experience in an open or accepting way, have been shown to reduce mind wandering on standardized tasks in several studies. Here we test 2 competing accounts for how mindfulness training reduces mind wandering, evaluating whether the attention-monitoring component of mindfulness training alone reduces mind wandering or whether the acceptance training component is necessary for reducing mind wandering. Healthy young adults (N = 147) were randomized to either a 3-day brief mindfulness training condition incorporating instruction in both attention monitoring and acceptance, a mindfulness training condition incorporating attention monitoring instruction only, a relaxation training condition, or an active reading-control condition. Participants completed measures of dispositional mindfulness and treatment expectancies before the training session on Day 1 and then completed a 6-min Sustained Attention to Response Task (SART) measuring mind wandering after the training session on Day 3. Acceptance training was important for reducing mind wandering, such that the attention-monitoring plus acceptance mindfulness training condition had the lowest mind wandering relative to the other conditions, including significantly lower mind wandering than the attention-monitoring only mindfulness training condition. In one of the first experimental mindfulness training dismantling studies to-date, we show that training in acceptance is a critical driver of mindfulness-training reductions in mind wandering. This effect suggests that acceptance skills may facilitate emotion regulation on boring and frustrating sustained attention tasks that foster mind wandering, such as the SART.
... While emotion regulation behaviors are widespread and largely intuitive, people nevertheless sometimes fail to implement them effectively. For instance, they may fail to invoke regulatory skills when they are not cued with appropriate emotion regulation strategies[3,39]. Such observations give rise to a more general question about how technology affordances can aid those who fail to self-regulate their emotions. ...
Conference Paper
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Emotion regulation is crucial for healthy adaptation [47, 24],while emotion dysregulation can lead to the development of mental health disorders such as anxiety or depression [7]. Everyone, one way or another, sometimes fails to effectively regulate their emotions, making this a challenging problem with broad potential impact. In our research, we are exploring three ways in which haptics-enabled wearables can facilitate effective emotion regulation, formulated based onGross’s model of emotion regulation [23]. We hypothesize that an individual-level biofeedback haptic could foster healthier and more effective patterns of emotion regulation.We have designed and implemented HapLand, a scalable, robust biofeedback haptic system testbed to facilitate research-based haptics-enabled wearables design for the purpose of emotion regulation. In this paper, we give an overview of HapLand and our plans for using HapLand for future re-search.
... Emotion Regulation Therapy (ERT) is mechanism-targeted, experientially-oriented CBT that integrates traditional and contemporary CBT [30] and emotion-focused therapies [31]. Rooted in a framework that draws from basic and translational affect science, ERT was developed to improve treatment for conditions in which PNT is considered a crucial maintaining factor, such as in the case of caregiver distress. ...
Article
Informal caregivers (ICs) are integral to care provided to patients facing life-threatening or incurable illnesses. This responsibility causes considerable burden, as approximately one half of ICs report clinically significant symptoms of depression and/or anxiety that persist when left untreated. Psychosocial interventions containing efficacious treatment principles (e.g., cognitive behavior therapy [CBT]) show disappointing results in reducing anxiety and depression in ICs. This may reflect failure of these interventions to specifically target crucial mechanisms underlying the central feature of distress caused by the patient's illness-notably, persever-ative negative thinking (PNT). Emotion Regulation Therapy (ERT) is an efficacious CBT developed to explicitly target mechanisms underlying PNT and the emotional concomitants that arise in response to stressful situations. This open trial was conducted to evaluate the acceptability and initial efficacy of ERT adapted to the experience of cancer ICs (ERT-C). Thirty-one ICs provided informed consent and completed eight weekly individual sessions of ERT-C. Participants completed self-report measures of depression and anxiety symptoms, PNT, emotion regulation deficits, and caregiver burden before and after treatment. ERT-C was well tolerated as indicated by 22 treatment completers and feedback provided in exit interviews. ICs demonstrated reduced depression and anxiety symptoms, PNT, and emotion regulation deficits with moderate to large effect sizes (Hedge's g range: 0.36-0.92). Notably, care-giver burden was not reduced but ICs expressed more ability to confront caregiving-related challenges. Findings offer promising but preliminary support for ERT-C as a conceptual model and treatment modality for distressed cancer ICs.
... The results of this study provide suggestions for developing an intervention plan to improve mental health condition of adolescents. Previous studies confirm a universal benefit of interventions that focus on changing maladaptive emotion regulation (Fresco et al., 2013). They show that in a country like Bangladesh, just like in other countries, targets for prevention and intervention of psychopathology could be found in changing maladaptive cognitive strategies like rumination, catastrophizing, and self-blame into more adaptive strategies like positive reappraisal. ...
... From our perspective, emotional regulation is all about recognising, understanding, influencing, controlling and experiencing and expressing emotions. Researchers such as Fresco, Mennin, Heimberg and Ritter [1] have carried out research to the same effect, defining emotional regulation in a similar way. Other researchers have explained that emotional regulation can at times be unconscious, or conscious. ...
Chapter
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Emotional regulation is a developmental skill that everyone must learn. It is the ability for you to tune into, make sense of and control your own strong feelings. It affectively influences how well you can adapt to situations and events in your life, as well as how you navigate and adapt to the world. A lack of healthy emotional regulation can lead one to become dysregulated. Two important phenomenon underpin our ability to regulate: emotional complexity and splitting. The more acknowledgment and understanding that we give to our emotions (not just the thoughts in our mind but the feelings in our better), the more control and problem solving skills we can harness to sustain a good standard of personal well-being.
... In light of the increasing evidence indicating how depressive rumination complicates the severity and treatment efficacy of conditions such as MDD 36 , interventions for the acute treatment and relapse prevention have been developed that specifically target processes such as negative self-referentiality including depressive rumination [37][38][39][40][41][42] . With respect to acute treatment, interventions such as Emotion Regulation Therapy (ERT) incorporate techniques from CBT and mindfulness-based intervention to tackle pathological processes such as worrying and rumination. ...
Article
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Depressive rumination is considered a prominent risk factor for the occurrence, severity, and duration of depressive episodes. A variety of treatment options have been developed to treat depressive rumination of which mindfulness based programs are especially promising. In the current study, we investigated the neural underpinnings of a short mindfulness intervention and mindful emotion regulation in high and low trait ruminators in an ecologically valid environment using functional near‑infrared spectroscopy (fNIRS). Participants were randomly assigned to a mindfulness instruction (MT) group or an instructed thinking (IT) group. Participants in the MT group were trained to either focus their attention mindfully on their breath or their emotions, while the IT group focused their attention on the past or future. Afterwards, all participants underwent an emotion regulation paradigm in which they either watched negative or neutral movie clips. During both paradigms cortical hemodynamic changes were assessed by means of fNIRS. Participants in the MT group showed lower activity in the cognitive control network (CCN) during the focus on breath condition in comparison to the focus on emotion condition. Additionally, oxygenated hemoglobin in the MT group tended to be lower than in the IT group. Further, self‑reports of emotional distress during the instruction paradigm were reduced in the MT group. During the emotion regulation paradigm, we observed reduced emotional reactivity in terms of emotional distress and avoidance in the MT group in comparison to the IT group. Furthermore, on a neural level, we observed higher CCN activity in the MT group in comparison to the IT group. We did not find any effect of rumination, neither on the intervention nor on the emotion regulation task. The results of this pilot study are discussed in light of the present literature on the neural correlates of mindfulness based interventions in rumination and emphasize the use of fNIRS to track neural changes in situ over the course of therapy.
... BCI has a wide range of applications in the real world, such as robot controlling [3], stroke rehabilitation [4], and emotion regulation for mental disorders [5]. Among various BCI applications, emotion recognition via EEG has huge potentials in Cognitive Behavioural Therapy (CBT) [6], Emotion Regulation Therapy (ERT)/Emotion-Focused Therapy (EFT) [7] [8] by enabling artificial intelligence (AI) to identify human emotions. Recently, EEG emotion recognition has caught the attention of researchers [9] [10]. ...
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In this paper, we propose LGG, a neurologically inspired graph neural network, to learn local-global-graph representations from Electroencephalography (EEG) for a Brain-Computer Interface (BCI). A temporal convolutional layer with multi-scale 1D convolutional kernels and kernel-level attention fusion is proposed to learn the temporal dynamics of EEG. Inspired by neurological knowledge of cognitive processes in the brain, we propose local and global graph-filtering layers to learn the brain activities within and between different functional areas of the brain to model the complex relations among them during the cognitive processes. Under the robust nested cross-validation settings, the proposed method is evaluated on the publicly available dataset DEAP, and the classification performance is compared with state-of-the-art methods, such as FBFgMDM, FBTSC, Unsupervised learning, DeepConvNet, ShallowConvNet, EEGNet, and TSception. The results show that the proposed method outperforms all these state-of-the-art methods, and the improvements are statistically significant (p<0.05) in most cases. The source code can be found at: https://github.com/yi-ding-cs/LGG
... Behavior Therapy (Linehan, 1993), and Emotion Regulation Therapy (Fresco et al., 2013) focus on increasing emotional awareness and recognition to help facilitate better outcomes. Within these modalities, emotional awareness training exercises, such as mindfulness (see meta-analysis in Cooper, Yap, & Batalha, 2018) are typically used. ...
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From scary stories to horror films and haunted houses, the horror genre is wildly popular. Although horror aims to elicit fear and anxiety in its audience, many people with anxiety are horror fans and some report using horror to cope with their anxiety. In this article, we provide a theoretical rationale for why people with anxiety might find relief in horror films. First, we discuss aspects of horror that could make it particularly alluring to people with anxiety and how some features of horror films have the potential to reduce anxiety in the moment. Next, we examine how engagement with horror could build skills for resilience in more generalized situations. We build on processes from evidence- based therapies (i.e., cognitive behavioral therapy and exposure therapy) to explain how horror media has the potential to be used as a therapeutic tool. Finally, we discuss steps for future research on horror as a therapeutic tool for anxiety-related disorders.
... daily life [1], affecting decision-making, perception, human interaction, and human intelligence [2]. Emotion recognition plays an important role in Cognitive Behavioural Therapy (CBT) [3], Emotion Regulation Therapy (ERT)/Emotion-Focused Therapy (EFT) [4] [5] [6], and the evaluation of medicine treatment [7] for emotion-related mental disorders, such as Generalized anxiety disorder (GAD) [8],and Depression [9]. With the potential applications in CBT and EFT, enabling artificial intelligence (AI) to identify human emotions has captured more and more interest from researchers recently [1]. ...
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In this paper, we propose TSception, a multi-scale convolutional neural network, to learn temporal dynamics and spatial asymmetry from affective electroencephalogram (EEG). TSception consists of dynamic temporal, asymmetric spatial, and high-level fusion Layers, which learn discriminative representations in the time and channel dimensions simultaneously. The dynamic temporal layer consists of multi-scale 1D convolutional kernels whose lengths are related to the sampling rate of the EEG signal, which learns its dynamic temporal and frequency representations. The asymmetric spatial layer takes advantage of the asymmetric neural activations underlying emotional responses, learning the discriminative global and hemisphere representations. The learned spatial representations will be fused by a high-level fusion layer. With robust nested cross-validation settings, the proposed method is evaluated on two publicly available datasets DEAP and AMIGOS. And the performance is compared with prior reported methods such as FBFgMDM, FBTSC, Unsupervised learning, DeepConvNet, ShallowConvNet, and EEGNet. The results indicate that the proposed method significantly (p<0.05) outperforms others in terms of classification accuracy. The proposed methods can be utilized in emotion regulation therapy for emotion recognition in the future. The source code can be found at: https://github.com/deepBrains/TSception-New
... The current paper outlines the application of CBT and an emotion regulation framework using elements from DBT, in a case with anxiety presenting with obsessive compulsive symptoms and school refusal. Combined interventions grounded in CBT and DBT principles have been utilized in the past with suicidal behaviour [12], generalized anxiety [13,9], and post-traumatic stress disorder [14], however, this combined approach is yet to be rigorously examined in the context of school refusal. ...
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Emotion Regulation Therapy (ERT) for generalized anxiety (GAD) and accompanying depression (MDD) is a theoretically-derived, evidence based, treatment that integrates principles from traditional and contemporary cognitive-behavioral and experiential approaches with basic and translational findings from affect science to offer a blueprint for improving intervention by focusing on the motivational responses and corresponding self-referential regulatory characteristics. Preliminary evidence supports the efficacy of a 20-session version of ERT. However, previous trials of ERT and other traditional and contemporary cognitive-behavioral therapies (CBTs) have often utilized relatively homogeneous samples. Various contextual and demographic factors may be associated with challenges that increase risk for negative mental and social outcomes for young adults aged 18-29, particularly for individuals from diverse backgrounds. The aim of this pilot study was to examine the effectiveness of a briefer 16-session
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The COVID-19 pandemic has the potential to profoundly affect youths' mental health. Understanding predictors of affective responding to the pandemic is critical for prevention and intervention efforts. This study examines emotion regulation as an important predictor of youth's changes in positive and negative affect. The present study of 115 participants (62 girls, M age = 11.77) explores the relation between pre-existing emotion regulation strategies, as measured by multi-week daily diaries pre-COVID, and youths' mean positive and negative affect levels and variability during a 28-day period amidst the pandemic, while including COVID-related worries and isolation as important moderators. The findings provide important insight into interactions between pre-existing vulnerabilities and COVID-related stressors in predicting affective adjustment in youth.
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Dysregulated emotion plays an important role for mental health problems. To elucidate the underlying mechanisms, researchers have focused on the domains of strategy-based emotion regulation, psychophysiological self-regulation, emotion evaluations, and resulting emotion dynamics. So far, these four domains have been looked at in relative isolation from each other, and their reciprocal influences and interactive effects have seldom been considered. This domain-specific focus constrains the progress the field is able to make. Here, we aim to pave the way towards more cross-domain, integrative research focused on understanding the raised reciprocal influences and interactive effects of strategy-based emotion-regulation, psychophysiological self-regulation, emotion evaluations, and emotion dynamics. To this aim, we first summarize for each of these domains the most influential theoretical models, the research questions they have stimulated, and their strengths and weaknesses for research and clinical practice. We then introduce the metaphor of a ball in a bowl that we use as a basis for outlining an integrative framework of dysregulated emotion. We illustrate how such a framework can inspire new research on the reciprocal influences and interactions between the different domains of dysregulated emotion and how it can help to theoretically explain a broader array of findings, such as the high levels of negative affect in clinical populations that have not been fully accounted for by deficits in strategy-based emotion regulation and the positive long-term consequences of accepting and tolerating emotions. Finally, we show how it can facilitate individualized emotion regulation interventions that are tailored to the specific regulatory impairments of the individual patient.
Article
Despite the success of available medical and psychosocial treatments, a sizable subgroup of individuals with commonly co-occurring disorders, generalized anxiety disorder (GAD) and major depressive disorder (MDD), fail to make sufficient treatment gains thereby prolonging their deficits in life functioning and satisfaction. Clinically, these patients often display temperamental features reflecting heightened sensitivity to underlying motivational systems related to threat/safety and reward/loss (e.g., somatic anxiety) as well as inordinate negative self-referential processing (e.g., worry, rumination). This profile may reflect disruption in two important neural networks associated with emotional/motivational salience (e.g., salience network) and self-referentiality (e.g., default network, DN). Emotion Regulation Therapy (ERT) was developed to target this hypothesized profile and its neurobehavioral markers. In the present study, 22 GAD patients (with and without MDD) completed resting state MRI scans before receiving 16 sessions of ERT. To test study these hypotheses, we examined the associations between baseline patterns of intrinsic functional connectivity (iFC) of the insula and of hubs within the DN (anterior and dorsal medial prefrontal cortex [MPFC] and posterior cingulate cortex [PCC]) and treatment-related changes in worry, somatic anxiety symptoms and decentering. Results suggest that greater treatment linked reductions in worry were associated with iFC clusters in both the insular and parietal cortices. Greater treatment linked gains in decentering, a metacognitive process that involves the capacity to observe items that arise in the mind with healthy psychological distance that is targeted by ERT, was associated with iFC clusters in the anterior and posterior DN. The current study adds to the growing body of research implicating disruptions in the default and salience networks as promising targets of treatment for GAD with and without co-occurring MDD.
Conference Paper
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La Terapia de Relajación Aplicada (RA) es un abordaje psicoterapéutico de muy fácil entrenamiento, cuya eficacia ha sido demostrada para el tratamiento de múltiples Trastornos de Ansiedad y problemas médicos. Durante los últimos 29 años se ha comparado a la RA con nuevos programas de tratamiento cognitivo-conductual específicos para Trastornos de Ansiedad; sin embargo, la RA continúa siendo uno de los tratamientos más eficaces del Trastorno de Ansiedad Generalizada, con modestas evidencias de eficacia para el Trastorno de Pánico, y con algunas evidencias para el Trastorno de Ansiedad Social. A pesar de su demostrada eficacia, la RA parece haber caído en desgracia dado que los nuevos desarrollos teóricos han abandonado a las técnicas de relajación en general, reencuadrándolas como estrategias de control disfuncional, o, incluso, catalogándolas erróneamente como prácticas iatrogénicas, inductoras de ansiedad o ataques de pánico. Por estas razones, ya prácticamente no existen publicaciones que permitan diseminar este simple abordaje que posibilita tratar múltiples problemáticas de ansiedad en forma integrada. Asimismo, a la fecha, no existen programas de entrenamiento ni guías publicadas en español o en inglés respecto de cómo integrar y encuadrar a este entrenamiento específico dentro del marco más amplio de una Terapia Cognitivo-Conductual. Este abandono de la RA no se condice con los lineamientos de la Práctica Psicoterapéutica Basada en las Evidencias, y priva a potenciales pacientes de acceder a una adicional oferta psicoterapéutica con apoyo empírico. El objetivo de la presente conferencia consiste en exponer una revisión de las críticas, ventajas y desventajas de la RA a la luz de las nuevas evidencias empíricas, y reestructurar prejuicios hacia la RA que obstaculizan su diseminación.
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Background Despite the vast majority of evidence indicating the efficacy of traditional and recent cognitive behaviour therapy (CBT) therapies in treating social anxiety disorder (SAD), some individuals with SAD do not improve by these interventions, particularly when co-morbidity is present. Aims It is not clear how emotion regulation therapy (ERT) can improve SAD co-morbid with symptoms of generalized anxiety disorder (GAD) and depression. This study investigated this gap. Method Treatment efficacy was assessed using a single case series methodology. Four clients with SAD co-occurring with GAD and depression symptoms received a 16-session version of ERT in weekly individual sessions. During the treatment, self-report measures and clinician ratings were used to assess the symptom intensity, model-related variables, and quality of life, work and social adjustment of participants every other week throughout the treatment. Follow-up was also conducted at 1, 2 and 3 months after treatment. Data were analysed using visual analysis, effect size (Cohen’s d ) and percentage of improvement. Results SAD clients with depression and GAD symptoms demonstrated statistically and clinically significant improvements in symptom severity, quality of life, work, social adjustment and model-related measures (i.e. negative emotionality/safety motivation, emotion regulation strategies). The improvements were largely maintained during the follow-up period and increased for some variables. Conclusion These findings showed preliminary evidence for the role of emotion dysregulation and motivational factors in the aetiology and maintenance of SAD and the efficacy of ERT in the treatment of co-morbid SAD.
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The study of vulnerabilities to depression typically identifies factors that are thought to be universally maladaptive or adaptive. In contrast, researchers recently have theorized that the ability to flexibly engage in different thoughts and behaviors that fit situational demands may be most indicative of psychological health. We review empirical evidence from 147 studies reporting associations between five components of flexibility (set-shifting, affective set-shifting, cardiac vagal control, explanatory flexibility, and coping flexibility) and depression and classify studies according to strength of study design. Evidence from correlational and case-controlled studies suggests cross-sectional relationships, but few prospective studies have been conducted. We discuss limitations of existing studies, identify new directions for programmatic research, and discuss implications that flexibility has for the prevention and treatment of depression.
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Background and aims: Difficulties in Emotion Regulation (ER) are related to the etiology and maintenance of several psychological disorders, including Eating Disorders (ED) and Gambling Disorder (GD). This study explored the existence of latent empirical groups between both disorders, based on ER difficulties and considering a set of indicators of personality traits, the severity of the disorder, and psychopathological distress. Methods: The sample included 1,288 female and male participants, diagnosed with ED (n = 906) and GD (n = 382). Two-step clustering was used for the empirical classification, while analysis of variance and chi-square tests were used for the comparison between the latent groups. Results: Three empirical groups were identified, from the most disturbed ER profile (Subgroup 1) to the most functional (Subgroup 3). The ER state showed a linear relationship with the severity of each disorder and the psychopathological state. Different personality traits were found to be related to the level of emotion dysregulation. Discussion and conclusion: In this study, three distinct empirical groups based on ER were identified across ED and GD, suggesting that ER is a transdiagnostic construct. These findings may lead to the development of common treatment strategies and more tailored approaches.
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Dysfunction in the ability to sustain, shift and broaden attention has been proposed as a mechanism of normative emotion regulation that is a common target of cognitive-behavioral therapies. Attention regulation deficits are central to generalized anxiety disorder (GAD) and may contribute to a generally rigid, avoidant, response style that produces substantial decrements in well-being and functioning. Emotion Regulation Therapy draws upon mindfulness-based regulatory skills to facilitate attentional change during an initial phase of treatment. Two studies examined task-based changes in flexibly shifting attention in response to conflicting emotional contexts and sustaining attention despite distressing emotional contexts. In Study 1, at pre-treatment, patients with GAD, as compared to controls performed significantly more poorly on an emotional conflict adaptation task (i.e., less ability to flexibly shift attention) and improved in conflict adaptation by mid-treatment (when attention regulation skills were being trained). This task-related change predicted increases in mindful observing abilities over the course of acute treatment but was not directly associated with clinical outcomes. In Study 2, a choice reaction time (RT) task was utilized to measure the ability to sustain attention by discriminating between two tones while overcoming the interference of aversive visual stimuli. At pre-treatment, participants with GAD demonstrated slower RTs (i.e., more difficulty sustaining attention on the tonal prompt) compared to controls and demonstrated more rapid RTs from pre- to mid-treatment. This improved task performance was related to clinical improvement and decreased functional impairment. RT change was also associated with greater nonreactivity towards experiences. Overall, these findings suggest that targeting mindful regulation skills improve attention regulation in individuals with GAD and may partially account for efficacious clinical outcomes throughout treatment.
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Lesbian, gay, and bisexual (LGB) individuals report higher levels of problematic alcohol and substance use than their heterosexual peers. This disparity is linked to the experience of LGB-specific stressors, termed minority stress. Additionally, bisexual individuals show increased rates of psychopathology, including problematic alcohol and substance use, above and beyond lesbian and gay individuals. However, not everyone experiencing minority stress reports increased rates of alcohol and substance misuse. Emotion regulation (ER), which plays a critical role in psychopathology in general, is theorized to modulate the link between minority stress and psychopathology. However, it remains largely unknown whether ER plays a role in linking instances of minority stress with substance and alcohol use outcomes. To address the gap, the current study assessed 305 LGB individuals' instances of minority stress, ER, and substance and alcohol use outcomes. We assessed the role of ER in problematic alcohol and substance use among LGB individuals using moderated mediation, where sexual minority status was entered as the moderator, and ER difficulties was entered as the mediator. The results indicated significant indirect effects of minority stress, through ER difficulties, on both problematic alcohol and substance use. However, there was no significant interaction with sexual orientation status, suggesting that ER may be important for all LGB individuals in predicting problematic alcohol and substance use. These results highlight the important role that ER plays between instances of minority stress and substance and alcohol use in LGB individuals, suggesting that ER skills may serve as a novel target for intervention.
Article
Latinx are one of the largest and most rapidly growing segments of the United States (U.S.) population that is significantly impacted by health disparities, including somatic health problems. Young Latinx adults (ages 18–25 years) are at a greater risk for being affected by such health inequalities and there is a need to understand individual-based differences that may contribute to and maintain somatic symptoms, including pain experience, pain beliefs, and perceptions of health. Thus, the current study investigated the explanatory role of worry in association between pain intensity, pain disability, pain-related anxiety, and perceived health among Latinx college students. Participants included 401 (Mage = 21 years; SD = 2.02; 83% female) Latinx students at a large, southwestern university. Results indicated that greater levels of worry were related to increased levels of pain intensity, pain disability, pain-related anxiety, and lower levels of perceived health. These findings were evident above and beyond variance accounted for by gender, age, physical functioning, and subjective social status. Overall, the results from the present investigation suggest that there is greater risk for more severe pain experiences, maladaptive beliefs regarding pain, and worse perceptions of health status among Latinx young adults who experience elevated levels of worry.
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Objective: Generalized anxiety disorder (GAD) and major depression (MDD), especially when they co-occur, are associated with suboptimal treatment response. One common feature of these disorders is negative self-referential processing (NSRP; i.e., worry, rumination), which worsens treatment outcome. Emotion Regulation Therapy (ERT) integrates principles from affect science with traditional and contemporary cognitive-behavioral treatments to identify and modify the functional nature of NSRP by targeting motivational and regulatory mechanisms, as well as behavioral consequences. Method: Building on encouraging open trial findings, 53 patients with a primary diagnosis of GAD (43% with comorbid MDD) were randomly assigned to immediate treatment with ERT (n = 28) or a modified attention control condition (MAC, n = 25). Results: ERT patients, as compared with MAC patients, evidenced statistically and clinically meaningful improvement on clinical indicators of GAD and MDD, worry, rumination, comorbid disorder severity, functional impairment, quality of life, as well as hypothesized mechanisms reflecting mindful attentional, metacognitive, and overall emotion regulation, which all demonstrated mediation of primary outcomes. This superiority of ERT exceeded medium effect sizes with most outcomes surpassing conventions for a large effect. Treatment effects were maintained for nine months following the end of acute treatment. Overall, ERT resulted in high rates of high endstate functioning for both GAD and MDD that were maintained into the follow-up period. Conclusions: Findings provide encouraging support for the efficacy and hypothesized mechanisms underlying ERT and point to fruitful directions for improving our understanding and treatment of complex clinical conditions such as GAD with co-occurring MDD. (PsycINFO Database Record
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Objectives The purpose of this study was to compare the efficacy of integrated cognitive behavioral therapy with Transdiagnostic Treatment on symptoms of patients with generalized anxiety disorder comorbid with depression. Methods The quasi-experimental design of two groups (integrated cognitive behavioral therapy group, Transdiagnostic treatment group) was used for competitive validity. The statistical population included people with comorbid anxiety disorder with depression who referred to counseling centers in Isfahan in 1398, from which 10 people were selected by purposive sampling and randomly assigned to two groups. Research instruments were GAD-7 scales, Beck Depression Inventory, and Penn State Worry Questionnaire (PSWQ). Results Visual charting, percentage of improvement, and reliable change index (RCI)) showed that both treatments produced clinically and statistically significant changes in therapeutic outcomes (symptoms of anxiety, worry and depressive symptoms) and continued therapeutic effects during follow-up. But the percentages of improvement in the integrated treatment group in all three components of symptoms of anxiety, worry and depression were higher. Conclusion Based on the obtained results and based on the Theoretical explanation of findings for effectiveness of therapy, integrated Cognitive Behavioral Therapy is preferred over transdiagnostic treatment in terms of the magnitude of change and stability, but both are similar in acceptance.
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Introduction: People with Illness Anxiety Disorder experience excessive worry and poor quality of life. The aim of the present study is to examine Effectiveness of Emotion Regulation Group Therapy on symptom reduction and quality of life in individuals with Illness Anxiety Disorder. This is an experimental study with pre-test and post-test design and control group. Population of the of the present study was All people with panic disorder in Shiraz city in 1398 who went to the psychiatric clinics of Shiraz University of Medical Sciences. The sample was 18 people with Illness Anxiety Disorder who were randomly assigned to the experimental group and the control group. Method: The subjects in the experimental group and the control group were assessed in both pre-test and post-test periods using Structured Clinical Interview for DSM-5, Anxiety and Related Disorders Interview Schedule for DSM-5 and The World Health Organization Quality of Life questionnaire. Results: results showed that Group format of Emotion Regulation Therapy significantly Improve Symptoms of anxiety and quality of life of individuals with Illness Anxiety Disorder. Conclusion: Emotion Regulation Therapy throughout using Body scan mindfulness technique, Awareness of physical senses and breathe technique, and also intervention in worry and emotion regulation construct which Known as mediators in the treatment of many disorders, significantly Improve symptoms and quality of life of people with Illness Anxiety Disorder.
Chapter
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Cognitive‐behavioral therapy (CBT) fundamentally aims to ameliorate generalized anxiety disorder (GAD) symptoms, which stem from habitual, inflexible, and spiraling systems of interaction between somatic, cognitive, and emotional responses to appraised threats. This chapter describes the core components of CBT often employed in clinical trials of GAD based on established manuals as well as recent treatment packages for GAD based on a CBT rationale such as metacognitive therapy, intolerance‐of‐uncertainty therapy, or emotion‐regulation therapy. It discusses the implementation of CBT by including self‐monitoring, relaxation training, progressive muscle relaxation, imagery training, meditation, applied relaxation, self‐control desensitization, stimulus control, worry exposure, and cognitive restructuring. Several studies have examined predictors of treatment outcome for GAD. Anxiety severity at baseline predicted higher severity post‐treatment as well as poorer follow‐up outcomes 10 to 14 years post‐treatment.
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Emotion regulation therapy (ERT) is an efficacious treatment for distress disorders (i.e., depression and anxiety), predicated on a conceptual model wherein difficult to treat distress arises from intense emotionality (e.g., neuroticism, dispositional negativity) and is prolonged by negative self-referentiality (e.g., worry, rumination). Individuals with distress disorders exhibit disruptions in two corresponding brain networks including the salience network (SN) reflecting emotion/motivation and the default mode network (DMN) reflecting self-referentiality. Using resting-state functional connectivity (rsFC) analyses, seeded with primary regions in each of these networks, we investigated whether ERT was associated with theoretically consistent changes across nodes of these networks and whether these changes related to improvements in clinical outcomes. This study examined 21 generalized anxiety disorder (GAD) patients [with and without major depressive disorder (MDD)] drawn from a larger intervention trial (Renna et al., 2018a), who completed resting state fMRI scans before and after receiving 16 sessions of ERT. We utilized seed-based connectivity analysis with seeds in the posterior cingulate cortex (PCC), right anterior insula, and right posterior insula, to investigate whether ERT was associated with changes in connectivity of nodes of the DMN and SN networks to regions across the brain. Findings revealed statistically significant treatment linked changes in both the DMN and SN network nodes, and these changes were associated with clinical improvement corresponding to medium effect sizes. The results are discussed in light of a nuanced understanding of the role of connectivity changes in GAD and MDD, and begin to provide neural network support for the hypothesized treatment model predicated by ERT.
Article
Emotion regulation dysfunction is characteristic of psychotic disorders, but little is known about how the use of specific types of emotion regulation strategies differs across phases of psychotic illness. This information is vital for understanding factors contributing to psychosis vulnerability states and developing targeted treatments. Three studies were conducted to examine emotion regulation across phases of psychosis, which included (a) adolescent community members with psychotic-like experiences (PLEs; n = 262) and adolescents without PLEs (n = 1,226); (b) adolescents who met clinical high-risk criteria for a prodromal syndrome (n = 29) and healthy controls (n = 29); and (c) outpatients diagnosed with schizophrenia or schizoaffective disorder (SZ; n = 61) and healthy controls (n = 67). In each study, participants completed the Emotion Regulation Questionnaire and measures of psychiatric symptoms and functional outcome. The three psychosis groups did not differ from each other in reported use of suppression; however, there was evidence for a vulnerability-related, dose-dependent decrease in reappraisal. Across each sample, a lower use of reappraisal was associated with poorer clinical outcomes. Findings indicate that emotion regulation abnormalities occur across a continuum of psychosis vulnerability and represent important targets for intervention.
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Worshiping celebrities is a complex and multidimensional issue that cognitive flexibility and emotional regulation are among the most important factors that can be effective in celebrity worship. This study aims to investigate the role of cognitive flexibility and emotional regulation problems in prediction of celebrity worship among university students. The statistical population of the study consisted of students of faculty of art and architecture of Guilan University in 1397, among which 280 female and male students were selected by convenience sampling method. Celebrity worship attitude scale (McCutcheon et al, 2002), Cognitive flexibility inventory (Dennis & Vander Wal, 2010) and difficulties in emotional regulation scale (Gratz & Roemer, 2004) were presented to the participants. Finally, data analysis was done by SPSS-24 software using multiple regression methods. According to the results, cognitive flexibility and difficulty in emotional regulation significantly predict celebrity worship (p<0/01). According to the findings of the research, applying programs and interventions to increase cognitive flexibility and the ability of emotional regulation can reduce celebrity worship that is associated with many physical and psychological disorders and negative social and cultural consequences.
Article
Introduction: Research indicates that individuals with generalized anxiety disorder (GAD) may experience deficits in positive affect (PA), and tend to dampen or intentionally suppress PA. Despite the presence of PA-related pathology in GAD, little is known about change in PA during GAD treatment. Objective: This study examines changes in PA, negative affect (NA) and worry in seven participants during cognitive behavioral therapy (CBT) for GAD. Method: Intensive repeated measures (i.e., time series) data were subjected to person-specific regression analysis to delineate individual change trajectories. Results: Significant improvement in worry was observed in all but one participant. Fear and irritability - indices of NA - each improved in 5/7 participants while sadness improved in 4/7 participants (worsening in one). Of all symptom domains, PA had the poorest treatment response: PA improved in only 2/7 participants and actually significantly worsened in 5/7 individuals even as NA and worry improved during therapy. Conclusion: These findings indicate that treatment gains from traditional CBT for GAD may not generalize to improvements in PA regulation, or even emotional functioning more broadly. This evidence is a call to increase the focus on PA regulation in treatment for GAD; perhaps PA could be a missing piece in our understanding of ways to bolster GAD treatment outcomes.
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This review summarizes the current meta-analysis literature on treatment outcomes of CBT for a wide range of psychiatric disorders. A search of the literature resulted in a total of 16 methodologically rigorous meta-analyses. Our review focuses on effect sizes that contrast outcomes for CBT with outcomes for various control groups for each disorder, which provides an overview of the effectiveness of cognitive therapy as quantified by meta-analysis. Large effect sizes were found for CBT for unipolar depression, generalized anxiety disorder, panic disorder with or without agoraphobia, social phobia, posttraumatic stress disorder, and childhood depressive and anxiety disorders. Effect sizes for CBT of marital distress, anger, childhood somatic disorders, and chronic pain were in the moderate range. CBT was somewhat superior to antidepressants in the treatment of adult depression. CBT was equally effective as behavior therapy in the treatment of adult depression and obsessive-compulsive disorder. Large uncontrolled effect sizes were found for bulimia nervosa and schizophrenia. The 16 meta-analyses we reviewed support the efficacy of CBT for many disorders. While limitations of the meta-analytic approach need to be considered in interpreting the results of this review, our findings are consistent with other review methodologies that also provide support for the efficacy CBT.
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This article outlines the early origins of Compassion Focused Therapy (CFT) from within the Cognitive Behavioral tradition (CBT). It will then focus on how our new understanding in the areas of affect regulation systems, and the importance of affiliative and kind relationships in regulating mental states, point to key processes that underpin mental health difficulties-as well as to possible mechanisms for therapy and change. CFT recognizes the huge debt to Eastern psychologies such as Buddhism that have articulated the importance of compassion for our personal and social well-being for thousands of years. However CFT was originally developed for, and with, people who suffer from high levels of shame and self-criticism and who find experiences of support, kindness, and compassion-both from themselves and from others-difficult or even frightening. The article will provide the conceptual background for the articles that follow which focus on the applications of CFT.
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Worry and rumination are cognitive processes, often represented as verbal or linguistic activities. Despite similarities in definition and description, worry has been most closely examined in relation to anxiety whereas rumination has traditionally been related to depression. This distinction remains in spite of high rates of comorbidity between anxiety and depression. This study sought to better understand the distinct and overlapping features of worry and rumination as well as their relationship to anxiety and depression. Seven hundred eighty-four unselected college students completed self-report measures of worry, rumination, anxiety, and depression. Items from the respective worry and rumination scales were submitted to factor analysis, which revealed a four-factor solution comprised of 2 worry factors and 2 rumination factors. A Worry Engagement factor as well as a Dwelling on the Negative factor emerged as distilled measures of worry and rumination, respectively. Scores on these factors were highly correlated with each other and demonstrated equally strong relationships to both anxiety and depression. Findings from this study suggest that worry and rumination represent related but distinct cognitive processes that are similarly related to anxiety and depression.
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review some of the empirically determined characteristics of worry / suggest theoretical perspectives that may account for the functions and origins of this ubiquitous process nature of worry [conceptual and imaginal cognitive activity, affective experience of worry, attentional activity and memory retrieval, behavioral responding, physiological activity] / functions of worry [cognitive avoidance of threat, inhibition of emotional processing] / origins of chronic worry and [generalized anxiety disorder] GAD [history of trauma, insecure attachment in childhood] (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Understanding generalized anxiety disorder (GAD) and developing interventions for its amelioration could contribute significantly to the understanding and treatment of all adult emotional disorders. GAD has a fairly high prevalence rate, is often associated with multiple additional Axis I diagnoses, and is a frequent comorbid condition for other anxiety and mood disorders. Moreover, worry is pervasive across all anxiety and depression problems. Learning about worry could teach us a considerable amount about human ways of being. We have been attempting to acquire basic knowledge about GAD and worry, and to develop effective forms of psychological intervention for over two decades. We have added several key components to traditional cognitive-behavioral therapy (CBT) approaches over the years, including teaching clients to focus on the present moment, to value tasks based on their intrinsic value rather than solely their eventual outcomes, and to deepen interpersonal and emotional contact with events. This chapter describes some of our specific interventions. We begin with general comments about the nature of human anxiety, which provide a context relevant to our development of GAD interventions. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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This review evaluates evidence of attentional biases in generalized anxiety disorder (GAD) and depressive disorder from studies using modified Stroop and visual probe tasks. There appears to be fairly consistent evidence for an attentional bias for external negative cues in GAD, and for the involvement of non-conscious processes in this bias. By contrast, in clinical depression, the evidence for an attentional bias is less robust, despite depressive disorder being commonly associated with high levels of co-morbid anxiety. Where an attentional bias has been found in depressed patients, it seems to occur mainly for self-relevant negative information which is presented under conditions that allow or encourage elaborative processing. Possible explanations for this discrepant pattern of results, and their theoretical and clinical implications are discussed.
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In this article we propose mechanisms that govern the processing of emotional information, particularly those involved in fear reduction. Emotions are viewed as represented by information structures in memory, and anxiety is thought to occur when an information structure that serves as program to escape or avoid danger is activated. Emotional processing is defined as the modification of memory structures that underlie emotions. It is argued that some form of exposure to feared situations is common to many psychotherapies for anxiety, and that confrontation with feared objects or situations is an effective treatment. Physiological activation and habituation within and across exposure sessions are cited as indicators of emotional processing, and variables that influence activation and habituation of fear responses are examined. These variables and the indicators are analyzed to yield an account of what information must be integrated for emotional processing of a fear structure. The elements of such a structure are viewed as cognitive representations of the stimulus characteristic of the fear situation, the individual's responses in it, and aspects of its meaning for the individual. Treatment failures are interpreted with respect to the interference of cognitive defenses, autonomic arousal, mood state, and erroneous ideation with reformation of targeted fear structures. Applications of the concepts advanced here to therapeutic practice and to the broader study of psychopathology are discussed.
Book
Since the original publication of this seminal work, acceptance and commitment therapy (ACT) has come into its own as a widely practiced approach to helping people change. This book provides the definitive statement of ACT—from conceptual and empirical foundations to clinical techniques—written by its originators. ACT is based on the idea that psychological rigidity is a root cause of a wide range of clinical problems. The authors describe effective, innovative ways to cultivate psychological flexibility by detecting and targeting six key processes: defusion, acceptance, attention to the present moment, self-awareness, values, and committed action. Sample therapeutic exercises and patient–therapist dialogues are integrated throughout. New to This Edition *Reflects tremendous advances in ACT clinical applications, theory building, and research. *Psychological flexibility is now the central organizing focus. *Expanded coverage of mindfulness, the therapeutic relationship, relational learning, and case formulation. *Restructured to be more clinician friendly and accessible; focuses on the moment-by-moment process of therapy.
Article
Several theories of the development of panic disorder (PD) with or without agoraphobia have emerged in the last 2 decades. Early theories that proposed a role for classical conditioning were criticized on several grounds. However, each criticism can be met and rejected when one considers current perspectives on conditioning and associative learning. The authors propose that PD develops because exposure to panic attacks causes the conditioning of anxiety (and sometimes panic) to exteroceptive and interoceptive cues. This process is reflected in a variety of cognitive and behavioral phenomena but fundamentally involves emotional learning that is best accounted for by conditioning principles. Anxiety, an anticipatory emotional state that functions to prepare the individual for the next panic, is different from panic, an emotional state designed to deal with a traumatic event that is already in progress. However, the presence of conditioned anxiety potentiates the next panic, which begins the individual's spiral into PD. Several biological and psychological factors create vulnerabilities by influencing the individual's susceptibility to conditioning. The relationship between the present view and other views is discussed.
Article
A truly integrative approach to treatment needs to combine methods of working with affect, cognition, and behavior, but established principles of affective change are sorely missing in the literature. Emotion theory and research suggests that emotion awareness, regulation, and transformation are 3 major principles of emotional change. In addition to these principles, 3 general factors that help guide integrative intervention in their use are discussed. Intervention should be guided by the source of the affect involved in the client's distress (amygdala- or prefrontal cortex-generated emotion), the type of affect dysregulation involved (too much or too little emotion), and the type of change process to be used (quick change to improve coping or longer change to restructure character).
Article
Cognitive-Behavioral Treatment for Generalized Anxiety Disorder: From Science to Practice provides a review of the empirical support for the different models of GAD. It includes a detailed description of the assessment and step-by-step treatment of GAD (including many examples of therapist-client dialogue), data on treatment efficacy in individual and group therapy, and concludes with a description of maintenance and follow-up strategies.
Article
Errors in Byline, Author Affiliations, and Acknowledgment. In the Original Article titled “Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication,” published in the June issue of the ARCHIVES (2005;62:617-627), an author’s name was inadvertently omitted from the byline on page 617. The byline should have appeared as follows: “Ronald C. Kessler, PhD; Wai Tat Chiu, AM; Olga Demler, MA, MS; Kathleen R. Merikangas, PhD; Ellen E. Walters, MS.” Also on that page, the affiliations paragraph should have appeared as follows: Department of Health Care Policy, Harvard Medical School, Boston, Mass (Drs Kessler, Chiu, Demler, and Walters); Section on Developmental Genetic Epidemiology, National Institute of Mental Health, Bethesda, Md (Dr Merikangas). On page 626, the acknowledgment paragraph should have appeared as follows: We thank Jerry Garcia, BA, Sara Belopavlovich, BA, Eric Bourke, BA, and Todd Strauss, MAT, for assistance with manuscript preparation and the staff of the WMH Data Collection and Data Analysis Coordination Centres for assistance with instrumentation, fieldwork, and consultation on the data analysis. We appreciate the helpful comments of William Eaton, PhD, Michael Von Korff, ScD, and Hans-Ulrich Wittchen, PhD, on earlier manuscripts. Online versions of this article on the Archives of General Psychiatry Web site were corrected on June 10, 2005.
Chapter
Across theoretical orientations, attempts to avoid and suppress difficult psychological content are presumed to interfere with psychological functioning and diminish well-being. Thus, a common theme in psychotherapy, which transcends theoretical orientation, is the promotion of acceptance. Recently, the use of mindfulness practices, and other experiential exercises aimed at increasing acceptance, to enhance existing cognitive and behavioral therapies has gained considerable attention. The goal of this chapter is to describe the theory underlying these efforts, provide a brief history of their development, describe the clinical strategies used with these approaches, and review the research that supports these efforts. We will also suggest future directions aimed at stimulating additional research literature and informing clinical practice.
Article
The present article describes the basic therapeutic techniques used in the cognitive-behavioral therapy (CBT) of generalized anxiety disorders and reviews the methodological characteristics and outcomes of 13 controlled clinical trials. The studies in general display rigorous methodology, and their outcomes are quite consistent. CBT has been shown to yield clinical improvements in both anxiety and depression that are superior to no treatment and nonspecific control conditions (and at times to either cognitive therapy alone or behavioral therapy alone) at both posttherapy and follow-up. CBT is also associated with low dropout rates, maintained long-term improvements, and the largest within-group and between-group effect sizes relative to all other comparison conditions.
Conference Paper
The authors sought to define the latent factors associated with childhood anxiety and depression, using a structural equations/confirmatory factor-analytic approach involving multiple informants (i.e., parent and child report) of symptoms. A sample of 216 children and adolescents with diagnoses of an anxiety disorder or comorbid anxiety and mood disorders and their parents were: administered measures of childhood fear, anxiety, and depression. Results of comparative modeling best supported 3-factor solutions (fear, anxiety, and depression) that were consistent with recent conceptual models of anxiety and depression (e.g., tripartite model). Results also suggested that 3 widely used measures of childhood negative emotion are conceptually heterogeneous (containing item sets that loaded on different latent factors). Implications for the assessment of childhood negative emotions are discussed.
Book
An ACT Approach Chapter 1. What is Acceptance and Commitment Therapy? Steven C. Hayes, Kirk D. Strosahl, Kara Bunting, Michael Twohig, and Kelly G. Wilson Chapter 2. An ACT Primer: Core Therapy Processes, Intervention Strategies, and Therapist Competencies. Kirk D. Strosahl, Steven C. Hayes, Kelly G. Wilson and Elizabeth V. Gifford Chapter 3. ACT Case Formulation. Steven C. Hayes, Kirk D. Strosahl, Jayson Luoma, Alethea A. Smith, and Kelly G. Wilson ACT with Behavior Problems Chapter 4. ACT with Affective Disorders. Robert D. Zettle Chapter 5. ACT with Anxiety Disorders. Susan M. Orsillo, Lizabeth Roemer, Jennifer Block-Lerner, Chad LeJeune, and James D. Herbert Chapter 6. ACT with Posttraumatic Stress Disorder. Alethea A. Smith and Victoria M. Follette Chapter 7. ACT for Substance Abuse and Dependence. Kelly G. Wilson and Michelle R. Byrd Chapter 8. ACT with the Seriously Mentally Ill. Patricia Bach Chapter 9. ACT with the Multi-Problem Patient. Kirk D. Strosahl ACT with Special Populations, Settings, and Methods Chapter 10. ACT with Children, Adolescents, and their Parents. Amy R. Murrell, Lisa W. Coyne, & Kelly G. Wilson Chapter 11. ACT for Stress. Frank Bond. Chapter 12. ACT in Medical Settings. Patricia Robinson, Jennifer Gregg, JoAnne Dahl, & Tobias Lundgren Chapter 13. ACT with Chronic Pain Patients. Patricia Robinson, Rikard K. Wicksell, Gunnar L. Olsson Chapter 14. ACT in Group Format. Robyn D. Walser and Jacqueline Pistorello
Article
In this article, the author describes a new theoretical perspective on positive emotions and situates this new perspective within the emerging field of positive psychology. The broaden-and-build theory posits that experiences of positive emotions broaden people's momentary thought-action repertoires, which in turn serves to build their enduring personal resources, ranging from physical and intellectual resources to social and psychological resources. Preliminary empirical evidence supporting the broaden-and-build theory is reviewed, and open empirical questions that remain to be tested are identified. The theory and findings suggest that the capacity to experience positive emotions may be a fundamental human strength central to the study of human flourishing.
Article
In this article, the author describes a new theoretical perspective on positive emotions and situates this new perspective within the emerging field of positive psychology. The broaden-and-build theory posits that experiences of positive emotions broaden people's momentary thought-action repertoires, which in turn serves to build their enduring personal resources, ranging from physical and intellectual resources to social and psychological resources. Preliminary empirical evidence supporting the broaden-and-build theory is reviewed, and open empirical questions that remain to be tested are identified. The theory and findings suggest that the capacity to experience positive emotions may be a fundamental human strength central to the study of human flourishing.
Article
Worry and depressive rumination have both been described as unproductive, repetitive thought which contributes to anxiety or depression, respectively. It was hypothesized that repetitive thought, rather than its specific forms, is a general concomitant of negative mood. Study 1 was a cross-sectional test of the hypothesis. Repetitive thought was positively correlated with anxiety and depression in students (n = 110). In patients (n = 40), repetitive thought was positively correlated with anxiety and depression, and rumination was also specifically correlated with depression. Study 2 was a prospective test of the hypothesis. In students (n = 90), there were significant cross-sectional relationships between repetitive thought and both anxiety and depression. In addition, repetitive thought at least partially predicted maintenance of anxious symptoms. Phenomena such as goal interruption, failures of emotional processing, and information processing may lead to repetitive thought which increases negative mood states, including both anxiety and depression.
Article
The present paper deals with the application of a cognitive-behavioral protocol targeting intolerance of uncertainty (CBT-IU) to a hypothetical clinical case of GAD. The rationale for the CBT-IU protocol is presented, as well as a description of its divergence from standard cognitive-behavioral interventions. The treatment components of (1) worry awareness training, (2) uncertainty recognition and exposure, (3) reevaluation of positive beliefs about the function of worry, (4) problem reorientation and training, (5) cognitive exposure, and (6) relapse prevention are described, with an emphasis on their application to the case conceptualization of “William” (Robichaud, this issue). Issues pertaining to the assessment of GAD and future research directions are also discussed.
Chapter
Generalized anxiety disorder and major depression (often termed “distress disorders”; see Watson, 2005) are commonly comorbid and appear to be characterized by temperamental features that reflect heightened sensitivity to underlying motivational systems related to threat/safety and reward/loss. Further, individuals with these disorders tend to perseverate (i.e., worry, ruminate) as a way to manage this motivationally relevant distress and often utilize these self-conscious processes to the detriment of engaging new contextual learning. Emotion Regulation Therapy integrates principles from traditional and contemporary cognitive behavioral treatments (e.g., skills training & exposure) with basic and translational findings from affect science to offer a blueprint for improving intervention by focusing on the motivational responses and corresponding regulatory characteristics of individuals with distress disorders. This emphasis on affect science permits identification of candidate mechanisms of treatment in terms of core disruptions of normative cognitive, emotional, and motivational systems, which in turn, helps generate more targeted solutions for clients to utilize adaptive ways to cope or compensate for these core deficits. In essence, contrasting a client’s difficulties with what we understand as normative functioning allows us to generate theory-driven hypotheses that form that basis of our case conceptualization and treatment planning. Outcome and mechanism data provide preliminary support for the use of ERT to treat distress disorders.
Chapter
Investigations of emotional processes such as sadness, elation, fear, and anxiety have historically been viewed as core components of numerous psychopathological conditions (Barlow, 2002; Kring & Werner, 2004). Despite their centrality in psychopathology, emotions have historically been a source of confusion and disagreement in clinical psychology, in part due to a lack of conceptual clarity in the definition of emotion, awareness of the purpose it serves, and an understanding of how psychopathology can be generated from absence, deficits, or excesses in efforts to regulate emotions (Greenberg, 2002; Samoilov & Goldfried, 2000). The affective science field (e.g., Davidson, Jackson, & Kalin, 2000) provides an opportunity to expand our paradigms regarding the role of emotion-related processes in conceptualizing and treating psychopathology. In this chapter, we review (1) a conceptualization of emotion regulation that stresses distinctions in generative and regulatory characteristics; (2) the application of an emotion dysregulation perspective to various forms of psychopathology; and (3) the utilization of an emotion regulation framework for integrating various emotion-related approaches to treatment.
Article
A detailed description of treatment utilizing the Unified Protocol (UP), a transdiagnostic emotion-focused cognitive-behavioral treatment, is presented using a clinical case example treated during the most current phase of an ongoing randomized controlled trial of the UP. The implementation of the UP in its current, modular version is illustrated. A working case conceptualization is presented from the perspective of the UP drawing from theory and research that underlies current transdiagnostic approaches to treatment and consistent with recent dimensional classification proposals (Brown & Barlow, in press). Treatment is illustrated module-by-module describing how the principles of the UP were applied in the presented case.
Chapter
96 Following a brief overview of the diagnostic criteria and epidemiology of major depressive disorder (MDD), we describe the current major empirically supported theories of depression and the therapies based on them. We begin the discussion of the assess-ment by describing diagnostic assessment tools. Next, we discuss using the general theories and therapies of depression described in the rst part of the chap-ter to create a conceptualization and treatment plan for a particular patient. We conclude with a review of assessment tools and strategies for monitoring the pro-cess and outcome of therapy, and a brief discussion of some future directions of assessment of depression. We focus this review on MDD, both because space is limited and because the empirical support for the tools we describe is strongest for MDD. However, many other mood disorders (including dysthymic disorder, adjustment disorder with depressed mood, schizoaf-fective disorder, bipolar disorder, and cyclothymic disorder) share features with MDD, and many of the assessment tools described below will be helpful in those cases. For a discussion of assessment issues related speci cally to bipolar disorder, the reader may consult Chapter 6 in this volume by Johnson, Miller, and Eisner. MDD is an episodic mood disorder characterized by depressed mood or anhedonia (loss of interest and pleasure in life) that has persisted for most of the day, nearly every day, for at least 2 weeks and is accom-panied by ve or more of the following symptoms: weight gain or signi cant weight loss not associated with dieting, decrease or increase in appetite, insom-nia or hypersomnia, psychomotor agitation or retar-dation (observable by others), fatigue or loss of energy, feelings of worthlessness, excessive or inappropriate guilt, diminished ability to think or concentrate, indecisiveness, or suicidality (American Psychiatric Association, 2000). The symptoms cause clinically signi cant distress or impairment in social, occupa-tional, or other important areas of functioning and are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
Article
In this article we outline the history, elements, and variations of functional accounts of emotions. Summarising diverse theories and observations, we propose that functional accounts of emotions: (1) address why humans have emotions; (2) de® ne emotions as solutions to problems and opportunities related to physical and social survival; (3) treat emotions as systems of interrelated components; and (4) focus on the bene® cial consequences of emotions. This conceptual approach to emotion is complemented by several empirical strategies, including the study of emotion dysfunction, the effects of emotions on others, and the relations between emotions and personal and social outcomes. We conclude by considering how functional accounts of emotion vary, including in terms of their level of analysis, speci® city, manner of organisation, and range of focus, and the implications functional accounts have for the study of emotion.
Article
In response to clinical observations and research findings that individuals with generalized anxiety disorder are reactive to their internal experiences, avoid and suppress painful emotions, thoughts, and sensations, and limit their involvement in meaningful activities, an Acceptance Based Behavioral Therapy (ABBT) was developed to specifically target these responses. ABBT incorporates acceptance and mindfulness strategies with more traditional behavior therapy techniques. Specifically, ABBT uses mindfulness and acceptance approaches as an alternate response to the rigid, avoidant responses characteristic of GAD. Likewise, therapy focuses on identifying and enacting behaviors that are congruent with what is personally meaningful to the client rather than engaging in actions that are motivated by avoidance of anxiety. This article provides a case conceptualization from an ABBT perspective for “William,” the composite client presented in Robichaud (this issue). The article goes on to demonstrate how an ABBT approach to treatment may unfold session-by-session for “William.”
Article
This book provides an updated theory of the nature of anxiety and the brain systems controlling anxiety, combined with a theory of hippocampal function, which was first proposed thirty years ago. While remaining controversial, the core of this theory, of a 'Behavioural Inhibition System', has stood the test of time, with its main predictions repeatedly confirmed. Novel anti-anxiety drugs share none of the side effects or primary pharmacological actions of the classical anti-anxiety drugs on the actions of which the theory was based; but they have both the behavioural and hippocampal actions predicted by the theory. This text is the second edition of the book and it departs significantly from the first. It provides, for the first time, a single construct - goal conflict - that underlies all the known inputs to the system; and it includes current data on the amygdala. Its reviews include the ethology of defence, learning theory, the psychopharmacology of anti-anxiety drugs, anxiety disorders, and the clinical and laboratory analysis of amnesia. The cognitive and behavioural functions in anxiety of the septo-hippocampal system and the amygdala are also analysed, as are their separate roles in memory and fear. Their functions are related to a hierarchy of additional structures - from the prefrontal cortex to the periaqueductal gray - that control the various forms of defensive behaviour and to detailed analysis of the monoamine systems that modulate this control. The resultant neurology is linked to the typology, symptoms, pre-disposing personality and therapy of anxiety and phobic disorders, and to the symptoms of amnesia. © Jeffrey A. Gray and Neil McNaughton 2000 , 2003. All rights reserved.
Article
The tendency to respond to negative life events and negative mood states with ruminative thinking has been linked to emotion dysregulation and to a heightened risk for the onset and maintenance of emotional disorders. To further investigate this maladaptive response style, the present study examined whether rumination is linked to individual differences in the ability to intentionally forget emotional material. In a directed forgetting task, participants were instructed to memorise a list of positive and negative words and were subsequently told to forget these words. Next, participants were told to memorise a new list and, finally, recall was tested for all to-be-forgotten and to-be-remembered words. Our results demonstrate a close relation between rumination and recall in the forget condition but not in the remember condition. Specifically, compared to participants who scored low on the Ruminative Responses Scale (RRS), participants who scored high exhibited reduced forgetting of positive and negative to-be-forgotten words. These results remained stable when depression scores were included as a covariate suggesting that irrespective of depressive symptoms, rumination and intentional forgetting of emotional material are closely related.
Article
In the present paper we present the outlines of a model that may help to guide us in our understanding of the relationship between perseverative thinking and health. We will emphasize the relationship between perseverative thinking and vagal cardiac control and propose a group of underlying neural structures that serve to integrate these functions in the service of self-regulation and adaptability of the organism. We will attempt to place this network in the context of systems models which involve feedback and feedforward circuits with special attention to negative feedback mechanisms and inhibitory processes. From a systems perspective, inhibitory processes can be viewed as negative feedback circuits that allow for the interruption of ongoing behavior and the re-deployment of resources to other tasks. When these negative feedback mechanisms are compromised, positive feedback loops may develop as a result of dis-inhibition. From this perspective, the relative sympathetic activation seen in perseverative thinking may represent dis-inhibition due to faulty inhibitory mechanisms.
Article
Individual differences in emotional reactivity or affective style can be decomposed into more elementary constituents. Several separable of affective style are identified such as the threshold for reactivity, peak amplitude of response, the rise time to peak and the recovery time. latter two characteristics constitute components of affective chronometry The circuitry that underlies two fundamental forms of motivation and and withdrawal-related processes-is described. Data on differences in functional activity in certain components of these are next reviewed, with an emphasis on the nomological network of surrounding individual differences in asymmetric prefrontal The relevance of such differences for understanding the nature affective dysfunction in affective disorders is then considered. The ends by considering what the prefrontal cortex “does” in certain of affective style and highlights some of the important questions for future research.
Article
Presents a behavioral analysis of depression which includes a discussion of avoidance, escape, and reinforcement parameters. The decreased frequency of many kinds of positively reinforced activity is seen as the common denominator among depressed persons. Basic behavioral processes which contribute to or reduce the frequency of a person's conduct are discussed, including changes in the environment, schedules of reinforcement, and suppressed anger. Implications of a behavioral analysis for research and verbal interaction with the therapist are discussed. It is concluded that behavioral and clinical concepts can be combined as a method of uncovering the actual events of psychopathology and therapy. (16 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
A truly integrative approach to treatment needs to combine methods of working with affect, cognition, and behavior, but established principles of affective change are sorely missing in the literature. Emotion theory and research suggests that emotion awareness, regulation, and transformation are 3 major principles of emotional change. In addition to these principles, 3 general factors that help guide integrative intervention in their use are discussed. Intervention should be guided by the source of the affect involved in the client's distress (amygdala- or prefrontal cortex-generated emotion), the type of affect dysregulation involved (too much or too little emotion), and the type of change process to be used (quick change to improve coping or longer change to restructure character). (PsycINFO Database Record (c) 2012 APA, all rights reserved)