The role of emotion regulation in affective disturbance and psychotic-like experiences in adolescent inpatients

Abstract

Background & rationale: Improving child and adolescent mental health is a national priority. Evidence suggests that effective psychological intervention at the earliest opportunity can reduce the likelihood of a severe and enduring course across a broad spectrum of disorders. Poor emotion regulation (ER) is implicated in the development and persistence of a range of psychopathology, including affective disturbance, post-traumatic symptomatology, and persisting psychotic-like experiences (PLEs). As all of these factors contribute to childhood vulnerability for persisting future mental health problems, including clinical psychosis, understanding their inter-relationships with emotion regulation, and with clinical recovery, could improve interventions to reduce future mental health risk and promote resilience. The current study is the first, to author’s knowledge, to investigate the associations between ER, affective disturbance, trauma, and PLEs and their transdiagnostic roles in clinical recovery from mental health crisis in adolescents. Method: Forty-two adolescent inpatients, aged 12-18 years, completed measures of general psychopathology, affective disturbance, ER, trauma, and PLEs at the start of admission, and a measure of recovery at discharge. A subset repeated the assessment measures at discharge. Results: Participants showed severe ER difficulties at admission, which were strongly associated with affective disturbance, but only weakly associated with trauma and PLEs. Substantial functional recovery occurred over the course of the inpatient stay, but this was unrelated to specific self-report clinical measures at admission. Of these, only ER showed significant change from admission to discharge, independently of functional recovery. Conclusions: Emotion regulation was found to be a key feature of adolescent mental health crisis, and a worthwhile target of inpatient interventions. However, functional and regulatory improvements during the admission were not mirrored by change in self-reported clinical symptoms. Future research should consider the longevity and later impact of improvements in ER: inpatient interventions may require ongoing targeted community support around areas such as improving access to ER strategies to effect symptomatic improvement and thereby reduce future mental health risk.

Date of Award	2014
Original language	English
Awarding Institution	King's College London
Supervisor	Suzanne Jolley (Supervisor) & Sophie Browning (Supervisor)