An important philosophical issue in the study of addiction is what difference the fact that a person is addicted makes to attributions of autonomy (and responsibility) to their drug-oriented behavior. In spite of accumulating evidence suggesting the role of emotional dysregulation in understanding addiction, it has received surprisingly little attention in the debate about this issue. I claim that, as a result, an important aspect of the autonomy impairment of many addicted individuals has been largely overlooked. A widely (...) shared assumption in the philosophical literature is that for addiction to impair a person’s autonomy it has to make them (in some sense) take drugs against their will. So-called “willing addicts” are therefore usually seen as exempted from the autonomy impairment believed to characterize “unwilling addicts”, the latter being those who ‘truly want’ to stop using drugs but find their attempts repeatedly derailed by failures of self-control. In this article, I argue that the association between addiction and emotional dysregulation shows why this assumption is false. Emotional dysregulation is not only consistent with the possibility that many addicts take drugs ‘willingly’, it supports the hypothesis that they use drugs because they truly want to. The article proposes an explanation for why emotional dysregulation should nevertheless be seen as an aspect of their loss of control and an important reason why they have impaired autonomy. I end by exploring some implications of this account for addict’s decision-making capacity when they are prescribed the drugs to which they are addicted. -/- . (shrink)

Borderline personality disorder is a complex psychopathological phenomenon. It is usually thought to consist in a vast instability of different aspects that are central to our experience of the world, and to manifest as “a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity” [American Psychiatric Association, 2013, p. 663]. Typically, of the instability triad—instability in self, affect and emotion, and interpersonal relationships—only the first two are described, examined, and conceptualized from an experiential point of view. (...) In this context, disorders of self have often motivated analyses of self-experience and the sense of self, affective disorders have been frequently considered in the light of emotional experience and its phenomenological structure. Patterns in the phenomenology of social experience have found comparatively little traction when it comes to the conceptualization of the interpersonal disturbances in borderline. In this paper, I argue that interpersonal instability in borderline consists in much more than fragile and shifting relationships but, most importantly, also involves certain styles in experiencing others. These styles, I suggest, may play an explanatory role for the borderline-typical patterns of interpersonal turmoil and so deserve more attention. To better describe and understand these styles, I explore the phenomenological structure of borderline affective instability and discuss the implications it might have for how a person experiences and relates to other people. Considering core aspects of borderline affective instability, such as alexithymia, emotional contagion, emotion dysregulation, and chronic emptiness, I propose borderline can be interpreted as a disturbance of interaffective exchange, which gives rise to certain ways of experiencing others that imply a social impairment. (shrink)

Few studies have examined how trait emotion dysregulation relates to momentary affective experiences and the emotion regulation strategies people use in daily life. In the current study, 112 c...

Driving is central to adult independence and autonomy; yet most autistic young adults do not acquire driver’s licenses. It is important to understand barriers to achieving this milestone for autistic adults. Differences in negative affect and emotion dysregulation associated with autism may interfere with managing difficult driving situations. The current study compared perceived driving difficulty, emotion dysregulation, and negative affect in emerging drivers with and without autistic traits, and investigated how emotion dysregulation and negative affect relate to (...) perceived DD. We expected greater perceived DD, emotion dysregulation, and negative affect in participants with AT and a positive correlation of perceived DD with both emotion dysregulation and negative affect in the whole sample. Thirty-seven adolescents and young adults self-reported perceived DD in 15 scenarios and completed the Difficulty in Emotion Dysregulation Scale and the Depression, Anxiety, and Stress Scale. Autistic participants scored significantly higher on mean perceived DD, DERS Impulse subscale, DASS total and DASS Stress subscale scores. Perceived DD positively correlated with the DERS and DASS total scores, all DASS subscales, and DERS Nonacceptance, Goals, and Impulse subscales across the whole sample. The findings highlight the roles of emotion dysregulation and negative affect in perceived DD in emerging drivers with AT. In particular, emotional stress and impulsivity may map onto mechanisms of over-reactivity to negative affect and explain why autistic people perceive particular situations as difficult when driving. Implications and directions for future research are discussed. (shrink)

Studies suggested that emotion dysregulation and identity processes are involved in social media (SM) misuse, even if their proximal role has not been investigated. Previous studies rarely discriminated between specific activities or between types of SM. We recruited 50 young adults and implemented a momentary ecological assessment measurement. Four times by day, during seven days, we measured SM use, frequency of several activities on SM, emotion dysregulation, distress and clarity of self-concept. Daily time spent on Facebook, Instagram and (...) TikTok were retrieved from devices. Intradaily changes in emotion dysregulation and clarity of self-concept predict changes in SM addiction symptoms and frequency of use according to the type of activity. Daily changes in time spent on SM were not predicted by emotion dysregulation, distress and self-concept clarity. Findings suggest that emotion dysregulation and poor self-concept clarity are proximal risk factors for SM misuse. (shrink)

This study aims to investigate the mediating role of psychological inflexibility as a transdiagnostic factor in the relationship between emotional dysregulation and sleep problems with symptoms of emotional disorders. A total of 500 subjects from three universities were selected by random multistage clustering, and they completed the Pittsburgh Sleep Quality Index, Difficulties in Emotional Regulation Scale, and Acceptance and Action Questionnaire–II, Inventory of Depression and Anxiety Symptoms. The results of correlation coefficients revealed that there is a (...) positive and significant correlation among emotional dysregulation, sleep problems, and psychological inflexibility with emotional disorders. In addition, the results showed that psychological inflexibility acts as a transdiagnostic factor that mediates the relationship between emotional dysregulation and sleep problems with symptoms of emotional disorders. These findings illustrate how emotional dysregulation and sleep problems affect emotional disorders through psychological inflexibility. (shrink)

ABSTRACTPrevious work on the contribution of family environments to adolescent emotion dysregulation has tended to focus on broad parenting characteristics ; however, it is possible that day-to-day variability in parenting may also relate to emotion dysregulation. The current study sought to test whether inconsistency in the quality of daily parent-youth interactions related to multiple indices of emotion dysregulation in adolescents. Two-hundred-twenty-two adolescents participated with one parent. Adolescents completed 14-days of diary reporting on the quality of interactions with (...) their parent and their emotion dysregulation experiences for each day. Analyses reveal that, beyond the effects of average interaction quality, adolescents with greater variability in the quality of their interactions with their parent reported greater average emotion dysregulation across the days of diary recording and demonstrated greater variability in thei... (shrink)

People narrating the experience of dysregulated anger after a brain injury call upon metaphor in patterned ways to help them make sense of their situation. Here, I analyze the use of the metaphor of the doubled self in a personal narrative of brain injury, and I situate this metaphor in its cultural history by analyzing Dr Jekyll and Mr Hyde and The Incredible Hulk as landmark moments in its development. A pattern of thought reflecting Seneca’s philosophy on the incompatibility of (...) anger with rational selfhood emerges. I discuss implications for the way we care for people struggling with post-brain-injury anger. (shrink)

One of the main objectives of psychotherapy is to address emotion dysregulation that causes pathological symptoms and distress in patients. Following psychodynamic theory, we propose that in humans, the combination of emotions plus conditioned anxiety due to traumatic attachment can lead to dysregulated affects. Likewise, defenses can generate and maintain dysregulated affects (altogether Dysregulated Affective States, DAS). We propose the Experiential-Dynamic Emotion Regulation methodology, a framework to understand emotion dysregulation by integrating scientific evidence coming from the fields of (...) affective neuroscience and Experiential-Dynamic Psychotherapy aimed at resolving DAS. This method and the techniques proposed can be integrated within other approaches. Similarities and differences with the Cognitive model of emotion regulation and cognitive-behavioral approaches are discussed within the paper. (shrink)

This study examined psychopathological correlates of implicit and explicit shame and guilt in 30 clinical and 129 non-clinical youths aged 8–17 years. Shame and guilt were measured explicitly via two self-reports and a parent report, and implicitly by means of an Implicit Association Test (IAT), while a wide range of psychopathological symptoms were assessed with questionnaires completed by children, parents, and teachers. The results showed no differences of implicit and explicit shame and guilt between the clinical and non-clinical group, implying (...) that dysregulation of these self-conscious emotions is not per definition associated with psychopathology. Correlational analyses indicated that self-reported explicit shame was positively associated with a broad range of internalizing psychopathology, while self-reported explicit guilt was associated with higher levels of anxiety and to some extent lower levels of externalizing psychopathology. Correlations with parent-rated shame and guilt revealed the same pattern of results but were in general weaker. Furthermore, implicit shame and guilt did not show significant correlations with the various measures of psychopathology. It can be concluded that the link between shame and guilt and psychopathology is complex, and partly dependent on the disorder under study and context-related factors defining the maladaptive nature of these self-conscious emotions. (shrink)

There is debate within the literature as to whether emotion dysregulation (ED) in Attention-Deficit Hyperactivity Disorder (ADHD) reflects deviant attentional mechanisms or atypical perceptual emotion processing. Previous reviews have reliably examined the nature of facial, but not vocal, emotion recognition accuracy in ADHD. The present meta-analysis quantified vocal emotion recognition (VER) accuracy scores in ADHD and controls using robust variance estimation, gathered from 21 published and unpublished papers. Additional moderator analyses were carried out to determine whether the nature of (...) VER accuracy in ADHD varied depending on emotion type. Findings revealed a medium effect size for the presence of VER deficits in ADHD, and moderator analyses showed VER accuracy in ADHD did not differ due to emotion type. These results support the theories which implicate the role of attentional mechanisms in driving VER deficits in ADHD. However, there is insufficient data within the behavioural VER literature to support the presence of emotion processing atypicalities in ADHD. Future neuro-imaging research could explore the interaction between attention and emotion processing in ADHD, taking into consideration ADHD subtypes and comorbidities. (shrink)

We tested whether cognitive fusion impairs emotion differentiation and thereby mediates relations between cognitive fusion and depression and panic symptoms among 55 adults, 50.9% women). Using visual stimuli, we elicited multiple emotion states and measured emotional intensity – the subjective emotion intensity of elicited emotions, as well as emotional differentiation – the degree of co-activation of multiple negative emotions when a specific emotion was elicited. First, as hypothesised, we found that cognitive fusion predicted lower levels of emotion differentiation. (...) In contrast, as hypothesised, these effects were significantly greater than the effects of cognitive fusion on emotion intensity. Second, as predicted, MECA, but not SEI, predicted depression and panic symptoms. Finally, we found that MECA mediated the effects of cognitive fusion on depression and panic symptoms. The present findings contribute novel, preliminary empirical insight into associations between cognitive fusion, impaired emotion differentiation and mental ill-health. (shrink)

This perspective paper aims at discussing theoretical principles that could explain how emotion regulation and physical diseases mutually influence each other in the context of borderline personality disorder (BPD). Furthermore, this paper discusses the clinical implications of the functional relationships between emotion regulation, BPD and medical conditions considering dialectical behavior therapy (DBT) as a well-validated therapeutic intervention, which encompasses these issues. The inflexible use of maladaptive emotion regulation strategies (e.g., suppression, experiential avoidance, and rumination) might directly increase the probability of (...) developing physical diseases through a physiological pathway, or indirectly through a behavioral pathway. Some metabolic and chronic medical conditions could significantly impact emotional functioning through biological alterations involved in emotion regulation. Several empirical studies have shown high co-occurrence rates between BPD and several chronic physical diseases, especially ones linked to emotion-based maladaptive behaviors. DBT addresses physical diseases reported by individuals with BPD reducing problematic behaviors functionally associated to emotion dysregulation and identifying physical health as a goal forBuilding a Life Worth Living. (shrink)

Emotion dysregulation (ED) is a vulnerability factor for affective disorders that may originate from deficits in cognitive control (CC). Although measures of ED are often designed to assess trait-like tendencies, the extent to which such measures capture a time-varying (TV) or state-like construct versus a time-invariant (TI) or trait-like personality characteristic is unclear. The link between the TV and TI components of ED and CC is also unclear. In a 6-wave, 5-month longitudinal study, community participants (n = 1281) completed (...) the Difficulties in Emotion Regulation Scale (DERS-16), a commonly used measure of ED and measures of CC. A latent variable (trait-state-occasion) model showed that the proportion of TI factor variance (.80) was greater than the TV factor variance (.19). Although TV factor stability was significant, the coefficients were small in magnitude. Furthermore, regression weights for the ED TI factor (average β = −.62) were significant and larger than those for the TV factor (average β = −.10) in predicting latent CC at each of the six-time points. These findings suggest that ED, as assessed by the DERS-16, is largely TI and this TI component is more strongly linked to CC than the TV component. (shrink)

ABSTRACTRecent models of social anxiety disorder emphasise the role of emotion dysregulation; however, the nature of the proposed impairment needs clarification. In a replication and extension framework, four studies examined whether individuals with social anxiety are impaired in using cognitive reappraisal and expressive suppression. Self-reports and lab-based tasks of suppression and reappraisal were utilised among individuals with high and low levels of social anxiety. A meta-analysis of these studies indicated that, compared to controls, HSAs reported less frequent and effective (...) use of reappraisal and more frequent and effective use of suppression. Counter to most models and our hypotheses, HSAs were more successful than controls in lab-based reappraisal of shame-arousing pictures as measured by subjective ratings, but not by event-related potentials. HSAs were less successful than controls in lab-based suppression of shame-arousing pictures as measured by subjective ratings, but not... (shrink)

ABSTRACTNegative feedback has paradoxical features to it. This form of feedback can have informational value under some circumstances, but it can also threaten the ego, potentially upsetting behaviour as a result. To investigate possible consequences of the latter type, two experiments presented positive or negative feedback within a sequence-prediction task that could not be solved. Following feedback, participants had to control their behaviours as effectively as possible in a motor control task. Relative to positive feedback, negative feedback undermined control in (...) a manner suggesting emotional upset. These reactions lasted for at least three seconds and were especially pronounced among people reporting that they typically lose control in the context of their negative emotions. The findings document a novel form of behavioural dysregulation that occurs in response to negative feedback while also highlighting the utility of motor control perspectives on self... (shrink)

Emotion evaluations are assumed to play a crucial role in the emotion regulation process. We tested a postulate from our framework of emotion dysregulation (Nowak, U., Wittkamp, M. F., Clamor, A., & Lincoln, T. M. [2021]. Using the Ball-in-Bowl metaphor to outline an integrative framework for understanding dysregulated emotion. Frontiers in Psychiatry, 12, 118), namely that the extent to which individuals evaluate an emotion as harmful and their personal resources to modify and accept/tolerate the emotion as sufficient predict the (...) subsequent use of regulation strategies. Participants (n = 118) from a community sample took part in an experience-sampling assessment over 7 days including 10 daily paired measurements. The first measured momentary affective valence and arousal along with harmfulness evaluations and evaluations of personal resources to modify and accept/tolerate an emotion. The second followed three minutes later and measured emotion regulation strategies. The more harmful individuals evaluated an emotion, the more likely they were to use an emotion regulation strategy. The more harmful individuals evaluated an emotion, and the less sufficient they evaluated their personal resources to accept/tolerate an emotion, the more likely they were to use a maladaptive emotion regulation strategy. We conclude that emotions that people evaluate as harmful or difficult to accept are most likely to be regulated in a maladaptive manner. This implies that modifying beliefs about emotions could represent a promising treatment approach. (shrink)

The situational context within which an activity takes place, as well as the personality characteristics of individuals shape the types of strategies people choose in order to regulate their emotions, especially when confronted with challenging or undesirable situations. Taking self-regulation as the framework to study emotions in relation to learning and performing chamber music canon repertoire, this quasi-experimental and intra-individual study focused on the self-rated emotional states of a professional classical cellist during long-term sustained practice across 100-weeks. This helped (...) to develop greater awareness of different emotions and how they vary over artistic events (9 profiled concerts and 1 commercially recorded album). Data analysis included traditional psychometric measurements to test the internal consistency of the time series data as well as the relationship between variables (artistic events). The study mapped the cellist’s flexible regulation of 17 different positive and negative emotions empirically linked to learning and achievement while practicing within the social context of performing music publicly at a high level. Findings arising from the study help with understandings of how to support musicians to maximize their artistic potential by reducing emotion dysregulation and strengthening the types of adaptive methods that enable them to manage their own emotions. (shrink)

There is growing evidence that some individuals engage in both self-harm and aggression during the course of their lifetime. The co-occurrence of self-harm and aggression is termed dual-harm. Individuals who engage in dual-harm may represent a high-risk group with unique characteristics and pattern of harmful behaviours. Nevertheless, there is an absence of clinical guidelines for the treatment and prevention of dual-harm and a lack of agreed theoretical framework that accounts for why people may engage in this behaviour. The present work (...) aimed to address this gap in the literature by providing a narrative review of previous research of self-harm, aggression and dual-harm, and through doing so, presenting an evidence-based theory of dual-harm – the cognitive-emotional model of dual-harm. This model draws from previous studies and theories, including the General Aggression Model, diathesis-stress models and emotional dysregulation theories. The cognitive-emotional model highlights the potential distal, proximal and feedback processes of dual-harm, the role of personality style and the possible emotional regulation and interpersonal functions of this behaviour. In line with our theory, various clinical and research implications for dual-harm are suggested, including hypotheses to be tested by future studies. (shrink)

Emotional dysregulation, age, gender, and obesity are transdiagnostic risk factors for the development and maintenance of eating disorders. Previous studies found that patients with ED had less meaning in life than the non-clinical population, and that meaning in life acted as a buffer in the course of ED; however, to the data, there are no studies about the mediator role of meaning in life in association between the emotional dysregulation and the ED psychopathology.Objective: To analyze the (...) mediating role of meaning in life in the relationship between emotional dysregulation and the ED psychopathology in three samples with diverse risk factors for ED.Method: Sample 1, n = 153 undergraduate young women; sample 2, n = 122 participants with obesity; and sample 3, n = 292 participants with ED. Multiple mediation analysis was performed.Results: Sample 1: meaning in life showed a mediation effect between emotional dysregulation and the ED psychopathology, body satisfaction, and depression symptoms ; sample 2: meaning in life showed a mediation effect between emotional dysregulation and binge eating and purging behaviors and depression symptoms ; sample 3: meaning in life showed a mediation effect between emotional dysregulation and the ED psychopathology, body satisfaction, borderline symptoms, and hopelessness.Conclusions: These studies suggest the importance of considering meaning in life as a variable in the onset and maintenance of ED. (shrink)

Introduction: Adolescence is the most critical life period for the development of eating disorder symptomatology. Although problems in identity functioning and emotion dysregulation have been proven important risk and maintaining factors of ED symptomatology, they have never been integrated in a longitudinal study.Methods: The present study is part of the Longitudinal Identity research in Adolescence -study and aimed to uncover the temporal interplay between identity functioning, cognitive emotion regulation, and ED symptomatology in adolescence. A total of 2,162 community adolescents (...) participated at three measurement points with 1-year intervals. They reported on identity functioning, cognitive emotion regulation, and ED symptomatology.Results: Cross-lagged paths could be fixed for boys and girls and showed bidirectional associations between both dimensions of identity functioning and both rumination and catastrophizing over time. Similarly, these maladaptive cognitive emotion regulation strategies were bidirectionally related to ED symptomatology over time. Finally, indirect pathways pointed to bidirectional associations between both dimensions of identity functioning and bulimia symptoms through rumination and catastrophizing. Only unidirectional associations emerged for drive for thinness and almost no cross-lagged associations were found with positive reappraisal.Conclusion: The present study demonstrates that identity confusion may contribute to the development of ED symptomatology in adolescence through cognitive emotion dysregulation. It also reveals that these ED symptoms hamper identity development through emotion dysregulation. These results stress the importance of targeting both identity functioning and cognitive emotion regulation in the prevention and intervention of ED symptoms. (shrink)

This article suggests a way to circumvent some of the problems that follow from the lack of consensus on a definition of emotion (Izard, 2010; Kleinginna & Kleinginna, 1981) and emotion regulation (Cole, Martin, & Dennis, 2004) by adopting a conceptual framework based on discrete emotions theory and focusing on specific emotions. Discrete emotions theories assume that neural, affective, and cognitive processes differ across specific emotions and that each emotion has particular motivational and regulatory functions. Thus, efforts at regulation should (...) target the specific dysregulated emotions. The positive effects of emotion regulation are more likely to be optimized when they result from or lead to emotion utilization—the constructive use of the energy of emotion arousal. Effective processes for regulation differ for basic emotions and emotion schemas. This article identifies neural systems that facilitate emotion experiences and emotion regulation processes. It considers the implications of the developmental change from basic emotions to emotion schemas, and also briefly discusses the effects of interventions on changes in emotion knowledge, emotion regulation, and social and emotional competence. (shrink)

Objective: There is a demonstrated link between the mental health and substance use comorbidities experienced by young adults, however the vast majority of psychological interventions are disorder specific. Novel psychological approaches that adequately acknowledge the psychosocial complexity and transdiagnostic needs of vulnerable young people are urgently needed. A modular skills-based program for emotion regulation and impulse control addresses this gap. The current one armed open trial was designed to evaluate the impact that 12 weeks exposure to ERIC alongside usual care (...) had on young people's ability to regulate emotions, as well as examine potential moderating mechanisms.Methods: Seventy nine young people were enrolled to the 12 week intervention period. Twenty one practitioners from youth and community health services delivered relevant ERIC modules adjunct to usual care. Linear mixed effects regression was used to examine change over time across the primary outcome of emotion dysregulation and secondary outcomes of depression, anxiety, stress, experiential avoidance and mindfulness. Moderation analyses were conducted to test whether the magnitude of change in emotion dysregulation moderated change over time in secondary outcomes.Results: Analyses revealed significant improvement in the primary outcome of emotion dysregulation with a moderate effect size, in addition to decreases in the secondary outcomes of depression, anxiety, stress and experiential avoidance. No improvements in mindfulness were reported. Moderation analyses revealed that the residualised change over time in emotion dysregulation moderated the change over time in symptoms of distress, depression, anxiety, stress, experiential avoidance, and mindfulness.Conclusion: Reductions in the severity of emotion dysregulation, depression, anxiety, stress and experiential avoidance are promising, and were evident despite the complexity of the participants and the diversity of the service setting. The improvements found in each outcome were only observed for those young people whose emotion regulation also improved, providing preliminary evidence for the role of emotion regulation as a key treatment target in this population. (shrink)

Improving emotion regulation is central to borderline personality disorder (BPD) treatment, but little research indicates which emotion regulation strategies are optimally effective and when. Basic emotion science suggests that engagement emotion regulation strategies that process emotional content become less effective as emotional intensity increases, whereas disengagement strategies that disengage from it do not. This study examined whether emotional reactivity to emotional stimuli predicts the effectiveness of engagement and disengagement emotion regulation across self-report, general physiologic (heart rate), (...) sympathetic (skin conductance responses), and parasympathetic (respiratory sinus arrythmia) emotion in BPD, healthy, and clinical control (i.e. generalized anxiety disorder; GAD) groups. 120 participants (40 per group) were exposed to emotion inductions and then instructed to implement engagement (mindful awareness) and disengagement (distraction) strategies while self-report and physiological emotion measurements were taken. In the BPD and GAD groups, higher heart rate or respiratory sinus arrythmia reactivity, respectively, predicted improved mindful awareness effectiveness. Higher skin conductance reactivity predicted worsened distraction effectiveness in BPD. Higher reactivity may potentiate engagement emotion regulation, and exacerbate disengagement from emotional content, in BPD. Future research should examine other domains of emotion regulation that may be influenced by emotional intensity, and other forms of emotional intensity that may influence them. (shrink)

The article presents the results of research on relationships between types of social participation and emotion regulation. In the study, Gratz’ and Roemer’s perspective on emotion regulation and Reinders’ and Butz’s concept of types of social participation were applied. Participants were 1151 students from three types of vocational schools: basic vocational school, technical upper secondary school, and specialized upper secondary school. The results of studies conducted with the use of Difficulties in Emotion Regulation Scale and Social Participation Questionnaire indicate that (...) there are small, however, significant, differences in the levels of social participation dimensions and the frequency of particular types of social participation between students from the three investigated types of vocational schools. The level of transitive orientation turned out to be higher among students from the basic vocational schools than among students from the specialized upper secondary schools and the technical upper secondary schools. In each educational group, the level of transitive orientation was significantly higher than the level of moratorium orientation. The hypothesis about the relationship between dimensions of emotion regulation and types of social participation, particularly with respect to the dimension of “lack of emotional awareness”, was confirmed. The most effective style in terms of emotion regulation turned out to be the assimilation type. The highest level of emotion dysregulation proved to be connected with the segregation type. (shrink)

BackgroundCognitive Behavioral Therapy is delivered in most of the early intervention services for psychosis in different countries around the world. This approach has been demonstrated to be effective in decreasing or at least delaying the onset of psychosis. However, none of them directly affect the comorbidity of these types of patients that is often the main cause of distress and dysfunctionality. The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders is a psychological intervention that combines cognitive-behavioral and third-generation (...) techniques that address emotional dysregulation as an underlying mechanism that these disorders have in common. The application of this intervention could improve the comorbid emotional symptoms of these patients.Materials and methodsThe study is a randomized controlled trial in which one group receives immediate UP plus standard intervention and the other is placed on a waiting list to receive UP 7 months later, in addition to standard care in one of our early psychosis programs. The sample will be 42 patients with UHR for psychosis with comorbid emotional symptoms. The assessment is performed at baseline, at the end of treatment, and at 3-months’ follow-up, and includes: general psychopathology, anxiety and depression, positive and negative emotions, emotional dysregulation, personality, functionality, quality of life, cognitive distortions, insight, and satisfaction with the UP intervention.DiscussionThis will be the first study of the efficacy, acceptability, and viability of the UP in a sample of young adults with UHR. The results of this study may have clinical implications, contributing to improving the model of care for young people who consult for underlying psychotic, anxiety, and/or depressive symptoms that can lead to high distress and dysfunctionality.Clinical trial registration[https://clinicaltrials.gov/], identifier [NCT04929938]. (shrink)

Cognitive impairment, alterations in mood, emotion dysregulation are just a few of the consequences of depression. Despite depression being reported as the most common mental disorder worldwide, examining depression or risks of depression is still challenging. Emotional reactivity has been observed to predict the risk of depression, but the results have been mixed for negative emotional reactivity. To better understand the emotional response conflict, we asked our participants to describe their feeling in meaningful sentences alongside reporting (...) their reactions to the emotionally evocative words. We presented a word on the screen and asked participants to perform two tasks, rate their feeling after reading the word using the self-assessment manikin scale, and describe their feeling using the property generation task. The emotional content was analyzed using a novel machine-learning algorithm approach. We performed these two tasks in blocks and randomized their order across participants. Beck Depression Inventory was used to categorize participants into self-reported non-depressed and depressed groups. Compared to the ND, the D group reported reduced positive emotional reactivity when presented with extremely pleasant words regardless of their arousal levels. However, no significant difference was observed between the D and ND groups for negative emotional reactivity. In contrast, we observed increased sadness and inclination toward low negative context from descriptive content by the D compared to the ND group. The positive content analyses showed mixed results. The contrasting results between the emotional reactivity and emotional content analyses demand further examination between cohorts of self-reported depressive symptoms, no-symptoms, and MDD patients to better examine the risks of depression and help design early interventions. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Clinical CommentaryRathi Mahendran, Associate ProfessorThe doctor-patient relationship has an important role in medical practice and in medical ethics.1 In modern times, the word “boundary” is used to frame the relationship. In the context of therapy, Gutheil and Simon have described it as “the edge of appropriate or professional behaviour, transgression of which involves the therapist stepping out of the clinical role”.2 Boundaries establish for medical professionals the distinctions between (...) professional and personal identity.3 In a therapeutic setting, boundaries distinguish acceptable and appropriate interactions and the parameters of professional conduct.4 Implicit in the concept of boundaries are the basic ethical principles of beneficence (doing good, acting in another person’s best interests), non-maleficence (doing no harm) and justice with respect for the individual’s needs and autonomy.The doctor-patient relationship is particularly important in psychological therapies where trust, integrity, confidentiality, a safe environment and empathy are fundamental to the therapeutic process. A person with BPD manifests emotional dysregulation with instability in interpersonal relationships, self-image, affect and impulsivity.5 This, together with identity disturbances, makes them a particularly vulnerable group with heightened reliance on their therapist.6Psychotherapy has been described as an interaction which serves to alleviate distress, change behaviour and alter the patient’s perspective of issues. This description however does not reflect the magnitude and significant power differentials in the relationship. Trust and a close bond are needed to allow issues to be addressed.7 In the process, patients’ fantasies and unmet emotional needs [End Page 191] might lead them to knowingly or unknowingly view their therapist differently and to seek a relationship. Similarly, multiple factors in the therapist (situational factors, intrapsychic and interpersonal factors) can undermine the therapeutic process.8Boundary TransgressionsThere is really no universal definition for a “therapeutic boundary” possibly because, as Simon explains, it is “a function of the nature of the patient, the treatment and the status of the therapeutic alliance”.9 Minor violations are referred to as boundary crossings which may arise because the therapist exhibits poor judgement.10 Such actions are non-exploitative and pose little risk to patients.11 Duckworth et al. describe how boundary crossings begin as “exaggerations of desirable attitudes”. Special arrangements and sessions for the patient and extending therapy sessions may be construed as desirable and arguably as effective for the therapeutic alliance.12 Yet, if not examined objectively, they become “subtle breaks in the therapeutic frame”.13Psychotherapists trained in analytic therapy hold very rigid views of doctor-patient interactions in psychological therapy. Some would argue that providing a personal telephone number for a patient in crisis situations is a permissible boundary crossing.14 Similarly, self-disclosure for modelling and on-site behaviour therapy interventions may be viewed as necessary for the therapeutic encounter.15The most commonly recognised boundary crossing, however, is self-disclosure.16 It occurs when the therapist relates a personal experience or information to the patient which is how the incident began in this case.17 It gradually progressed to an informal, friendly style of interaction, accepting a hug, thanking her for being a good friend, all of which are dissonant with the psychotherapeutic process.18In the first place, should the therapist have even offered to drive her home, notwithstanding the heavy downpour? While that offer could be viewed as helpful, the disclosure of marital problems was inappropriate and created confusion. We can only speculate upon the therapist’s behaviour. Was he trying to establish for his patient that they were both experiencing problems to gain her trust? Was he exhibiting some form of identification or did he have some unmet need for affirmation and for care and nurturance? It is difficult to rationalise the apparently thoughtless and impulsive behaviour.19The therapist was, at that point, vulnerable with marital problems and facing separation.20 Procci has highlighted that therapists who breach boundaries, “usually have serious personal problems and may have a psychiatric diagnoses”.21 Even though the relationship was non-sexual, it [End Page 192] moved beyond a boundary crossing and should be viewed as a boundary violation. While the most serious form of boundary violation is the sexual encounter... (shrink)

Aging is associated with decreased functional connectivity in the main brain networks, which can underlie changes in cognitive and emotional processing. Neurofeedback is a promising non-pharmacological approach for the enhancement of brain connectivity. Previously, we showed that a single session of infra-low frequency neurofeedback results in increased connectivity between sensory processing networks in healthy young adults. In the current pilot study, we aimed to evaluate the possibility of enhancing brain connectivity during aging with the use of infra-low frequency neurofeedback. (...) Nine females aged 52 ± 7 years with subclinical signs of emotional dysregulation, including anxiety, mild depression, and somatoform symptoms, underwent 15 sessions of training. A resting-state functional MRI scan was acquired before and after the training. A hypothesis-free intrinsic connectivity analysis showed increased connectivity in regions in the bilateral temporal fusiform cortex, right supplementary motor area, left amygdala, left temporal pole, and cerebellum. Next, a seed-to-voxel analysis for the revealed regions was performed using the post- vs. pre-neurofeedback contrast. Finally, to explore the whole network of neurofeedback-related connectivity changes, the regions revealed by the intrinsic connectivity and seed-to-voxel analyses were entered into a network-based statistical analysis. An extended network was revealed, including the temporal and occipital fusiform cortex, multiple areas from the visual cortex, the right posterior superior temporal sulcus, the amygdala, the temporal poles, the superior parietal lobule, and the supplementary motor cortex. Clinically, decreases in alexithymia, depression, and anxiety levels were observed. Thus, infra-low frequency neurofeedback appears to be a promising method for enhancing brain connectivity during aging, and subsequent sham-controlled studies utilizing larger samples are feasible. (shrink)

Background: Mentalizing, the mental capacity to understand oneself and others in terms of mental states, has been found to be reduced in several mental disorders. Some studies have suggested that eating disorders may also be associated with impairments in mentalizing. The aim of this work is to investigate the possible presence of mentalizing subtypes in a sample of patients with EDs.Method: A sample of patients with eating disorders completed a battery of measures assessing mentalization and related variables, including the Reflective (...) Functioning Questionnaire, the Difficulties in Emotion Regulation Strategies, the Interpersonal Reactivity Index. Clinicians rated patients in relation to imbalances in different dimensions of mentalization to prementalizing modes and attachment style by using the Mentalization Imbalances Scale, the Modes of Mentalization Scale, and the Adult Attachment Questionnaire. A latent profile analysis was conducted to test the possible presence of different subgroups. MANOVA was used to test the possible differences between the four mentalizing profiles in relation to emotion dysregulation, empathy, and adequate and impairments in mentalizing.Results: The latent profile analysis suggested the presence of four different profiles in relation to impairments in the dimensions of mentalization: affective/self/automatic imbalances, external imbalance, cognitive/self/automatic imbalances, and cognitive/other/automatic imbalances. Patients belonging to profile 1 are characterized by the prevalence of affective mentalization that overwhelms the capacity to reflect on mental states with an imbalance on the self-dimension; profile 2 patients are excessively focused on the external cues of mentalization; profile 3 patients are characterized by an over-involvement on the cognitive and self-facets of mentalization, with an impairment in adopting the other mind perspective; and profile 4 patients have similar impairments compared to profile 3 patients but with an excessive focus on others and deficits in self-reflection. These profiles were heterogeneous in terms of EDs represented in each group and presented significant differences on various variables such as attachment style, emotion dysregulation, empathy, interpersonal reactivity, and reflective function. This study represents, so far, the first work that confirms the presence of different mentalizing patterns in ED patients.Conclusions: ED patients can be classified in relation to impairments in different dimensions of mentalization above and beyond ED diagnosis. (shrink)

Religion has long been theorized to serve important functions for societies and individuals; specifically, as a source of knowledge about what is real and as a source of norms prescribing how individuals should behave. However, science and scientists appear to be playing an increasingly large role in public discourse. A majority of adults in the U.S. report interest in science and an increasing number are obtaining degrees in the sciences – more so among males than females. As a result, we (...) examined whether and how participants’ demographic background, religious background, and two indicators of well-being relate to a “belief in science” index, and whether those relations differed among males and females. 560 young adults from diverse ethnic and religious backgrounds participated. The findings presented here suggest that belief in science and religiosity are strongly inversely correlated, and if belief in science does confer emotion-related benefits, it may operate differently across demographic categories. Specifically, we find that belief in science is related to emotion dysregulation and death anxiety among males, but not females, even though females scored lower on these indicators of well-being overall. (shrink)

International studies focus on the successful transition into higher education, which is considered crucial for both the students and the educational institution in the context of students' learning and adjustment in higher education. The aim of the current study was to identify student profiles that include cognitive, metacognitive, and motivational aspects of learning, but also aspects of resilience, emotion dysregulation, and anxiety. The sample consists of 316 Greek undergraduate students. The results showed four different -cognitive-emotional learner profiles: the (...) emotionally stable and highly adaptive learner; the emotionally dysregulated and at risk learner; the emotionally dysregulated and highly adaptive learner; the emotionally stable and at risk learner. Emotionally dysregulated and at risk learner has a lower GPA than the emotional stable and highly adaptive learner, the emotionally dysregulated and highly adaptive learner and the emotionally stable and at risk learner. (shrink)

Anorexia Nervosa (AN) is a psychiatric illness that presents a complex variety of perceptual alterations and somatic sensations. These alterations occur at the level of (1) bodily representations and (2) bodily experiences. The alterations are widespread, and they involve multiple cognitive functions. We reviewed the current literature linking the psychiatric literature on AN with the philosophical debate on the Cognitive Penetrability of Perception (CPP). We describe the alterations in perception, starting from the most widespread and studied, i.e., those concerning distortions (...) in the estimation of the dimensions of one's body (“dysmorphophobia” or “body image disturbance”) to then describe those of more recent analysis involving alterations in bodily experiences. Body image disturbances in AN have been linked to alexithymia, emotional dysregulation, and altered interoceptive awareness, highlighting the complex interaction between emotion, cognition, and perception in AN. We show how the recent debate on CPP can benefit from the empirical investigations in AN, and can, in turn, serve to outline new lines of research. (shrink)

Social cognition is the ability to identify, understand, and interpret mental states and emotions. Psychopathic traits are typically described in two ways; Primary: shallow affect, emotional detachment, and relationship difficulties, and Secondary Psychopathic Traits: antisocial traits, impulsiveness, and emotional dysregulation. People with high psychopathic traits tend to perform lower on measures of social cognition. This study investigated the relationship of social cognition to primary and secondary psychopathic traits in a non-clinical sample, and investigated the psychometric properties of (...) the Reading the Mind in the Eyes Test Short Forms. A community-based male sample was recruited through an online platform. Psychopathic traits were measured using Levenson, Kiehl, and Fitzpatrick's Self-Report Psychopathy Scale, and stratified into Primary and Secondary Psychopathic traits. Secondary validation of the RMET Short Forms was completed investigating scale reliability, and validity. Findings suggest excellent psychometrics in a large community cohort for the RMET Short Forms, with significant negative correlations on social cognitive performance and high self-report psychopathy. The item valence within the social cognitive measure was also examined, and correlated significantly with both Primary and Secondary Psychopathic traits. This study provides further validation of the RMET Short Forms, and adds to the literature on the scale by investigating performance on short-form specific valence. This study further suggests that in a non-clinical community sample of males, that higher psychopathic traits correlated significantly, and negatively, with social cognitive performance. (shrink)

Several psychosocial models have been proposed to explain the etiology of eating disorders and obesity separately despite research suggesting they should be conceptualized within a shared theoretical framework. The objective of the current study was to test an integrated comprehensive model consisting of a host of common risk and protective factors expected to explain both eating and weight disorders simultaneously in a large school-based sample of adolescents. Data were collected from 3,043 youth from 41 schools in the Ottawa region, Canada. (...) Working with interested school staff, validated self-report scales in the form of a questionnaire booklet were administered to participating students to assess several understood risk and protective factors common to both eating disorders and obesity. Anthropometric measurements of weight and height were taken at the end of the questionnaire administration period by trained research staff. Structural equation modeling with cross-validation was used to test the hypothesized model. Findings demonstrated that dysregulated eating was associated with both eating disorder and weight status with diet culture and emotion dysregulation directly associated with some of these disordered eating patterns. It equally pointed to how lifestyle made up of high sedentary behaviors, low vigorous exercise and varied eating patterns contributed to both emotion dysregulation and poor body image which subsequently affected eating issues and weight status simultaneously, signaling the complex interplay of psychosocial factors that underlie these concerns. This study provides evidence for an integrated psychosocial model consisting of socio-environmental, psychological, and behavioral factors may best explain the complex interplay of risk and protective factors influencing eating disorders and obesity. It equally highlights understanding the direct and indirect effects of some of the most salient risk factors involved in eating and weight-related concerns, including the strong effects of diet culture and stressors such as weight-based teasing, providing interventionalists evidence of important risk factors to consider targeting in eating disorder and weight-based prevention efforts. (shrink)

In Mexico, there is little research on the study of self-injury and even less on possible explanatory models. With this in mind, this study aimed to determine the relationship between self-injury and depression, emotional dysregulation, and coping styles, to generate an explanatory model of the problem. The study was carried out using a quantitative, cross-sectional, explanatory scope, design and a sample of 5835 adolescents enrolled in 62 public high schools in the state of Sonora. Logistic regressions were performed (...) for data analysis, and as a result it was found that, for students with severe self-injury, the model explains 61 % of the variance in the data and correctly classifies 84.1 % of the participants; whereas, in mild self-injury, the model explains 72 % of the variance in the data and correctly classifies 88.2 % of the students. Likewise, the depression dimensions showed the highest explanatory level and positive correlations with emotional dysregulation and avoidance coping style, as well as negative correlations with approach coping style. At the end, the importance of the independent variables for future research is discussed, as well as anomalous results and other data of interest. (shrink)

BackgroundDespite the extensive research on war atrocities and risk factors for psychopathology, there is a paucity of research on the potential mediating and moderating effect of neuroticism in refugee children and adolescents.ObjectiveThis study aimed to analyze whether neuroticism mediated and/or moderated the relationship between war atrocities and different types of psychopathology in Syrian refugee children and adolescents who resettled in Lebanon and Jordan.Participants and SettingParticipants were 1,000 Syrian refugee children and adolescents of both sexes.MethodsQuestionnaires were administered in an interview format (...) with children at school by two trained psychologists. Descriptive statistics and inter-correlations among variables were used Then the mediator and moderator effect of neuroticism in the relationship between war atrocities and posttraumatic stress, emotion regulation and behavioral and emotional disorders were examined.ResultsA partial mediating effect of neuroticism on posttraumatic stress disorder, emotion dysregulation, and emotional and behavioral disorders was revealed. Findings also indicated full moderating effects of neuroticism on PTSD as well as partial moderating effects on emotion dysregulation, and emotional and behavioral.ConclusionsFindings contribute to the neuroticism literature by showing that high-N children develop more problems that are psychopathological and have more severe affective reactions to war atrocities in post- resettlement contexts. Early interventions aimed to reduce neuroticism might contribute to a better prognosis in refugee children at high-risk for psychological disorders. (shrink)

This target article considers the relation of fluid cognitive functioning to general intelligence. A neurobiological model differentiating working memory/executive function cognitive processes of the prefrontal cortex from aspects of psychometrically defined general intelligence is presented. Work examining the rise in mean intelligence-test performance between normative cohorts, the neuropsychology and neuroscience of cognitive function in typically and atypically developing human populations, and stress, brain development, and corticolimbic connectivity in human and nonhuman animal models is reviewed and found to provide evidence of (...) mechanisms through which early experience affects the development of an aspect of cognition closely related to, but distinct from, general intelligence. Particular emphasis is placed on the role of emotion in fluid cognition and on research indicating fluid cognitive deficits associated with early hippocampal pathology and with dysregulation of the hypothalamic-pituitary-adrenal axis stress-response system. Findings are seen to be consistent with the idea of an independent fluid cognitive construct and to assist with the interpretation of findings from the study of early compensatory education for children facing psychosocial adversity and from behavior genetic research on intelligence. It is concluded that ongoing development of neurobiologically grounded measures of fluid cognitive skills appropriate for young children will play a key role in understanding early mental development and the adaptive success to which it is related, particularly for young children facing social and economic disadvantage. Specifically, in the evaluation of the efficacy of compensatory education efforts such as Head Start and the readiness for school of children from diverse backgrounds, it is important to distinguish fluid cognition from psychometrically defined general intelligence. (Published Online April 5 2006) Key Words: cognition; cognition-emotion reciprocity; developmental disorders; emotion; fluid cognition; Flynn effect; general intelligence; limbic system; neuroscience; phenylketonuria; prefrontal cortex; psychometrics; schizophrenia. (shrink)

The World Health Organization defined COVID-19 as a pandemic on March 11, due to the spread of the new SARS-CoV-2 coronavirus in all continents. Italy had already witnessed a very fast spread that brought the Government to place the entire country under quarantine on March 11, reaching more than 30,700 fatalities in 2 months. We hypothesized that the pandemic and related compulsory quarantine would lead to an increase of anxiety state and protective behaviors to avoid infections. We aimed to investigate (...) whether protective behaviors might have been enhanced or limited by anxiety and emotional reactions to previous experience of stressful conditions. We collected data from 618 Italian participants, by means of an online survey. Participants were asked to rate their level of worry for the pandemic, and to complete two questionnaires measuring the anxiety level: the state-trait anxiety inventory and the Pre-traumatic stress reaction checklist. Finally, the respondents were also asked to report about their compliance with protective behaviors suggested to avoid the spread of the virus. Results show that respondents with higher levels of worry reported higher levels of anxiety and pre-traumatic reactions, with positive correlations among the three measurements, and that higher frequency of the three protective behaviors were put in place by respondents with higher levels of worry. Moreover, regression analysis showed that worry for COVID-19 was most predicted by age, anxiety levels, and Pre-traumatic stress. These results could be interpreted in an evolutionary framework, in which the level of worry leads persons to become more cautious maximizing long-term survival at the cost of short-term dysregulation. (shrink)

_Manual of Regulation-Focused Psychotherapy for Children with Externalizing Behaviors: A Psychodynamic Approach_ offers a new, short term psychotherapeutic approach to working dynamically with children who suffer from irritability, oppositional defiance and disruptiveness. _RFP-C_ enables clinicians to help by addressing and detailing how the child’s externalizing behaviors have meaning which they can convey to the child. Using clinical examples throughout, Hoffman, Rice and Prout demonstrate that in many dysregulated children, _RFP-C_ can: Achieve symptomatic improvement and developmental maturation as a result of (...) gains in the ability to tolerate and metabolize painful emotions, by addressing the crucial underlying emotional component. Diminish the child’s use of aggression as the main coping device by allowing painful emotions to be mastered more effectively. Help to systematically address avoidance mechanisms, talking to the child about how their disruptive behavior helps them avoid painful emotions. Facilitate development of an awareness that painful emotions do not have to be so vigorously warded off, allowing the child to reach this implicit awareness within the relationship with the clinician, which can then be expanded to life situations at home and at school. This handbook is the first to provide a manualized, short-term dynamic approach to the externalizing behaviors of childhood, offering organizing framework and detailed descriptions of the processes involved in _RFP-C_. Supplying clinicians with a systematic individual psychotherapy as an alternative or complement to PMT, CBT and psychotropic medication, it also shifts focus away from simply helping parents manage their children’s misbehaviors. Significantly, the approach shows that clinical work with these children is compatible with understanding the children’s brain functioning, and posits that contemporary affect-oriented conceptualizations of defense mechanisms are theoretically similar to the neuroscience construct of implicit emotion regulation, promoting an interface between psychodynamics and contemporary academic psychiatry and psychology. Manual of Regulation-Focused Psychotherapy for Children with Externalizing Behaviors: A Psychodynamic Approach is a comprehensive tool capable of application at all levels of professional training, offering a new approach for psychoanalysts, child and adolescent counselors, psychotherapists and mental health clinicians in fields including social work, psychology and psychiatry. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Compelling ReasonsTim Thornton, MA, MPhil, PhD, DLitt (bio)There are many compelling reasons to have an interest in the philosophy of/and psychiatry. In 1994, when persuaded by Bill Fulford to walk down the corridor at Warwick University to join in his teaching of what seemed a newly developing subject—against my protestations that I knew nothing about mental health care—my main interest was in the irreducibility of meaning to the 'realm (...) of [natural scientific] law,' in Sellars's phrase. This had the bonus of complementing Bill's championing of the irreducibility and centrality of values in psychiatry. (It was only later we realized we disagreed about the not inconsequential issue of whether norms and values were subjective preferences or objective features of the world.) It seemed plausible to me that the irreducibility of the space of reasons to the realm of law might have interesting consequences for psychiatry. But mine was a purely disinterested academic interest. This is perhaps the usual approach to what is in part a professionalized academic subject with its formal rules for publication and dissemination of research.It has only been in the last decade that I have experienced things in a more personal way, following what I would term, though psychiatry would not, a nervous breakdown. My image of a breakdown came from reading Saul Bellow's novel Herzog. The titular Herzog has been left by his wife, cruelly, and retires from academic life to write letters. For example, to Heidegger. "Dear Doktor Professor Heidegger, I should like to know what you mean by the expression 'the fall into the quotidian.' When did this fall occur? Where were we standing when it happened?" I thought I would be able to maintain some sort of inquiring mind and write experientially grounded philosophy of psychiatry as a catharsis. I could study my own illness. This immediately proved a ridiculous hope.As a philosopher with a cognitivist bent—language, thought, and intentionality being guiding interests—I had always assumed that madness was only really a matter of what Jaspers calls 'primary delusions,' belief-like states that strain their belief-status, are hard for others to make sense of, and occur only with particularly severe forms of mental illness. But madness is also a matter of doing, saying and feeling as well as pure reasoning. What I would, previously and disinterestedly, have described as a dysregulation of emotional reactions turned out to transform my entire experience of the world and my ability to think rationally about it. I lost the ability to put my experiences into words. In truth, I lost all interest in that project. Only when not distressed could I take a view on my loss of world. Distressed, I did not understand myself.This is a neat illustration of epistemic disjunctivism. But it also highlights a challenge for, and some of the brilliance in those who have contributed to, the philosophy of mental health care, through their expertise by experience. While experience may be a necessary condition for particular forms of expertise, my own case reveals that it is not sufficient. Further, even an everyday and familiar mental illness (like my own) can render the articulation of experience, in a way that makes sense to others, very much harder. Hence the fact [End Page 11] that there is a thriving mental health service and patient movement, making their own experiences available to others combining first-person narratives with conceptual and phenomenological insight is both admirable and helps to set a part of PPP's future agenda: bringing first-person experience within a philosophically and clinically informed discipline. [End Page 12]Tim Thornton Tim Thornton, MA, MPhil, PhD, DLitt, is Professor of Philosophy and Mental Health and Mental Health and Deputy Head for Research in the School of Nursing at the University of Central Lancashire. As well as contemporary philosophy of thought and language, his research concerns conceptual issues at the heart of mental health care. He has published research papers on clinical judgement, idiographic and narrative understanding, the interpretation of psychopathology and reductionism and social constructionism in psychiatry.Copyright © 2023 Johns Hopkins University Press... (shrink)