Misophonia May Be Linked to Emotion Dysregulation

Misophonia—having reduced tolerance for and intense negative emotional reactions to triggering sounds like eating, snoring, gum-snapping, and pen-clicking—may be linked to emotion dysregulation, a study in the Journal of Psychiatric Research suggests.

Laura J. Dixon, Ph.D., of the University of Mississippi, and colleagues analyzed data from 4,005 adults who completed several questionnaires to assess misophonia symptoms, stress, and emotion dysregulation. The questionnaires were based on:

• The Misophonia Questionnaire, to measure sensitivity to certain sounds and emotional and behavioral reactions to misophonia sounds
• The Difficulties in Emotion Regulation Scale, to assess emotion dysregulation, including lack of emotional clarity (Clarity), difficulties engaging in goals (Goals), difficulties controlling emotions when experiencing distress (Impulse), limited access to effective emotion regulation strategies (Strategies), and nonacceptance of emotional responses (Nonacceptance)
• The Work and Social Adjustment Scale, to measure functional impairment due to misophonia across five domains, including ability to work, tasks for the home, social leisure activities, private leisure activities, and relationships with others
• The four-item version of the Perceived Stress Scale, to control for recent stress

Overall, 185 individuals reported clinically significant misophonia symptoms, while another 3,490 reported at least some level of sensitivity to one or more triggering sounds and were classified as having subclinical misophonia.

Two main findings emerged from the questionnaires. First, people with clinical levels of misophonia had significantly greater difficulties in emotion regulation compared with those with subclinical symptoms. Second, emotion dysregulation was significantly associated with sensitivity to misophonia sounds, reactions to misophonia sounds, and misophonia-related impairment, even after controlling for demographic factors and an individual’s current stress.

“[T]he Clarity, Goals, and Nonacceptance subscales were significant, which corresponds to difficulties in knowing and being clear about one’s emotions, focusing on and engaging in goal-directed behaviors, and having a tendency to be less accepting of distress reactions and experiencing secondary negative reactions to the distress (e.g., anger, embarrassment), respectively,” the researchers wrote. “[E]motion dysregulation is central to many disorders, particularly when negative emotions are present, and misophonia is no exception. [F]uture research should conduct comparisons with clinical groups to identify deficits that may be particularly unique to misophonia symptomatology.”

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Online Emotion Regulation Therapy May Reduce Frequency of Self-Injury

Adolescents who engage in non-suicidal self-injury (deliberate harm to one’s body without suicidal intent) are known to be at risk of a variety of problems, including suicidal behaviors. A study published yesterday in JAMA Network Open suggests that adolescents diagnosed with non-suicidal self-injury (NSSI) who participate in an online emotion regulation therapy may be less likely to engage in such self-harm behaviors compared with those receiving usual care.

“There are very few empirically supported treatments for NSSI in adolescence. Dialectical behavior therapy is promising; however, it is a long and resource-demanding treatment that is not widely available,” wrote Johan Bjureberg, Ph.D., of the Karolinska Institutet in Stockholm and colleagues. “Briefer and more accessible treatments for NSSI are needed.”

To test whether a brief treatment delivered online might be able to help youth, Bjureberg and colleagues recruited adolescents aged 13 to 17 diagnosed with non-suicidal self-injury disorder (listed as a condition for further study in DSM-5) who did not have any immediate suicide risk. In total, 166 adolescents were randomly assigned to receive either 12 weeks of online emotion regulation therapy alongside usual care or usual care alone.

Usual care included weekly symptom assessments and supportive therapy sessions every two weeks. The online therapy included 11 educational modules for the adolescents and six modules for their parents. Emotion dysregulation is believed to in part drive NSSI behavior, and the modules aim to teach participants more adaptive ways of responding to their emotions. The participants also had online access to a therapist who encouraged engagement and answered questions.

NSSI frequency was both self-reported by the adolescents weekly and assessed by clinicians before and after treatment.

At the start of the study, the participants reported about 2.5 NSSI episodes per week. From pretreatment to one month post-treatment, the adolescents receiving the online therapy reported a 68% reduction in the number of NSSI episodes per week, whereas those in usual care alone reported no change. Similarly, at the one-month follow-up, the clinicians observed an 82% reduction in NSSI frequency for the online therapy group compared with a 47% reduction for those in usual care. The adolescents receiving the online therapy also reported greater improvements in their emotion regulation and overall functioning as well as fewer self-destructive behaviors compared with usual care at one-month and three-month follow-ups.

There was no difference in depression, anxiety, and stress symptoms between the two groups after the treatment, the researchers wrote. They noted that these findings are consistent with the online therapy’s emphasis on encouraging participants to accept internal experiences and control their behaviors while emotionally distressed, rather than trying to control the emotions themselves. “[T]argeting emotion regulation may not be sufficient for the treatment of anxiety and depression among adolescents,” they wrote.

To read more on this topic, see the Psychiatric News article “People Who Self-Injure Describe Behaviors as Addictive.”

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Study Highlights Importance of Targeting Emotion Regulation to Reduce Self-Harm in Youth

Youth at high risk of suicide may be less likely to engage in self-harm following dialectical behavior therapy (DBT) compared with individual and group supportive therapy (IGST) due to improvements in their ability to regulate emotions, suggests a report published yesterday in the Journal of the American Academy of Child & Adolescent Psychiatry. The findings expand on previously reported results indicating the efficacy of DBT for reducing self-harm and suicide attempts in highly suicidal self-harming adolescents.

“These data suggest that DBT may be particularly beneficial for changing behavior to a point where youth refrain from self-harm,” wrote Joan Rosenbaum Asarnow, Ph.D., of the University of California, Los Angeles, and colleagues.

The authors analyzed data from a previous trial of 173 youth aged 12 to 18 years who had elevated past-month suicidal ideation and a history of prior suicide attempts and repeated self-harm episodes. They received either six months of weekly and individual DBT or IGST. Whereas DBT aims to strengthen skills that lead to improved emotion regulation (including sensitivity to emotional stimuli and the ability to regulate negative affective responses), IGST emphasizes acceptance, validation, and feelings of connectedness and belonging, the authors noted.

Participants in the DBT group received weekly individual psychotherapy, multifamily group skills training, youth and parent telephone coaching, and weekly therapist team consultation. Parents were also seen in the first session, and families were offered up to seven additional family sessions. Participants in the IGST group received individual sessions and adolescent supportive group therapy, as-needed parent sessions (up to seven sessions), and weekly therapist team consultation.

The participants were evaluated at baseline, three months, 6 months, 9 months, and 12 months using several measures, including the Suicide Attempt Self-Injury Interview (SASII) and Difficulties in Emotion Regulation Scale (DERS). A total of 84 participants in the DBT group and 80 in the IGST group completed the six-month treatment, and 77 in the DBT group and 69 in the IGST group completed 12-month follow-up.

As previously reported, participants in the DBT group were significantly less likely to self-harm during the treatment and follow-up period. Youth in the DBT group showed greater improvements in emotion regulation during the active treatment and follow-up. The “improvements in emotion regulation at post-treatment significantly predicted greater self-harm remission at 12 months … and mediated the effect of DBT on self-harm remission at 12 months,” the authors added.

“Our results … suggest that improvements in emotion regulation contributed to the DBT effect on self-harm remission, perhaps due to increased DBT-skill use—a healthy safe way to manage painful emotions,” they continued. “These findings support the significance of emotion regulation as a therapeutic target in treatments for self-harming youth and improvements in emotion regulation as a therapeutic change mechanism in DBT.”

For related information, see the American Journal of Psychiatry article “Suicide Attempt Prevention: A Technology-Enhanced Intervention for Treating Suicidal Adolescents After Hospitalization.”

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Parent-Child Psychotherapy Leads to Improvements in Young Children With Depression

An adapted parent-child psychotherapy proven to help children with disruptive disorders may also reduce symptoms of depression in very young children, according to a study published today in AJP in Advance.

“The study provides very promising evidence that an early and brief psychotherapeutic intervention that focuses on the parent-child relationship and on enhancing emotion development may be a powerful and low-risk approach to the treatment of depression,” lead author Joan L. Luby, M.D., of Washington University School of Medicine in St. Louis said in a press release.

In standard parent-child interaction therapy (PCIT), a therapist first educates parents on ways to successfully interact with their child and then coaches parents as they practice these techniques with their child in an office setting. Previous studies show that PCIT is an effective way to treat disruptive behavior disorders in young children. Luby and colleagues wanted to know if adapting PCIT to focus on enhancing a child’s emotional competence and emotion regulation could reduce symptoms of depression in very young children with major depressive disorder.

Children aged 3 to 6 who met criteria for early childhood depression and their parents were randomly assigned to Parent Child Interaction Therapy–Emotion Development (PCIT-ED, n=114) or a waitlist group (n=115). In addition to depression, some of the children in the study met criteria for comorbid anxiety, attention-deficit/hyperactivity disorder, and/or oppositional defiant disorder at baseline. After the parent-child PCIT-ED pairs completed 12 PCIT sessions, they received training during which parents were taught how to validate their child’s emotions and help the child regulate these emotions. The researchers interviewed children and parents at the beginning and end of the 18-week study to assess the children’s psychiatric symptoms, ability to regulate emotions, and level of impairment and functioning. They also asked parents about how they coped with their child’s negative emotions and their own levels of stress and depression.

Compared with those in the waitlist group, children in the PCIT-ED group were found to have lower rates of depression, lower depression severity, and lower impairment at the end of the study. In addition, rates of comorbid disorders at trial completion, including anxiety disorders and oppositional defiant disorder, were significantly lower in the PCIT-ED group.

The therapy also appeared to have positive effects on the parents of the children with depression, Luby and colleagues reported. “Parents who received the active treatment displayed more emotionally focused parenting techniques and reported marked reductions in stress and a greater sense of positive responsiveness from their child. Also notable was that the treatment resulted in significant reductions in parental depression, even though this was not a direct target of treatment,” they wrote.

“The study findings suggest that early intervention for depression may be a window of opportunity to modify emotional functioning, utilizing the powerful influence of the parent-child relationship during this relatively neuroplastic developmental period to remediate depressive symptoms,” the authors concluded. “Given that depression is a chronic and relapsing disorder, these findings on an early, low-cost, low-risk psychotherapeutic intervention suggest that early identification and treatment of depressive disorders should become a public health priority.”

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