Emotional Regulation in Teens and Improvement of Constructive Skills (EmoTIConS): study protocol for a randomized controlled trial

Laura Pedrini, Roberta Rossi, Laura Rosa Magni, Mariangela Lanfredi, Serena Meloni, Clarissa Ferrari, Ambra Macis, Nicola Lopizzo, Valentina Zonca, Annamaria Cattaneo, Laura Pedrini, Roberta Rossi, Laura Rosa Magni, Mariangela Lanfredi, Serena Meloni, Clarissa Ferrari, Ambra Macis, Nicola Lopizzo, Valentina Zonca, Annamaria Cattaneo

Abstract

Background: Emotional dysregulation (ED) constitutes a relevant factor involved in the onset and maintenance of many mental disorders. Targeting ED during adolescence could be a determinant both to identify high-risk individuals and to promote preventive interventions. This study will aim to evaluate the impact of a brief Dialectical Behavioral Therapy (DBT)-based intervention for adolescent students by measuring changes in emotional regulation skills and impulsive behaviors. Moreover, alterations in biological features related to stress response and inflammation will be assessed as potential biological variables associated with ED.

Methods: This is a randomized trial. A total of 20 classes of adolescent students will be recruited among high schools in Brescia, a city in northern Italy. They will be randomized to the psychoeducational intervention (experimental group) or to a control condition (control group). The intervention will be based on DBT Skills Training for Emotional Problem Solving for Adolescents, and will consist of four monthly, 2-h sessions (for a total of 8 h) scheduled during regular school time. Participants will be assessed at baseline, post-intervention, and at 3 and 6 months of follow-up. The primary outcome measures will be represented by changes in the use of emotional regulation skills and by changes in the frequency of impulsive behaviors. Salivary samples will be collected at baseline and post-intervention to explore possible biological features underlying ED.

Discussion: Data from the present project will offer the opportunity to better understand the complex phenomenon of ED. Repeated assessment will cover several domains (emotional, behavioral, social, biological) as potential factors associated with ED. Moreover, it will be possible to establish the effect of the proposed intervention, thus helping to improve knowledge on the impact of school-based universal preventive programs. Finally, the current trial will propose an integrated screening and intervention-based model. Ultimately, this could reduce barriers to youths' mental health care by fostering collaboration between schools and mental health services.

Trial registration: ClinicalTrials.gov NCT04349709 . Registered on April 16, 2020.

Keywords: Adolescents; Cortisol; Emotional dysregulation; Randomized controlled trial; School; Socioemotional learning; Stress.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

References

    1. Kessler RC, Angermeyer M, Anthony JC, DE Graaf R, Demyttenaere K, Gasquet I, Girolamo G DE, Gluzman S, Gureje O, Haro JM, Kawakami N, Karam A, Levinson D, Medina Mora ME, Oakley Browne MA, Posada-Villa J, Stein DJ, Adley Tsang CH, Aguilar-Gaxiola S, Alonso J, Lee S, Heeringa S, Pennell BE, Berglund P, Gruber MJ, Petukhova M, Chatterji S, Ustün TB. Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization's World Mental Health Survey Initiative. World Psychiatry. 2007;6(3):168–176.
    1. Roberts C, Freeman J, Samdal O, Schnohr CW, de Looze ME, Nic Gabhainn S, et al. The Health Behaviour in School-aged Children (HBSC) study: methodological developments and current tensions. Int J Public Health. 2009. 10.1007/s00038-009-5405-9.
    1. Cosma A, Stevens G, Martin G, Duinhof EL, Walsh SD, Garcia-Moya I, Költő A, Gobina I, Canale N, Catunda C, Inchley J, de Looze M. Cross-national time trends in adolescent mental well-being from 2002 to 2018 and the explanatory role of schoolwork pressure. J Adolesc Health. 2020;66(6):S50–S58. doi: 10.1016/j.jadohealth.2020.02.010.
    1. Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. J Psychopathol Behav Assess. 2004;26(1):41–54. doi: 10.1023/B:JOBA.0000007455.08539.94.
    1. Malhi GS, Byrow Y, Outhred T, Das P, Fritz K. Irritability and internalizing symptoms: modeling the mediating role of emotion regulation. J Affect Disord. 2017;211:144–149. doi: 10.1016/j.jad.2016.12.021.
    1. Vasilev CA, Crowell SE, Beauchaine TP, Mead HK, Gatzke-Kopp LM. Correspondence between physiological and self-report measures of emotion dysregulation: a longitudinal investigation of youth with and without psychopathology. J Child Psychol Psychiatry Allied Discip. 2009;50(11):1357–1364. doi: 10.1111/j.1469-7610.2009.02172.x.
    1. Leichsenring F, Leibing E, Kruse J, New AS, Leweke F. Borderline personality disorder. Lancet. 2011;377(9759):74–84. doi: 10.1016/S0140-6736(10)61422-5.
    1. Young KS, Sandman CF, Craske MG. Positive and negative emotion regulation in adolescence: links to anxiety and depression. Brain Sci. 2019;9(4):76. doi: 10.3390/brainsci9040076.
    1. Golombek K, Lidle L, Tuschen-Caffier B, Schmitz J, Vierrath V. The role of emotion regulation in socially anxious children and adolescents: a systematic review. Eur Child Adolesc Psychiatry. 2020;29(11):1479–1501. doi: 10.1007/s00787-019-01359-9.
    1. Barahmand U, Khazaee A, Hashjin GS. Emotion dysregulation mediates between childhood emotional abuse and motives for substance use. Arch Psychiatr Nurs. 2016;30(6):653–659. doi: 10.1016/j.apnu.2016.02.007.
    1. Simons RM, Hahn AM, Simons JS, Murase H. Emotion dysregulation and peer drinking norms uniquely predict alcohol-related problems via motives. Drug Alcohol Depend. 2017;177:54–58. doi: 10.1016/j.drugalcdep.2017.03.019.
    1. Rajappa K, Gallagher M, Miranda R. Emotion dysregulation and vulnerability to suicidal ideation and attempts. Cognit Ther Res. 2012;36(6):833–839. doi: 10.1007/s10608-011-9419-2.
    1. Peh CX, Shahwan S, Fauziana R, Mahesh MV, Sambasivam R, Zhang YJ, Ong SH, Chong SA, Subramaniam M. Emotion dysregulation as a mechanism linking child maltreatment exposure and self-harm behaviors in adolescents. Child Abus Negl. 2017;67:383–390. doi: 10.1016/j.chiabu.2017.03.013.
    1. Arens AM, Gaher RM, Simons JS. Child maltreatment and deliberate self-harm among college students: testing mediation and moderation models for impulsivity. Am J Orthopsychiatry. 2012;82(3):328–337. doi: 10.1111/j.1939-0025.2012.01165.x.
    1. Espeleta HC, Brett EI, Ridings LE, Leavens ELS, Mullins LL. Childhood adversity and adult health-risk behaviors: examining the roles of emotion dysregulation and urgency. Child Abuse Negl. 2018;82:92–101. doi: 10.1016/j.chiabu.
    1. CASEL. Safe and sound - an educational leader’s guide to evidence-based social and emotional programs. Collab Acad Soc Emot Learn [CASEL]. 2003.
    1. Zins JE, Bloodworth MR, Weissberg RP, Walberg HJ. The Scientific Base Linking Social and Emotional Learning to School Success. In: J. E, Zins RP, Weissberg MC, Walberg WHJ, editors. Building academic success on social and emotional learning: what does the research say? New York:Teachers College Press; 2004. p. 3–22.
    1. Taylor RD, Oberle E, Durlak JA, Weissberg RP. Promoting positive youth development through school-based social and emotional learning interventions: a meta-analysis of follow-up effects. Child Dev. 2017;88(4):1156–1171. doi: 10.1111/cdev.12864.
    1. Sharp C, Vanwoerden S, Wall K. Adolescence as a sensitive period for the development of personality disorder. Psychiatric Clinics of North America. 2018;41(4):669–683. doi: 10.1016/j.psc.2018.07.004.
    1. Linehan MM. Cognitive behavioural therapy of borderline personality disorder. New York: Guilford Press; 1993.
    1. Ritschel LA, Lim NE, Stewart LM. Transdiagnostic applications of DBT for adolescents and adults. Am J Psychother. 2015;69(2):111–128. doi: 10.1176/appi.psychotherapy.2015.69.2.111.
    1. Neacsiu AD, Rompogren J, Eberle JW, McMahon K. Changes in problematic anger, shame, and disgust in anxious and depressed adults undergoing treatment for emotion dysregulation. Behav Ther. 2018;49(3):344–359. doi: 10.1016/j.beth.2017.10.004.
    1. Wilks CR, Lungu A, Ang SY, Matsumiya B, Yin Q, Linehan MM. A randomized controlled trial of an Internet delivered dialectical behavior therapy skills training for suicidal and heavy episodic drinkers. J Affect Disord. 2018;232:219–228. doi: 10.1016/j.jad.2018.02.053.
    1. Chen EY, Cacioppo J, Fettich K, Gallop R, McCloskey MS, Olino T, et al. An adaptive randomized trial of dialectical behavior therapy and cognitive behavior therapy for binge-eating. Psychol Med. 2017;47(4):703–717. doi: 10.1017/S0033291716002543.
    1. Goldstein TR, Fersch-Podrat RK, Rivera M, Axelson DA, Merranko J, Yu H, Brent DA, Birmaher B. Dialectical behavior therapy for adolescents with bipolar disorder: results from a pilot randomized trial. J Child Adolesc Psychopharmacol. 2015;25(2):140–149. doi: 10.1089/cap.2013.0145.
    1. Perepletchikova F, Nathanson D, Axelrod SR, Merrill C, Walker A, Grossman M, Rebeta J, Scahill L, Kaufman J, Flye B, Mauer E, Walkup J. Randomized clinical trial of dialectical behavior therapy for preadolescent children with disruptive mood dysregulation disorder: feasibility and outcomes. J Am Acad Child Adolesc Psychiatry. 2017;56(10):832–840. doi: 10.1016/j.jaac.2017.07.789.
    1. Uliaszek AA, Rashid T, Williams GE, Gulamani T. Group therapy for university students: a randomized control trial of dialectical behavior therapy and positive psychotherapy. Behav Res Ther. 2016;77:78–85. doi: 10.1016/j.brat.2015.12.003.
    1. Zapolski TC, Smith GT. Pilot study: implementing a brief DBT skills program in schools to reduce health risk behaviors among early adolescents. J Sch Nurs. 2017;33(3):198–204. doi: 10.1177/1059840516673188.
    1. Martinez RR, Marraccini ME, Knotek SE, Neshkes RA, Vanderburg J. Effects of Dialectical Behavioral Therapy Skills Training for Emotional Problem Solving for Adolescents (DBT STEPS-A) program of rural ninth-grade students. School Mental Health. 2021. 10.1007/s12310-021-09463-5.
    1. Zimmermann P, Iwanski A. Emotion regulation from early adolescence to emerging adulthood and middle adulthood: age differences, gender differences, and emotion-specific developmental variations. Int J Behav Dev. 2014;38(2):182–194. doi: 10.1177/0165025413515405.
    1. Ahmed SP, Bittencourt-Hewitt A, Sebastian CL. Neurocognitive bases of emotion regulation development in adolescence. Dev Cogn Neurosci. 2015;15:11–25. doi: 10.1016/j.dcn.2015.07.006.
    1. Kessler RC, McLaughlin KA, Green JG, Gruber MJ, Sampson NA, Zaslavsky AM, et al. Childhood adversities and adult psychopathology in the WHO world mental health surveys. Br J Psychiatry. 2010;197(5):378–385. doi: 10.1192/bjp.bp.110.080499.
    1. Jennissen S, Holl J, Mai H, Wolff S, Barnow S. Emotion dysregulation mediates the relationship between child maltreatment and psychopathology: a structural equation model. Child Abus Negl. 2016;62:51–62. doi: 10.1016/j.chiabu.2016.10.015.
    1. Braquehais MD, Picouto MD, Casas M, Sher L. Hypothalamic-pituitary-adrenal axis dysfunction as a neurobiological correlate of emotion dysregulation in adolescent suicide. World J Pediatr. 2012;8(3):197–206. doi: 10.1007/s12519-012-0358-0.
    1. Iorio CRD, Carey CE, Michalski LJ, Corral-Frias NS, Conley ED, Hariri AR, et al. Hypothalamic-pituitary-adrenal axis genetic variation and early stress moderates amygdala function. Psychoneuroendocrinol. 2017;80:170–178. doi: 10.1016/j.psyneuen.2017.03.016.
    1. Reid B, Danese A. Challenges in researching the immune pathways between early life adversity and psychopathology. Dev Psychopathol. 2020;32(5):1597–1624. doi: 10.1017/S0954579420001157.
    1. Goodyer IM, Herbert J, Tamplin A, Altham PME. Recent life events, cortisol, dehydroepiandrosterone and the onset of major depression in high-risk adolescents. Br J Psychiatry. 2000;177:499–504. doi: 10.1192/bjp.177.6.499.
    1. Halligan SL, Herbert J, Goodyer I, Murray L. Disturbances in morning cortisol secretion in association with maternal postnatal depression predict subsequent depressive symptomatology in adolescents. Biol Psychiatry. 2007;62(1):40–46. doi: 10.1016/j.biopsych.2006.09.011.
    1. Alink LR, van Ijzendoorn MH, Bakermans-Kranenburg MJ, Mesman J, Juffer F, Koot HM. Cortisol and externalizing behavior in children and adolescents: mixed meta-analytic evidence for the inverse relation of basal cortisol and cortisol reactivity with externalizing behavior. Dev Psychobiol. 2008;50(5):427–450. doi: 10.1002/dev.20300.
    1. Young R, Sweeting H, West P. Associations between DSM-IV diagnosis, psychiatric symptoms and morning cortisol levels in a community sample of adolescents. Soc Psychiatry Psychiatr Epidemiol. 2012;47(5):723–733. doi: 10.1007/s00127-011-0374-8.
    1. Beauchaine TP, Constantino JN, Hayden EP. Psychiatry and developmental psychopathology: unifying themes and future directions. Compr Psychiatry. 2018;87:143–152. doi: 10.1016/j.comppsych.2018.10.014.
    1. Chan A-W, Tetzlaff JM, Altman DG, Laupacis A, Gøtzsche PC, Krleža-Jerić K, Hróbjartsson A, Mann H, Dickersin K, Berlin J, Doré C, Parulekar W, Summerskill W, Groves T, Schulz K, Sox H, Rockhold FW, Rennie D, Moher D. SPIRIT 2013 Statement: defining standard protocol items for clinical trials. Ann Intern Med. 2013;158(3):200–207. doi: 10.7326/0003-4819-158-3-201302050-00583.
    1. Mazza JJ, Dexter-Mazza ET, Miller AL, Rathus JH, Murphy HE. DBT Skills in Schools Skills Training for Emotional Problem Solving for Adolescents (DBT STEPS-A) New York: Guilford Press; 2016. DBT Skills in Schools.
    1. Rathus JH, Miller A. DBT Skills Manual for Adolescents. New York: Guildford Press; 2015.
    1. Neacsiu AD, Rizvi SL, Vitaliano PP, Lynch TR, Linehan MM. The dialectical behavior therapy ways of coping checklist: development and psychometric properties. J Clin Psychol. 2010;66(6):563–582. doi: 10.1002/jclp.20685.
    1. D’Zurilla T, Nezu A, Maydeu-Olivares A. Social Problem-Solving Inventory-Revised (SPSI-R): technical manual. Multi-Health Systems: North Tonawanda, New York; 2002.
    1. Hawkins D, Sofronoff K, Sheffield J. Psychometric properties of the social problem solving inventory-revised short-form: is the short form a valid and reliable measure for young adults? Cognit Ther Res. 2009;33(5):462–470. doi: 10.1007/s10608-008-9209-7.
    1. Giromini L, Velotti P, De Campora G, Bonalume L, Cesare ZG. Cultural adaptation of the difficulties in emotion regulation scale: reliability and validity of an Italian Version. J Clin Psychol. 2012;68(9):989–1007. doi: 10.1002/jclp.21876.
    1. Weinberg A, Klonsky ED. Measurement of emotion dysregulation in adolescents. Psychol Assess. 2009;21(4):616–621. doi: 10.1037/a0016669.
    1. Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–613. doi: 10.1046/j.1525-1497.2001.016009606.x.
    1. Birmaher B, Brent DA, Chiappetta L, Bridge J, Monga S, Baugher M. Psychometric properties of the screen for child anxiety related emotional disorders (SCARED): a replication study. J Am Acad Child Adolesc Psychiatry. 1999;38(10):1230–1236. doi: 10.1097/00004583-199910000-00011.
    1. Crocetti E, Hale WW, 3rd, Fermani A, Raaijmakers Q, Meeus W. Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED) in the general Italian adolescent population: a validation and a comparison between Italy and The Netherlands. J Anxiety Disord. 2009;23(6):824–829. doi: 10.1016/j.janxdis.2009.04.003.
    1. Steinberg L, Sharp C, Stanford MS, Tharp AT. New tricks for an old measure: the development of the Barratt Impulsiveness Scale-Brief (BIS-Brief) Psychol Assess. 2013;25(1):216–226. doi: 10.1037/a0030550.
    1. Fossati A, Krueger RF, Markon KE, Borroni S, Maffei C. Reliability and validity of the Personality Inventory for DSM-5 (PID-5): predicting DSM-IV Personality Disorders and Psychopathy in Community-Dwelling Italian Adults. Assessment. 2013. 10.1177/1073191113504984.
    1. Bernstein DP, Ahluvalia T, Pogge D, Handelsman L. Validity of the childhood trauma questionnaire in an adolescent psychiatric population. J Am Acad Child Adolesc Psychiatry. 1997;36(3):340–348. doi: 10.1097/00004583-199703000-00012.
    1. Anniko MK, Boersma K, van Wijk NPL, Byrne D, Tillfors M. Development of a Shortened Version of the Adolescent Stress Questionnaire (ASQ-S): construct validity and sex invariance in a large sample of Swedish adolescents. Scand J Child Adolesc Psychiatry Psychol. 2018;6(1):4–15. doi: 10.21307/sjcapp-2018-001.
    1. Zullig KJ, Collins R, Ghani N, Patton JM, Scott Huebner E, Ajamie J. Psychometric support of the school climate measure in a large, diverse sample of adolescents: a replication and extension. J Sch Health. 2014;84(2):82–90. doi: 10.1111/josh.12124.
    1. Malecki CK, Demaray MK. Measuring perceived social support: development of the Child and Adolescent Social Support Scale (CASSS) Psychol Sch. 2002;39(1):1–18. doi: 10.1002/pits.10004.
    1. Cosci F, Svicher A, Bech P. The family assessment device: a clinimetric analysis. Psychother Psychosom. 2016;85(4):241–243. doi: 10.1159/000445438.
    1. Flynn D, Joyce M, Weihrauch M, Corcoran P, Gallagher E, O’Sullivan C. Title of subordinate document. In: In: Dialectical Behaviour Therapy – Skills Training for Emotional Problem Solving for Adolescents (DBT STEPS-A): Pilot Implementation in an Irish Context. . Accessed 15 Nov 2021.
    1. Dadaczynski K, Bruun Jensen B, Grieg Viig N, Sormunen M, von Seelen J, Kuchma V, Vilaça T. Health well-being and education: building a sustainable future. The Moscow statement on Health Promoting Schools. Health Educ. 2020;130(1):11–19. doi: 10.1108/HE-12-2019-0058.

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