Nonsuicidal self-injury (NSSI) in adolescents with depressive disorder is characterized by recurrent impulsivity and is a predictor of future suicidal behavior, necessitating effective and feasible interventions. Mindfulness-based cognitive therapy for adolescents (MBCT-A), a first-line treatment for depression, was evaluated in this trial for its efficacy in reducing NSSI in this population.

In this randomized, single-blind, controlled trial, 94 hospitalized adolescents diagnosed with depressive disorder and engaging in NSSI were allocated to either MBCT-A plus treatment-as-usual (TAU) or TAU alone. The primary outcome was the severity of NSSI, measured by the Adolescent Self-Harm Scale (ASHS) at baseline, post treatment (4 weeks), and at 1-month follow-up. Secondary outcomes encompassed symptoms of anxiety, depression, emotion regulation, risk behaviors, life satisfaction, resilience, rumination, coping styles, and mindfulness. Both intention-to-treat (ITT) and per-protocol (PP) analyses were conducted.

Both ITT and PP analyses revealed significant between-group differences in NSSI severity at 4 weeks. Compared to the control group, the MBCT-A group showed significant improvements in mindfulness awareness, nonreactivity, emotional awareness, depressive symptoms, emotion regulation, and rumination (all P < 0.05). At the 1-month follow-up, the intervention group maintained a significant reduction in NSSI severity (interaction effect: F = 9.454, P < 0.001).

MBCT-A is effective in reducing NSSI behavior and improving mindfulness, emotion regulation, and depressive symptoms among adolescents with depressive disorder and NSSI. These findings support the clinical application of MBCT-A for this high-risk population.

Clinical neuropsychology historically emphasized the assessment of “cold” cognitive functions, whereas emotional and motivational processes remain rarely evaluated. This point-of-view article argues for the inclusion of affective–motivational assessment into neuropsychological practice and outlines the key domains that should be routinely considered.

Drawing on neuroscience and clinical research, we review four core affective–motivational domains: emotional reactivity, emotion regulation, emotion recognition, and social cognition. For each domain, we summarize self-report instruments and performance-based tasks. Beyond these domains, we discuss emotional-cognitive interference as a cross-cutting modulatory mechanism that may influence overall neuropsychological performance.

Evidence indicates that emotional and motivational processes shape cognitive functioning, predict functional outcomes, and contribute uniquely to diagnosis, rehabilitation adherence, and quality of life. Validated tools are available for assessing each domain, and many clinical conditions present affective and social disturbances that may be more disabling than cognitive deficits. Despite this, surveys consistently show that affective–motivational domains are rarely assessed in practice.

Integrating emotional–motivational assessment is essential for achieving a comprehensive characterization of clinically relevant dimensions of everyday functioning. We propose a modular framework guided by referral questions and emphasize the need to develop a brief affective–motivational screener analogous to cognitive screeners such as the Mini-Mental State Examination or Montreal Cognitive Assessment. Systematic assessment of these domains can enhance diagnostic accuracy, strengthen rehabilitation planning, and more accurately reflect the complexity of everyday functioning.

Best practice guidelines recommend CBT for everyone with psychosis, yet high rates of non-engagement and early drop-out result in many not receiving ‘full dose’ therapy. For those who do engage, effect sizes are typically modest. Most people with psychosis have an insecure attachment style, characterised by predictable and problematic patterns of beliefs, emotion regulation and interpersonal behaviours, including help-seeking. Attachment-congruent adaptations to CBT could improve retention and recovery outcomes for people who are also insecurely attached.

This is the first evaluation of attachment-congruent adaptations to CBT for psychosis. We assessed impact of therapy for the first five people (aged 30–50) to complete therapy and measures.

We used a single case ABC design and measured paranoia, voices, help-seeking, coping, and personal goals over baseline, intervention, and follow-up phases. We predicted that adapted CBT would lead to improved outcomes which would be maintained at follow-up. Trait measures of voices, paranoia, attachment, and recovery are used to describe the sample.

Participants presented with complex needs, including paranoia, voices, and attachment insecurity. Baseline phases showed high and variable levels of psychosis. All showed improvements in paranoia, voices, willingness to seek help, ability to cope, and/or personal recovery goals over the intervention phase. Gains were largely maintained or improved further at follow-up.

Attachment-congruent adaptations to CBT are likely to benefit people with psychosis who present with the additional cognitive, affective and behavioural complexities characteristic of insecure attachment, which threaten access and impact of recommended treatments if not addressed.

Emotion regulation relies on the interplay between prefrontal and limbic brain regions, with prefrontal regions implicated in the top-down modulation of the amygdala. In social anxiety disorder, disruptions in these networks have been reported, but most studies used undirected functional connectivity.

Dynamic causal modelling (DCM) was used to assess effective (i.e. directed) connectivity differences during emotion processing and regulation in individuals with social anxiety disorder compared with healthy controls.

A total of 102 participants (61 with social anxiety disorder, 41 healthy controls) performed a functional magnetic resonance imaging emotion regulation task under two conditions: viewing neutral/negative faces, and downregulating emotions using a self-chosen strategy. DCM was applied to model effective connectivity among the amygdala and key prefrontal regions. Connectivity patterns were characterised in healthy controls, and group comparisons tested how social anxiety disorder differed from this baseline model using parametric empirical Bayes. Leave-one-out cross-validation (LOOCV) evaluated whether connectivity differences predicted diagnostic group, symptom severity and emotion regulation difficulties.

In healthy controls, observation of negative faces was characterised by reciprocal influences between the amygdala and prefrontal cortex (PFC), including increased amygdala-to-ventromedial PFC (vmPFC) connectivity and inhibitory vmPFC-to-amygdala connectivity. During emotion regulation, healthy controls showed negative modulation from the amygdala to all prefrontal regions. Patients with social anxiety disorder did not differ from controls in amygdala–prefrontal connectivity; their alterations were confined to prefrontal circuits, with inhibitory connectivity from the pre-supplementary motor area (preSMA) to dorsolateral PFC during observation and bidirectional excitatory connectivity between the preSMA and vmPFC during regulation. LOOCV indicated that connectivity differences predicted diagnostic group.

The results support the idea that emotion processing and regulation influence connectivity between prefrontal areas and the amygdala in a complex, feedback-driven manner. Our findings suggest that aberrant emotion regulation in social anxiety disorder appears to be more closely linked to differences in intra-prefrontal circuits than deficits in amygdala–prefrontal connectivity.

Emotion regulation, while closely linked to depressive symptoms, has seldom been examined together with them in studies of the relationship between chronotype and suicidality. We therefore examined whether chronotype predicts suicidality through the sequential mediation of poor emotion regulation and depressive symptoms. In addition, we examined whether these mediation pathways differ between morning-type and evening-type groups.

This study included 3109 Korean adults from the general population. Chronotype, depressive symptoms, emotion regulation, and suicidality were assessed using the Composite Scale of Morningness, Self-Rating Depression Scale, Emotion Regulation Skills Questionnaire, and the Suicidality module of the Mini International Neuropsychiatric Interview, respectively.

Chronotype did not have a direct effect on suicidality. Instead, eveningness was indirectly linked to higher suicidality. Specifically, individuals with stronger eveningness tendencies reported poorer emotion regulation, which increased depressive symptoms; depressive symptoms, in turn, predicted suicidal ideation, which emerged as a significant predictor of suicide attempts. Subgroup analyses revealed that the same sequential pathway was significant only among evening-types, but not among morning-types.

Chronotype appears to play a role in suicide risk in the general population. Screening for chronotype and focusing on emotion regulation and depressive symptoms may enhance prevention efforts tailored to chronotype, especially for evening-type individuals.

Trauma-related psychopathology is markedly elevated among refugee populations, particularly those living in sustained displacement. While economic, social and psychological factors have been linked to the deterioration of mental health following trauma and displacement, these factors have rarely been investigated concurrently and longitudinally. Consequently, there is little information on the potential longitudinal mechanisms driving mental ill-health in displacement settings. This study explored the temporal association between economic stressors, social stressors, emotion dysregulation and psychopathology in 1,235 refugees displaced in Indonesia.

Refugee participants from Farsi, Dari, Arabic, Somali and English-speaking backgrounds completed an online survey at four timepoints, 6 months apart. Factors of interest were measured using validated instruments including the Patient Health Questionnaire (to assess depressive symptoms), Posttraumatic Diagnostic Scale (to assess posttraumatic stress [PTS] symptoms), Post-Migration Living Difficulties Checklist (to index economic and social stressors) and Difficulties in Emotion Regulation Scale (to assess emotion dysregulation).

Random-intercept cross-lagged panel analysis revealed that economic stressors and emotion dysregulation were central to the longitudinal course of trauma-related psychopathology. Specifically, economic stressors were associated with subsequent increases in PTS symptoms (B = 0.07, p = 0.047), depressive symptoms (B = 0.17, p < .001) and social stressors (B = 0.28, p < .001), while emotion dysregulation was antecedent to increases in PTS (B = 0.16, p < .001), depression symptoms (B = 0.13, p < .001), and social stressors (B = 0.10, p = .017). Additionally, depression was associated with subsequent increases in economic stressors (B = 0.18, p = .001) and social stressors were associated with subsequent increases in economic stressors (B = 0.12, p = .037).

The current study identified both economic stressors and emotion dysregulation as the main drivers of psychopathology for refugees. This indicates that both the structural barriers encountered in the environment and one’s internal capacity have a substantial impact on wellbeing. These findings highlight that alongside psychological interventions, policy changes that facilitate economic empowerment are critically, and equally, important.

Mentalising skills may be conceptualised as composed by both personal and interpersonal competencies, in turn shaped by early adverse experiences and coping strategies. Although cross-sectional observations described a role for mentalising skills in burnout development, large-scale longitudinal studies on the topic remain limited, especially in relation to psychiatry training.

The primary aim was to investigate protective and risk factors for higher burnout scores across time. Secondary aims included testing whether psychiatry exhibited different burnout scores across time in comparison to other medical residents.

A cohort of 1803 medical residents (1131 psychiatry residents) was assessed for mentalising skills, conceptualised as composed of emotional regulation (Difficulties in Emotion Regulation Scale), interpersonal competencies (Interpersonal Competence Questionnaire), coping strategies (Coping Orientation to Problems Experienced) and burnout dimensions (Maslach Burnout Inventory). One-year follow-up was available for 520 psychiatry residents (73.03% response rate) and 234 other medical residents (35.94% response rate). Longitudinal mixed models and bivariate latent change models were employed.

Across all residents, greater levels of burnout were associated with higher scores in insecure attachment, emotional dysregulation and maladaptive coping, as well as lower scores in interpersonal skills. Attending at least one supervision per month was associated with lower burnout scores across time. According to a bivariate latent change model, emotional regulation improvements through years were associated with lower burnout scores across time. In psychiatry residents, lower burnout scores across time were observed as compared to other medical residents. Psychiatry residents benefited from a higher protective effect of interpersonal competencies (group by moderator by time interaction) and coping strategies against burnout.

Mentalising skills may mitigate burnout development. Training in psychiatry emerged as a potential mitigating factor against burnout increases. Structured supervisions may foster professional development and emotional resilience.

Non-suicidal self-injury (NSSI) is a major clinical and public health issue in adolescence. Although psychological factors such as depression, anxiety and emotion dysregulation have been widely examined, less is known about how pain perception and autonomic reactivity interact with these variables in NSSI.

This study aimed to compare pressure pain threshold (PPT), autonomic responses and psychological characteristics between adolescents with NSSI and healthy controls, and to explore associations between pain perception, psychopathology, emotion regulation and NSSI functions.

Sixty-eight adolescents (34 with NSSI, 34 controls) participated. PPT was assessed using a pressure algometer. Depressive symptoms, anxiety symptoms and emotion regulation difficulties were measured, and NSSI functions were evaluated using a standardised tool. Systolic (SBP)/diastolic blood pressure and heart rate were recorded before and after pain stimulation. Correlational analyses and mixed (repeated measures) analyses of variance were performed.

The NSSI group showed a significantly higher PPT than controls (mean difference 1.43 kg/cm2; 95% CI: 0.64–2.00; p < 0.001). A significant group × time interaction emerged for SBP (η2 = 0.09), indicating a blunted post-pain response in the NSSI group. Emotion regulation difficulties were positively associated with PPT (r = 0.28). PPT was also positively correlated with sensation seeking (r = 0.36), autonomy (r = 0.34) and peer bonding (r = 0.36) functions of NSSI.

Adolescents with NSSI demonstrate elevated pain thresholds and altered autonomic reactivity. These findings highlight the importance of considering pain processing alongside psychological characteristics and NSSI functions in clinical assessment and intervention planning.

In this study, a classifier (hyperplane) is determined to distinguish the neural responses during emotion regulation versus viewing images in healthy adults and then applied to determine (i) the effectiveness of the emotion regulation response (defined as emotion regulation distance from the hyperplane [DFHER]) in independent samples of healthy adults, patients with BD, and the patients’ unaffected relatives (URs) and (ii) the association of DFHER with the duration of future (hypo)manic and depressive episodes for patients with BD over a 16-month follow-up period.

Study participants (N = 226) included 65 healthy adults (35 used for support vector machine [SVM] learning [HCTrain] and 30 kept as an independent test sample [HCTest]), 87 patients with newly diagnosed BD (67% BD type 2) and 74 URs. BOLD response data came from an emotion regulation task. Clinical symptoms were assessed at baseline fMRI and after 16 months of specialized treatment.

The SVM ML analysis identified a hyperplane with 75.7% accuracy. Patients with BD showed reduced DFHER relative to the HCTest and UR groups. Reduced DFHER was associated with reduced improvement in psychosocial functioning during the 16-month follow-up time (B = −1.663, p = 0.02).

The neural response during emotion regulation can be relatively well distinguished in healthy adults via ML. Patients with newly diagnosed BD show significant disruption in the recruitment of this emotion regulation response. Disrupted may indicate a reduced capacity for functional improvement during specialized treatment in a mood disorder clinic.

In-person, therapist-supported interventions targeting emotion regulation have been shown to improve the mental health of adolescents. Increasingly, self-directed digital interventions (e.g. mobile apps) are being developed as a cost-effective, scalable solution to widen access to support. However, evidence of the acceptability and feasibility of these interventions has yet to be synthesised.

To identify existing evidence on the benefits, acceptability and feasibility of self-directed digital interventions that target emotion regulation in adolescents (aged 11–18 years).

A Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)-guided systematic review was conducted to identify studies published from 1 January 2010 to 13 November 2024 investigating self-directed digital emotion regulation interventions for adolescents. A total of ten electronic databases were searched (e.g. PsycInfo). Data on the effects, and perceived acceptability, of the interventions were extracted, with results narratively synthesised. Methodological quality was assessed using the Effective Public Health Practice Project Quality Assessment tool.

Six out of 9049 studies met the eligibility criteria and included preliminary evidence on self-directed digital interventions that target emotion regulation, in a pooled sample of 1271 adolescents. All interventions identified were brief (most <1 month) and included different components to target emotion regulation (e.g. mindfulness, mood monitoring). Most interventions demonstrated benefits for emotion regulation and were acceptable for use by an adolescent population.

Although the evidence base was small, the included studies demonstrate preliminary evidence of the benefits and acceptability of self-directed, digital interventions for emotion regulation in adolescents. Future research should focus on approaches beyond mindfulness, including components to target the related skills required to access emotion regulation strategies (e.g. emotional awareness) and use them flexibly.

Accumulating evidence suggests that stress, social relationships, and sex/gender differences in brain function, particularly of the orbitofrontal cortex (OFC), may drive problematic alcohol use. How these factors interact to effect alcohol use, and if they do so differently in men and women, has yet to be explored.

Using a subsample of the publicly available Human Connectome Project data consisting of young adults with problematic alcohol use (N = 491; 41.75% women, ≥1 symptom of alcohol abuse/dependence), we used a moderated moderation approach to test whether perceived stress and sex/gender moderated the effect of a multidimensional measure of social relationship quality on drinking levels. We subsequently tested whether OFC function moderated these effects.

We found that in women, higher friendship and companionship had a protective effect on drinking levels, particularly for women under high stress. In contrast, in men, higher friendship and companionship were linked to increased drinking levels under stress. Preliminary evidence suggested that this effect in men was driven by a subgroup of men with higher OFC reactivity to negative emotional faces.

Our findings suggest that women benefit from friendship and companionship as a form of stress-relief in the context of problematic drinking, whereas men do not, supporting the need of interventions that facilitate emotionally supportive, pro-recovery social environments particularly in men. Preliminary evidence further suggests a role of emotional dysregulation in men. Overall, our findings support the importance of developing sex/gender and neurobiologically informed interventions that target stress-related alcohol use.