Cognitive Behavioural Therapy for Mild-to-Moderate Transdiagnostic Emotional Dysregulation

Original Paper
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Abstract

Recent research has found that emotional dysregulation is a transdiagnostic feature across a range of common mental health difficulties and within the general population. However, existing treatment for emotional dysregulation is typically long-term, intensive or focused on personality constructs. The aims of this paper are to (1) present a transdiagnostic cognitive model of emotional dysregulation (2) present a short-term cognitive behavioural therapy intervention for mild-to-moderate presentations of emotional dysregulation.

Keywords

Cognitive therapy Cognitive behavioural therapy Emotional dysregulation Depression Anxiety Continuum 

Notes

Acknowledgements

The authors wish to acknowledge Miriam Fehily for her contribution to this paper.

References

  1. Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30(2), 217–237.CrossRefPubMedGoogle Scholar
  2. American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th Ed.). Arlington, VA: American Psychiatric Publishing.CrossRefGoogle Scholar
  3. Barlow, D. H., Allen, L. B., & Choate, M. L. (2004). Towards a unified treatment for emotional disorders. Behaviour Therapy, 35, 205–230.CrossRefGoogle Scholar
  4. Barrett, L. F. (2013). Psychological construction: The Darwinian approach to the science of emotion. Emotion Review, 5(4), 379–389.CrossRefGoogle Scholar
  5. Bateman, A., & Fonagy, P. (2013). Mentalization-based treatment. Psychoanalytic Inquiry, 33(6), 595–613.CrossRefPubMedPubMedCentralGoogle Scholar
  6. Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford Press.Google Scholar
  7. Bosmans, G., Braet, C., & Van Vlierberghe, L. (2010). Attachment and symptoms of psychopathology: Early maladaptive schemas as a cognitive link? Clinical Psychological Psychotherapy, 17, 374–385.CrossRefGoogle Scholar
  8. Brenning, K. M., & Braet, C. (2013). The emotion regulation model of attachment: An emotion-specific approach. Personal Relationships, 20, 107–123.CrossRefGoogle Scholar
  9. Brenning, K. M., Soenens, B., Braet, C., & Bosmans, G. (2012). Attachment and depressive symptoms in middle childhood and early adolescence: Testing the validity of the emotion regulation model of attachment. Personal Relationships, 19, 445–464.CrossRefGoogle Scholar
  10. Brumariu, L. E. (2015). Parent–child attachment and emotion regulation. New Directions for Child and Adolescent Development, 148(148), 31–45.CrossRefGoogle Scholar
  11. Burr, L. A., Javiad, M., Jell, G., Werner-Seidler, A., & Dunn, B. D. (2017). Turning lemonade into lemons: Dampening appraisals reduce positive affect and increase negative affect during positive activity scheduling. Behaviour Research and Therapy, 91, 91–101.CrossRefPubMedGoogle Scholar
  12. Carpenter, R. W., & Trull, T. J. (2013). Components of emotion dysregulation in borderline personality disorder: A review. Current Psychiatry Reports, 15(1), 335.CrossRefPubMedPubMedCentralGoogle Scholar
  13. Clark, D. M. (1989). Anxiety states: Panic and generalized anxiety. In K. Hawton, P. M. Salkovskis, J. Kirk & D. M. Clark (Eds.), Cognitive behaviour therapy for psychiatric problems: A practical guide (pp. 52–96). Oxford: Oxford University Press.Google Scholar
  14. Cuthbert, B. N., & Insel, T. R. (2013). Toward the future of psychiatric diagnosis: The seven pillars of RDoC. BMC Medicine, 11(1), 126.CrossRefPubMedPubMedCentralGoogle Scholar
  15. Distel, M. A., Trull, T. J., & Willemsen, G. (2009). The five-factor model of personality and borderline personality disorder: A genetic analysis of comorbidity. Biological Psychiatry:, 66, 1131–1138.CrossRefGoogle Scholar
  16. Distel, M. A., Willemsen, G., & Ligthart, L. (2007). Genetic and environmental influences on the covariance between the four core factors of borderline personality disorder. Behavioural Genetics, 37, 734–809.CrossRefGoogle Scholar
  17. Dvorak, R. D., Sargent, E. M., Kilwein, T. M., Stevenson, B. L., Kuvaas, N. J., & Williams, T. J. (2014). Alcohol use and alcohol-related consequences: Associations with emotion regulation difficulties. The American Journal of Drug and Alcohol Abuse, 40(2), 125–130.CrossRefPubMedGoogle Scholar
  18. Ehring, T., Tuschen-Caffier, B., Schnülle, J., Fischer, S., & Gross, J. J. (2010). Emotion regulation and vulnerability to depression: Spontaneous versus instructed use of emotion suppression and reappraisal. Emotion, 10(4), 563–572.CrossRefPubMedGoogle Scholar
  19. Fassbinder, E., Schweiger, U., Martius, D., Brand-de Wilde, O., & Arntz, A. (2016). Emotion regulation in schema therapy and dialectical behavior therapy. Frontiers in psychology, 7, 1373.PubMedPubMedCentralGoogle Scholar
  20. Fresco, D. M., Mennin, D. S., Heimberg, R. G., & Ritter, M. (2013). Emotion regulation therapy for generalized anxiety disorder. Cognitive and Behavioral Practice, 20(3), 282–300.CrossRefPubMedPubMedCentralGoogle Scholar
  21. Gross, J. J. (2013). Emotion regulation: Taking stock and moving forward. Emotion, 13(3), 359.CrossRefPubMedGoogle Scholar
  22. Gross, J. J. (2015a). Emotion regulation: Current status and future prospects. Psychological Inquiry, 26(1), 1–26.CrossRefGoogle Scholar
  23. Gross, J. J. (2015b). The extended process model of emotion regulation: Elaborations, applications, and future directions. Psychological Inquiry, 26(1), 130–137.CrossRefGoogle Scholar
  24. Harrison, A., Sullivan, S., Tchanturia, K., & Treasure, J. (2009). Emotion recognition and regulation in anorexia nervosa. Clinical Psychology and Psychotherapy, 16, 348–356.CrossRefPubMedGoogle Scholar
  25. Huprich, S. K., Nelson, S. M., Paggeot, A., Lengu, K., & Albright, J. (2017). Object relations predicts borderline personality disorder symptoms beyond emotional dysregulation, negative affect and impulsivity. Personality Disorder, 8(1), 46–53.CrossRefGoogle Scholar
  26. Kendler, K. S., Myers, J., & Reichborn-Kjennerud, T. (2011). Borderline personality disorder traits and their relationship with dimensions of normative personality: A web-based cohort and twin study. Acta Psychiatrica Scandinavica, 123(5), 349–359.CrossRefPubMedGoogle Scholar
  27. Koenigsberg, H. W. (2010). Affective instability: Toward an integration of neuroscience and psychological perspectives. Journal of Personality Disorders, 24(1), 60–82.CrossRefPubMedGoogle Scholar
  28. Krueger, R. F., & Tackett, J. L. (2005). Progress and innovation: Personality disorders and the vanguard of psychopathology research. Journal of Personality Disorders, 19(5), 540–546.CrossRefPubMedGoogle Scholar
  29. Leahy, R. L., Tirch, D., & Napolitano, L. A. (2011). Emotion regulation in psychotherapy: A practitioner’s guide. New York, NY: Guilford Press.Google Scholar
  30. Lenzenweger, M. F., Lane, M. C., Loranger, A. W., & Kessler, R. C. (2007). DSM-IV personality disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 62, 553–564.CrossRefPubMedPubMedCentralGoogle Scholar
  31. Linehan, M. M. (1993). Cognitive-behavioral treatment for borderline personality disorder. New York: Guilford.Google Scholar
  32. Liu, D. Y., & Thompson, R. J. (2017). Selection and implementation of emotion regulation strategies in major depressive disorder: An integrative review. Clinical Psychology Review, 57, 183–194.CrossRefPubMedGoogle Scholar
  33. Livesley, W. J. (2007). A framework for integrating dimensional and categorical classifications of personality disorder. Journal of personality disorders, 21(2), 199.CrossRefPubMedGoogle Scholar
  34. Malik, S., Wells, A., & Wittkowski, A. (2015). Emotion regulation as a mediator in the relationship between attachment and depressive symptomatology: A systematic review. Journal of Affective Disorders, 172, 428–444.CrossRefPubMedGoogle Scholar
  35. Marganska, A., Gallagher, M., & Miranda, R. (2013). Adult attachment, emotion dysregulation, and symptoms of depression and generalized anxiety disorder. American Journal of Orthopsychiatry, 83(1), 131.CrossRefPubMedGoogle Scholar
  36. Marwaha, S., Parsons, N., Flanagan, S., & Broome, M. (2013). The prevalence and clinical associations of mood instability in adults living in England: Results from the Adult Psychiatric Morbidity Survey 2007. Psychiatry Research, 205(3), 262–268.CrossRefPubMedGoogle Scholar
  37. Mennin, D. S., Ellard, K. K., Fresco, D. M., & Gross, J. J. (2013). United we stand: Emphasizing commonalities across cognitive-behavioral therapies. Behavior Therapy, 44, 234–248.CrossRefPubMedPubMedCentralGoogle Scholar
  38. Mennin, D. S., Fresco, D. M., Ritter, M., & Heimberg, R. G. (2015). An open trial of emotion regulation therapy for generalized anxiety disorder and cooccurring depression. Depression and Anxiety, 32(8), 614–623.CrossRefPubMedPubMedCentralGoogle Scholar
  39. Mennin, D. S., McLaughlin, K. A., & Flanagan, T. J. (2009). Emotion regulation deficits in generalized anxiety disorder, social anxiety disorder, and their co-occurrence. Journal of Anxiety Disorders, 23(7), 866–871.  https://doi.org/10.1016/j.janxdis.2009.04.006.CrossRefGoogle Scholar
  40. Meyer, S., Raikes, H. A., Virmani, E. A., Waters, S., & Thompson, R. A. (2014). Parent emotion representations and the socialization of emotion regulation in the family. International Journal of Behavioral Development, 38(2), 164–173.CrossRefGoogle Scholar
  41. Mikulincer, M., & Shaver, P. R. (2012). Attachment perspective on psychopathology. World Psychiatry, 11, 11–15.CrossRefPubMedPubMedCentralGoogle Scholar
  42. Mikulincer, M., Shaver, P. R., & Pereg, D. (2003). Attachment theory and affect regulation: The dynamics, development and cognitive consequences of attachment—related strategies. Motivation and Emotion, 27(2), 77–102.CrossRefGoogle Scholar
  43. Moyal, N., Henik, A., & Anholt, G. E. (2013). Cognitive strategies to regulate emotions—current evidence and future directions. Frontiers in Psychology, 4, 1019.Google Scholar
  44. Oatley, K., Keltner, D., & Jenkins, J. M. (2006). Understanding emotions (2nd edn.). Malden: Blackwell Publishing.Google Scholar
  45. Raju, R., Corrigan, F., Davidson, A., & Johnson, D. (2012). Assessing and managing mild to moderate emotion dysregulation. Advances in Psychiatric Treatment, 18(2), 82–93.CrossRefGoogle Scholar
  46. Roemer, L., Lee, J. K., Salters-Pedneault, K., Erisman, S. M., Orsillo, S. M., & Mennin, D. S. (2009). Mindfulness and emotion regulation difficulties in generalized anxiety disorder: Preliminary evidence for independent and overlapping contributions. Behavior Therapy, 40(2), 142–154.CrossRefPubMedGoogle Scholar
  47. Ruscitti, C., Rufino, K., Goodwin, N., & Wagner, R. (2016). Difficulties in emotion regulation in patients with eating disorders. Borderline Personality Disorder and Emotion Dysregulation, 3, 3.CrossRefPubMedPubMedCentralGoogle Scholar
  48. Sakakibara, R., & Endo, T. (2016). Cognitive appraisal as a predictor of cognitive emotion regulation choice. Japanese Psychological Research, 58(2), 175–185.CrossRefGoogle Scholar
  49. Scott, L. N., Kim, Y., Nolf, K. A., Hallquist, M. N., Wright, A. G., Stepp, S. D., Morse, J. Q., & Pilkonis, P. A. (2013). Preoccupied attachment and emotional dysregulation: Specific aspects of borderline personality disorder or general dimensions of personality pathology? Journal of Personality Disorders, 27(4), 473–495.CrossRefPubMedPubMedCentralGoogle Scholar
  50. Selby, E. A., & Joiner, T. E. Jr. (2009). Cascades of emotion: The emergence of borderline personality disorder from emotional and behavioral dysregulation. Review of General Psychology, 13(3), 219–229.CrossRefPubMedPubMedCentralGoogle Scholar
  51. Shaw, P., Stringaris, A., Nigg, J., & Leibenluft, E. (2014). Emotion dysregulation in attention deficit hyperactivity disorder. American Journal of Psychiatry, 171(3), 276–293.CrossRefPubMedPubMedCentralGoogle Scholar
  52. Sloan, E., Hall, K., Moulding, R., Bryce, S., Mildred, H., & Staiger, P. K. (2017). Emotion regulation as a transdiagnostic treatment construct across anxiety, depression, substance, eating and borderline personality disorders: A systematic review. Clinical Psychology Review.  https://doi.org/10.1016/j.cpr.2017.09.002 PubMedGoogle Scholar
  53. Teasdale, J. D., Segal, Z. V., Williams, J. M. G., Ridgeway, V. A., Soulsby, J. M., & Lau, M. A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 68(4), 615.CrossRefPubMedGoogle Scholar
  54. Van Dijke, A., & Ford, J. D. (2015). Adult attachment and emotion dysregulation in borderline personality and somatoform disorders. Borderline Personality Disorder and Emotion Dysregulation, 2, 6.CrossRefPubMedPubMedCentralGoogle Scholar
  55. Webb, T. L., Miles, E., & Sheeran, P. (2012). Dealing with feelings: A meta-analysis of the effectiveness of strategies derived from the process model of emotional regulation. Psychological Bulletin, 138(4), 775–808.CrossRefPubMedGoogle Scholar
  56. Wells, A. (1995). Meta-cognition and worry: A cognitive model of generalized anxiety disorder. Behavioural and Cognitive Psychotherapy, 23(3), 301–320.CrossRefGoogle Scholar
  57. Wells, A., & Clark, D. M. (1997). Social phobia: A cognitive approach. In G. C. L. Davey (Ed.), Phobias: A handbook of description, treatment and theory (pp. 3–26). Chichester: Wiley.Google Scholar
  58. Winsper, C. (2017). The aetiology of borderline personality disorder (BPD): Contemporary theories and putative mechanisms. Current Opinion in Psychology.  https://doi.org/10.1016/j.copsyc.2017.10.005 PubMedGoogle Scholar
  59. Young, J., Klosko, J., & Weishaar, M. E. (2003). Schema therapy: A practitioner’s guide. New York: The Guildford Press.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.St John of God HospitalStillorganIreland

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