Emotion dysregulation in adults with ADHD: The role of cognitive reappraisal and expressive suppression

Qianrong Liu; Wai Chen; David A Preece; Defeng Xu; Haimei Li; Ningning Liu; Guanghui Fu; Yufeng Wang; Qiujin Qian; James J Gross; Lu Liu

doi:10.1016/j.jad.2022.09.058

Emotion dysregulation in adults with ADHD: The role of cognitive reappraisal and expressive suppression

J Affect Disord. 2022 Dec 15:319:267-276. doi: 10.1016/j.jad.2022.09.058. Epub 2022 Sep 23.

Authors

Qianrong Liu¹, Wai Chen², David A Preece³, Defeng Xu⁴, Haimei Li¹, Ningning Liu¹, Guanghui Fu⁵, Yufeng Wang¹, Qiujin Qian⁶, James J Gross⁷, Lu Liu⁸

Affiliations

¹ Peking University Sixth Hospital/Institute of Mental Health, NHC Key Laboratory of Mental Health, Peking University, Beijing 100191, China; National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing 100191, China.
² Mental Health Service, Fiona Stanley Hospital, Perth, Australia; Graduate School of Education, University of Western Australia, Australia; School of Medicine, University of Notre Dame Australia, Fremantle, Australia.; School of Psychology, Murdoch University, Perth, Australia; Curtin Medical School, Curtin University, Perth, Australia; The enAble Institute, Curtin University, Perth, Australia.
³ The enAble Institute, Curtin University, Perth, Australia; School of Psychology, Curtin University, Perth, Australia; School of Psychological Science, University of Western Australia, Perth, Australia.
⁴ Peking University Sixth Hospital/Institute of Mental Health, NHC Key Laboratory of Mental Health, Peking University, Beijing 100191, China; National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing 100191, China; Department of Psychiatry, Shandong Mental Health Center, Shandong University, Jinan, Shandong, 250014, China.
⁵ Peking University Sixth Hospital/Institute of Mental Health, NHC Key Laboratory of Mental Health, Peking University, Beijing 100191, China; National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing 100191, China; Department of Psychiatry, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China; The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou 310003, China.
⁶ Peking University Sixth Hospital/Institute of Mental Health, NHC Key Laboratory of Mental Health, Peking University, Beijing 100191, China; National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing 100191, China. Electronic address: qianqiujin@bjmu.edu.cn.
⁷ Department of Psychology, Stanford University, United States.
⁸ Peking University Sixth Hospital/Institute of Mental Health, NHC Key Laboratory of Mental Health, Peking University, Beijing 100191, China; National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing 100191, China. Electronic address: liulupku@bjmu.edu.cn.

PMID: 36162656
DOI: 10.1016/j.jad.2022.09.058

Abstract

Background: Emotion dysregulation (ED) is a common clinical feature of attention-deficit/hyperactivity disorder (ADHD). The present study examined the role of cognitive reappraisal (CR) and expressive suppression (ES) in adults with ADHD. In addition, resting-state fMRI (rs-fMRI) data were analyzed to identify neural substrates of CR/ES-ED relationships.

Methods: A total of 309 adults with ADHD and 163 healthy controls were recruited. ED was assessed using the 'emotional control' (EC) subscale from Behavior Rating Inventory of Executive Function-Adult Version. The Emotion Regulation Questionnaire was used to measure CR and ES. The functional connectivities (FCs) with the amygdala as Region of Interest, were analyzed in a subsample to explore their association with CR, ES and EC, respectively.

Results: Higher EC scores (indicative of lesser emotional control), as well as lower CR and higher ES utilization were detected in adults with ADHD compared with healthy controls. CR and ES were both negatively correlated with EC in adults with ADHD. Mediation analysis detected a potential effect of ADHD diagnosis on EC via CR. In addition, a unique significant mediation effect was found between ES-related FC of the right amygdala-prefrontal cortex and ED expression in adults with ADHD, confirming the '↑ES → ↓FCs _[amygR-PFC] →↓EC' relationship.

Limitations: Only self-reported scales and rs-fMRI data were included in these analyses.

Conclusions: Our findings provide preliminary evidence that in adults with ADHD, less frequent use of CR accounts for ED expression, while more frequent use of ES may play a unique compensatory role in emotion regulation.

Keywords: ADHD; Cognitive reappraisal; Emotion dysregulation; Expressive suppression; Resting-state fMRI.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Attention Deficit Disorder with Hyperactivity* / diagnosis
Cognition
Emotions / physiology
Executive Function / physiology
Humans
Magnetic Resonance Imaging