Mindful attention is qualitatively receptive and non-reactive, and is thought to facilitate adaptive emotional responding. Using a multi-method approach, I studied the relationship between individual differences in self-reported trait mindfulness and electrocortical, electromyographic, electrodermal, and self-reported responses to emotional pictures. Specifically, while subjects passively viewed IAPS pictures, electrocortical data, skin conductance, and also electromyographic data were recorded. Afterwards, subjects rated their subjective valence and arousal while viewing the pictures again. If trait mindfulness reduces general emotional responding, then responses from individuals with high mindfulness would be associated with decreased late positive potential amplitudes, decreased skin conductance response, and decreased subjective ratings of valence and arousal to emotional pictures. High mindfulness would also be associated with a decreased emotional modulation of startle eyeblink amplitudes and of startle P3 amplitudes during emotional pictures. Although analysis showed clear effects of emotion on dependent measures, in general, mindfulness did not moderate these effects.

Obesity is one of the most serious public health challenges of the 21^st century, associated with a range of adverse physical, psychological, social and economic consequences. The aetiology of obesity is complex; however, the psychological factors associated with overweight and obesity remain poorly understood. The first paper critically appraises evidence for three of the most developed psychological theories of obesity. Based on these findings, literature from the fields of emotion regulation and attachment are reviewed, and a novel developmental theory of obesity based on an integration of these theoretical constructs is proposed. Recommendations for future research based on a theoretical framework of emotion regulation are made, and implications for clinical practice including a focus on enhancing caregiver sensitivity are highlighted. The second paper explores the applicability of an established cognitive model of Bulimia Nervosa (BN) and binge eating to an overweight and obese sample. Findings support the relevance of cognitive aspects of the model in an overweight and obese sample, and highlight the potential role of early attachment relationships in the formation of cognitions that make an individual vulnerable to overweight and obesity in later life. Theoretical and clinical implications based on the established cognitive model are considered. Limitations include reliance on self-report and the correlational nature of analyses used. Recommendations for future research with larger, more representative samples to address these limitations are made. Overall, this dissertation makes a unique contribution to the psychological understanding of overweight and obesity, which has the potential to enhance treatment outcomes and suggests useful avenues for further research.

This Thesis follows the portfolio format and a brief overview is given here. Chapter one is a systematic review of the literature on the relationship between emotion regulation, anxiety and depression in older adults. Chapter two is a research journal which explores the relationship between fear of falling and emotion regulation in community dwelling older adults. The systematic review is written up for publication in the Journal of Affective Disorders. The research article is written up for publication in Aging and Mental Health. Their respective style guidelines were followed. Purpose The aim of the thesis was to explore the relationship between emotion regulation and psychological distress in older adults. The aim of the systematic review was to explore the relationship between self-reported emotion regulation, anxiety and depression in older adults. The empirical study aimed to look at the relationship between fear of falling, a common type of psychological distress in older adults, and emotion regulation. It also aimed to look at the relationship between fear of falling related avoidance behaviour and emotion regulation. Methods The literature was systematically searched for research which has explored the relationship between emotion regulation, anxiety and depression in older adults. The papers which met the inclusion criteria were rated according to predetermined quality criteria. An overview of the results and implications were discussed. The empirical research used a cross-sectional design to examine the research hypothesis. Older adults completed self-report measures of emotion regulation, fear of falling, fear-related avoidance behaviour, anxiety and depression. Correlational analysis explored the relationship between the study variables. A linear regression model examined the unique contribution of emotion regulation to fear of falling after controlling for age, falls history, anxiety and depression. Results 12 studies met the inclusion criteria for the systematic review. The most prevalent relationship explored was that between rumination and depression with consistent evidence that higher levels of rumination were related to higher levels of depressive symptoms. Common methodological limitations were the lack of valid and reliable emotion regulation measures for older adults, non-random sampling, and failure to control for important confounding factors. Within the empirical research, a significant relationship between emotion regulation and fear of falling was found. There was also a significant relationship between emotion regulation and fear of falling avoidance behaviour. After controlling for age, number of falls, depression and anxiety, emotion regulation was no longer significantly associated with fear of falling. Depression was the only modifiable variable that retained a significant association to fear of falling.

Recent epidemiological data from the National Comorbidity Survey (NCS) estimate significant lifetime prevalence rates for anxiety and mood disorders, suggesting nearly one in three people would meet diagnostic criteria for an anxiety and/or mood disorder at some point during their lifetime (NCS, 2007). Comorbidity research has also revealed that people often suffer from these disorders concurrently (Rodriguez et al., 2004). Many have argued that anxiety and mood disorders frequently co-occur because they share similar etiological factors (Barlow, 1991; Clark & Watson, 1991; Watson, 2005). Additional empirical research has suggested that depressive and anxiety disorders share similar genetic diatheses and merely present differently because of variation in environmental stressors (Hettema, Neale, & Kendler, 2001; Rutter Moffit, & Caspi, 2006). As a result, an investigation of shared emotion regulation and affective processes across anxiety and mood disorders may reveal parallel etiological factors and areas for intervention. Research examining emotion and affective dysregulation indicates that mood and anxiety pathology may be characterized by similar emotional control and understanding deficits (Amstadter, 2008; Bradley, 2000; Sandin et al., 1996). Models of emotion dysregulation suggest that individuals suffering from anxiety pathology report decreased understanding of emotions, higher reactivity and sensitivity to emotions, and poor emotional management and mood repair skills (Mennin et al., 2005). Similarly, studies have observed parallel difficulties in those with depression (Liverant, Brown, Barlow, & Roemer, 2008; Rude and McCarthy, 2003). Additionally, research has indicated that efforts to reappraise or suppress emotions may affect the intensity and valence of emotional experiences (Gross & John, 2004). The current study builds off this research by incorporating elements of previous models of emotion dysregulation and anxiety and mood pathology in an effort to develop a comprehensive model of affective process that may underlie both anxious and depressive symptomatology. A total of 526 undergraduate students participated in the present investigation by completing a series of self-report instruments measuring affect and psychopathology. Response patterns were analyzed using AMOS 4.0 in order to examine the structural relationships between negative affectivity, positive affectivity, emotion reappraisal, emotion suppression, negative emotional reactivity, and poor understanding of emotions. Initial tests of a single model of emotion dysregulation suggested that the development of two separate models best represented subject responses. As a result, distinct models for suppression and reappraisal were tested concurrently. Tests of model invariance revealed similar structural qualities across gender, ethnicity, and levels of general distress for both models. Following modification, final fit indices suggested good fit for the reappraisal model (CFI = .99, TLI = .99, RMSEA = .057); however, the suppression model did not appear similarly representative of subject response behavior (CFI = .89, TLI = .85, RMSEA = .073). Findings of the current study suggest that the use of emotional reappraisal may be associated with increased positive affective and decreased negative affective states. Further, attempts to reappraise emotional experiences may influence the relationships poor understanding of emotions and fear of strong affect demonstrated with negative and positive affect. Data support previously articulated psychotherapy treatment strategies (Beck, 1979; Barlow & Cerny, 1988; Linehan, 1993; Hayes, 2004), but also indicate that current cognitive behavioral therapies may benefit from heightened attention to emotions and the incorporation of affective regulation skill building strategies. Future research directions, study strengths and limitations, and additional implications of present results are included.

Purpose: The systematic review aimed to review and evaluate constructs and measures of emotion regulation (ER) in the psychosis spectrum population literature. The empirical study aimed to examine the feasibility and acceptability of a trans-diagnostic emotion regulation (ER) group developed for an acute inpatient setting. Methods: The literature was systematically searched for research related to the measurement of emotion regulation (ER) in a psychosis spectrum population. A mixed method design was employed to assess acceptability and feasibility of a six session ER skills group delivered in an acute mental health inpatient setting. The group intervention was developed and piloted over a 5 month period. The mixed method design included a multiple single case series design and qualitative exit interviews, conducted with eight participants. Results: 24 papers met criteria for inclusion in the systematic review. 15 different self-report tools were identified as measures of ER strategies in this review. Descriptive data from the empirical study indicated high attendance and low attrition rates. Group level analysis identified large effect sizes for change in ER skills. Case series data indicated that sustained change, on at least one measured variable, occurred for four participants. Qualitative themes triangulate findings related to acceptability of the group, change in ER strategies and increased emotional acceptance. Conclusions: ER conceptualisation is variable in the literature reviewed, where the understanding of how ER and psychosis are linked is limited. The emphasis on the literature reviewed is on cognitive strategies of ER. The pilot study indicates that the intervention is feasible and acceptable, with preliminary evidence identifying potential clinical benefits. The challenges in evaluating interventions in an acute inpatient environment are discussed.

Personality disorders (PD) are among the most complex aspects of human behaviour to understand and manage. Stability is thought to be one of the major distinguishing features between PD’s and other forms of psychopathology, however, recent studies have challenged this notion. Borderline personality disorder (BPD) is the focus of this review and is characterised by interpersonal and emotion regulation difficulties. This thesis aimed to first examine the naturalistic course of BPD, through systematic review of the current literature. Following screening, 12 studies, that met all inclusion/exclusion criteria, were critically evaluated. The results, from studies rated as methodologically sound, suggested that the categorical diagnosis of BPD has poor stability over time, with only 3%-35% of participants retaining a diagnosis of BPD over time. However, the studies reviewed were limited by the population they examined: mainly working age adults with mental health problems. Therefore, studies need to be continued and replicated to increase our understanding of the lifespan course of BPD. PD’s within older adults with mental health problems is a highly debated topic. Clinicians have highlighted the presence of PD symptoms within this group and the need for appropriate therapies. Schema therapy is one intervention that has shown to be effective in the treatment of PD symptoms within a working adult population. A recent Delphi-study led to the consensus that existing therapies for PD, such as schema therapy, that have shown to be effective in working aged adults are applicable to older adults. Therefore, the empirical project focused on exploring the theoretical underpinnings of schema therapy in older adults with mental health problems. 3 self-report questionnaires were administered to 62 participants (aged 65- 85 years); Young’s Schema Questionnaire – Short Form (YSQ-S3), Coolidge Axis-II Inventory (Short) (SCATI-II) and The Regulation of Emotions Questionnaire (REQ- 2). Analysis highlighted that YSQ-S3 and REQ-2 scores significantly predicted 69% of the variance in SCATI-II scores. To the author’s knowledge, this study is the first of its kind to find support for the relationships between early maladaptive schemas (EMS), PD symptoms and the use of dysfunctional emotion regulation (ER) strategies, consistent with the schema therapy model, in older adults with mental health problems.

abstract: Previous studies have established a link between parenting style (e.g. authoritarian, authoritative, permissive) and depression in children and adolescents. Parenting factors are also implicated in the development of emotion regulation. There is a gap in the literature, however, concerning perceptions of parenting in relation to adult depression. The current study examined the effect of parenting on reported adult depressive symptoms. Of interest was the role of emotion regulation strategies in this relationship. Participants were recruited through Amazon Mechanical Turk, and the sample consisted of 302 adults (125 males, 177 females) ranging in age from 18 to 65. Measures of how participants were parented by their mothers and fathers, emotion regulation strategies most frequently utilized, and current depressive symptoms were collected using an online survey. The emotion regulation strategy, positive reappraisal, was found to moderate the relation between maternal authoritative parenting and depression. Permissive parenting was also significantly predictive of depression, but catastrophizing fully mediated only the relation between maternal permissive parenting and depressive symptoms. Authoritarian parenting was unrelated to depression and emotion regulation in this study. The findings of this study indicate that the effects of how an individual was parented may persist into adulthood. Implications of these findings and future directions for further research are discussed. / Dissertation/Thesis / M.S. Psychology 2013

Recent developments in social neuroscience have stirred up increased interest within the bioethical debate (for a review see: Specker et al. 2014). Moral enhancement is a concept that directly embodies the idea of making brain science work for the social and moral good. In recent ethical discussions about biomedical means of moral enhancement, scholars have focused on so called ‘direct means of moral enhancement,’ discussing the ethical permissibility of modifying the emotional underpinnings of moral behaviour (Douglas, 2008; 2013; Persson and Savulescu, 2008; Savulescu and Persson, 2012). However, critics have argued that such modification only seems like moral enhancement, that behavioural modification is not ‘true’ moral enhancement, for the reason that it changes behaviours without making agents better moral agents. Critics have also noted that it can undermine freedom (e.g. Harris, 2011; see also: Douglas, 2014). This thesis addresses the ethical issues relating to enhancement. In the first part of this work I consider conceptual issues surrounding the concept of moral enhancement and argue that moral enhancement is plausible if we adjust our expectations to match those we have of cognitive enhancement. I examine the difference between pro-sociality and morality, and argue that an increase in empathy and reduction in anger cannot be seen as straightforward moral enhancements. The second part examines the objections related to moral disagreement, medicalization and narrative identity. The third part of this work focuses of the issues related to freedom and agency. I argue that voluntary direct emotion modulation, if embedded in appropriate reflection, is a prima facie desirable way of moral enhancement.

Emotion Regulation Group Therapy (ERGT) är en transdiagnostisk gruppbehandling för personer med svårigheter med känsloreglering och självskadebeteende. Nationella självskadeprojektet, som fört behandlingsmetoden till Sverige, rekommenderar att genusspecifika förhållningssätt utvecklas för att göra vården mer jämlik. Syftet med denna studie var att beskriva behandlarnas kliniska erfarenhet av ERGT och manliga patienter. Sex behandlare blev intervjuade. Metod för analys av intervjuerna var systematisk textkondensering. Resultat visade att behov av genusperspektiv i ERGT var störst i början av vårdkontakten då bedömning av svårigheter med känsloreglering och bedömning av förekomst av självskada sker. Det som kräver särskild medvetenhet är att män kan ha svårt att beskriva känslor och hur självskadebeteendet ofta är mer indirekt. Erfarenheten hos behandlare var att upplevelsen av olikheter minskade med tiden, då gruppen kunnat se bortom föreställningar och normer, att det svårighet med känsloreglering och självskadebeteendets funktion istället var det gemensamma.

There has recently been increased interest in the study of transdiagnostic mechanisms and therapies. Targeting transdiagnostic mechanisms rather than using a single disorder approach should increase efficiency of therapeutic interventions, but only if the proper mechanisms can be identified. Low distress tolerance and difficulties with emotion regulation are hypothesized as transdiagnostic mechanisms associated with anxiety disorders and worry. Due to the high comorbidity and prevalence of anxiety disorders and their shared symptoms of pathological worry, understanding these transdiagnostic mechanisms is important to the development of more effective and efficient treatments. This study used a multiple baseline, single-case experimental design to evaluate the efficacy of emotion regulation skills training for pathological worry and low distress tolerance in outpatients with anxiety disorders. Eight participants (6 women, 2 men) with at least one diagnosed anxiety disorder were randomized into a 2- or 4-week baseline period. The average age of participants was 29.1 (SD = 8.2; range 19 to 42). Participants completed weekly and daily assessments throughout the study, attended 7 sessions of treatment, and underwent a final diagnostic assessment 4 weeks after completing treatment. Emotion regulation skills training was hypothesized to increase distress tolerance, reduce worry, and lead to a remission in anxiety disorder diagnoses. Overall, the hypotheses were partially supported. Six participants displayed a reliable reduction in worry and 5 experienced an increase in distress tolerance at the follow-up assessment. Most participants still met criteria for at least one anxiety disorder after completing the study, indicating continued functional impairment from symptoms. Only 2 participants experienced complete remission of all clinical diagnoses. The results failed to show a consistent pattern of improvement, indicating that emotion regulation skills training alone may not be sufficient for robust, sustained reductions in anxiety disorder symptoms. However, results do support that worry and emotional distress tolerance can be changed through emotion regulation skills training. The small sample size limits the test of hypotheses. Suggestions for future research based on this study include incorporating interpersonal emotion regulation strategies with this treatment approach, repeating the treatment module to facilitate mastery of skills, or utilizing a group format for skills development.