Implementation of a brief online skills group of dialectical behaviour therapy for emotional dysregulation in Latinx: a withdrawal experimental single-case design.

BACKGROUND: Dialectical behaviour therapy (DBT) skills groups have shown promise as an effective treatment for clients with emotional dysregulation, especially when combined with individual DBT. However, their efficacy is not well established as an online therapy, or in the Latinx population. AIMS: This study aimed to explore satisfaction, retention and effects of an internet-based DBT group added to individual online sessions. METHOD: An ABAB withdrawal experimental single-case design was conducted to evaluate the effect of a brief online DBT skills group on emotional dysregulation, anxiety and depression for five Latinx participants. DBT skills group (phase B) were compared with placebo group sessions (phase A) and fortnightly individual DBT sessions were offered throughout to manage risk. RESULTS: Visual inspection showed a decrease in level of emotional dysregulation and a large effect size according to the Nonoverlap of All Pairs when comparing group DBT and placebo phases. Although depression symptoms decreased after introducing group DBT, anxiety indicators decreased most during the second round of group placebo sessions. DISCUSSION: Whilst only a pilot, this study suggests that online group DBT in Latinx populations is feasible and effective for changing emotional regulation processes but may not effectively target anxiety. Future research might increase the number of DBT sessions in order to enhance learning opportunities and generalization. Replication with larger sample sizes and diverse modalities is needed.

Associations between trauma and substance use among healthcare workers and public safety personnel during the SARS-CoV-2 (COVID-19) pandemic: the mediating roles of dissociation and emotion dysregulation.

BACKGROUND: Given the highly stressful environment surrounding the SARS-CoV-2 pandemic, healthcare workers (HCW) and public safety personnel (PSP) are at an elevated risk for adverse psychological outcomes, including posttraumatic stress disorder (PTSD) and alcohol/substance use problems. As such, the study aimed to identify associations between PTSD severity, related dissociation and emotion dysregulation symptoms, and alcohol/substance use problems among HCWs and PSP. METHODS: A subset of data (N = 498; HCWs = 299; PSP = 199) was extracted from a larger study examining psychological variables among Canadian HCWs and PSP during the pandemic. Structural equation modelling assessed associations between PTSD symptoms and alcohol/substance use-related problems with dissociation and emotion dysregulation as mediators. RESULTS: Among HCWs, dissociation fully mediated the relation between PTSD and alcohol-related problems (indirect effect ß = .133, p = .03) and emotion dysregulation partially mediated the relation between PTSD and substance-related problems (indirect effect ß = .151, p = .046). In PSP, emotion dysregulation fully mediated the relation between PTSD and alcohol-related problems (indirect effects ß = .184, p = .005). For substance-related problems among PSP, neither emotion dysregulation nor dissociation (ps >.05) had any effects. CONCLUSION: To our knowledge, this is the first study examining associations between PTSD severity and alcohol/substance use-related problems via mediating impacts of emotion dysregulation and dissociation among HCWs and PSP during the SARS-CoV-2 pandemic. These findings highlight dissociation and emotion dysregulation as important therapeutic targets for structured interventions aimed at reducing the burden of PTSD and/or SUD among Canadian HCWs or PSP suffering from the adverse mental health impacts of the SARS-CoV-2 pandemic.

Among healthcare workers, dissociation mediated relation between posttraumatic stress disorder (PTSD) severity and alcohol-related problems and emotion dysregulation mediated relation between PTSD severity and substance-related problems.Among public safety personnel, emotion dysregulation mediated relation between PTSD severity and alcohol-related problems. Neither dissociation nor emotion dysregulation mediated relation between PTSD severity and substance-related problems.Results underscore dissociation and emotion dysregulation as potential key therapeutic targets for intervention for healthcare workers and public safety personnel struggling with PTSD and comorbid alcohol/substance use-related problems.

A longitudinal approach to understanding boredom during pandemics: The predictive roles of trauma and emotion dysregulation.

Research during the COVID-19 pandemic and prior outbreaks suggest that boredom is linked to poor compliance with critical lifesaving social distancing and quarantine guidelines, as well as to numerous mental health difficulties. As such, continued understanding on what contributes to boredom is imperative. Extending beyond the roles of constraint, monotony, and trait dispositions (e.g., individual differences in boredom propensity), and informed by prior theories on the emotional contributors of boredom, the current longitudinal study examined the predictive role of "pandemic trauma" on people's boredom, with a focus on how emotion dysregulation mediates this relationship. Community participants (N = 345) completed questionnaires three times across an average of 3 1/2 weeks, rating their pandemic trauma, emotion dysregulation, and boredom over the past week each time. Pandemic trauma was assessed with items querying exposure to coronavirus, as well as the financial, resource-related, and interpersonal pandemic stressors that participants experienced. Emotion dysregulation was assessed with the Difficulties in Emotion Regulation Scale. Boredom was assessed with the short-form Multidimensional State Boredom Scale. The results of a theory-informed mediation model showed that participants' pandemic trauma at Time 1 positively and modestly predicted their boredom at Time 3 and that this relationship was partially and moderately mediated by participants' lack of emotional clarity and difficulties with engaging in goal-directed behaviors at Time 2. When people experience pandemic-related trauma, they subsequently struggle to understand their feelings and engage in goal-oriented actions, and, in turn, feel more bored. Theoretical and clinical implications as related to the emotional underpinnings of boredom are discussed.

A Systematic Review of Mobile Apps as an Adjunct to Psychological Interventions for Emotion Dysregulation.

BACKGROUND: Mental health care has been enriched with the progressive use of technology during the last ten years, in particular after the COVID-19 pandemic. Mobile applications (apps) and smartphones have become the most widespread access point for many people who look for self-help in the psychological domain. OBJECTIVE: We focused on a systematic review of mobile apps for mental health, focusing on the blending of apps with psychotherapy contexts, with a specific focus on emotional dysregulation. METHODS: A comprehensive literature search (January 2017 to August 2022) in PubMed, PsycInfo, Web of Science, and the Cochrane Library was conducted. Abstracts were included if they described mental health mobile apps targeting emotional dysregulation and their use during ongoing psychological or psychotherapy treatment for adults and adolescents. RESULTS: In total, 397 abstracts were identified; of these, 19 publications describing apps targeting borderline personality disorder, depression, anxiety, suicidal behaviors, and post-traumatic stress disorders met the inclusion criteria. CONCLUSIONS: App-enhanced psychotherapy might be a winning combination in many scenarios, but at the same time, many issues must still be faced in this yet emerging scientific field. In conclusion, we tried to put together some major guidelines for mental health mobile app development in the context of psychological treatments.

Mentalizing and emotion dysregulation in emerging adults during the COVID-19 pandemic: a pilot shortterm longitudinal study

Introduction: The COVID-19 pandemic represents an epidemiological and psychological crisis (APA, 2020). In this context, although emerging adults are less likely to get COVID-19, they might have suffered from the national lockdowns over the last year, as they are indeed involved in a crucial development period wherein interpersonal relationships undertake a fundamental function in their psychological well-being. To this end, mentalizing abilities and emotion dysregulation may play a crucial role as possible salutogenic or pathogenic factors on the onset of psychiatric symptoms during the three waves of the COVID-19 pandemic. Objective(s): 1) To examine the relationship between emotion dysregulation assessed at the end of the first wave of COVID-19, mentalizing assessed during the second wave, and psychiatric symptoms levels assessed during the third wave. 2) To examine the moderation role of mentalizing within the relation between emotion dysregulation and psychiatric symptoms. Method(s): Participants were 83 non-clinical emerging adults (Mage=22.18, SD=4.36;57.8% females). Measures applied were Difficulties in Emotion Regulation Scale (DERS) to examine emotion dysregulation, Reflective Functioning Questionnaire to examine mentalizing (RFQ-uncertainty;RFQ-certainty) and Symptom Checklist-90-Revised (SCL-90) to examine psychiatric symptoms (Global Severity Index, GSI). Result(s): DERS-total score (r=.31, p=.03) and both RFQ-uncertainty (r=.41, p<.01) and RFQ-certainty (r=-.33, p=.02) are associated with GSI. Secondly, a significant moderation role by RFQ-u emerged within the relation between DERS-total score and GSI (DELTAR2=.067, beta=.001, SE=.00, CI[.000, .002]). Conclusion(s): These results suggest that mentalizing and emotion dysregulation may play a pivotal role in the onset of psychiatric symptoms during the COVID-19 pandemic. Clinical implications are discussed.

Mental health symptom changes in pregnant individuals across the COVID-19 pandemic: a prospective longitudinal study.

BACKGROUND: Initial studies found that mental health symptoms increased in pregnant and postpartum individuals during the COVID-19 pandemic. Less research has focused on if these putative increases persist over time and what factors influence these changes. We examined the longitudinal change in mental health symptoms in pregnant and postpartum individuals and investigated moderation by maternal emotion dysregulation and the incidence of coronavirus. METHODS: Pregnant and postpartum individuals at the University of Utah were invited to join the COVID-19 and Perinatal Experiences (COPE) Study. Beginning on April 23, 2020 participants were sent a survey comprised of demographics, medical and social history, pregnancy information and self-assessments (Time 1). Participants were contacted 90 days later and invited to participate in a follow-up questionnaire (Time 2). Daily coronavirus case counts were accessed from the state of Utah and a 7-day moving average calculated. Within-subject change in mental health symptom scores, as measured by the Brief Symptom Inventory, was calculated. Linear mixed effects regression modeling adjusted for history of substance abuse and mental health disorders. RESULTS: 270 individuals responded between April 23rd, 2020 and July 15th, 2021. Mental health symptom scores improved by 1.36 points (0.7-2.0 p < 0.001). The decrease in mental health symptoms was not moderated by the prevalence of COVID-19 cases (p = 0.19) but was moderated by emotion dysregulation (p = 0.001) as defined by the Difficulties in Emotion Regulation Scale short form. Participants with higher emotion dysregulation also had higher mental health symptom scores. CONCLUSION: Mental health symptoms improved over the course of the pandemic in the same pregnant or postpartum participant. Our findings do not negate the importance of mental health care during the pandemic. Rather, we believe this identifies some aspect of resiliency and adaptability. Examining emotion dysregulation, or asking about a history of mental health, may be helpful in identifying persons at higher risk of heightened responses to stressors.

Post-Traumatic Stress Disorder and Alcohol Use Disorder During the COVID-19 Outbreak: Do Dissociation and Emotional Metacognitive Beliefs Mediate the Role of Emotion Dysregulation?

OBJECTIVE: Despite the well-documented relationship between emotion dysregulation and both post-traumatic stress disorder (PTSD) and alcohol use disorder symptoms, no studies investigated this issue in the context of the outbreak. Moreover, additional research investigating the role of mediators intervening in these pathways is required. Dissociation and emotional beliefs are two factors that may explain such relationships. However, a poor number of studies empirically tested their role. METHODS: A cross-sectional study on a sample of 719 community participants (32.5% males; Mage=34.36, standard deviation=14.38 years) was conducted. Participants fulfilled a battery of self-report questionnaires measuring levels of PTSD outbreak-related symptoms, alcohol use disorder, emotion dysregulation, emotional beliefs, and dissociation. RESULTS: Partial r-Pearson correlations showed that PTSD symptoms' level was positively and significantly related to all variables investigated in the study whereas alcohol use disorder level was positively and significantly associated with emotion dysregulation and only some dimension of emotional beliefs and dissociation. Results drawn from a structural equation model highlight the mediating role of both emotional belief and dissociation in the relationship linking emotion dysregulation and alcohol use disorder whereas only dissociation, but not emotional beliefs, mediated the link between emotion dysregulation and PTSD symptoms. CONCLUSION: Most of the hypotheses have been supported stressing the relevance of both dissociation and emotional beliefs in PTSD and alcohol use disorder symptoms. These two variables appear important framework from which deepen the impact of emotion dysregulation in psychopathology.

The Relationship between Intimate Partner Violence and Online Help-Seeking: A Moderated Mediation Model of Emotion Dysregulation and Perceived Anonymity.

During the COVID-19 pandemic, lockdowns and isolation have limited the availability of face-to-face support services for victims of intimate partner violence (IPV). Despite the growing need for online help in supporting IPV victims, far less is known about the underlying mechanisms between IPV and online help-seeking. We studied the mediating role of emotion dysregulation (ED) and the moderating role of perceived anonymity (PA) on the internet to explain IPV victims' willingness of online help-seeking (WOHS). Through a PROCESS analysis of the questionnaire data (n = 510, 318 female, 192 male, Mage = 22.41 years), the results demonstrate that: (1) ED has been linked with the experience of IPV, and IPV significantly induces ED. (2) When IPV victims realize the symptoms of ED, they have a strong willingness to seek external intervention to support themselves. ED mediates the relationship between IPV and online help-seeking. (3) For youth growing up in the era of social networking sites (SNS), personal privacy protection is an important factor when seeking online help. The anonymity of the internet has a positive effect on victims who experience IPV and ED, and it increases WOHS. This study introduces a new perspective on the psychological mechanism behind IPV victims' help-seeking behaviors, and it suggests that the improvement of anonymity in online support can be an effective strategy for assisting IPV victims.

Moderating effects of emotion regulation difficulties and resilience on students’ mental health and well-being during the COVID-19 pandemic

This study examined whether emotion regulation difficulties and resilience in college students moderated changes in mental health over the course of the COVID-19 pandemic. Participants (N = 321) completed surveys assessing mental health, in addition to levels of emotion dysregulation, and resilience during the pandemic, then utilized an anchoring prompt to recall mental health experiences before the pandemic. Correlations revealed participants with higher levels of emotion dysregulation also reported lower levels of resilience. Analyses using the SPSS Macro MEMORE (Montoya, 2019) revealed participants with higher levels of emotion regulation difficulties had greater increases in depression and insomnia, and greater decreases in well-being over the course of the COVID-19 pandemic, while participants with lower levels of resilience had greater increases in depression, anxiety, and insomnia over the course of the pandemic. These results highlight the importance of additional support services and mental health training at universities to meet college students’ immediate and long-term emotional needs stemming from the pandemic. © The Author(s) 2022.

Perduring COVID-19 pandemic, perceived well-being, and non-suicidal self-injury behaviors (NSSI) in emerging adults

Introduction. Covid-19 pandemic negatively influenced daily life and psychological well-being on global population. Since conditions of emotional distress appear to underlie non-suicidal self-injury (NSSI) episodes, particularly for individuals with difficulties in emotion regulation, the study explored the relationship between low psychological well-being and the occurrence of NSSI during COVID-19 pandemic. Methods. The study involved two community samples of Italian young adults (18-30 y.o.) recruited in post-lockdown (T1, N=159) or perduring COVID-19 period (T2, N=143). Participants completed online self-report questionnaires on reported NSSI episodes (DSHI), psychological well-being (PWB), and emotion dysregulation (DERS). Results. NSSI occurrence resulted higher in T1 (31.4%) than in T2 period (17.5%). No differences emerged in perceived well-being between T1 and T2, and participants with NSSI (vs. without) reported lower psychological well-being and more emotion dysregulation. Conclusion. Results are discussed according to an eudaimonic perspective that places self-realization and positive functioning as core characteristics of individual’s well-being and resilience to stressful life circumstances © 2022. by the Author(s);licensee Mediterranean Journal of Clinical Psychology, Messina, Italy. This article is an open access article, licensed under a Creative Commons Attribution 4.0 Unported License

Radical Acceptance of Reality: Putting DBT®-A Skill Groups Online During the COVID-19 Pandemic: A Qualitative Study.

Introduction: Emotion dysregulation is a common challenge pertaining to numerous psychiatric disorders in adolescence and is associated with increased morbidity and mortality. Dialectical Behavior Therapy for Adolescents (DBT®-A) has been shown to be an effective treatment, especially in the reduction of self-harm and suicidality. Measures in relation to the COVID-19 pandemic set strict limits on physical contacts with patients. In order to continuously provide evidence-based specialized care to patients suffering from emotion dysregulation, we offered two online DBT®-A skill groups in a video-group-call format. Objective: We aimed at assessing our online DBT®-A skills groups, collect according up- and downsides, and form a basis for advancement of this form of treatment provision. Also, the impact of the COVID-19 pandemic on patients was assessed. Methods: A physical DBT®-A skill group was switched to a video-group-call format and a second group was initiated de novo online. After five sessions, patients engaged in structured group discussions to reflect experiences. Discussion content was analyzed via Inductive Category Formation within the Framework of Qualitative Content Analysis. Results: Patients unanimously found the COVID-19 pandemic challenging, but also reported differentially on its impact. Downsides were balanced by subjective "gains" in time and a perceived reduction in stress. Technical problems of the online format were discussed, but did not limit the positive experience of still receiving treatment. Patients of both online DBT®-A skill groups valued the offer, felt connected, and reported benefits from the treatment. The transition group additionally discussed changes in structure and content of the group sessions after the switch to online meetings and reflected differential functions of the group. Discussion: Although the sample size is small, and conclusions are drawn from Inductive Qualitative Content Analysis, the presented results are of interest. In our investigation, video-group-calls were both safe and beneficial for patients. This alternative to physical meetings is not only interesting for further waves of the current pandemic but also for service provision in remote areas with limited access to specialized care. Further research is needed to challenge and refine our results and to explore extensions to "basic" video-group-calls, such as "break-out sessions," blended therapy, or real-time supervision within an online session.

'Feeling fat' amid the COVID-19 pandemic: Examining the role of emotion dysregulation in the body displacement hypothesis.

'Feeling fat,' the somatic experience of being overweight not entirely explained by objective weight, may occur due to the projection of negative affect onto the body. Individuals may manage 'feeling fat' via eating pathology (e.g., binge eating or dietary restriction) rather than address the source of negative affect. Thus, 'feeling fat' may occur in the absence of adaptive emotion regulation strategies. The COVID-19 pandemic has increased negative affect widely and may potentially contribute to the experience of 'feeling fat' and eating pathology among individuals with emotion dysregulation. This study examined whether emotion dysregulation moderates 'feeling fat's' role as a mechanism underlying the relationship between COVID-19-related distress and eating pathology. This uniqueness of this model to eating pathology was investigated by comparing effects for binge eating and dietary restriction versus anxiety, depression, and problematic alcohol use. Structural equation modelling was used to analyze questionnaire data from 877 participants (77.3% women). 'Feeling fat' explained significant variance in the relationship between COVID-19-related distress and both binge eating and restriction. Emotion dysregulation modulated the strength of these relationships. However, 'feeling fat's role in the relationship between pandemic-related distress and negative psychological outcomes was not unique to eating pathology and did not vary based upon emotion dysregulation. Individuals with elevated emotion dysregulation are more likely to report eating pathology, but not other outcomes, in the context of 'feeling fat'. In contrast, 'feeling fat' underlies the relationship between COVID-19-distress and transdiagnostic psychological outcomes, meaning 'feeling fat' should be considered in risk for psychopathology beyond eating disorders.

State and Trait Risk and Resilience Factors Associated with COVID-19 Impact and Obsessive-Compulsive Symptom Trajectories.

The COVID-19 pandemic may exacerbate common symptoms of obsessive-compulsive disorder, such as fears of contamination or causing harm to others. To investigate the potential impact of COVID-19 on obsessive-compulsive (OC) symptoms, we utilized a frequent sampling prospective design to assess changes in OC symptoms between April 2020 and January 2021. We examined in a broad clinical and non-clinical sample whether baseline risk (e.g., emotion dysregulation, anxiety sensitivity, intolerance of uncertainty) and protective (e.g., resilience) factors would predict OC symptom changes, and whether coping strategies would mediate week-to-week changes in COVID-19 impact and OC symptoms. Emotion dysregulation was associated with greater likelihood of OC symptom worsening, whereas resilience was associated with lower likelihood. Longitudinal mediation analyses revealed that coping strategies were not significant mediators; however, changes in adaptive coping were associated with subsequent-week OC symptom reductions. Regardless of perceived COVID-19 impact, implementing adaptive coping strategies may prospectively reduce OC symptoms. Supplementary Information: The online version contains supplementary material available at 10.1007/s41811-021-00128-4.

Risk of Suicidal Behavior in Children and Adolescents Exposed to Maltreatment: The Mediating Role of Borderline Personality Traits and Recent Stressful Life Events.

Childhood maltreatment (CM) is associated with increased non-suicidal self-injury (NSSI) and suicidal behavior (SB), independently of demographic and mental health conditions. Self-Trauma Theory and Linehan's Biopsychosocial Model might explain the emergence of Borderline Personality Disorder (BPD) symptoms as mediators of the association between CM and the risk of SB. However, little is known regarding such relationships when the exposure is recent for young persons. Here, we study 187 youths aged 7-17, with or without mental disorders. We explore CM experiences (considering the severity and frequency of different forms of neglect and abuse), recent stressful life events (SLEs), some BPD traits (emotion dysregulation, intense anger and impulsivity), and the risk of SB (including NSSI, suicide threat, suicide ideation, suicide plan and suicide attempt). We study the direct and mediating relationships between these variables via a structural equation analysis using the statistical software package EQS. Our findings suggest that youths exposed to more severe/frequent CM have more prominent BPD traits, and are more likely to have experienced recent SLEs. In turn, BPD traits increase the risk of SLEs. However, only emotion dysregulation and recent SLEs were found to be correlated with SB. Therefore, targeted interventions on emotion dysregulation are necessary to prevent NSSI or SB in children and adolescents exposed to CM, as is the minimization of further SLEs.

Deliberate self-harm in adolescents during COVID-19: The roles of pandemic-related stress, emotion regulation difficulties, and social distancing.

The objective of this study was to conduct an ecologically valid test of etiological models of deliberate self-harm (DSH) during the COVID-19 pandemic. Using a sample of Canadian adolescents, we investigated: (1) the association between COVID-19-related stress and DSH; (2) whether emotion regulation (ER) difficulties mediated/moderated this association, including whether these effects differed by age; and (3) whether the mediating/moderating effects of ER difficulties were stronger among socially distanced youth. Canadian adolescents (N = 809) aged 12-18 were recruited on social media and completed an online survey. COVID-19-related stress was associated with recent DSH. Nonacceptance of emotional responses and limited access to ER strategies fully mediated this association. The indirect effect through nonacceptance of emotional responses was stronger among more socially distanced youth, whereas the indirect effect through limited access to ER strategies was stronger among older and more socially distanced youth. COVID-19-related stress and ER difficulties did not interact to predict DSH, nor did age or social distancing moderate these interactions. These results align with etiological models proposing central roles for stress and ER difficulties in DSH. Furthermore, this study underscores a need to support adolescents, particularly older teens with reduced in-person interactions, in adaptively coping with pandemic-related stress.

A Fear of COVID-19 and PTSD Symptoms in Pathological Personality: The Mediating Effect of Dissociation and Emotion Dysregulation.

Background: The 2019 coronavirus disease (COVID-19) outbreak is currently putting a strain on the mental health resilience of the world's population. Specifically, it is likely to elicit an intense response to fear and to act as a risk factor for the onset of posttraumatic stress disorder (PTSD). Some individuals may be more at risk than others, with pathological personality variables being a potential candidate as a central vulnerability factor. In addition, the pathways that lead the pathological personality to PTSD and intense fear responses to COVID-19 are likely to be explained by poor emotion regulation capacities, as well as by dissociative mechanisms. Aims: This study aimed to shed light on vulnerability factors that may account for the onset of PTSD and intense responses of fear in response to COVID-19 outbreak and to test the mediating role of emotion dysregulation and dissociation proneness in these pathways. Methods: We used a longitudinal design of research administered to a sample of community individuals (N = 308; meanage = 35.31, SD = 13.91; 22.7% were male). Moreover, we used self-report questionnaires to measure pathological personality, emotion regulation capacities, dissociative proneness at the beginning of the lockdown, and PTSD symptoms and fear of COVID-19 at the end of the Italian lockdown (from March 9 to May 18, 2020). Structural equation modeling was used to test the hypotheses. Results: We found that pathological personality levels longitudinally predicted PTSD and fear of COVID-19 levels. Moreover, the associations between emotion dysregulation and dissociation were shown to significantly and totally mediate the relationship between pathological personality and PTSD, whereas no significant mediation effects were observed in relation to fear of COVID-19. Conclusions: Individuals with pathological personality traits may be more vulnerable to the onset of negative psychological consequences related to COVID-19 outbreak, such as PTSD symptomatology and fear levels. Emotion regulation capacities appear to be relevant targets of interventions for PTSD symptomatology. Future research should explore the mediating variables linking pathological personality to intense fear responses to COVID-19.

Emotional eating during COVID-19 in the United Kingdom: Exploring the roles of alexithymia and emotion dysregulation.

Emotional eating, generally defined as (over)-eating in response to negative emotions, has been associated with poor physical and psychological outcomes. During a time of heightened negative affect, it is important to understand the impact of the COVID-19 pandemic and associated lockdown measures on eating behaviours, and further elucidate the ways in which emotional eating is related to emotion dysregulation and impaired abilities to identify emotions (i.e. alexithymia). The aims of this study were to explore perceived changes in eating behaviours in relation to self-reported negative affect during the pandemic and to examine direct and indirect effects of alexithymia on emotional eating. An online questionnaire measured these constructs in the general population of the United Kingdom (n = 136). Findings demonstrated that those who reported changes to their eating behaviours during the pandemic also reported greater levels of depression during the same time frame. Mediation analyses revealed that difficulties identifying and describing feelings both predicted emotional eating indirectly via emotion dysregulation. Findings contribute to the understanding of the mechanisms underpinning the relationship between alexithymia and emotional eating and describe changes to eating behaviours during COVID-19. We discuss how these findings should be applied, and recommendations for future research.

Loneliness, Emotion Dysregulation, and Internalizing Symptoms During Coronavirus Disease 2019: A Structural Equation Modeling Approach.

Background: Our study aimed to test the hypotheses that an increased level of loneliness experienced during coronavirus disease 2019 (COVID-19) confinement was predictive of internalizing symptoms and that this pathway was mediated by emotion dysregulation levels. Methods: To reach this aim, we performed an online longitudinal survey recruiting 1,330 participants at Time 1 (at the beginning of the lockdown) and 308 participants at Time 2 (few days before the end of the lockdown). All filled out a set of questionnaires: demographic data, University of California, Los Angeles Loneliness scale, Difficulties in Emotion Regulation Scale-18 items, and Depression Anxiety and Stress Scale-21 items. Hypotheses were tested using structural equation modeling in two steps and controlling for age. First, hypotheses were tested on cross-sectional data. Then, a cross-lagged panel analysis was performed on longitudinal data. Results: Models obtained a good fit and evidenced the predictive role of loneliness levels on the three outcomes (i.e., depression, anxiety, and stress). Moreover, we found that emotion dysregulation levels partially mediated the longitudinal relationship between loneliness and both depression and stress but not between loneliness and anxiety levels. Conclusions: This study points out that a central goal of clinical intervention could be the ability to regulate negative emotional states.