Objectives: To determine whether task-shifting the treatment of Postpartum depression (PPD) is effective in both treating mothers and mitigating the potential negative effects of PPD exposure on infant emotion regulation (ER). Methods: In Study 1, a randomized controlled trial (RCT) with a waitlist control group was used to examine whether a nine-week group Cognitive Behavioural Therapy (CBT) intervention delivered by peers can effectively treat PPD in mothers. Study 2 used data from this same RCT to determine if maternal PPD treatment with peer-delivered group CBT intervention would lead to adaptive change in markers of ER in their infants. Finally, Study 3 used data from a RCT with a treatment-as-usual control group to examine whether maternal treatment with a Public Health Nurse (PHN)-delivered group CBT intervention led to adaptive change in markers of infant ER. In both Studies 2 and 3, markers of infant ER included two neurophysiological measures and a maternal-report measure of infant temperament. Results: Study 1 found that peer-delivered group CBT led to significant improvements in symptoms of depression and anxiety in mothers and reductions in symptoms remained stable six months after treatment initiation. Study 2 found evidence of change in two neurophysiological measures of infant ER following maternal treatment with peer-delivered intervention, but not in the maternal-report measure of infant temperament. Finally, Study 3 found evidence of change in a single neurophysiological marker of infant ER following maternal treatment with the PHN-delivered intervention, but found no change following maternal treatment in a second neurophysiological marker and maternal-report measure of infant ER. Conclusions: The studies in this thesis highlight the potential of using task-shifting to fill a gap in the healthcare system’s treatment of PPD. This work suggests that interventions delivered by peers and PHNs may not only be effective in treating those with PPD, but may also benefit their infants by mitigating any PPD-related consequences on infant ER development. This thesis contributes to the evidence that suggests timely maternal treatment of PPD may disrupt the transmission of psychiatric risk from parent to infant. / Dissertation / Doctor of Philosophy (PhD) / Postpartum depression (PPD) is common and has consequences for both mothers and their infants. The negative impact of PPD exposure on infant emotion regulation (ER) is especially harmful because of its association with later psychopathology. As a result, the objectives of the present thesis were to i) determine whether task-shifting the treatment of PPD is effective in treating mothers while ii) mitigating the potential negative effects of PPD exposure on infant ER. The results of this thesis indicate that a task-shifted, peer-delivered treatment is effective in treating mothers with PPD and that treating mothers with a task-shifted treatment may also lead to adaptive changes in infant ER. This thesis indicates that task-shifting the treatment of PPD may improve outcomes for mothers, prevent PPD-related consequences on infant ER development, and ultimately, improve future outcomes for their infants.

This study explores the relationships among parent, peer, and romantic attachment, identity processing style, and emotion regulation. Previous studies have revealed potential associations among each of the aforementioned factors (e.g., between identity and attachment as well as between attachment and emotion regulation), but this is the first study to examine the three factors together, putting emphasis on romantic attachment. It was predicted that attachment will vary depending on the interaction between identity processing style and emotion regulation. College students (N= 390) in psychology courses participated in an anonymous online survey for course credit. Parent attachment was significantly predicted by age, gender, cognitive reappraisal, the diffuse-avoidant identity style, and the normative identity style; peer attachment was significantly predicted by expressive suppression, the diffuse-avoidant identity style, and the informational identity style. Regarding romantic attachment, attachment-anxiety was significantly predicted by the diffuse-avoidant identity style and attachment-avoidance was significantly predicted by age and expressive suppression. Additional analyses and their theoretical implications are further discussed.

Socioemotional theories posit that the experience of overcoming unique life challenges over a lifetime enhances self-efficacy and emotional resilience among older adults. Older adults demonstrate greater emotional well-being and motivation to regulate emotions than younger adults, but specific regulatory mechanisms supporting late-life emotional resilience remain unclear. Cognitive reappraisal is an effective but cognitively demanding emotion regulation strategy and shows mixed efficacy in later-life. While a growing repertoire of autobiographical memories may be a resource with age, the role of autobiographical recall in momentary reappraisal has never been tested empirically. In this online study, older and younger adults were trained to reappraise the meaning of negative images as more positive by associating them either to any relevant autobiographical memory from the past (n=153), a specific cued autobiographical memory (reappraisal, n=118), or without autobiographical reference (n=156). Results revealed all strategies to be effective in regulating negative image intensity across age. While older adults outperformed younger adults in the non-AM condition, the opposite was observed for uncued AM reappraisals, and no age differences were found for cued AM reappraisals. Non-AM reappraisal was easiest to employ for all participants, and older adults reported all reappraisal strategies as easier than younger adults. While older adults found their AMs more helpful and more similar to reappraised images than younger adults, AM- image similarity was surprisingly associated with lower reappraisal efficacy. Findings suggests that AM reappraisal benefits are mixed for older adults, likely due to efficacy but higher associated cognitive burden of AM recall. We posit that older adults may sacrifice immediate hedonic relief, to engage with challenging but helpful emotion regulation strategies. We discuss limitations of this study, and areas for future directions to substantiate interpretations further.

Reappraisal — reinterpreting a situation to change emotional response — is an effective emotion regulation strategy that relies on cognitive control network activity, including engagement of the dorsolateral prefrontal cortex (dlPFC), to attenuate amygdala activity. Greater dlPFC-Amygdala functional connectivity predicts instructed reappraisal task success, and daily use of reappraisal for younger adults (Pico-Perez et al.., 2018) but not older adults (Opitz et al., 2012), while the connectivity of the vmPFC is predictive of physiological markers of ER success for all ages (Sakaki et al., 2016 & Urry et al., 2006). However, the relationship between Resting-State Functional Connectivity (RSFC) and reappraisal task success across the lifespan has yet to be investigated. Participants in the Cambridge Center for Aging Neuroscience study (N=299) completed an 8-minute resting-state fMRI scan. In each trial of an emotion regulation task, participants either viewed or reappraised a negative film and reported post-regulation positive affect. RSFC across bilateral amygdala and the mPFC, the left and the right dlPFC were calculated with Matlab’s CONN Toolbox. The hypothesis is that the strength of the amygdala-mPFC RSFC will predict lower negative and higher positive affect scores after reappraising, however, this study data failed to find evidence to support this hypothesis. The association between the amygdala-dlPFC RSFC and post-reappraisal negative affect scores was moderated by age. Positive affect was higher when there was a stronger negative RSFC in young and middle-aged adults, and this relationship was not significant at older ages (~72). Our results suggest that dlPFC-amygdala activity at rest may be a predictor of emotion regulation in younger and midlife adults but that dlPFC-amygdala activity may be less predictive of emotion regulation outcomes in later life.

Childhood maltreatment by a caregiver can occur in many forms, ranging from overt abuse to more subtle neglect. Amidst a primary focus on the outcome of posttraumatic stress disorder (PTSD), less research attention has been given to understanding the impact of maltreatment on one's developing sense of self, internal working model (IWM) of relationships, and emotion regulation capacities. Difficulties experiencing, regulating, and enjoying a full range of affect are common transdiagnostic features among adult survivors of child maltreatment, who frequently display emotional reactivity (e.g., mood swings, anger) and/or disengagement (e.g., numbing, dissociation). What makes the difference between individuals who lash out in emotional outbursts, those who tend to withdraw or dissociate, and those who frequently alternate between these two affective poles? In a mixed college and community sample of 417 adults, we explored two covert forms of childhood emotional maltreatment (e.g., chronic emotional disengagement and frightened/helpless parenting) as potentially linked to adult psychological and relational functioning. Controlling for the effects of childhood physical and sexual abuse, path analysis indicated that these types of maltreatment were significantly associated with insecure attachment patterns, emotional reactivity, and dissociation in adulthood. These findings inform therapeutic work with survivors of childhood trauma, signifying the importance of thorough assessment to uncover potential psychological legacies of emotional abuse and/or neglect, which can at times be overlooked or assumed to be less pathogenic than other more obvious forms of maltreatment.

京都大学 / 新制・課程博士 / 博士(人間・環境学) / 甲第24696号 / 人博第1069号 / 新制||人||250(附属図書館) / 2022||人博||1069(吉田南総合図書館) / 京都大学大学院人間・環境学研究科共生人間学専攻 / (主査)教授 内田 由紀子, 教授 齋木 潤, 教授 小村 豊, 准教授 Rappleye Jeremy / 学位規則第4条第1項該当 / Doctor of Human and Environmental Studies / Kyoto University / DGAM

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