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.

Indiana University-Purdue University Indianapolis (IUPUI) / Background: People with schizophrenia experience significant deficits in empathic skills, which are important for effective interpersonal relationships. Researchers have speculated about the roles of personal distress, emotion regulation, and metacognition in empathic interaction, but the impact of these constructs on empathy has yet to be empirically investigated. This study examines the relationships among these constructs in a sample of people with schizophrenia receiving community-based treatment (N = 58). It was hypothesized that better emotion regulation and metacognition, as well as reduced personal distress, would predict empathy. Further, emotion regulation was expected to mediate the relationship between personal distress and empathy, and metacognition was expected to moderate the relationship between personal distress and empathy. Method: Participants with schizophrenia or schizoaffective disorder completed self-report questionnaires of emotion regulation and personal distress, a performance-based measure of empathy, and an observer-rated interview to assess metacognition. Results: Metacognition, but not emotion regulation or personal distress, significantly predicted cognitive empathy performance, with a trend-level association for affective empathy performance. Mediation analyses revealed that emotion regulation mediates the relationship between personal distress and affective empathy performance, and moderation analyses revealed that metacognition moderates the same relationship. Moderation results suggest the relationship between personal distress and affective empathy performance is significant for those with low metacognition, but that the relationship is the opposite of hypotheses – increased personal distress is associated with better performance. Conclusions: This study is the first of its kind to examine performance-based empathy with personal distress, emotion regulation, and metacognition. Results suggest interventions targeted to improve metacognition may be useful in enhancing empathic skills. Future work is needed to improve existing measures of empathy and personal distress, and to parse apart the intricacies of the relationships among personal distress, emotion regulation, and empathy.

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Adverse childhood experiences (ACEs) have been shown to have significantly deleterious effects on an individual’s overall health (Felitti et al., 1998), including poor subjective experiences of health (Khrapatina & Berman, 2017). Difficulties in emotion regulation (DERs), which reflect the inability to identify, interpret, and manage strong emotions, may be one mechanism through which ACEs affect health. Successful emotion regulation has been associated with high levels of self-reported health, whereby DERs has been linked to poor selfreported health (Kinnunen et al., 2005). The current study seeks to determine whether DERs (Gratz & Roemer, 2004) mediate the relationship between ACEs and subjective experiences of health. Utilizing a sample of students from a mid-sized university in rural Appalachia, the mediating role of DERs was tested using the PROCESS macro for SPSS with bootstrapping (5000 samples). Results demonstrated that DERS did significantly mediate the relationship between ACEs and self-reported health [R2 = .12, F(2,616) = 43.60, p < .000; indirect effect of DERS total t(616) = -7.01, p < .000, CI = -.04, -.02]. The identification of DERs as one mechanism through which ACEs increases the risk of poor self-reported health offers one target for interventions designed to mitigate the negative outcomes of ACEs and promote resilience in the face of past adversity

Previous research has indicated that emotion regulation (ER) strategy use is crucial for predicting emotional and behavioral functioning. The current study examined the construct of ER by integrating ER strategy use with flexibility to use strategies and overall level of experienced emotion to determine the adaptiveness of ER as a process. Self-report data regarding strategy use, flexibility, and affect intensity was collected from undergraduate psychology students (N = 380). A latent class analysis (LCA) was used to test the predicted 4-class model of ER. A 4-class model and 2-class model were supported. MANOVA results indicated that both models predicted outcomes of ER difficulties, secure attachment, and internalizing and externalizing behaviors; the comparison model of high/low strategy use did not predict ER difficulties or internalizing and externalizing behaviors. Our results suggest that integrating strategy use, flexibility, and emotionality yields classes of ER predict functioning better than strategy use alone.

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