Research on factors that predict opioid cravings is lacking. Anhedonia may be a predictor of cravings and particularly relevant to cravings when people struggle to regulate emotions but has yet to be examined among justice-involved populations. This study aimed to examine the relationship between anhedonia, opioid cravings, and emotion dysregulation (ED) in this population. Participants completed several measures. The results showed that anhedonia and opioid cravings were significantly related at the bivariate level, but not in moderation models. The DERS-36 total score and ‘DERS Impulse’ subscale had a significant, positive effect on cravings in moderation models. In a higher severity sample of people who used heroin, there was a significant interaction wherein the relationship between anhedonia and cravings was positive at high levels of difficulty controlling behaviors when distressed. These findings indicate the need to understand how anhedonia and ED influence opioid cravings among justice-involved people with severe heroin use.

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Disruptive behavior, such as aggression and rule-breaking, tend to increase in adolescence and are linked to negative academic outcomes and psychosocial difficulties. Emotion dysregulation also increases from childhood to adolescence. An individual’s implicit beliefs about their emotions, such as whether they view emotions as changeable versus fixed, may relate to how they regulate their emotions. Adolescents who view emotions as fixed may be less likely to use adaptive emotion regulation strategies and experience emotion dysregulation. Viewing one’s anger as fixed may lead to more emotion dysregulation which may then contribute to aggression and violence towards others. Neurological studies show that emotion dysregulation and disruptive behavior activate similar brain structures, providing support that emotion dysregulation may be a possible pathway to disruptive behavior. There is evidence for implicit emotion theories impact on depression symptoms through emotion dysregulation, with little research on how it might impact disruptive behavior disorder symptoms. Therefore, we hypothesized that a fixed mindset towards emotions would relate to increased disruptive behavior symptoms, and this effect would be mediated by emotion dysregulation. Participants were 165 adolescents (M = 14.56 years; 33.7% female; 73.5% European American) and their parents, both of whom completed questionnaires via Qualtrics online platform. Adolescents reported on their implicit theories of emotion and emotion dysregulation. Parents reported on their adolescent’s disruptive behaviors, such as conduct problems and oppositionality. We tested the mediation models in SPSS using the Process macro v.4.2. There were no significant indirect effects of a fixed mindset on oppositionality. However, a fixed mindset had an indirect relation to conduct problems. There was a direct effect of a fixed mindset on conduct problems, which was no longer significant once emotion dysregulation was entered into the model. These results show that emotion dysregulation mediates the link between implicit emotion theories and conduct problems, but not oppositionality, in adolescence. There may have been no association with oppositionality behaviors because they typically occur at a younger age than conduct problems. Adolescents who view emotions as unchangeable may not attempt emotion regulation strategies as often, which leads to more conduct problems. In clinical settings, it might be advantageous to assess and address how youth view their emotions and support emotion regulation strategies. Although this study relied on cross-sectional self-report data, it provides an important first step to exploring risk factors and pathways for disruptive behaviors. Future research may benefit from experimental and longitudinal designs to investigate causality.

Adverse Childhood Experiences (ACEs) are events that occur during a person’s childhood that can affect their physical, mental, and social health later in life. Abuse, neglect or household disfunction are common events labeled as ACEs to study the effects of childhood trauma. ACEs have been linked to several negative physical and mental health outcomes, such as substance abuse, heart and lung diseases, anxiety and depression. Furthermore, several studies have shown that emotion dysregulation and attachment anxiety mediate the relationships between ACEs and negative health outcomes. Emotion dysregulation and attachment anxiety can also be linked to a commonly studied social aliment, imposter phenomenon. Individuals experiencing imposter phenomenon may feel as though they are undeserving of their personal accomplishments or have achieved them by luck or chance. Emotion dysregulation can lead to a lack of control, or perceived control, over one’s emotions. This lack of control could theoretically lead to feelings of inadequacy and fakeness experienced by those suffering from imposter phenomenon. Likewise, attachment anxiety can lead to fear of abandonment in relationships caused by the similar feelings of inadequacy. The aim of the present research was to therefore determine whether ACEs may predict greater feelings of the imposter phenomenon through emotion dysregulation and attachment anxiety. A total of 464 participants completed measures of ACEs, emotion dysregulation, attachment anxiety, and the imposter phenomenon online in REDCap. A bootstrap (5000 repetitions) mediation analysis conducted in JASP indicated that although ACEs do not directly predict the imposter phenomenon, greater ACEs indirectly predicted greater feelings of being an imposter through both emotion dysregulation and attachment anxiety. That is, the more ACEs one experiences theoretically leads to greater emotion dysregulation and higher attachment anxiety, both of which predict greater feelings of being an imposter. These results suggest that ACEs may disrupt the development of healthy coping mechanisms and regulation strategies that could feed into an inability to recognize one’s abilities and successes. Furthermore, experiencing negative mental and physical outcomes due to ACEs could produce a negative self-worth, leading to feelings of being an imposter. Likewise, anxiety in other aspects of life, such as relationships, could lead to these same feelings. Although the present research suggests that ACEs indirectly predict the imposter phenomenon, future research may show numerous factors impacting the imposter phenomenon with multiple interacting variables. Future research should aim to examine these factors prospectively and in different populations other than the one studied here. As with any self-report research, there could be discrepancies in data reported due to recall and impression management, especially when participants are asked about sensitive subjects, such as ACEs and intimate relationships. Despite these limitations, these results help provide a greater understanding of the effect ACEs and childhood trauma can have on social well-being and can also lead to a better understanding of development of and treatments for the imposter phenomenon.

Introduction: The perinatal period, which consists of pregnancy and up to one year postpartum, is considered a period of vulnerability. During this time, women are at higher risk than at other times in their lives of developing a mental health disorder, particularly anxiety and depressive disorders. Perinatal mental health disorders have a tremendous negative impact on not only the mother, but also their children who may develop cognitive, behavioural, and emotional problems that last well into adulthood. Emotion dysregulation has been implicated in both anxiety and depressive disorders and, due to endocrine changes during the perinatal period, may play an important role in perinatal mental health. Perinatal emotion dysregulation has yet to be explored. The purpose of this thesis was to 1) better understand the link between emotion dysregulation and perinatal mental health, 2) assess whether current perinatal treatments effectively target emotion dysregulation, and 3) develop an effective psychological treatment protocol for perinatal emotion dysregulation. Methods: We designed and conducted three studies to meet our research aims. The first study compared emotion reactivity and emotion regulation, two aspects of emotion dysregulation, in perinatal women with an anxiety and/or depressive disorder to better understand perinatal emotion dysregulation. The second study examined the bidirectional relationship between Cognitive Behavioural Therapy (CBT) for perinatal anxiety and emotion dysregulation to examine whether emotion dysregulation moderates CBT treatment outcomes and whether CBT is an effective treatment modality for perinatal emotion dysregulation. This was examined in two samples of participants: participants from a randomized controlled trial and routine clinical care. In the third study, we developed a novel Dialectical Behavioural Therapy (DBT) informed treatment program for perinatal emotion dysregulation and examined the effectiveness of the program through a pilot study. Results: Our research revealed several important findings. First, heightened emotional reactivity may be a protective factor during the perinatal period; less flexibility in emotional reactivity and difficulties with emotion regulation were associated with worse perinatal mental health, and relationship dissatisfaction. Second, CBT was an effective treatment for low levels of emotion dysregulation but not for moderate or severe perinatal emotion dysregulation. Only 16% of routine clinical care participants and 28% of participants from the randomized controlled trial demonstrated clinically reliable change in emotion dysregulation. Emotion dysregulation did not moderate CBT treatment outcomes on anxiety or depression. This suggest that emotion dysregulation appears to be a distinct factor that may warrant more specialized treatment. Third, our short term, DBT informed, skills group was effective in significantly reducing perinatal emotion dysregulation. The DBT informed treatment may be more effective in targeting perinatal emotion dysregulation than CBT as illustrated by 48% of participants demonstrating clinically reliable change compared to the 16%-28% in the CBT treatment. Conclusions: This line of research allows us to have a better understanding of perinatal emotion dysregulation and may aid in the development of best practice assessment and treatment guidelines for emotion dysregulation during the perinatal period. Limitations and future directions are discussed. / Dissertation / Doctor of Philosophy (PhD)

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