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Objectives Lifetime DSM‐5 diagnoses generated by the lay‐administered Composite International Diagnostic Interview for DSM‐5 (CIDI) in the World Mental Health Qatar (WMHQ) study were compared to diagnoses based on blinded clinician‐administered reappraisal interviews. Methods Telephone follow‐up interviews used the non‐patient edition of the Structured Clinician Interview for DSM‐5 (SCID) oversampling respondents who screened positive for five diagnoses in the CIDI: major depressive episode, mania/hypomania, panic disorder, generalized anxiety disorder, and obsessive‐compulsive disorder. Concordance was also examined for a diagnoses of post‐traumatic stress disorder based on a short‐form versus full version of the PTSD Checklist for DSM‐5 (PCL‐5). Results Initial CIDI prevalence estimates differed significantly from the SCID for most diagnoses (χ12${\\chi }_{1}^{2}$  = 6.6–31.4, p = 0.010 < 0.001), but recalibration reduced most of these differences and led to consistent increases in individual‐level concordance (AU‐ROC) from 0.53–0.76 to 0.67–0.81. Recalibration of the short‐form PCL‐5 removed an initially significant difference in PTSD prevalence with the full PCL‐5 (from χ12${\\chi }_{1}^{2}$  = 610.5, p < 0.001 to χ12${\\chi }_{1}^{2}$  = 2.5, p = 0.110) while also increasing AU‐ROC from 0.76 to 0.81. Conclusions Recalibration resulted in valid diagnoses of common mental disorders in the Qatar National Mental Health Survey, but with inflated prevalence estimates for some disorders that need to be considered when interpreting results.

BackgroundBeliefs about the usefulness and controllability of emotions are associated with emotion regulation and psychological distress in the general population. Although individuals with schizophrenia-spectrum disorders evidence emotion regulation abnormalities, it is unclear whether emotional beliefs contribute to these difficulties and their associated poor clinical outcomes.MethodsParticipants included 72 individuals with schizophrenia-spectrum diagnoses (outpatients with schizophrenia n = 38; youth at clinical high-risk for psychosis, n = 34) and healthy controls (CN: n = 61) who completed the Emotional Beliefs Questionnaire, Emotion Regulation Questionnaire, and measures of clinical symptom severity.ResultsThose with schizophrenia-spectrum diagnoses reported believing that emotions were less controllable than CN; however, groups did not differ regarding beliefs about the usefulness of emotion. Greater beliefs of the uncontrollability of emotion were associated with greater use of suppression, less use of reappraisal, and increased negative symptoms. Emotion regulation partially mediated the association between emotional beliefs and negative symptoms.ConclusionsIndividuals in the schizophrenia-spectrum display superordinate beliefs that emotions are uncontrollable. These beliefs may influence emotion regulation strategy selection and success, which contributes to negative symptoms. Findings suggest that beliefs of emotional uncontrollability reflect a novel process related to both emotion regulation and negative symptoms that could be targeted in psychosocial treatments.

Many psychological disorders are characterized by difficulties in emotion regulation. It is unclear, however, whether different disorders are associated with the use of specific emotion regulation strategies, and whether these difficulties are stable characteristics that are evident even after recovery. It is also unclear whether the use of specific strategies is problematic across all disorders or whether disorders differ in how strongly strategy use is associated with symptom severity. This study investigated (1) the specificity of use of emotion regulation strategies in individuals diagnosed with current major depressive disorder (MDD), with social anxiety disorder (SAD), and in never-disordered controls (CTL); and (2) the stability of strategy use in formerly depressed participants (i.e., remitted; RMD). Path analysis was conducted to examine the relation between strategy use and symptom severity across diagnostic groups. Compared to the CTL group, participants in both clinical groups endorsed more frequent use of rumination and expressive suppression, and less frequent use of reappraisal. Specific to SAD were even higher levels of expressive suppression relative to MDD, as well as a stronger relation between rumination and anxiety levels. In contrast, specific to MDD were even higher levels of rumination and lower levels of reappraisal. Interestingly, elevated rumination, but not decreased reappraisal, was found to be a stable feature characterizing remitted depressed individuals. These results may provide insight into ways in which emotion regulation strategy use maintains psychological disorders.

Abstract Background Emotion dysregulation is crucial to both poor social functioning and psychotic symptom formation in patients with schizophrenia. The efficient use of emotion regulation strategies, such as cognitive reappraisal, has been less frequently observed in the early phases of psychotic disorder. It is unknown whether neurophysiological responses related to emotion regulation by cognitive reappraisal are altered in early psychosis. Methods Fifty-four patients with first-episode psychosis (FEP), 34 subjects at clinical high risk (CHR) for psychosis, and 30 healthy controls (HCs) participated in event-related potential recordings during a validated emotion regulation paradigm to measure the effect of cognitive reappraisal on emotion regulation. Late positive potentials (LPPs), which reflect emotional arousal, were compared across the groups and the 3 conditions (negative, cognitive reappraisal, and neutral). The relationship among LPP modulation by cognitive reappraisal and social/role functioning and severity of psychotic symptoms was investigated in the early psychosis group. Results The FEP and CHR participants showed comparably larger LPP amplitudes in the negative and cognitive reappraisal conditions than in the neutral condition, whereas the HCs presented larger LPPs in the negative condition than in the cognitive reappraisal and neutral conditions. LPP modulation by cognitive reappraisal was negatively correlated with positive symptom severity in the FEP patients and with disorganization severity in the CHR subjects. Conclusions Inefficient use of cognitive reappraisal may be related to the impaired emotion regulation and psychotic symptoms from the very beginning of psychotic disorder. This study provides the first neurophysiological evidence regarding current concepts of emotion regulation in early psychosis.

PurposeRecent literature highlights that no emotion regulation strategy is universally helpful or harmful. The present study aimed to build understanding of for whom and what cognitive reappraisal is helpful, by testing the influential hypothesis that reappraisal is most helpful when there is good individual or situational capacity to apply this strategy effectively.MethodsThe present study tested how eight variables theorised to be associated with the effectiveness of reappraisal moderated the link between reappraisal use and changes in depression, anxiety, loneliness, functional impairment, and wellbeing in a nationally representative sample, over three (n = 752) and twelve month (n = 512) periods.ResultsContrary to our hypothesis, we found reappraisal was most beneficial for individuals or in situations characterised by additional vulnerabilities (e.g., average or high levels of stress, neuroticism, difficulty identifying feelings, or poor self-efficacy). Results also support prior evidence that reappraisal can be more helpful for improving wellbeing than reducing mental health symptoms.ConclusionsAltogether, our findings provide new insight into the complex nature of relationships between reappraisal and psychological outcomes. A key clinical implication is that reappraisal may be particularly helpful for people with stable vulnerabilities (e.g., neuroticism).

The mindful reappraisal hypothesis of the Mindfulness - to - Meaning Theory (Garland et al. in Psychol Inquiry 26(4):293–314, 2015a ; Psychol Inquiry 26(4):377–387, 2015b ) proposes that mindfulness generates eudaimonic well-being by promoting positive reappraisal, the positive psychological process through which stressful events are re-construed as benign, meaningful, or growth-promoting. To test this hypothesis, we examined prospective relations between state mindfulness and positive reappraisal in a community sample participating in a mindfulness-based intervention (MBI). At seven weekly time points throughout the MBI, participants (N = 234) engaged in a 10-min mindfulness meditation exercise at home and completed a measure of the degree of state mindfulness experienced during the meditation, as well as a measure of their use of positive reappraisal over the previous week. Support for the mindful reappraisal hypothesis of the Mindfulness - to - Meaning Theory was found: in latent growth curve and multivariate autoregressive latent trajectory models, increases in the trajectory of state mindfulness experienced during meditation were significantly and robustly associated with more frequent use of positive reappraisal over the course of participation in the 8 week-long MBI. Thus, mindfulness and reappraisal may reciprocally enhance one another as interdependent components of a positive feedback loop whose structure might be best described as an upward spiral.

Although deficits in affective processing are a core component of anorexia nervosa (AN), we lack a detailed characterization of the neurobiological underpinnings of emotion regulation impairment in AN. Moreover, it remains unclear whether these neural correlates scale with clinical outcomes. We investigated the neural correlates of negative emotion regulation in a sample of young women receiving day-hospital treatment for AN (n = 21) and healthy controls (n = 21). We aimed to determine whether aberrant brain activation patterns during emotion regulation predicted weight gain following treatment in AN patients and were linked to AN severity. To achieve this, participants completed a cognitive reappraisal paradigm during functional magnetic resonance imaging. Skin conductance response, as well as subjective distress ratings, were recorded to corroborate task engagement. Compared to controls, patients with AN showed reduced activation in the dorsolateral prefrontal cortex (dlPFC) during cognitive reappraisal [pFWE<0.05, threshold-free cluster enhancement (TFCE) corrected]. Importantly, psycho-physiological interaction analysis revealed reduced functional connectivity between the dlPFC and the amygdala in AN patients during emotion regulation (pFWE<0.05, TFCE corrected), and dlPFC-amygdala uncoupling was associated with emotion regulation deficits (r = -0.511, p = 0.018) and eating disorder severity (r = -0.565, p = .008) in the AN group. Finally, dlPFC activity positively correlated with increases in body mass index (r = 0.471, p = 0.042) and in body fat mass percentage (r = 0.605, p = 0.008) following 12 weeks of treatment. Taken together, our findings indicate that individuals with AN present altered fronto-amygdalar response during cognitive reappraisal and that this response may serve as a predictor of response to treatment and be linked to clinical severity.

Background Adult emotion regulation is not only occurring within the person but includes strategies that happen in social interactions and that are framed as co-regulating. The current study investigates the role of the interpersonal emotion regulation strategies of co-reappraisal and co-brooding in couples for adjustment disorder symptoms as the disorder will be outlined in the International Classification of Diseases-11 (ICD-11). Methods Couples registered together in an online questionnaire study reporting whether or not they are adjusting to a major stressor that is psychologically challenging to them. In total, one hundred and forty-six participants ( N  = 73 male; N  = 73 female) reported having experienced a major stressor in the last 12 months and were thus be identified as at risk for adjustment disorder. Those individuals at risk were assessed for adjustment disorder and depressive symptoms; intra- and interpersonal emotion regulation (co-/brooding, co-/reappraisal) were assessed not only in the individual at risk but also in the romantic partner. Results Regression-based dyadic analyses revealed that above and beyond intrapersonal emotion regulation, interpersonal co-brooding and for the female participants also co-reappraisal were significantly associated with symptoms of adjustment disorder and depression, standardized betas varied between .24 and .36, suggesting medium effect sizes. An association with the female partner’s tendency to reappraise with fewer symptoms in the male partner at risk for adjustment disorder could also be observed. Conclusions Co-brooding and co-reappraisal represent emotion regulation strategies that happen in social interaction and seem to play a relevant role in the context of adjustment disorders above and beyond the commonly assessed intrapersonal emotion regulation strategies.

A growing body of research has revealed that labeling an emotion, or putting one's feelings into words, can help to downregulate that affect, as occurs with intentional forms of emotion regulation, such as reappraisal and distraction. We translated this basic research to a real-world clinical context, in which spider-fearful individuals were repeatedly exposed to a live spider. Using a between-subjects design, we compared the effects of affect labeling, reappraisal, distraction from the feared stimulus, and exposure alone during this brief course of exposure therapy on subsequent fear responding. At a 1-week posttest involving a different spider in another context, the affect-labeling group exhibited reduced skin conductance response relative to the other groups and marginally greater approach behavior than the distraction group; however, the affect-labeling group did not differ from the other groups in self-reported fear. Additionally, greater use of anxiety and fear words during exposure was associated with greater reductions in fear responding. Thus, perhaps surprisingly, affect labeling may help to regulate aspects of emotion in a clinical context.

BackgroundLoneliness, a transdiagnostic feature of psychopathology, is an experience of perceived isolation only weakly linked to the amount of time spent alone. Although traditional loneliness interventions aim to increase social contact, targeting maladaptive cognition about time alone may be an effective way to reduce loneliness. We investigated whether a brief reappraisal manipulation enables individuals to experience their time alone more positively. We also tested the impact of trait loneliness, compulsive social media use, and trait reappraisal on experiences of time alone.MethodsCollege students and community members (N = 220) were randomly assigned to read a passage about the benefits of solitude (n = 74), the true prevalence of loneliness (n = 72), or a control topic (n = 74). Participants then sat alone for 10 min.ResultsAcross conditions, positive and negative mood significantly decreased after sitting alone. Participants who read about the benefits of solitude experienced a smaller reduction in positive mood than those in the control condition. Participants who less frequently used reappraisal in their everyday lives benefited most from the manipulation.ConclusionsOur results provide preliminary evidence that reappraising time alone as solitude may boost resilience to the decrements in positive mood associated with time alone. Limitations, clinical implications, and directions for future research are discussed.