The “thinking threshold”: A therapeutic concept guided by emotion regulation flexibility.

Cognitive reappraisal is an emotion regulation strategy with significant empirical support. However, it is also true that many people have difficultly using cognitive reappraisal—and any cognitive strategy that requires significant mental effort—while experiencing intense emotions. Per the tenants of emotion-regulation flexibility, we provide information on a therapeutic concept we call the “thinking threshold” which helps clients identify the level of emotional distress at which their thinking becomes impaired. When clients are above the “thinking threshold” they are guided to use behavioral and bodily-focused emotion regulation strategies, and to use cognitive reappraisal and problem solving when below the “thinking threshold.” In this paper, we outline the rationale for considering emotion-regulation flexibility with clients, identify why level of emotional intensity is an important context to consider when helping clients identify effective emotion regulation strategies, and review research supporting the notion that effortful cognitive strategies are less effective at high levels of emotional distress. We also describe how we teach clients to use the “thinking threshold” concept and provide a brief case study demonstrating the utility of the concept with a client. Finally, we review ways in which the “thinking threshold” could be tailored and adapted alongside acceptance-based approaches, and we describe future directions for both empirical examination of the “thinking threshold” as well as expansion within clinical practice.

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Very distal vein bypass in patients with thromboangiitis obliterans

VASA ◽

10.1024/0301-1526/a000624 ◽

2017 ◽

Vol 46 (4) ◽

pp. 304-309 ◽

Cited By ~ 4

Author(s):

Achim Neufang ◽

Carolina Vargas-Gomez ◽

Patrick Ewald ◽

Nicolaos Vitolianos ◽

Tolga Coskun ◽

...

Keyword(s):

Conservative Treatment ◽

Vein Graft ◽

Duplex Ultrasound ◽

Critical Limb Ischaemia ◽

Thromboangiitis Obliterans ◽

Surgical Revascularization ◽

Autologous Vein ◽

Therapeutic Concept ◽

Autologous Vein Graft ◽

Vein Bypass

Abstract. Background: Surgical revascularization for chronic critical limb ischaemia in patients with thromboangiitis obliterans (TAO) still remains controversial. Generally, besides cessation of smoking, conservative treatment supported by intravenous administration of vasoactive agents is regarded as the treatment of choice, in combination with local wound therapy or minor amputation. Patients and methods: In four male patients (42-47 years) surgical revascularization was chosen as therapy for established gangrene or non-healing ulceration after unsuccessful conservative treatment and cessation of smoking. Angiography was able to identify a suitable distal arterial segment for the bypass which was revascularized by means of an autologous vein graft. Grafts were followed with repetitive duplex ultrasound. Revision of the bypass graft was initiated if indicated by pathological duplex findings. Results: In all cases a bypass could be constructed with either the ipsilateral greater saphenous vein or arm veins. A distal origin configuration was possible in three cases with popliteo-pedal or cruro-pedal bypasses. In the fourth case the distal superficial femoral artery was used for inflow. Two early graft thromboses underwent successful revision. During follow-up, duplex ultrasound identified graft stenoses in three bypasses which were successfully treated with endovascular techniques. All grafts are patent with complete resolution of ischaemic symptoms after 46, 42, 32, and 29 months. The patients remained non-smokers and returned to a professional life. Conclusions: Surgical therapy with distal vein bypass for persistent ischaemic symptoms after definitive cessation of smoking seems feasible in selected cases with TAO and a suitable distal artery. Close follow-ups of the patients with duplex ultrasound are necessary to identify developing vein graft stenoses. Angioplasty seems to be an important part of the long-term therapeutic concept.

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Integrative therapy in patients with intermittent claudication

VASA ◽

10.1024/0301-1526/a000413 ◽

2015 ◽

Vol 44 (2) ◽

pp. 85-91

Author(s):

Erich Minar

Keyword(s):

Intermittent Claudication ◽

Modern Technology ◽

Walking Distance ◽

Interventional Treatment ◽

Therapeutic Concept ◽

Integrative Therapy ◽

Risk Factor Modification ◽

Supervised Exercise ◽

Main Challenge ◽

Exercise Programmes

The generally accepted first-line treatment in patients with intermittent claudication is risk factor modification, medical treatment and exercise training. In an era of reduced resources, the benefit of any further invasive intervention must be weighted against best conservative therapy for patients with claudication. According to some recent trials an integrative therapeutic concept combining best conservative treatment - including (supervised) exercise therapy - with endovascular therapy gives the best midterm results concerning walking distance and health-related quality of life. The improved mid- and long-term patency rate with use of modern technology further supports this concept. The conservative and interventional treatment strategy are more complimentary than competitive. The current main challenge is to overcome the economic barriers concerning the availability of exercise programmes.

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The Difficulties in Emotion Regulation Scale (DERS)

Swiss Journal of Psychology ◽

10.1024/1421-0185/a000093 ◽

2013 ◽

Vol 72 (1) ◽

pp. 5-11 ◽

Cited By ~ 29

Author(s):

Elise S. Dan-Glauser ◽

Klaus R. Scherer

Keyword(s):

Emotion Regulation ◽

Well Being ◽

French Translation ◽

French Version ◽

Inappropriate Behaviors ◽

Initial Validation ◽

Difficulties In Emotion Regulation ◽

Instrument Measuring ◽

Highly Correlated ◽

Psychopathological Disorders

Successful emotion regulation is a key aspect of efficient social functioning and personal well-being. Difficulties in emotion regulation lead to relationship impairments and are presumed to be involved in the onset and maintenance of some psychopathological disorders as well as inappropriate behaviors. Gratz and Roemer (2004 ) developed the Difficulties in Emotion Regulation Scale (DERS), a comprehensive instrument measuring emotion regulation problems that encompasses several dimensions on which difficulties can occur. The aim of the present work was to develop a French translation of this scale and to provide an initial validation of this instrument. The French version was created using translation and backtranslation procedures and was tested on 455 healthy students. Congruence between the original and the translated scales was .98 (Tucker’s phi) and internal consistency of the translation reached .92 (Cronbach’s α). Moreover, test-retest scores were highly correlated. Altogether, the initial validation of the French version of the DERS (DERS-F) offers satisfactory results and permits the use of this instrument to map difficulties in emotion regulation in both clinical and research contexts.

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Kognitive Emotionsregulation und Psychopathologie: Erste teststatistische Untersuchung des deutschen Cognitive Emotion Regulation Questionnaire (CERQ) in einer klinischen Stichprobe

Zeitschrift für Psychiatrie Psychologie und Psychotherapie ◽

10.1024/1661-4747/a000248 ◽

2015 ◽

Vol 63 (4) ◽

pp. 255-265 ◽

Cited By ~ 2

Author(s):

Stefanie M. Görgen ◽

Noelle Loch ◽

Wolfgang Hiller ◽

Michael Witthöft

Keyword(s):

Emotion Regulation ◽

Somatoforme Störungen ◽

Cognitive Emotion Regulation

Zusammenfassung. Ein besseres Verständnis der Rolle von Prozessen und Stilen der Emotionsregulation (ER) im Kontext psychischer Störungen erscheint essentiell, um psychische Störungsmodelle und Behandlungskonzepte zu optimieren. Diese Studie überprüfte den Cognitive Emotion Regulation Questionnaire (CERQ) in einer klinischen Stichprobe von ambulanten Psychotherapiepatienten (N = 156) hinsichtlich seiner teststatistischen Güte sowie im Hinblick auf Zusammenhänge mit Psychopathologie. Der CERQ wies eine gute Reliabilität (.70 ≤ α ≤ .84) sowie faktorielle Validität auf. Im Vergleich zu einer Bevölkerungsstichprobe berichtete die klinische Stichprobe höhere Ausprägungen in dysfunktionalen und niedrigere Ausprägungen in funktionalen ER-Strategien. Mittels eines Strukturgleichungsmodells zeigte sich, dass unter Berücksichtigung der Skaleninterkorrelationen drei kognitive ER-Strategien einen signifikanten und inkrementellen Beitrag zur Vorhersage der Gruppenzugehörigkeit zur klinischen Gruppe leisten (Rumination, Planung, Andere beschuldigen). Die klinischen Subgruppen (depressive, Angst- und somatoforme Störungen) unterschieden sich nicht signifikant hinsichtlich des Einsatzes einzelner ER-Strategien. Der Einsatz des CERQ kann auch in klinischen Stichproben empfohlen werden, um transdiagnostisch relevante Prozesse einer veränderten Emotionsregulation zu untersuchen.

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Video Games and Emotion Regulation

GeroPsych ◽

10.1024/1662-9647/a000196 ◽

2018 ◽

Vol 31 (4) ◽

pp. 205-213 ◽

Cited By ~ 1

Author(s):

Kathryn L. Ossenfort ◽

Derek M. Isaacowitz

Keyword(s):

Older Adults ◽

Emotion Regulation ◽

Video Games ◽

Age Differences ◽

Interactive Media ◽

Age Groups ◽

Younger Adults ◽

Media Usage ◽

The Everyday ◽

Media Preferences

Abstract. Research on age differences in media usage has shown that older adults are more likely than younger adults to select positive emotional content. Research on emotional aging has examined whether older adults also seek out positivity in the everyday situations they choose, resulting so far in mixed results. We investigated the emotional choices of different age groups using video games as a more interactive type of affect-laden stimuli. Participants made multiple selections from a group of positive and negative games. Results showed that older adults selected the more positive games, but also reported feeling worse after playing them. Results supplement the literature on positivity in situation selection as well as on older adults’ interactive media preferences.

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Assessment of health related issues in individuals’, couples’, and families’ daily life

Zeitschrift für Gesundheitspsychologie ◽

10.1026/0943-8149.16.3.146 ◽

2008 ◽

Vol 16 (3) ◽

pp. 146-149 ◽

Cited By ~ 2

Author(s):

Meinrad Perrez ◽

Michael Reicherts ◽

Yves Hänggi ◽

Andrea B. Horn ◽

Gisela Michel ◽

...

Keyword(s):

Emotion Regulation ◽

Daily Life ◽

Ecological Validity ◽

Reliability And Validity ◽

Well Being ◽

Computer Assisted ◽

Emotional States ◽

Self Reports ◽

Health Related ◽

Lower Variability

Abstract. Most research in health psychology is based on retrospective self reports, which are distorted by recall biases and have low ecological validity. To overcome such limitations we developed computer assisted diary approaches to assess health related behaviours in individuals’, couples’ and families’ daily life. The event- and time-sampling-based instruments serve to assess appraisals of the current situation, feelings of physical discomfort, current emotional states, conflict and emotion regulation in daily life. They have proved sufficient reliability and validity in the context of individual, couple and family research with respect to issues like emotion regulation and health. As examples: Regarding symptom reporting curvilinear pattern of frequencies over the day could be identified by parents and adolescents; or psychological well-being is associated with lower variability in basic affect dimensions. In addition, we report on preventive studies to improve parental skills and enhance their empathic competences towards their baby, and towards their partner.

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Der Cognitive Emotion Regulation Questionnaire (CERQ)

Zeitschrift für Klinische Psychologie und Psychotherapie ◽

10.1026/1616-3443/a000079 ◽

2011 ◽

Vol 40 (2) ◽

pp. 94-106 ◽

Cited By ~ 45

Author(s):

Noelle Loch ◽

Wolfgang Hiller ◽

Michael Witthöft

Keyword(s):

Emotion Regulation ◽

Cognitive Emotion Regulation

Zusammenfassung. Theoretischer Hintergrund: Der Cognitive Emotion Regulation Questionnaire (CERQ; Garnefski, Kraaij & Spinhoven, 2001 ) erfasst neun Dimensionen kognitiver Emotionsregulation. Fragestellung: Es wurde eine deutsche Adaption des CERQ entwickelt und hinsichtlich Reliabilität, Dimensionalität und Zusammenhängen mit Depressivität und Angstsensitivität getestet. Methode: Die Studie wurde als postalische Fragebogenstudie durchgeführt. Von den zufällig ausgewählt und angeschriebenen 3000 Personen, sendeten 423 den Fragebogen zurück, die finale Stichprobe umfasste N = 414. Angstsensitivität und Depressivität wurden mit dem ASI-3 und dem PHQ-9 erfasst. Ergebnisse: Das 9-Faktorenmodell des CERQ konnte nach einer Verringerung auf drei Items pro Faktor zufriedenstellend repliziert werden. Angstsensitivität und Depressivität zeigten stärkere Zusammenhänge mit dysfunktionalen als mit funktionalen ER-Strategien. Am stärksten waren sie mit Katastrophisierung, Selbstbeschuldigung, Rumination, Neubewertung und Positiver Refokussierung, am schwächsten mit Akzeptanz und Refokussierung auf Planung. Schlussfolgerungen: Der deutsche CERQ ist hinsichtlich Skalenstruktur, Reliabilität und Zusammenhängen mit psychopathologischen Merkmalen vergleichbar mit der niederländischen Originalversion. Obwohl weitere Untersuchungen, insbesondere zur Konstruktvalidität, nötig sind, erscheint der CERQ geeignet für den Einsatz in der Emotionsregulationsforschung.

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Comparable Modulation of the Late Positive Potential by Emotion Regulation in Younger and Older Adults

Journal of Psychophysiology ◽

10.1027/0269-8803/a000009 ◽

2010 ◽

Vol 24 (3) ◽

pp. 186-197 ◽

Cited By ~ 23

Author(s):

Sandra J. E. Langeslag ◽

Jan W. Van Strien

Keyword(s):

Emotion Regulation ◽

Facial Expressions ◽

Age Differences ◽

Late Positive Potential ◽

Self Report ◽

Apparent Discrepancy ◽

Positive Potential ◽

Psychophysiological Responses ◽

Psychophysiological Measures ◽

Emotional Pictures

It has been suggested that emotion regulation improves with aging. Here, we investigated age differences in emotion regulation by studying modulation of the late positive potential (LPP) by emotion regulation instructions. The electroencephalogram of younger (18–26 years) and older (60–77 years) adults was recorded while they viewed neutral, unpleasant, and pleasant pictures and while they were instructed to increase or decrease the feelings that the emotional pictures elicited. The LPP was enhanced when participants were instructed to increase their emotions. No age differences were observed in this emotion regulation effect, suggesting that emotion regulation abilities are unaffected by aging. This contradicts studies that measured emotion regulation by self-report, yet accords with studies that measured emotion regulation by means of facial expressions or psychophysiological responses. More research is needed to resolve the apparent discrepancy between subjective self-report and objective psychophysiological measures.

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Exploring Particular Facets of Cognitive Emotion Regulation and Their Relationships With Nonsuicidal Self-Injury Among Adolescents

Crisis ◽

10.1027/0227-5910/a000566 ◽

2019 ◽

Vol 40 (4) ◽

pp. 280-286 ◽

Cited By ~ 1

Author(s):

Nir Madjar ◽

Nicole Segal ◽

Gilad Eger ◽

Gal Shoval

Keyword(s):

Emotion Regulation ◽

High School Students ◽

Analysis Of Covariance ◽

Depression Symptoms ◽

Emotion Regulation Strategies ◽

Cognitive Emotion Regulation ◽

School Students ◽

Self Injury ◽

Regulation Strategies ◽

Nonsuicidal Self Injury

Abstract. Background: Nonsuicidal self-injury (NSSI) has been found to be associated with poor emotion regulation. Aims: The goal of this study was to examine the association of multidimensional cognitive emotion regulation strategies with NSSI among adolescents and compare the different patterns of NSSI. Method: A sample of 594 high-school students (54.4% boys; mean age = 14.96 years), from five regional schools across Israel, were assessed for five facets of cognitive emotion regulation strategies (acceptance, refocus on planning, positive refocusing, putting into perspective, and positive reappraisal) and NSSI behaviors using validated scales. Participants were allocated into three groups: repetitive NSSI (more than six occasions of NSSI; 7.1%), occasional NSSI (at least one incident but less than six; 8.3%), and no NSSI (84.6%). Results: Analysis of covariance, controlling for gender and depression symptoms, revealed that students with NSSI reported higher levels of acceptance, but lower levels of refocus on planning and putting into perspective. Limitations: The study used a cross-sectional design, which was a limitation. Conclusion: These findings demonstrate that particular cognitive emotion regulation strategies differ substantially in their relationship with NSSI. Adolescents who focus on planning and putting stressful situations into perspective may have increased resilience, whereas adolescents who are accepting of negative events that have happened may be more prone to maladaptive coping behaviors.

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