emotional issues

Emotion dysregulation and psychological inflexibility are widely regarded as key contributors to a range of mental health issues and are integral to several treatment models in the mental health field. However, no study has examined whether the two constructs reflect distinct aspects of psychological functioning or whether they can be clearly differentiated from mental health symptoms and associated impairment. Adolescence is a key period for the onset of mental health problems, making a better understanding of psychological processes involved in mental health in this age group important. The Difficulties in Emotion Regulation Scale (DERS-16, emotion dysregulation) and the Avoidance and Fusion Questionnaire for Youth (AFQ-Y8, psychological inflexibility) are widely used assessment tools of emotion dysregulation and psychological inflexibility, but critical evaluations of their validity are sparse. Using exploratory and confirmatory factor analysis, we examined the discriminant validity of emotion dysregulation and psychological inflexibility as measured via the DERS-16 and the AFQ-Y8 in a sample of 633 adolescents (M_age = 16.6 [1.98]). Emotion dysregulation and psychological inflexibility did not demonstrate discriminant validity. Instead, four strongly correlated factors emerged, each comprising a combination of items from both assessment tools: (1) interference stemming from distressing thoughts and emotions, (2) negative self-evaluation, (3) loss of control when emotional, and (4) confusion about one's emotions. These factors were strongly correlated and adequately captured by an overarching factor, which we termed the X factor, which in turn was very strongly correlated with core symptoms of anxiety and depression and functional impairment stemming from mental health issues. In conclusion, the constructs of emotion dysregulation and psychological inflexibility, as assessed by the DERS-16 and AFQ-Y8, do not show discriminant validity in adolescents. Furthermore, the constructs measured by these tools are almost empirically indistinguishable from anxiety, depression, and functional impairment.

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Mindfulness skills training constitute a core element of dialectical behavior therapy (DBT) that has been proposed as a key component to improve emotion dysregulation (ED) in borderline personality disorder (BPD). However, the relationship between the time spent practicing mindfulness skills at home and changes in ED is not well-understood. This study aimed to determine whether daily mindfulness practice meaningfully improves ED, and, if so, the minimum dose needed to do so. A total of 75 BPD outpatients participated in a 10-week DBT mindfulness skill training program. We systematically tracked the participants' mindfulness practice and their ED levels throughout the sessions. A total of 499 observations were recorded. We used multilevel modeling with a time-lagged approach to investigate the association between weekly practice and ED over time. Greater mindfulness practice predicted improvements in ED in the following week. A bidirectional relationship was also found; a higher level of ED impaired subsequent mindfulness practice. When accounting for the previous week's ED level, participants who practiced ≥3 days and >30 min per week experienced a statistically significant decrease in ED compared to those who did not engage in regular practice. These results highlight the key role of mindfulness practice as a behavioral component to improve emotion regulation in individuals with BPD. These findings suggest that therapists should inform patients about the minimum dose of mindfulness practice needed to improve emotion regulation in order to adjust expectations and improve treatment outcomes.

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