Осознанность и эмоциональная дисрегуляция при расстройствах по типу интернализации: трансдиагностическое сравнение БДР, ОКР и их коморбидности

Контекст и актуальность. Эмоциональная регуляция и осознанность представляют собой трансдиагностические механизмы, лежащие в основе интернализирующих расстройств, таких как обсессивно-компульсивное расстройство (ОКР) и большое депрессивное расстройство (БДР). Эти механизмы оказывают значительное влияние на выраженность симптомов и эффективность терапии. Учитывая биологические и феноменологические пересечения между ОКР и БДР, а также высокую коморбидность ними, а также рост числа таких случаев в Иране, необходимо всестороннее понимание аспектов осознанности и регуляции эмоций в этих популяциях. Цель. В настоящем исследовании мы сравнили средних баллы по оценкам эмоциональной эмоций и осознанности среди четырех групп пациентов: с большим депрессивным расстройством (БДР), с обсессивно-компульсивным расстройством (ОКР), с ОКР, у которых впоследствии развились симптомы депрессии (коморбидность ОКР и БДР), и здоровые участники контрольной группы. Всего были отобраны 419 участников, включая 101 человека с диагнозом БДР, 36 человек с диагнозом ОКР, 150 человек с диагнозом ОКР, у которых впоследствии развились депрессивные симптомы (коморбидность), и 132 здоровых участника контрольной группы. Гипотеза. Мы предположили, что сочетание ОКР и БДР приведет к большим трудностям в управлении эмоциями и осознанности. Методы и материалы. Участники заполнили Шкалу депрессии Бека (BDI-II), Йель-Брауновскую шкалу симптомов обсессивно-компульсивного расстройств, Шкалу трудностей регуляции эмоций (DERS) и Пятифакторный опросник осознанности (FFMQ). Результаты. Анализ ковариации показал, что группа с коморбидностью сообщала о более выраженных нарушениях как в компонентах регуляции эмоций, так и в компонентах осознанности по сравнению с тремя другими группами. Кроме того, лица с диагнозом ОКР продемонстрировали лучшие показатели по компонентам осознанности и регуляции эмоций, чем группа с БДР, за исключением нереактивности, по которой лица с БДР показали лучшие результаты. Контрольная группа имела более высокие баллы по всем компонентам. Выводы. Сочетание ОКР и БДР приводит к большим трудностям в управлении эмоциями и осознанности, чем каждое из этих расстройств по-отдельности.

1. Abramowitz, J.S., Jacoby, R.J. (2014). Obsessive‐compulsive disorder in the DSM‐5. Clinical Psychology (New York), 21(3), 221-235. https://doi.org/10.1111/cpsp.12076
2. Aday, J., Rizer, W., Carlson, J.M. (2017). Neural mechanisms of emotions and affect. In: M. Jeon (Ed.), Emotions and Affect in Human Factors and Human-Computer Interaction (pp. 27-52). Academic Press (Elsevier). https://doi.org/10.1016/B978-0-12-801851-4.00002-1
3. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Association.
4. Arnarson, Þ.Ö., Ólason, D.Þ., Smári, J., Sigurðsson, J.F. (2008). The Beck Depression Inventory Second Edition (BDI-II): psychometric properties in Icelandic student and patient populations. Nordic Journal of Psychiatry, 62(5), 360-365. https://doi.org/10.1080/08039480802141166
5. Asadi, S., Daraeian, A., Rahmani, B., Kargari, A., Ahmadiani, A., Shams, J. (2016). Exploring yale-brown obsessive-compulsive scale symptom structure in Iranian OCD patients using item-based factor analysis. Psychiatry Research, 245, 416-422. https://doi.org/10.1016/j.psychres.2016.08.028
6. Baer, R.A., Smith, G.T., Lykins, E., Button, D., Krietemeyer, J., Sauer, S. (2008). Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples. Assessment, 15(3), 329-342. https://doi.org/10.1177/1073191107313003
7. Barnhofer, T., Duggan, D.S., Griffith, J.W. (2011). Dispositional mindfulness moderates the relation between neuroticism and depressive symptoms. Personality and Individual Differences, 51(8), 958-962. https://doi.org/10.1016/j.paid.2011.07.032
8. Başkaya, E., Özgüç, S., Tanrıverdi, D. (2021). Examination of the effectiveness of mindfulness-based cognitive therapy on patients with obsessive-compulsive disorder: Systematic review and meta-analysis. Issues in Mental Health Nursing, 42(9), 861-870. https://doi.org/10.1080/01612840.2021.1904914
9. Bice, M.R., Ball, J., Ramsey, A.T. (2014). Relations between mindfulness and mental health outcomes: need fulfillment as a mediator. Journal of Applied Sport Psychology, 26(2), 191-201. https://doi.org/10.1080/10413200.2014.931066
10. Bierens, M., Hartman, C.A., Klip, H., Deckers, S., Buitelaar, J.K., Rommelse, N.N.J. (2023). Emotion dysregulation as a cross-disorder trait in child psychiatry predicting quality of life and required treatment duration. Frontiers in Psychiatry, 14, 1192513. https://doi.org/10.3389/fpsyt.2023.1192513
11. Blanke, E.S., Schmidt, M., Riediger, M., Brose, A. (2020). Thinking mindfully: How mindfulness relates to rumination and reflection in daily life. Emotion, 20(2), 324-328. https://doi.org/10.1037/emo0000544
12. Calkins, A.W., Berman, N.C., Wilhelm, S. (2013). Recent advances in research on cognition and emotion in OCD: a review. Current Psychiatry Reports, 15(6), 357. https://doi.org/10.1007/s11920-013-0357-4
13. Carlson, R.V., Boyd, K.M., Webb, D.J. (2004). The revision of the Declaration of Helsinki: past, present and future. British Journal of Clinical Pharmacology, 57(6), 695-713. https://doi.org/10.1111/j.1365-2125.2004.02103.x
14. Dalbudak, E., Evren, C., Aldemir, S., Evren, B. (2014). The relationship of internet addiction severity with depression, anxiety, and alexithymia, temperament and character in university students. Cyberpsychology, Behavior, and Social Networking, 17(5), 272-278. https://doi.org/10.1089/cyber.2013.0398
15. Demeyer, I., De Lissnyder, E., Koster, E.H.W., De Raedt, R. (2012). Rumination mediates the relationship between impaired cognitive control for emotional information and depressive symptoms: A prospective study in remitted depressed adults. Behaviour Research and Therapy, 50(5), 292-297. https://doi.org/10.1016/j.brat.2012.02.012
16. Didonna, F., Rossi, R., Ferrari, C., Iani, L., Pedrini, L., Rossi, N. (2019). Relations of mindfulness facets with psychological symptoms among individuals with a diagnosis of obsessive–compulsive disorder, major depressive disorder, or borderline personality disorder. Psychology and Psychotherapy, 92(4), 512-531. https://doi.org/10.1111/papt.12198
17. Dixon-Gordon, K.L., Turner, B.J., Rosenthal, M.Z., Chapman, A.L. (2017). Emotion regulation in borderline personality disorder: an experimental investigation of the effects of instructed acceptance and suppression. Behavior Therapy, 48(6), 750-764. https://doi.org/10.1016/j.beth.2017.03.001
18. Eisenberg, N., Cumberland, A., Spinrad, T.L., Fabes, R.A., Shepard, S.A., Reiser, M., Murphy, B.C., Losoya, S.H., Guthrie, I.K. (2001). The relations of regulation and emotionality to children's externalizing and internalizing problem behavior. Child Development, 72(4), 1112-1134. https://doi.org/10.1111/1467-8624.00337
19. Enkema, M.C., McClain, L., Bird, E.R., Halvorson, M.A., Larsson, S.P. (2020). Associations between mindfulness and mental health outcomes: A systematic review of ecological momentary assessment research. Mindfulness, 11(11), 2455-2469. https://doi.org/10.1007/s12671-020-01462-8
20. Fiddaroini, F.N., Yusuf, A., Rachmawati, P.D. (2020). Effect of mindfulness-based cognitive therapy on symptoms of depression: A systematic review. STRADA Jurnal Ilmiah Kesehatan, 9(1), 792-800.
21. Ghassemzadeh, H., Mojtabai, R., Karamghadiri, N., Ebrahimkhani, N. (2005). Psychometric properties of a Persian-language version of the Beck Depression Inventory - Second edition: BDI-II-PERSIAN. Depression and Anxiety, 21(4), 185-192. https://doi.org/10.1002/da.20070
22. Ghassemzadeh, H., Raisi, F., Firoozikhojastefar, R., Meysamie, A., Karamghadiri, N., Nasehi, A.A. (2017). A study on sexual function in obsessive–compulsive disorder (OCD) patients with and without depressive symptoms. Perspectives in Psychiatric Care, 53(4), 208-213. https://doi.org/10.1111/ppc.12154
23. Ghorbani, N., Watson, P.J., Farhadi, M., Chen, Z. (2014). A multi-process model of self-regulation: influences of mindfulness, integrative self-knowledge and self-control in Iran. International Journal of Psychology, 49(2), 115-122. https://doi.org/10.1002/ijop.12033
24. Gillan, C.M., Papmeyer, M., Morein-Zamir, S., Sahakian, B.J., Fineberg, N.A., Robbins, T.W. (2011). Disruption in the balance between goal-directed behavior and habit learning in obsessive-compulsive disorder. American Journal of Psychiatry, 168(7), 718-726. https://doi.org/10.1176/appi.ajp.2011.10071062
25. González-Martín, A.M., Aibar-Almazán, A., Rivas-Campo, Y., Castellote-Caballero, Y., Carcelén-Fraile, M.D.C. (2023). Mindfulness to improve the mental health of university students: a systematic review and meta-analysis. Frontiers in Public Health, 11, 1284639. https://doi.org/10.3389/fpubh.2023.1284639
26. Gratz, K.L., Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41-54. https://doi.org/10.1023/B:JOBA.0000007455.08539.94
27. Gross, J.J. (2013). Emotion regulation: Taking stock and moving forward. Emotion, 13(3), 359-365. https://doi.org/10.1037/a0032135
28. Gross, J.J. (2014). Emotion regulation: Conceptual and empirical foundations. In: J.J. Gross (Ed.), Handbook of Emotion Regulation (2nd ed., pp. 3-20). Guilford Publications.
29. Hasegawa, A., Somatori, K., Nishimura, H., Hattori, Y., Kunisato, Y. (2021). Depression, rumination, and impulsive action: A latent variable approach to behavioral impulsivity. The Journal of Psychology, 155(8), 717-737. https://doi.org/10.1080/00223980.2021.1939248
30. Hill, C.L.M., Updegraff, J.A. (2012). Mindfulness and its relationship to emotional regulation. Emotion, 12(1), 81-90. https://doi.org/10.1037/a0026355
31. Joormann, J., Stanton, C.H. (2016). Examining emotion regulation in depression: A review and future directions. Behaviour Research and Therapy, 86, 35-49. https://doi.org/10.1016/j.brat.2016.07.007
32. Karyadi, K.A., VanderVeen, J.D., Cyders, M.A. (2014). A meta-analysis of the relationship between trait mindfulness and substance use behaviors. Drug and Alcohol Dependence, 143, 1-10. https://doi.org/10.1016/j.drugalcdep.2014.07.014
33. Khanjani, S., Foroughi, A.A., Bazani, M., Rafiee, S., Tamannaeifar, S., Habibi, M. (2022). Psychometric properties of Persian version of five facets of mindfulness questionnaire. Journal of Research in Medical Sciences, 27, 29.
34. Khosravani, V., Samimi Ardestani, S.M., Sharifi Bastan, F., Malayeri, S. (2021). Difficulties in emotion regulation and symptom dimensions in patients with obsessive-compulsive disorder. Current Psychology, 40(4), 1944-1953. https://doi.org/10.1007/s12144-018-0091-5
35. Kozubal, M., Szuster, A., Wielgopolan, A. (2023). Emotional regulation strategies in daily life: the intensity of emotions and regulation choice. Frontiers in Psychology, 14, 1151833. https://doi.org/10.3389/fpsyg.2023.1151833
36. LeMoult, J., Joormann, J., Kircanski, K., Gotlib, I.H. (2016). Attentional bias training in girls at risk for depression. Journal of Child Psychology and Psychiatry, 57(11), 1326-1333. https://doi.org/10.1111/jcpp.12587
37. Magán, I., Sanz, J., García-Vera, M.P. (2008). Psychometric Properties of a Spanish Version of the Beck Anxiety Inventory (BAI) in General Population. Spanish Journal of Psychology, 11(2), 626-640. https://doi.org/10.1017/S1138741600004637
38. Moini, J., Koenitzer, J., LoGalbo, A. (2021). Global Emergency of Mental Disorders. Academic Press.
39. Murphy, D.L., Moya, P.R., Fox, M.A., Rubenstein, L.M., Wendland, J.R., Timpano, K.R. (2013). Anxiety and affective disorder comorbidity related to serotonin and other neurotransmitter systems: obsessive–compulsive disorder as an example of overlapping clinical and genetic heterogeneity. Philosophical Transactions of the Royal Society B: Biological Sciences, 368(1615), 20120435. https://doi.org/10.1098/rstb.2012.0435
40. Nolen-Hoeksema, S., Wisco, B.E., Lyubomirsky, S. (2008). Rethinking rumination. Perspectives on Psychological Science, 3(5), 400-424. https://doi.org/10.1111/j.1745-6924.2008.00088.x
41. Nowakowski, M.E., McFarlane, T., Cassin, S. (2013). Alexithymia and eating disorders: a critical review of the literature. Journal of Eating Disorders, 1, 21. https://doi.org/10.1186/2050-2974-1-21
42. Ochsner, K.N., Gross, J.J. (2008). Cognitive emotion regulation: insights from social cognitive and affective neuroscience. Current Directions in Psychological Science, 17(2), 153-158. https://doi.org/10.1111/j.1467-8721.2008.00566.x
43. Onur, O., Uluyol, O., Teksin, G. (2021). Emotion regulation difficulties in obsessive-compulsive disorder presenting with reactive and autogenous obsessions. Bilişsel Davranışçı Psikoterapi ve Araştırmalar Dergisi, 10(1), 1-8. https://doi.org/10.5455/bcp.20210507045510
44. Opialla, S., Lutz, J., Scherpiet, S., Hittmeyer, A., Jäncke, L., Rufer, M. (2015). Neural circuits of emotion regulation: a comparison of mindfulness-based and cognitive reappraisal strategies. European Archives of Psychiatry and Clinical Neuroscience, 265(1), 45-55. https://doi.org/10.1007/s00406-014-0510-z
45. Overbeek, T., Schruers, K., Vermetten, E., Griez, E. (2002). Comorbidity of obsessive-compulsive disorder and depression: prevalence, symptom severity, and treatment effect. Journal of Clinical Psychiatry, 63(12), 1106-1112. https://doi.org/10.4088/jcp.v63n1204
46. Rajezi Esfahani, S., Motaghipour, Y., Kamkari, K., Zahiredin, A., Janbozorgi, M. (2012). Reliability and validity of the Persian version of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Iranian Journal of Psychiatry and Behavioral Sciences, 6(1), 49-56.
47. Raphiphatthana, B., Jose, P.E., Kielpikowski, M. (2016). How do the facets of mindfulness predict the constructs of depression and anxiety as seen through the lens of the tripartite theory? Personality and Individual Differences, 97, 265-272. https://doi.org/10.1016/j.paid.2016.03.057
48. Remijnse, P.L., van den Heuvel, O.A., Nielen, M.M.A., Veltman, D.J., van Balkom, A.J.L.M. (2013). Cognitive inflexibility in obsessive-compulsive disorder and major depression is associated with distinct neural correlates. PLoS ONE, 8(3), e59600. https://doi.org/10.1371/journal.pone.0059600
49. Rowe, C., Deledalle, A., Boudoukha, A.H. (2022). Psychiatric comorbidities of obsessive‐compulsive disorder: A series of systematic reviews and meta‐analyses. Journal of Clinical Psychology, 78(7), 1328-1350. https://doi.org/10.1002/jclp.23312
50. Santana, L., Fontenelle, J.M., Yücel, M., Fontenelle, L.F. (2013). Rates and correlates of nonadherence to treatment in obsessive-compulsive disorder. Journal of Psychiatric Practice, 19(1), 42-53. https://doi.org/10.1097/01.pra.0000426327.48412.8c
51. Seyed Hashemi, S.G., Shalchi, B., Yaghoubi, H. (2018). Difficulties in emotion regulation, psychological well-being, and hypersexuality in patients with substance use disorder in Iran. Iranian Journal of Psychiatry and Behavioral Sciences, 12(1), e10449. https://doi.org/10.5812/ijpbs.10449
52. Sharma, E., Sharma, L.P., Balachander, S., Lin, B., Manohar, H., Khanna, P., Lu, C., Garg, K., Thomas, T., Au, A.C.L., Selles, R.R., Højgaard, D.R.M.A., Skarphedinsson, G., Stewart, S.E. (2021). Comorbidities in obsessive-compulsive disorder across the lifespan: a systematic review and meta-analysis. Frontiers in Psychiatry, 12, 703701. https://doi.org/10.3389/fpsyt.2021.703701
53. Thompson, R.J., Kuppens, P., Mata, J., Jaeggi, S.M., Buschkuehl, M., Jonides, J., Gotlib, I.H. (2015). Emotional clarity as a function of neuroticism and major depressive disorder. Emotion, 15(5), 615-624. https://doi.org/10.1037/emo0000067
54. Way, B.M., Creswell, J.D., Eisenberger, N.I., Lieberman, M.D. (2010). Dispositional mindfulness and depressive symptomatology: correlations with limbic and self-referential neural activity during rest. Emotion, 10(1), 12-24. https://doi.org/10.1037/a0018312
55. Whitehead, M., Suveg, C. (2016). Difficulties in emotion regulation differentiate depressive and obsessive–compulsive symptoms and their co-occurrence. Anxiety, Stress, & Coping, 29(2), 161-175. https://doi.org/10.1080/10615806.2015.1020756
56. Williams, J.M.G. (2008). Mindfulness, depression and modes of mind. Cognitive Therapy and Research, 32(6), 721-733. https://doi.org/10.1007/s10608-008-9204-z
57. Wong, S.Y., Mak, W.W., Cheung, E.Y., Ling, C.Y., Lui, W.W., Tang, W., Ma, H.S. (2011). A randomized, controlled clinical trial: the effect of mindfulness-based cognitive therapy on generalized anxiety disorder among Chinese community patients: protocol for a randomized trial. BMC Psychiatry, 11, 187. https://doi.org/10.1186/1471-244X-11-187.