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Item 501 Maternal PTSD and Child Brain Function During Implicit Emotion Regulation(Cambridge University Press, 2024-04-03) Crum, Kathleen I.; Aloi, Joseph; LeFevre, Katherine; McCormack, Kennedy; Hulvershorn, Leslie; Psychiatry, School of MedicineOBJECTIVES/GOALS: Maternal mental health, such as post-traumatic stress disorder (PTSD), is closely linked to child mental health. PTSD in mothers is associated with their children’s emotional responses. We examined associations between maternal PTSD and child brain function during emotion regulation. METHODS/STUDY POPULATION: Eight children ages 10-12 years, whose mothers had trauma histories, performed the Emotional N-Back task during functional MRI scanning. Mothers and children each reported on their trauma exposure and PTSD symptom severity. BOLD response to fearful faces during the Emotional N-Back was extracted from two specific brain regions of interest, amygdala and anterior cingulate cortex. These regions are involved in emotional response and attentional control, which are processes intrinsic to emotion regulation. An independent samples t-test was conducted on children’s BOLD response to fearful faces, with maternal PTSD symptom severity (high, low) as the independent variable. A parallel analysis was conducted with child PTSD symptom severity (high, low) as the independent variable. RESULTS/ANTICIPATED RESULTS: We found a main effect of maternal PTSD within brain regions of relevance to implicit emotion regulation. Compared to children whose mothers reported low PTSD symptom severity (n=4), children whose mothers reported high PTSD symptom severity (n=4) showed greater responsiveness to fearful faces in anterior cingulate cortex (t=2.04, p=.09,d=1.44) and amygdala (t=2.44, p=.05, d=1.72) at trending significance. A parallel analysis with child PTSD symptom severity showed no differences in brain function by this factor (ps=.55-.61). DISCUSSION/SIGNIFICANCE: Our pilot study is the first, to our knowledge, to examine associations between maternal PTSD and brain function during emotion regulation in their children. This study lays a foundation for future work; our goal is to explore dysfunction in emotion regulation neurocircuitry as one mechanism linking maternal PTSD to their children’s mental health.Item ADHD-related sex differences in emotional symptoms across development(Springer, 2024) De Ronda, Alyssa C.; Rice, Laura; Zhao, Yi; Rosch, Keri S.; Mostofsky, Stewart H.; Seymour, Karen E.; Biostatistics and Health Data Science, School of MedicineTo investigate developmental changes in emotion dysregulation (ED) and associated symptoms of emotional lability, irritability, anxiety, and depression, among girls and boys with and without ADHD from childhood through adolescence. Data were collected from a sample of 8-18-year-old children with (n = 264; 76 girls) and without (n = 153; 56 girls) ADHD, with multiple time-points from a subsample of participants (n = 121). Parents and youth completed rating scales assessing child ED, emotional lability, irritability, anxiety, and depression. Mixed effects models were employed to examine effects and interactions of diagnosis, sex [biological sex assigned at birth], age among boys and girls with and without ADHD. Mixed effects analyses showed sexually dimorphic developmental patterns between boys and girls, such that boys with ADHD showed a greater reduction in ED, irritability, and anxiety with age compared to girls with ADHD, whose symptom levels remained elevated relative to TD girls. Depressive symptoms were persistently elevated among girls with ADHD compared to boys with ADHD, whose symptoms decreased with age, relative to same-sex TD peers. While both boys and girls with ADHD showed higher levels of ED during childhood (compared to their sex-matched TD peers), mixed effects analyses revealed substantial sexually dimorphic patterns of emotional symptom change during adolescence: Boys with ADHD showed robust improvements in emotional symptoms from childhood to adolescence while girls with ADHD continued to show high and/or increased levels of ED, emotional lability, irritability, anxiety and depression.Item Altered intrinsic functional connectivity of the cingulate cortex in children with severe temper outbursts(Cambridge University Press, 2018-05) Roy, Amy Krain; Bennett, Randi; Posner, Jonathan; Hulvershorn, Leslie; Castellanos, F. Xavier; Klein, Rachel G.; Psychiatry, School of MedicineSevere temper outbursts (STO) in children are associated with impaired school and family functioning and may contribute to negative outcomes. These outbursts can be conceptualized as excessive frustration responses reflecting reduced emotion regulation capacity. The anterior cingulate cortex (ACC) has been implicated in negative affect as well as emotional control, and exhibits disrupted function in children with elevated irritability and outbursts. This study examined the intrinsic functional connectivity (iFC) of a region of the ACC, the anterior midcingulate cortex (aMCC), in 5- to 9-year-old children with STO (n = 20), comparing them to children with attention-deficit/hyperactivity disorder (ADHD) without outbursts (ADHD; n = 18). Additional analyses compared results to a sample of healthy children (HC; n = 18) and examined specific associations with behavioral and emotional dysregulation. Compared to the ADHD group, STO children exhibited reduced iFC between the aMCC and surrounding regions of the ACC, and increased iFC between the aMCC and precuneus. These differences were also seen between the STO and HC groups; ADHD and HC groups did not differ. Specificity analyses found associations between aMCC-ACC connectivity and hyperactivity, and between aMCC-precuneus iFC and emotion dysregulation. Disruption in aMCC networks may underlie the behavioral and emotional dysregulation characteristic of children with STO.Item Emotional response inhibition in bipolar disorder: a functional magnetic resonance imaging study of trait- and state-related abnormalities(Elsevier, 2013-01-15) Hummer, Tom A.; Hulvershorn, Leslie A.; Karne, Harish S.; Gunn, Abigail D.; Wang, Yang; Anand, Amit; Psychiatry, School of MedicineBACKGROUND: Impaired response inhibition and poor impulse control are hallmarks of the manic phase of bipolar disorder but are also present during depressive and, to a lesser degree, euthymic periods. The neural mechanisms underlying these impairments are poorly understood, including how mechanisms are related to bipolar trait or state effects. METHODS: One-hundred four unmedicated participants with bipolar mania (BM) (n = 30), bipolar depression (BD) (n = 30), bipolar euthymia (BE) (n = 14), and healthy control subjects (n = 30) underwent functional magnetic resonance imaging during emotional and nonemotional go/no-go tasks. The go/no-go task requires participants to press a button for go stimuli, while inhibiting the response to no-go trials. In separate blocks, participants inhibited the response to happy faces, sad faces, or letters. RESULTS: The BE group had higher insula activity during happy face inhibition and greater activity in left inferior frontal gyrus during sad face inhibition, demonstrating bipolar trait effects. Relative to the BE group, BD and BM groups demonstrated lower insula activity during inhibition of happy faces, though the depressed sample had lower activity than manic patients. The BD and BM groups had a greater response to inhibiting sad faces in emotion processing and regulation regions, including putamen, insula, and lateral prefrontal cortex. The manic group also had higher activity in insula and putamen during neutral letter inhibition. CONCLUSIONS: These results suggest distinct trait- and state-related neural abnormalities during response inhibition in bipolar disorder, with implications for future research and treatment.Item Levels of distress tolerance in schizophrenia appear equivalent to those found in borderline personality disorder(Wiley, 2020-09) Bonfils, Kelsey A.; Lysaker, Paul H.; Psychiatry, School of MedicineObjective: Distress tolerance is an important but understudied construct for those with schizophrenia-spectrum disorders. This study compared levels of distress tolerance between people diagnosed with schizophrenia and borderline personality disorder (BPD) to better characterize distress tolerance in schizophrenia-spectrum disorders. Method: Using cross-sectional data, we examined group differences in distress tolerance in people with schizophrenia-spectrum disorders (n = 55) and BPD (n = 32) through mean comparison and equivalence analyses. Results: Our results indicate that, in our data, distress tolerance did not differ between those with schizophrenia and those with BPD, and was in fact statistically equivalent between groups. In contrast, those with BPD tended to report more difficulty on some aspects of emotion regulation. Conclusion: Findings from this study suggest that increased focus on distress tolerance is called for in research on schizophrenia. Furthermore, people with schizophrenia-spectrum disorders may benefit from interventions targeting distress tolerance.Item Negative urgency and emotion regulation predict positive smoking expectancies in non-smoking youth(ScienceDirect, 2016-07) Dir, Allyson L.; Banks, Devin E.; Zapolski, Tamika C. B.; McIntyre, Elizabeth; Hulvershorn, Leslie A.; Psychology, School of ScienceINTRODUCTION: The purpose of the study was to better understand early risk for positive smoking expectancies, which have been shown to be consistent predictors of smoking initiation among youth. Two affect-based risk factors-negative urgency and emotion dysregulation-associated with smoking behaviors among youth, were examined for unique and interactive effects on positive smoking expectancies among substance-naïve youth. METHODS: Participants were 61 10-14-year-old children with virtually no drug use (less than 5 substance use incidents across the lifetime), who were drawn from the community. RESULTS: Both negative urgency and emotion dysregulation were significantly associated with positive social facilitation smoking expectancies. Further, negative urgency was significantly related to positive social facilitation smoking expectancies at higher levels of emotion dysregulation (b=.09, p=.001). CONCLUSION: The findings provide evidence that both emotion dysregulation and negative urgency are positively associated with positive social-related smoking expectancies among a sample of 10-14-year-olds. Children who are emotionally dysregulated and who act rashly in response to negative emotions appear more likely to endorse beliefs regarding the socially enhancing effects of smoking, suggesting that these youth may be at high risk for smoking initiation.Item Racial Discrimination and Alcohol Use Among Adolescents: The Role of Emotion Regulation(2024-08) Khazvand, Shirin; Zapolski, Tamika; Cyders, Melissa; Dir, Ally; Wu, WeiBackground: Racial discrimination has been consistently associated with risk for alcohol use outcomes among racial/ethnic minority groups. This is particularly concerning given that engagement in alcohol use during adolescence has significant downstream effects on an individual's health into adulthood. Understanding factors that influence the relationship between racial discrimination and alcohol outcomes are needed to better understand the risk pathway and to identify malleable targets for interventions to reduce alcohol use among racial/ethnic minority adolescents. One potential candidate is emotion regulation as there is evidence that exposure to discrimination is associated with emotion regulation difficulties, and that emotion regulation difficulties are associated with alcohol outcomes. It is also plausible that emotion regulation is an external factor that strengthens or weakens to direct association between racial discrimination and alcohol use. Thus, the current study examined difficulties in emotion regulation (as measured by the State Difficulties in Emotion Regulation, S-DERS) as a mediator and moderator separately on the relationship between racial discrimination related stress (RDRS) and alcohol outcomes (i.e., use, quantity, frequency, alcohol use disorder, binge drinking, high intensity alcohol use) and risk for problems associated with substance use. To better understand the nuances within the emotion regulation construct, this study also examined the four subscales of the S-DERS (e.g., difficulties in nonacceptance, modulation, lack of awareness, lack of clarity) in a parallel mediation and moderation model to account for each domain’s unique effect on the racial discrimination-alcohol pathway. Methods: 714 self-identifying racial/ethnic minority adolescents aged 10-19 years old (62.9% male, mean age 16.21 years old, 58.1% African American/Black, 19% American, 9.9% Hispanic/Latino, 9.7% Asian American/Pacific Islander, 1.3% Middle Eastern/North African) completed an online questionnaire that included measures assessing experiences of racial discrimination related stress, state difficulties in emotion regulation, and alcohol outcomes. Results: Findings indicated a significant indirect effect of RDRS on alcohol outcomes through total state difficulties in emotion regulation (past year use b = 0.002, p <0.001; frequency b = 0.005, p <0.001; quantity b = 0.003, p <0.001; alcohol use disorder b = 0.056, p <0.001; binge drinking b = 0.004, p <0.001; high intensity alcohol use b = 0.003, p <0.001; risk for problems associated with substance use b = 0.007, p <0.001). When examining the subscales of emotion regulation, a significant indirect effect was found for difficulties in modulation within the relationship between RDRS and past year use, quantity, frequency, alcohol use disorder, binge drinking, and high-intensity alcohol use, but not for risk for problems associated with substance use. There were no significant indirect effects observed for the other subscales of emotion regulation. Additionally, when examining whether S-DERS or the S-DERS subscales moderated the relationship between RDRS and alcohol outcomes, no significant effects were found. Conclusion: These findings expand our understanding on potential mechanisms that underlie the racial discrimination-alcohol risk pathway among racial/ethnic minority adolescents, which may in turn help clarify the multifaceted nature of emotion regulation. As such, findings suggest that a unique effect was found for difficulties in modulation of emotions when accounting for the other domains of emotion regulation when examining the RDRS and alcohol outcomes relationship. Given that this study was cross-sectional, additional research utilizing a prospective study design can build off the current findings to confirm the proposed temporal pathway between RDRS, emotion regulation, and alcohol use outcomes. Moreover, findings suggest that difficulties in modulation and emotion regulation may be important constructs to include within treatments aimed at reducing alcohol use and prevention efforts among racial/ethnic minority adolescents experiencing racial discrimination related distress.Item Reductions in Alexithymia and Emotion Dysregulation After Training Emotional Self-Awareness Following Traumatic Brain Injury: A Phase I Trial(Wolters Kluwer, 2017-09) Neumann, Dawn; Malec, James F.; Hammond, Flora M.; Physical Medicine and Rehabilitation, School of MedicineOBJECTIVES: To examine the acceptability and initial efficacy of an emotional self-awareness treatment at reducing alexithymia and emotion dysregulation in participants with traumatic brain injury (TBI). SETTING: An outpatient rehabilitation hospital. PARTICIPANTS: Seventeen adults with moderate to severe TBI and alexithymia. Time postinjury ranged 1 to 33 years. DESIGN: Within subject design, with 3 assessment times: baseline, posttest, and 2-month follow-up. INTERVENTION: Eight lessons incorporated psychoeducational information and skill-building exercises teaching emotional vocabulary, labeling, and differentiating self-emotions; interoceptive awareness; and distinguishing emotions from thoughts, actions, and sensations. MEASURES: Toronto Alexithymia Scale-20 (TAS-20); Levels of Emotional Awareness Scale (LEAS); Trait Anxiety Inventory (TAI); Patient Health Questionnaire-9 (PHQ-9); State-Trait Anger Expression Inventory (STAXI); Difficulty With Emotion Regulation Scale (DERS); and Positive and Negative Affect Scale (PANAS). RESULTS: Thirteen participants completed the treatment. Repeated-measures analysis of variance revealed changes on the TAS-20 (P = .003), LEAS (P < .001), TAI (P = .014), STAXI (P = .015), DERS (P = .020), and positive affect (P < .005). Paired t tests indicated significant baseline to posttest improvements on these measures. Gains were maintained at follow-up for the TAS, LEAS, and positive affect. Treatment satisfaction was high. CONCLUSION: This is the first study published on treating alexithymia post-TBI. Positive changes were identified for emotional self-awareness and emotion regulation; some changes were maintained several months posttreatment. Findings justify advancing to the next investigational phase for this novel intervention.Item Regulating Together: Emotion Dysregulation Group Treatment for ASD Youth and Their Caregivers(Springer Nature, 2023) Shaffer, Rebecca C.; Schmitt, Lauren M.; Reisinger, Debra L.; Coffman, Marika; Horn, Paul; Goodwin, Matthew S.; Mazefsky, Carla; Randall, Shelley; Erickson, Craig; Pediatrics, School of MedicineIndividuals with autism spectrum disorder (ASD) experience behavioral and emotional symptoms hypothesized to arise from emotion dysregulation (ED), difficulty modulating emotional experience, expression, and intensity in an acceptable and contextually appropriate manner. We developed Regulating Together (RT)—an intensive-outpatient, caregiver-assisted group program to meet the ASD + ED intervention critical need. A within-subjects trial was conducted (5-week-control lead-in period, 5-week-treatment, and 5-and 10-weeks-post-treatment follow-ups). Forty-four youth with ASD + ED (25 8–12, 19 13–18 yr-olds, 88% male, mean FSIQ of 96) participated. Improvements were found in reactivity, emotion regulation knowledge, and flexibility post-treatment and 10-weeks post-treatment. A reduction in inpatient hospitalization rates by 16% from the 12 months pre-RT to 12 months post-RT was observed. RT shows promise to reduce ED in ASD.