Elsevier

Behavior Therapy

Volume 50, Issue 5, September 2019, Pages 924-937
Behavior Therapy

Negative Emotional Action Termination (NEAT): Support for a Cognitive Mechanism Underlying Negative Urgency in Nonsuicidal Self-Injury,☆☆

https://doi.org/10.1016/j.beth.2019.02.001Get rights and content

Highlights

  • We evaluated emotional response inhibition in adults with and without NSSI history.

  • NSSI was associated with worse negative emotional action termination (NEAT).

  • NEAT explained variance in the relationship between negative urgency and NSSI.

  • Negative urgency in NSSI may be related to a deficit in this cognitive process.

Abstract

Negative urgency, the self-reported tendency to act impulsively when distressed, increases risk for nonsuicidal self-injury (NSSI). NSSI is also associated with impaired negative emotional response inhibition (NERI), specifically negative emotional action termination (NEAT), a cognitive process theoretically related to negative urgency. We previously found that adults with NSSI history had difficulty inhibiting behavioral responses to affective images depicting negative content (but not positive or neutral images) in an Emotional Stop-Signal Task. We sought to replicate this finding, determine whether this deficit extends to negative emotional action suppression (NEAS; an earlier stage of NERI), and explore whether impairment in these two stages of emotional response inhibition helps explain the relationship between negative urgency and NSSI. Eighty-eight adults with NSSI history (n = 45) and healthy control participants (n = 43) without NSSI history or psychopathology completed a clinical interview, symptom inventories, an impulsivity questionnaire, and behavioral assays of early and late NERI (NEAS and NEAT, respectively). The NSSI group had worse NEAT than the control group in the Emotional Stop-Signal Task, but no group differences in NEAS were observed in an Emotional Go/No-go task. However, both early and late stages of NERI accounted for independent variance in negative urgency. We additionally found that NEAT explained variance in the association between negative urgency and NSSI. These results suggest that impulsive behavior in NSSI may involve specifically impaired inhibitory control over initiated negative emotional impulses. This deficit in late response inhibition to negative emotional stimuli might reflect a cognitive mechanism or pathway to elevated negative urgency among people who self-injure.

Section snippets

Inhibitory Control In NSSI

Impulsive action results from impaired inhibitory control: a set of neurocognitive processes responsible for suppressing undesirable or inappropriate information and behavioral responses (Bari & Robbins, 2013). Inhibitory control includes three stages (Sebastian et al., 2013): (a) interference inhibition; (b) action restraint or suppression (early response inhibition); and (c) action cancellation or termination (late response inhibition). Interference inhibition refers to attentional/behavioral

Participants

Participants aged 18 + were recruited online via the university study pool and through advertisements posted in the community. The sample comprised a mix of local students and nonstudent adults seeking paid research opportunities. Interested individuals completed a web screening that collected demographic and psychiatric information. Eligibility criteria included English proficiency, no concussion history, and no impairments in motor ability, hearing, or vision. Participants provided informed

Self-report Measures

The average age of NSSI onset was 14.45 years (SD = 3.00). The most commonly endorsed method of NSSI was cutting/carving skin (57.78%), followed by scraping skin (35.56%), self-battery (26.67%), burning (24.44%), and picking skin (22.22%). Forty percent endorsed some other method (e.g., self-flagellation). Twenty-five participants (55.56%) endorsed multiple methods (two: n = 8, 17.78%; three: n = 9; 20%; four to six: n = 8; 17.78%). Four participants (8.89%) reported past-week NSSI episodes (M

Discussion

This study sought to extend previous work by clarifying the nature of emotional response inhibition in NSSI and how it relates to self-reported negative urgency. We replicated the previous association between NSSI and poor late response inhibition to negative affective images in the Emotional Stop-Signal Task, without group differences to neutral or positive images (Allen & Hooley, 2015). On each trial in this task, participants rapidly judge the valence of the presented image as positive or

Conflict of Interest Statement

The authors declare that there are no conflicts of interest.

References (59)

  • M.A. Cyders et al.

    Measurement of constructs using self-report and behavioral lab tasks: Is there overlap in nomothetic span and construct representation for impulsivity?

    Clinical Psychology Review

    (2011)
  • M.K. Dahlgren et al.

    Prefrontal cortex activation during cognitive interference in nonsuicidal self-injury

    Psychiatry Research: Neuroimaging

    (2018)
  • K.G. Denny et al.

    Trait aggression is related to anger-modulated deficits in response inhibition

    Journal of Research in Personality

    (2012)
  • K.R. Fox et al.

    Meta-analysis of risk factors for nonsuicidal self-injury

    Clinical Psychology Review

    (2015)
  • C.A. Hamza et al.

    Impulsivity and nonsuicidal self-injury: A review and meta-analysis

    Clinical Psychology Review

    (2015)
  • T.A. Hare et al.

    Biological Substrates of Emotional Reactivity and Regulation in Adolescence During an Emotional Go-Nogo Task

    Biological Psychiatry

    (2008)
  • I.B. Janis et al.

    Are self-injurers impulsive?: Results from two behavioral laboratory studies

    Psychiatry Research

    (2009)
  • J. Mond et al.

    Validity of the Eating Disorder Examination Questionnaire (EDE-Q) in screening for eating disorders in community samples

    Behaviour Research and Therapy

    (2004)
  • E.N. Riley et al.

    Negative urgency and lack of perseverance: Identification of differential pathways of onset and maintenance risk in the longitudinal prediction of nonsuicidal self-injury

    Behavior Therapy

    (2015)
  • A. Sebastian et al.

    Disentangling common and specific neural subprocesses of response inhibition

    NeuroImage

    (2013)
  • F. Verbruggen et al.

    Response inhibition in the stop-signal paradigm

    Trends in Cognitive Sciences

    (2008)
  • S.P. Whiteside et al.

    The five factor model and impulsivity: Using a structural model of personality to understand impulsivity

    Personality and Individual Differences

    (2001)
  • P.S. Yip et al.

    Means restriction for suicide prevention

    The Lancet

    (2012)
  • American Psychiatric Association

    Diagnostic and statistical manual of mental disorders

    (1994)
  • R.C. Arnau et al.

    Psychometric evaluation of the Beck Depression Inventory-II with primary care medical patients

    Health Psychology

    (2001)
  • A.T. Beck et al.

    An inventory for measuring clinical anxiety: Psychometric properties

    Journal of Consulting and Clinical Psychology

    (1988)
  • A.T. Beck et al.

    Beck Anxiety Inventory Manual

    (1993)
  • A.T. Beck et al.

    Manual for the Beck Depression Inventory-II

    (1996)
  • J.M. Berg et al.

    Parsing the heterogeneity of impulsivity: A meta-analytic review of the behavioral implications of the UPPS for psychopathology

    Psychological Assessment

    (2015)
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      This might imply that the emotional component in e.g., executive function tasks is associated with deficits rather than cognitive performance per se. In fact, there is first evidence for the importance of ‘affective cognition’ in the context of NSSI (Allen and Hooley, 2019; Burke et al., 2021). Considerable development of neurocognition and in particular executive functioning alongside the remarkable neural changes during adolescence (Blakemore, 2008) increase vulnerability for mental health difficulties in young people (Heim and Binder, 2012; Leichsenring et al., 2011; Spatz Widom et al., 2007).

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    We thank Rich McNally, Ph.D., Matt Nock, Ph.D., and Heather Schatten, Ph.D., for their comments on this manuscript, as well as Yael Goldstein for her assistance with data collection.

    ☆☆

    Funding: This work was supported by a grant from Harvard University awarded to the first author [Roger Brown Memorial Fund] and the National Institutes of Health [R01MH108610].

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