Reading Report written by BRIAND Enora, CALLARD Marlène, FORCIER Chloé, GAUDUCHON Anthony & JAGUENET Elsa
Key word : psychopathology, emotion regulation, transdiagnostic process, rumination, cognitive repraisal, Gross model
I/ Introduction
“Because of the apparent ubiquity of ER difficulties in psychopathology, several authors have proposed that ER should be regarded as a transdiagnostic process.” (Cludius and coll., 2020).
Emotional regulation (ER) problems, established here as a transdiagnostic process, are thought to impact on psychological disorders. Cognitive reappraisal, negative rumination and positive rumination are examples of adaptive and non-adaptive cognitive emotional regulation strategies. Currently, the dominant approach in psychology, based on the biomedical model, focused on the disorder, in order to establish a diagnosis. However, during the last decade, a growing number of authors and researchers highlighted gaps in this model, such as the inadequacy of traditional classifications to clinical practice (Dalgleish and coll., 2020). They started to study psychological concepts, like ruminations and perfectionism, that were supposed to participate in the maintenance or development of multiple disorders. This way of considering mental process, beyond classifications, is called the transdiagnostic approach, or process approach. The knowledge on this subject is still quite poor, but this approach could greatly modify the therapist’s management of patients. Barbara Cludius and Thomas Ehring, from the Munich psychology department, and Douglass Mennin, from the Columbia psychology department, have therefore explored more precisely the question of emotional regulation, one of their main research interests, in several disorders.
II/ Summary
The aim of this study is to examine emotional regulation strategies, through a review of scientific literature, to determine whether there are significant evidence of the transdiagnostic nature of these processes or not. From a cognitive point of view, the authors consider that a mental process can be considered as transdiagnostic when it is involved in several disorders, and contributes to develop or to at least maintain these disorders. Cludius and his collegues (2020) refer to the Gross model, which distinguishes adaptative ER strategies, such as cognitive reappraisal and positive repeated thoughts, from maladaptive strategies, such as negative ruminations. The hypothesis is that difficulties in ER strategies could be one of the common factors for multiple mental diseases, and could participate in the persistence or development of these diseases.
The specific point of this article is that the researchers focused on a comprehensive examination of three cognitive ER strategies, which are widely studied from a transdiagnostic perspective. The authors chose two criteria to test their hypothesis : the evidence of the presence of each ER strategy across disorders, and the evidence of a causal link between the altered ER strategy and symptoms. Another example of a transdiagnostic process is self-esteem.
Among the selected strategies, the use of cognitive reappraisal has been investigated in many studies and for various diseases. However, very few studies have considered cognitive reappraisal from a causal perspective, even if longitudinal studies converge to show that low use of cognitive reappraisal is a risk factor for anxiety and depression. Thus, several studies agree that cognitive reappraisal has a bidirectional relationship with symptoms, with a causal role and additionally a maintenance role.
Regarding negative ruminations, studies indicate causal involvement in the development or maintenance of disorders.
For positive rumination, research is limited and results are mixed on causality. Studies indicate that high positive rumination should be regarded as specific to manic and hypo-manic symptoms of bipolar disorder.
Cludius et al.’s scientific review reaches two conclusions. On one hand, reduced cognitive reappraisal strategies and extensive use of negative ruminations are significantly involved in several mental disorders. On the other hand, a high level of positive ruminations cannot be considered as a transdiagnostic process, because it is mainly present in bipolar disorder.
III/ Critical evaluation
As a review of the literature, this article uses data from other researches. The authors based their work on a strong bibliography of approximately 50 articles. The higher you use the literature, the stronger the review is. By the way, the number is not the only thing that is important, there is also the quality of the literature used by the authors. As students, it’s difficult to judge the quality of what the article says, but we can observe that authors are very critical of what they say. That means that they did not only search articles to confirm their conclusions, they tried to give us different points of view. They explore the presence or the absence of the three strategies of Emotion Regulation they worked on in different pathologies, and also the causality (or non-causality) link. This type of plan shows us that they tried to be very clear on the recent scientific literature, like a review of literature has to do.
Even if the bibliography seems strong, the authors conclude that we need to work deeper on Emotion Regulation to declare that ER strategies, as transdiagnostic processes, have a causal relation with mental disorders. “The mere presence of a certain process across disorders does not necessarily imply that it is causally involved in the development and/or maintenance of psychopathology” (Cludius and coll., 2020). It shows that it is important to keep working on, because Emotion Regulation processes and psychopathology are very complex and it may be difficult to link them. We found that the fact that authors invite other researchers to continue their work is very important because of the lack of consensus.
One of the criticisms we can make about this article is that authors don’t take position and are always on a blurry vision of what they say, as shown by the following extracts :
- “Results from a small number of treatment studies and laboratory-based experimental studies support a causal link between the use of cognitive reappraisal and reduced negative emotions as well as symptoms, although there is also evidence for a bidirectional relationship” (Cludius and coll., 2020).
- “The limited amount of research on positive rumination has revealed mixed results regarding causality” (Cludius and coll., 2020).
As they wrote, there are too many contradictions in scientific literature, but maybe a tendency can be observed. Emphasizing this tendency can help people who read this article to understand what is the core issue of this article : to determine relevant and genuine therapeutic tools, applicable to the greatest number of mental disorders.
IV/ Conclusion
We found this article interesting, because it introduces a change from the traditional categorical and biomedical approach of mental processes, and because it appears to be relevant for our own research works (TER). Indeed, the psychologist has to be an expert in human functioning, and the dimensional approach offers great keys to understand patients.
Moreover, process approach may be very useful for us, as future psychologists, to manage and help patients suffering from several disorders. Working with patients on their emotion regulation strategies, for example with CBT tools, can help reducing common symptoms, like social anxiety or substance abuse. Working with patients on ER strategies precisely means helping them to develop adapted and not pathological emotion regulation patterns. ER strategies are pathological when they are used all the time and in all situations by the patient, without adaptation to the environment. This article reminds us of another article: “In the transdiagnostic model in psychopathology, emotional regulation difficulties are identified as a proximal risk factor that can generate a multilevel detrimental impact in the subject.” (Muñoz-Navarro and coll., 2022). However, we must be careful to not pathologize everything (Bortolon & Raffard, 2021), because it mainly depends on how the patient feels about his functioning in daily life. The psychologist has to chose the most relevant therapeutic plan for each patient. Muñoz-Navarro and coll. (2022) propose a transdiagnostic therapeutic management using ER strategies for emotional disorders. Finally, further research on transdiagnostic concepts and ER strategies needs to be conducted for a better understanding of this clinical issue.
V/ Bibliography
Bortolon, C., & Raffard, S. (2021). Une approche psychologique des hallucinations : Mécanismes psychologiques (partie I). Annales Médico-psychologiques, revue psychiatrique, 179(5), 409 416. https://doi.org/10.1016/j.amp.2020.08.009
Cludius, B., Mennin, D., & Ehring, T. (2020). Emotion regulation as a transdiagnostic process. Emotion, 20(1), 37 42. https://doi.org/10.1037/emo0000646
Dalgleish, T., Black, M., Johnston, D., & Bevan, A. (2020). Transdiagnostic approaches to mental health problems : Current status and future directions. Journal of Consulting and Clinical Psychology, 88(3), 179 195. https://doi.org/10.1037/ccp0000482
Monestès, J.-L., & Baeyens, C. (2016). L’approche transdiagnostique en psychopathologie. In L’approche transdiagnostique en psychopathologie (p. 1 7). Dunod. https://doi.org/10.3917/dunod.mones.2016.01.0003
Muñoz-Navarro, R., Medrano, L. A., Limonero, J. T., González-Blanch, C., Moriana, J. A., Ruiz-Rodríguez, P., & Cano- Vindel, A. (2022). The mediating role of emotion regulation in transdiagnostic cognitive behavioural therapy for emotional disorders in primary care : Secondary analyses of the PsicAP randomized controlled trial. Journal of Affective Disorders, 303, 206 215. https://doi.org/10.1016/j.jad.2022.01.029
Reading Report written by BRIAND Enora, CALLARD Marlène, FORCIER Chloé, GAUDUCHON Anthony & JAGUENET Elsa