Benjamin J. Mitchell

Objective: Disordered eating (DE) frequently emerges during adolescence and is associated with adverse health outcomes. While negative affect (NA) and emotion regulation (ER) disturbances are implicated in DE, limited research has examined ER flexibility (the ability to use varied regulatory strategies) as a risk factor for DE among adolescents. Method: Adolescents receiving treatment for an eating disorder ( N = 39; M _age = 15.4 ± 1.6; 13–18 years; 97.4% White) completed a 14‐day daily diary protocol assessing NA, three indices of ER flexibility (number of ER strategies, strategy variability [the standard deviation of number of strategies index], strategy effectiveness), and DE behaviors (DEBs). Within‐ and between‐person relationships between regulatory flexibility and daily DEBs were examined via multilevel models. Moderation analyses examined whether ER indices moderated the relationship between mean NA and daily DEBs. Results: Endorsing a higher number of ER strategies was associated with greater DEBs at the within‐ and between‐person levels. Conversely, greater strategy effectiveness at the within‐ and between‐person levels was associated with fewer DEBs. Strategy variability moderated the relationship between mean NA and daily DEBs. Discussion: Among a treatment‐seeking sample of adolescents with eating disorders, this study highlights how greater overall use of ER strategies was associated with greater DEBs, whereas effective use of ER strategies was protective. Interventions aimed at helping adolescents master effective regulatory strategies should be prioritized over teaching a breadth of strategies.

Objective: Approach–avoidance behaviors are key maintaining processes in pediatric anxiety and obsessive-compulsive disorder (OCD). However, limited research has examined which modifiable, transdiagnostic variables are most strongly and uniquely associated with these behaviors. Identifying modifiable variables is clinically important because they can be directly targeted in treatment, and transdiagnostic variables are relevant across multiple conditions that benefit from approach-based interventions. Method: Using baseline data from 112 parent–youth dyads enrolled in a larger intervention study, we applied an exploratory network analysis to examine the interconnections between candidate variables and both child- and parent-reported approach–avoidance behaviors. Results: Higher child-reported distress tolerance was uniquely associated with lower child-reported avoidance, whereas higher parent-reported child anxiety symptoms were uniquely associated with greater parent-reported child avoidance. Child- and parent-reported avoidance were also uniquely positively associated. Conclusions: Distress tolerance and anxiety symptom severity emerged as potentially important network correlates linked to approach–avoidance behaviors in anxious youth. These domains may warrant further investigation as potential intervention-relevant correlates of approach–avoidance behavior. Future research would benefit from examining correlates of approach–avoidance behaviors across additional clinical and non-anxiety contexts with larger samples.

Although many youth with Tourette syndrome (TS) have at least 1 comorbid psychiatric condition (eg, obsessive-compulsive disorder), the extent to which TS is associated with depression remains unclear. This cross-sectional study examined relationships among tic severity, tic-related functional impairment, and depressive symptoms in 277 youth with TS. Tic-related impairment, but not tic severity, was associated with both self- and parent-reported depressive symptoms. An age × sex interaction emerged, such that among younger participants, females reported higher depressive symptoms than males; however, this effect was observed only for self-report, not parent report. Additionally, both depressive symptoms and tic severity were associated with quality of life, though depressive symptoms accounted for substantially more variance. Overall, findings suggest that associations between tics and depression are modest and largely driven by impairment rather than tic severity per se. Depressive symptoms, however, significantly impact quality of life in youth with TS and warrant clinical attention.

A significant proportion of patients with obsessive-compulsive disorder (OCD) are admitted to inpatient hospital facilities. This most often occurs within general psychiatric units, given the scarcity of options specialized to OCD. This study surveyed 69 adults with self-reported OCD who had experienced 1 or more inpatient hospitalizations, with the goal of exploring perceptions of OCD-related care in general inpatient settings. Overall, participants reported negative views of their providers’ attention to OCD-specific needs. Nearly half indicated that none of their providers appeared proficient in or confident working with OCD. Participants were also dissatisfied with the OCD treatment they received. At the same time, more positive perceptions of providers’ ability to treat OCD were associated with a greater likelihood of perceived OCD symptom reduction during hospitalization. These findings are among the first to empirically highlight potential limitations in the standard of care for OCD in general psychiatric units. We discuss avenues for future research, including the need to develop and evaluate provider approaches that balance reducing accommodation of compulsions with supportive responding, which may lay the groundwork for evidence-based practices to better prepare providers to work with patients who have OCD in inpatient settings.

Research suggests that disgust may be more resistant to extinction than fear, with implications for anxiety disorder treatment. Theory suggests that disgust and fear are driven by distinct cognitive learning mechanisms, yet limited research has directly compared them experimentally as most prior work has examined either fear or disgust in isolation, often using different types of unconditioned stimuli (US). In the present online investigation (collected spring 2025), n = 332 participants (i.e., majority White and female undergraduates) were randomly assigned to one of four differential conditioning paradigms, each defined by the emotion and sensory modality of the US: (a) disgust-auditory (DA), (b) fear-auditory (FA), (c) disgust-images, or (d) fear-images. Participants rated the conditioned stimuli (CSs) using a standard US expectancy scale to assess expectancy learning and using discrete emotion ratings (fear and disgust) and valence ratings (pleasantness) to assess evaluative learning. During acquisition, the DA condition showed the strongest learning when measured via discrete emotion ratings, while the FA condition showed the strongest and fastest expectancy learning. DA was also the most resistant to extinction across both evaluative measures. No group differences emerged for reinstatement based on evaluative indices; however, FA produced the strongest reinstatement in US expectancy, while DA showed the weakest. Overall, results support the idea of differences in learning mechanism, suggesting that disgust learning is driven primarily by evaluative cognition, whereas fear learning is driven by expectancy cognition. Disgust's relative resistance to extinction may be a mechanism explaining poorer treatment outcomes for disorders characterized by heightened disgust. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Background: Disorders like obsessive-compulsive disorder are associated with heightened disgust. Research suggests that dominant methods for treating such disorders (e.g., exposure therapies) are less effective at targeting disgust. Alternative strategies are needed to enhance treatment effectiveness.Methods: In two studies, we investigated positive emotion (elicited via humorous content) for attenuating disgust responses to film clips. In Study 1, n = 174 undergraduates were randomized to view either a humorous, sad, or neutral clip prior to a disgusting clip. In study 2, n = 294 undergraduate participants were randomized to either view two clips with discrete emotional content (purely disgusting and purely amusing) or two mixed emotional clips (disgust mixed with amusement, amusement mixed with disgust).Results: Results of Study 1 showed that the humorous clip buffered against ratings of disgust. In Study 2, humorous content reduced reports of disgust. For both studies, the effect of the manipulation was not moderated by clinical characteristics, like disgust proneness, contamination concerns, or depression.Conclusion: Findings suggest that positive emotions can alter the appraisal of disgusting content, attenuating feelings of disgust, with potential clinical implications for treatment.

Purpose: Research has consistently found that individuals engage in risk-related behaviors, like substance use, binge eating, and social avoidance, to down-regulate negative emotion. Evidence and theory suggest that these behaviors may be driven by common cognitive-emotional processes and might operate as a class of behaviors. Coifman and Aurora (Cogn Ther Res 46:590–607, 2022. https://doi.org/10.1007/s10608-021-10284-8 ) proposed and found support for a two-dimensional model, in which behaviors were driven by the interplay of bottom-up emotional processes (increased negative affect) with reduced top-down cognitive processes (e.g., working memory) in patients and psychologically healthy adults. Methods: For the present investigation, we expand on these findings in two, distinct, at-risk samples: active-duty firefighters (Study 1) and first-year college students (Study 2). Participants completed diagnostic interviews, a working memory task, and six-seven months of weekly diaries indexing emotion, stress, and behavior. Results: Multilevel factor analysis in each sample revealed substantial covariation among the 5 risk-related behaviors assessed (substance use, binge eating, overspending, risky sex, and social avoidance) consistent with an underlying structure for these behaviors. Support for the two-dimensional model was clear in Study 1 but in Study 2, stress exposure and negative affect (but not working memory) predicted engagement in behaviors. Conclusions: Results indicate some support for the two-dimensional model and have clear implications for the assessment and treatment of affective disorders in which behavioral dysregulation is common. However, the disparate results are also discussed in the context of the methodology, as well as developmental and socio-cultural differences and indicate important opportunities for future research and refinement of the model.

Background: Dominant psychotherapies target how individuals experience and understand their daily emotion. Therefore, research examining how daily emotions influence long-term mental health outcomes may help inform treatment development. Methods: This investigation applied a multi-cohort (n = 378; n = 460), longitudinal design to test how reports of daily emotion predict psychological symptoms, loneliness, and wellbeing one-year later. Dynamic indices (polarity, inertia) reflecting “how” emotional experiences are conceptualized moment-to-moment and static indices (person-mean, standard deviation) of emotion were extracted from 10 daily reports. Each index was modelled individually, in concert with others, and in relation to a key dispositional factor in symptom development: trait anxiety. Results: Dynamic indices predicted outcomes one-year later, but only the effect of positive emotional inertia remained significant after accounting for mean intensity of affect. Daily reports of emotion also predicted small but significant variance in outcomes beyond trait anxiety. Conclusions: Results highlight the role of daily subjective experiences of emotion in long-term mental health outcomes and reinforce their importance as targets for treatment.