Four studies of emotion processing

First, Flechsenhar, Seitz, Bertsch & Herpertz (2022) published “The Association Between Psychopathology, Childhood Trauma, and Emotion Processing” in Psychological Trauma: Theory, Research, Practice, and Policy. I was drawn to this study because of its mention of transdiagnostic psychopathologies. The idea seems to be that, because the DSM often yields poor diagnostic accuracy, it may be wiser to use core constructs that relate to multiple diagnoses. Here’s the slightly edited abstract:

Childhood trauma is highly prevalent and can have a negative impact on the development of socioemotional processes resulting in a higher vulnerability for mental disorders in adulthood. Previous studies have associated the severity of childhood trauma with deficits in social functioning, such as a negative attention bias, suggesting altered social information processing as a mechanism underlying the association between childhood trauma and transdiagnostic psychopathologies. In a cross-sectional setup with a total of 103 participants (26 with major depressive disorder, MDD; 24 with posttraumatic stress disorder, PTSD; 22 with somatic symptom disorder, SDD; and 31 healthy volunteers, HV), this study applied eye tracking in an emotion recognition paradigm. Reaction times, accuracy, and gaze behavior were analyzed for 4 different facial expressions as a function of self-reported childhood trauma and diagnosis. The aim was to investigate to what extent emotion processing is associated with (a) childhood trauma, (b) psychopathology, and (c) respective interacting effects. Patients showed higher reaction times and error rates overall in classifying emotions than HVs, especially for the recognition of anger and fear. Individuals with a diagnosis of PTSD and MDD were particularly slow in their response to these emotions. Higher scores of reported childhood trauma were associated with faster responses for classifying anger and fear and slower initiation of eye movements for SSD, MDD, and HVs for anger. These findings indicate that childhood trauma may contribute to attentional and information-processing biases relevant for social interaction. Identifying individual social deficits offers implications for tailored therapeutic interventions. 

While the sample isn’t large, there is a healthy volunteer group to which patients with the three disorders (MDD, PTSD, and SDD) are compared. It makes sense to me that individuals with PTSD and MDD are slower to recognize anger and fear. It also makes sense that those with higher reported childhood trauma are fast, if not accurate in classifying anger and fear.

The second study, by Davies, Pearson, Cao & Sturge-Apple (2022), is “Family-level antecedents of children’s patterns of reactivity to interparental conflict: Testing the reformulation of emotional security theory” published in Developmental Psychology. Here’s an edited version of the abstract and impact statement:

Guided by emotional security theory, this study examined the family-level antecedents of children’s reaction patterns to interparental conflict in a sample of 243 preschool children (M age = 4.60 years; 48% Black; 16% Latinx; 56% girls) and their parents in the Northeastern United States. This study suggests that there are distinct profiles of family functioning (i.e., interparental and parent–child qualities) that precede changes in children’s patterns of behavioral reactivity to conflict between their parents. Because children’s patterns of reactivity to conflict predict their mental health outcomes, understanding the family antecedents may help advance clinical targets and tools designed to promote children’s coping and adjustment. 

Behavioral observations of children’s responses to interparental conflict over two annual measurement occasions assessed their tendencies to exhibit four patterns of defending against threat: secure (i.e., efficiently address direct threats), mobilizing (i.e., high reactivity to potential threat and social opportunities), dominant (i.e., directly defeat threat), and demobilizing (i.e., reduce salience as a target of hostility). Latent profile analyses of inter-parental, co-parental, and parent characteristics derived from multiple methods at the first wave yielded four profiles corresponding with harmonious, enmeshed, compensatory, and detouring patterns of family-level functioning. Detouring occurs when parents, rather than directing anger or criticism toward each other, focus the negativity on the child and the parent-child conflict thus serves to distract from the tension in the marital subsystem. Additional analyses revealed that children in harmonious and compensatory family profiles exhibited more secure patterns of reactivity over a 1-year period than children in the enmeshed family profile. In contrast, subsequent mobilizing reactivity was most pronounced for children in the enmeshed family profile. Finally, children in the detouring profile exhibited substantially higher levels of demobilizing reactivity to interparental conflict. 

This study is important in creating the different profiles for children and parents when conflict is present in the home. The last two studies address adolescents. Mariotti, Bolden, & Finn (2020) published” Unifying treatment for mild anxiety and depression in preadolescence” in Psychotherapy. Here’s the edited abstract:

Anxiety disorders in children and adolescents are prevalent and, if left untreated, can lead to comorbid psychological disorders, substance use, poor socioemotional functioning, and academic and occupational underachievement. Subthreshold presentations of anxiety in youth could become problematic if overlooked, resulting in the afore-mentioned negative outcomes. Thus, it is important to treat such presentations, including with evidence-based treatments such as cognitive–behavioral therapy (CBT). However, because of not meeting the diagnostic criteria for which many CBT protocols were developed, subthreshold presentations of emotional problems could be an especially good match for transdiagnostic treatments like the Unified Protocol for Children (UP-C) [described as a transdiagnosed cognitive-behavioral intervention].

[T]his study aimed to preliminarily examine in a systemic case analysis (a) the efficacy of the UP-C for a preadolescent patient with mild anxiety/depression, and (b) the clinical utility of assessing both nomothetic and idiographic outcomes. Pre–post and time series outcome data demonstrated significant decreases in symptoms of depression, irritability, and negative reactions to events and significant increases in emotion identification and ownership of emotions. A network analysis of time series data described dynamics between parent and child ratings as well as the importance of child-rated anxiety and parent ratings of child’s ownership of emotions. This case study provides evidence for the efficacy of the UP-C with a preadolescent who displayed subclinical symptoms of an emotional disorder. Furthermore, this case study demonstrates the usefulness of nomothetic and idiographic assessments for treating psychological disorders in youth. 

While only a case study, I like the emphasis on subthreshold emotion processing. The final study by Trompeter et al.(2022) is “Difficulties with emotion regulation and weight/shape concerns as predictors of eating disorder behaviors among adolescents,” published in Journal of Psychopathology and Clinical Science. Here’s the slightly edited transcript:

Difficulties with emotion regulation are a proposed key transdiagnostic factor of mental health difficulties, including eating disorders. However, it remains unclear whether difficulties with emotion regulation prospectively predict engagement in eating disorder behaviors. The current study examined whether difficulties with emotion regulation were associated with eating disorder behaviors after 1 year, in addition to weight and shape concerns. A community sample of high school students (n = 3,074; 53.2% girls) completed self-report measures of eating behaviors, weight/shape concerns, and difficulties with emotion regulation at two time-points, 1 year apart. Findings indicated that greater difficulties with emotion regulation were uniquely associated with engaging in binge eating, fasting, and purging after 1 year. However, only greater weight and shape concerns, not difficulties with emotion regulation, were uniquely associated with engaging in driven exercise. Limited associations were detected for the frequency of eating disorder behaviors. Additionally, exploratory analyses were conducted to examine potential onset and persistence of eating disorder behaviors. Few gender differences were observed across analyses, with the exception of driven exercise, which was linked to difficulties with emotion regulation only among adolescent boys, but not girls. Findings suggest that difficulties with emotion regulation are a distinct factor in the occurrence of some eating disorder behaviors among adolescents. Exploratory findings further suggest that difficulties with emotion regulation appear to be particularly involved in the persistence of these behaviors in adolescents.

I’ve made it clear that I like research that focuses on emotions and acknowledges the limitations of a simple cognitive-behavioral approach. These studies suggest good questions to ask at intake.