Difficulties in emotion regulation moderates the relationship between mood symptoms and nightmares in an inpatient psychiatric sample

Background: Emotional processing and regulation of affect are often impaired in psychiatric patients. Nightmares could be considered a manifestation of problems with this process. In the present study, we examined how depression, anxiety and suicidal risk related to difficulties in emotion regulation and nightmares over the course of inpatient treatment. We also explored whether emotion regulation problems moderated the relationship between changes in depression, anxiety, and suicide risk to changes in nightmares from admission to discharge. Methods: The present study included 1215 adults admitted to an inpatient psychiatric hospital ranging from 18 to 87 years of age (M = 37.18, SD = 16.14). Mood symptoms, emotion regulation difficulties, nightmares and suicide risk were assessed at admission and discharge. Moderation analyses were calculated using Model 1 of the PROCESS Macro (Hayes, 2013). Results: Moderation analyses showed the associations between depression and nightmares (b = 0.25, p < .001) and suicide and nightmares (b = 0.34, p < .001) were strongest when patients had high levels of emotion regulation difficulties. Emotion regulation difficulties did not, however, moderate the relationship between anxiety and nightmares. Furthermore, improvement in depression and nightmares was significantly related to improvement in emotion regulation difficulties. Limitations: The homogeneity of the sample limits the generalizability of the results. Furthermore, the use of selfreport measures, especially sleep related assessments, can bias the data more than objective measures. Conclusions: These findings provide clinical implications when treating psychiatric patients such as a need for emotion regulation skills building.