Wenting Mu’s research while affiliated with Tsinghua University and other places

Objectives Different aspects of emotion dysregulation (ED) have been found to be broadly associated with various anxiety‐related disorders (ADs), but the mechanism underlying these transdiagnostic associations is largely unknown. There are at least two possible hypotheses. The generality hypothesis suggests that the associations are better explained by the link between a general ED factor and the general vulnerability factor derived from various ADs. The specificity hypothesis posits that specific ED facets make a unique contribution beyond the general ED factor. Methods In a treatment‐seeking sample of 351 patients with a primary diagnosis of an AD, we simultaneously examined both the general and facet‐specific effects of ED, as assessed by the Difficulties in Emotion Regulation Scale (DERS), on the general vulnerability factor underlying ADs over the course of treatment using a bifactor latent change modelling approach. Results Supporting the generality hypothesis, we found decreases in the general DERS factor were associated with symptoms reduction and improvement in life functioning. Except for emotional clarity, specific DERS factors had limited effects beyond the general factor. Conclusions Our findings suggested that the well‐documented broad associations between ED and various ADs are best explained by the relationship between the general ED factor, rather than specific facets, and the general vulnerability factor to ADs. Thus, assessing overall ED, rather than focusing on specific facets, may be more effective for screening individuals at risk for ADs and monitoring therapeutic progress in the treatment of ADs.

Background: Although risk markers for depressive disorders (DD) are dynamic, especially during adolescence, few studies have examined how change in risk levels during adolescence predict DD onset during transition to adulthood. We compared two competing hypotheses of the dynamic effects of risk. The risk escalation hypothesis posits that worsening of risk predicts DD onset beyond risk level. The chronic risk hypothesis posits that persistently elevated risk level, rather than risk change, predicts DD onset. Methods: Our sample included 393 girls (baseline age 13.5-15.5 years) from the adolescent development of emotions and personality traits project. Participants underwent five diagnostic interviews and assessments of risk markers for DD at 9-month intervals and were re-interviewed at a 6-year follow-up. We focused on 17 well-established risk markers. For each risk marker, we examined the prospective effects of risk level and change on first DD onset at wave six, estimated by growth curve modeling using data from the first five waves. Results: For 13 of the 17 depression risk markers, elevated levels of risk during adolescence, but not change in risk, predicted first DD onset during transition to adulthood, supporting the chronic risk hypothesis. Minimal evidence was found for the risk escalation hypothesis. Conclusions: Participants who had a first DD onset during transition to adulthood have exhibited elevated levels of risk throughout adolescence. Researchers and practitioners should administer multiple assessments and focus on persistently elevated levels of risk to identify individuals who are most likely to develop DD and to provide targeted DD prevention.

Obsessive-compulsive disorder (OCD) is associated with “emotional disconnections” (e.g., difficulty understanding your emotions), but very limited work has examined these links prospectively or in the context of OCD treatment. This study tested the hypotheses that emotional clarity and emotional awareness would predict improvement in OCD symptoms during Exposure and Response Prevention (ExRP) in a naturalistic treatment sample, based on the putative impact of these factors on emotional processing. We tested the effect of baseline levels of emotional clarity and awareness (measured using the Difficulties in Emotion Regulation Scale) on OCD symptoms at baseline, mid- and post-treatment (Obsessive-Compulsive Inventory, Revised) in a study of adults diagnosed with OCD and receiving ExRP in an open treatment clinic (N = 131) using multilevel modeling. Both lack of emotional clarity and lack of emotional awareness predicted OCD symptom severity at post-treatment. Lack of awareness also predicted greater improvement in OCD symptoms during treatment, while clarity did not. Consistent with previous research, individuals who reported being less clear about their emotions had more severe OCD symptoms at post-treatment. Extending previous findings, those who reported being more aware of their emotions before treatment showed less symptom improvement during treatment. Clinical and theoretical implications of these findings are discussed.

The Autism‐Spectrum Quotient (AQ) is a popular instrument used to assess the degree to which individuals exhibit features of autism spectrum conditions (ASC). The current study aimed to develop a theory‐driven factor structure of the AQ that would fit as well across samples as the 12 previously proposed factor structures, all of which, except for the original Baron‐Cohen model, had been developed on the basis of exploratory factor analysis (EFA) or principal component analysis. We first proposed a six‐factor solution: (1) social anhedonia; (2) interest in details/patterns; (3) imagination ability; (4) desire for predictability/routine; (5) social cognition; and (6) social discourse convention. We tested the six‐factor structure and made final item selections (27 items) with EFA using data from college students (n = 503). Then, we empirically tested alternative factor structure models in three other independent samples (ns = 503; 1263; 1641) using confirmatory factor analysis. Results indicated that our model fit as well, if not better, than all of the other models across samples, regardless of parameter estimation methods and software packages. Overall, the theory‐driven replicable six‐factor structure that we report holds the potential to be used to measure the six domains of features that we identified in the AQ. Lay Summary Questionnaire measures of autism spectrum conditions have typically been used to measure approximately four broad dimensions. Our study suggests that the Autism‐Spectrum Quotient can be used to measure six more narrowly defined dimensions: social anhedonia, interest in details/patterns, imagination ability, desire for predictability/routine, social cognition, and social discourse convention. Additional work is needed to develop measures of a much wider variety of autism spectrum features.

Anxiety disorders are associated with poorer physical activity and sleep. While associated with significant reductions in anxiety, it is not clear whether CBT for anxiety also improves physical health, sleep and physical activity. We evaluated changes in psychological and physical health outcomes using technology-based assessments in a naturalistic sample of adult patients receiving CBT for anxiety disorders (N = 40). Participants were provided with a wearable device (Fitbit) and ecological momentary assessments (EMA) throughout the duration of their CBT, or up to 20 weeks. We observed significant improvements in anxiety, depression, social isolation, and self-efficacy in emotion management. Self-reported sleep disorder symptoms, global physical health, or physical functioning and objectively measured sleep efficiency or physical activity (steps) did not significantly change. Steeper reductions in EMA-assessed anxiety were associated with steeper improvements in depression, social isolation, self-efficacy in emotion management, and physical function. These findings highlight the utility of EMA assessments during CBT in a naturalistic clinic. Whereas CBT for anxiety-related disorders is associated with significant improvements in affect, it may not be associated with improvements in sleep or physical activity. CBT for anxiety may require augmentation for patients who have goals of improving sleep, physical health, or physical activity.

Background Risk factors for depressive disorders (DD) change substantially over time, but the prognostic value of these changes remains unclear. Two basic types of dynamic effects are possible. The ‘Risk Escalation hypothesis’ posits that worsening of risk levels predicts DD onset above average level of risk factors. Alternatively, the ‘Chronic Risk hypothesis’ posits that the average level rather than change predicts first-onset DD. Methods We utilized data from the ADEPT project, a cohort of 496 girls (baseline age 13.5–15.5 years) from the community followed for 3 years. Participants underwent five waves of assessments for risk factors and diagnostic interviews for DD. For illustration purposes, we selected 16 well-established dynamic risk factors for adolescent depression, such as depressive and anxiety symptoms, personality traits, clinical traits, and social risk factors. We conducted Cox regression analyses with time-varying covariates to predict first DD onset. Results Consistently elevated risk factors (i.e. the mean of multiple waves), but not recent escalation, predicted first-onset DD, consistent with the Chronic Risk hypothesis. This hypothesis was supported across all 16 risk factors. Conclusions Across a range of risk factors, girls who had first-onset DD generally did not experience a sharp increase in risk level shortly before the onset of disorder; rather, for years before onset, they exhibited elevated levels of risk. Our findings suggest that chronicity of risk should be a particular focus in screening high-risk populations to prevent the onset of DDs. In particular, regular monitoring of risk factors in school settings is highly informative.

Prior work has shown a number of similarities between obsessive-compulsive disorder (OCD) and eating disorders such as perfectionism and depressive symptoms. However, distress and impairment due to eating pathology are also highly comorbid with other disorders, which brings into question whether the relationship with eating pathology is unique to OCD. The aims of the current study were 1) to test perfectionism and depression as mediators of the relationship between OCD and eating pathology, and 2) to determine whether OCD is related to greater distress/impairment regarding eating habits, exercising, or feelings about eating, shape, or weight above and beyond other disorders. Symptoms were assessed in 329 treatment-seeking patients in a secondary analysis of a clinical battery. The results showed that depressive symptoms and perfectionism were found to mediate the relationship between OCD and eating pathology. Additionally, a regression analysis showed that OCD, social anxiety disorder, and panic disorder symptoms were associated with eating pathology to a greater extent than other disorders. These results suggest that distress and impairment related to eating habits, exercising, or feelings about eating, shape, or weight are not unique to OCD and that depression and perfectionism may, in part, explain the association between OCD and eating pathology.

Body image is a multidimensional construct that reflects the way we perceive and feel about our physical appearance. This inside view of our body heavily influences our self-esteem, mental health, and overall well-being. Under the influence of mass media, peers and family, individuals, especially women, may feel pressured to conform to the societal standards of beauty, engage in upward social comparison, and consequently experience negative body image. While our sociocultural surroundings plays a role in the internalization process, other intrapersonal factors, such as appearance-based rejection sensitivity and lack of self-concept clarity, may heighten the risk for some individuals. Body image disturbances can be manifested in forms of avoidance behaviors, monitoring, eating restraints, and body modification. In order to promote body acceptance, we ought to gain insights into the formation of our body image and challenge the commonly held belief on who defines beauty.