A Preliminary Experimental

Investigation of Emotion Dysregulation

and Impulsivity in Risky Behaviours
Nicole H. Weiss,1 Matthew T. Tull,2 Lindsey T. Davis,3 Jasmin Searcy,4
Iman Williams4 and Kim L. Gratz2
1 Yale University, School of Medicine, New Haven, Connecticut, USA
2 University of Mississippi Medical Center, Department of Psychiatry and Human Behavior, Jackson,
Mississippi, USA
3 Ralph H. Johnson VA Medical Center, Savannah Primary Care Clinic, Savannah, Georgia, USA
4 Jackson State University, Department of Psychology, Jackson, Mississippi, USA

This prospective experimental study sought to examine the unique effects of emo-
tion dysregulation and impulsivity on risky behaviours over time. To this end, 20
African American women enrolled in a historically Black university in the south-
ern United States were randomly assigned to receive one of two brief empirically
supported skills training modules (i.e., emotion modulation [EM] or impulsivity
reduction [IR]). Participants completed measures of emotion dysregulation, impul-
sivity, and past-week risky behaviours before (pre-) and one week after (post-) the
experimental manipulation. Participants assigned to the EM condition reported
significant improvements from pre- to post-manipulation in overall emotion dys-
regulation (as well as all specific dimensions of emotion dysregulation other than
lack of emotional awareness), as well as two dimensions of impulsivity: negative
and positive urgency. Participants assigned to the IR condition reported a signifi-
cant decrease in one dimension of impulsivity (lack of premeditation) from pre- to
post-manipulation. Findings also revealed a significant effect of time on risky be-
haviours, with participants reporting significantly fewer past-week risky behaviours
at the post- (vs. pre-) manipulation assessment. Finally, changes in emotion dys-
regulation from pre- to post-manipulation accounted for the observed reduction in
risky behaviours over time (above and beyond changes in impulsivity dimensions).
Results highlight the relevance of emotion dysregulation to risky behaviours and
suggest that treatments targeting emotion dysregulation may be useful in reducing
risky behaviours.

 Keywords: emotion dysregulation, impulsivity, risky behaviours, African Amer-

ican, experimental design

Over the past decade, researchers have become increasingly interested in examining
the emotional and cognitive factors that underlie or maintain risky behaviours (i.e.,
any behaviour that puts one at risk for a negative outcome, be it physical, emotional,
127
social, or financial), with a particular focus on behaviours that place an individ-
ual at risk for negative health or safety outcomes (e.g., substance use and violence;
Lejuez et al., 2003; Webster & Jackson, 1997). Literature suggests that engagement in
risky behaviours, such as unprotected sex, substance use and risky driving behaviours,

Address for correspondence: Nicole H. Weiss, Ph.D., Department of Psychiatry, Yale University School of
Medicine, 389 Whitney Ave, New Haven, CT, 06511, USA. Email: [email protected]
Behaviour Change Volume 32 Number 2 2015 pp. 127–142 
c The Author(s) 2015
doi 10.1017/bec.2015.5
 Nicole H. Weiss et al.

peaks during emerging adulthood (i.e., ages 18–25; Arnett, 1992; Bachman, John-
ston, O’Malley, & Schulenberg, 1996). Further, there is some evidence to suggest that
these risks might be particularly pronounced among African American individuals,
with past studies demonstrating greater rates of some risky behaviours among African
American (vs. White and Latino/a) young adults (e.g., risky sexual behaviour and
problematic alcohol use; Dariotis, Sifakis, Pleck, Astone, & Sonenstein, 2011; Mulia,
Ye, Greenfield, & Zemore, 2009). Given the clinical relevance and public health
significance of these behaviours, as well as their demonstrated relations to other
negative clinical outcomes (e.g., physical injury, criminal behaviour, legal problems;
Wechsler, Davenport, Dowdall, Moeykens, & Castillo, 1994), investigation of the
mechanisms underlying risky behaviours among African American emerging adults
is needed. Two mechanisms worth investigating in this regard are emotion dysreg-
ulation and impulsivity, both of which have been found to be associated with risky
behaviours within clinical and non-clinical populations (e.g., Cyders, Flory, Rainer,
& Smith, 2009; Donohew et al., 2000; Messman-Moore, Walsh, & DiLillo, 2010;
Ryb, Dischinger, Kufera, & Read, 2006; Tull, Weiss, Adams, & Gratz, 2012; Weiss,
Tull, Viana, Anestis, & Gratz, 2012).
As defined here, emotion dysregulation is a multifaceted construct involving:
(a) a lack of awareness, understanding, and acceptance of emotions; (b) difficulties
controlling behaviours when experiencing emotional distress; (c) lack of access to
adaptive strategies for modulating the duration and/or intensity of aversive emotional
experiences; and (d) an unwillingness to experience emotional distress as part of
pursuing meaningful activities in life (Gratz & Roemer, 2004). Recent evidence
highlights the role of emotion dysregulation in risky behaviours (Tull et al., 2012;
Weiss et al., 2012). Individuals may come to rely on risky behaviours that function to
immediately reduce or distract attention away from aversive emotions (Heatherton &
Baumeister, 1991). However, risky behaviours are likely to exacerbate distress in the
long term. For example, reliance on risky behaviours to reduce or escape emotional
distress may reduce experiences in which the adaptive modulation of emotions is
reinforced (Fischer, Smith, Spillane, & Cyders, 2005). Risky behaviours may also
contribute to the experience of more negative emotions (e.g., guilt, shame) that further
drive risky behaviours. Finally, because risky behaviours may exacerbate distress in
the long term, individuals may perceive themselves as having less access to effective
emotion regulation strategies. Consistent with this theoretical literature, empirical
studies have found emotion dysregulation to be positively associated with deliberate
self-harm (Gratz & Roemer, 2008; Gratz & Tull, 2010a), binge eating (Whiteside
et al., 2007), risky sexual behaviour (Messman-Moore et al., 2010; Tull et al., 2012),
substance use (Bonn-Miller, Vujanovic, & Zvolensky, 2008), and aggressive behaviour
(Gratz, Paulson, Jakupcak, & Tull, 2009).
An extensive body of literature has also identified impulsivity as one factor that
places individuals at risk for engagement in risky behaviours (e.g., Eysenck & Eysenck,
128 1977; Zuckerman, 1984). Although multiple definitions of impulsivity have been pro-
posed in the literature (see Evenden, 1999; Perry & Carroll, 2008), recent literature
suggests that impulsivity is best defined as a multifaceted construct consisting of five
dimensions: (a) negative urgency (the tendency to act impulsively when experienc-
ing negative affect); (b) positive urgency (the tendency to act impulsively when
experiencing positive affect); (c) lack of premeditation (failure to reflect on the con-
sequences of an act before engaging in that act); (d) lack of perseverance (an inability
to focus or follow through on difficult or boring tasks); and (e) sensation seeking

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 Emotion Dysregulation, Impulsivity, and Risky Behaviours

(the tendency to enjoy and pursue activities that are exciting and an openness to
trying new experiences; Cyders et al., 2007; Whiteside & Lynam, 2001). These di-
mensions of impulsivity have been found to be positively associated with a range of
risky behaviours (e.g., risky sexual behaviour and substance abuse; Cyders et al., 2007;
Whiteside & Lynam, 2001, 2003; Whiteside, Lynam, Miller, & Reynolds, 2005).
Notably, however, recent investigations have found that emotion-related dimensions
of impulsivity (i.e., negative and positive urgency) are more strongly associated with
risky behaviours than other dimensions of impulsivity (Cyders et al., 2009; Cyders &
Smith, 2008a; Cyders et al., 2007; Zapolski, Cyders, & Smith, 2009). Together, these
aforementioned findings suggest that risky behaviours may be more strongly related to
maladaptive ways of responding to emotions or difficulties controlling behaviours in
the context of emotional distress.
The goal of the present study was to extend extant literature on the role of emotion
dysregulation and impulsivity in risky behaviours by using an innovative prospective
experimental design. Notably, no studies to date have concurrently examined the
effect of emotion dysregulation or impulsivity on risky behaviours, precluding deter-
mination of the causal role of these mechanisms in such behaviours. Thus, this study
sought to examine the unique effects of emotion dysregulation and impulsivity on risky
behaviours over time by randomly assigning participants to one of two brief empiri-
cally supported skills training modules (i.e., emotion modulation [EM] or impulsivity
reduction [IR]). Use of these skills-training modules as experimental manipulations
may elucidate the nature and direction of the relationships between emotion dysregu-
lation, impulsivity, and risky behaviours (see Coffey, Stasiewicz, Hughes, and Brimo,
2006, for a similar methodological approach).
We predicted that participants assigned to the EM (vs. IR) condition would report
greater reductions in emotion dysregulation (both overall and across specific dimen-
sions of emotion dysregulation), as well as the impulsivity dimensions of negative
and positive urgency (which overlap considerably with the conceptual definition of
emotion dysregulation used here and have been found to be closely related to emo-
tion dysregulation; Cyders & Smith, 2007, 2008b; Gratz & Roemer, 2004; Weiss,
Tull, Anestis, & Gratz, 2013). Given that the skills taught in the IR condition focus
on reducing rash action (e.g., examining short- and long-term consequences of risky
behaviours), we predicted that individuals assigned to the IR (vs. EM) condition
would report significantly greater reductions in lack of premeditation. No a priori hy-
potheses were made regarding the effect of EM and IR conditions on the impulsivity
dimensions of sensation seeking and lack of perseverance. Finally, we predicted that
participants would report significantly fewer past-week risky behaviours 1 week after
the experimental manipulation (compared to the week before the manipulation), and
that changes in emotion dysregulation and impulsivity from pre- to post-manipulation
would account for the observed reduction in risky behaviours over time.

Method 129
Participants
Participants were 23 African American women attending an urban historically Black
university in the southern United States. Participants ranged in age from 18 to 27,
with an average age of 20.74 (SD = 2.00). Approximately half the participants (52%)
reported an annual household income under $40,000, and 61% were not employed.
All participants were full-time students.

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 Nicole H. Weiss et al.

TABLE 1
Content of the 1-Hour Emotion Modulation and Impulsivity Reduction Manipulations

Emotion modulation (EM) • Discussion of the paradoxical effects of emotional

avoidance.
• Introduction of emotional approach and distraction as
adaptive emotion regulation strategies.
• Psychoeducation on the contextually dependent nature of
adaptive emotion regulation.
• Identification of approach and distraction strategies to
replace avoidant emotion regulation strategies, as well as
contexts best suited for each strategy.
Impulsivity reduction (IR) • Identification of impulsive behaviours utilised by the
participants, as well as the negative consequences
associated with these behaviours.
• Discussion of the short-lived nature of urges.
• Introduction of four strategies for reducing behavioural
urges: distraction/delay, behavioural substitution, pros and
cons, and consequence modification.

Experimental Manipulations
The EM and IR manipulations were adapted from an empirically supported,
acceptance-based emotion regulation group therapy (ERGT) for self-harm among
women with borderline personality pathology (Gratz & Gunderson, 2006; Gratz &
Tull, 2011). ERGT is a 14-week group therapy designed to teach patients adaptive
ways of responding to emotions, with an emphasis on the control of behaviours in
the presence of emotions (vs. the control of emotions themselves). Specific skills
focus on increasing the: (a) awareness, understanding, and acceptance of emotions;
(b) ability to engage in goal-directed behaviours and control impulsive behaviours
when experiencing negative emotions; (c) flexible use of situationally appropriate
strategies to modulate the intensity and/or duration of emotional responses (vs. elim-
inating emotions entirely); and (d) willingness to experience negative emotions in
pursuit of meaningful activities (Gratz & Gunderson, 2006; Gratz & Roemer, 2004).
ERGT has been shown to significantly reduce deliberate self-harm and other impul-
sive behaviours among women with borderline personality pathology (Gratz & Tull,
2011).
EM and IR manipulations covered material presented in single ERGT sessions and
were adapted by author NHW (with assistance from MTT and KLG) for use in a sam-
ple without a known history of deliberate self-harm (i.e., the focus of the sessions was
on strategies for modulating emotions and reducing impulsive behaviour more broadly
130 vs. focusing on deliberate self-harm in particular). Single ERGT modules targeted dis-
tinct factors (see Gratz & Gunderson, 2006) and did not overlap (see Table 1). The
EM condition was comprised of strategies to modulate the intensity and/or duration of
emotional arousal in a flexible, situationally appropriate manner, including distraction
(i.e., noticing intense and/or aversive emotions and then temporarily directing atten-
tion toward something other than the distressing emotion) and emotional approach
(e.g., getting in touch with emotions, allowing oneself to experience emotions, and
paying attention to the information being provided by emotions). The IR condition

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 Emotion Dysregulation, Impulsivity, and Risky Behaviours

taught skills for decreasing rash action and impulsive behaviour, including distrac-
tion/delay (i.e., directing attention away from urges to engage in impulsive behaviour
as a means of allowing the urge to pass), behavioural substitution (i.e., replacing
impulsive behaviours with healthier behaviours that serve a similar function), pros
and cons (i.e., attending to the long-term consequences of impulsive behaviour), and
consequence modification (i.e., changing the contingencies of impulsive behaviour
by rewarding attempts to resist urges for impulsive behaviour and eliminating rewards
associated with engagement in impulsive behaviour). Notably, skills presented in the
EM and IR conditions closely map on to our definitions of emotion regulation and
impulsivity, respectively, such that EM skills targeted the flexible use strategies to
modulate emotional responses in order to meet individual goals and situational de-
mands, whereas IR skills aimed to increase awareness of the negative consequences
and long-term effects of rash, unplanned actions.
To reduce experimenter bias, detailed experimental manipulation scripts were
developed for the EM and IR conditions. Authors NHW and LTD (clinical psychology
graduate students with over 3 years of clinical training) delivered the EM and IR
manipulations after being trained to adherence by MTT and KLG. All manipulations
were provided to participants in an individual format. Weekly meetings throughout
the study ensured experimenters did not deviate from the EM and IR manipulation
protocols. Authors NHW and LTD completed an equal number of EM (5) and IR
(5) sessions once study dropout was accounted for. Both EM and IR sessions lasted
approximately 60 minutes (MEM = 58.09, SDEM = 6.58; MIR = 60.83, SDIR = 6.53),
and were followed by 1 week of daily skills practice specific to the skills training
module. Participants were given explicit instructions on using skills outside of the lab.
A manipulation check was included to ensure validity of the experimental protocols
(see results).

Measures
Self-report measures of emotion dysregulation, impulsivity, and past-week engagement
in risky behaviours were administered before the experimental manipulation and 1
week post-manipulation.
The Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004)
is a 36-item self-report measure that assesses individuals’ typical levels of emotion
dysregulation across six domains: non-acceptance of negative emotions, difficulties
engaging in goal-directed behaviours when distressed, difficulties controlling impulsive
behaviours when distressed, limited access to emotion regulation strategies perceived
as effective, lack of emotional awareness, and lack of emotional clarity. The DERS has
been found to demonstrate good test–retest reliability (ρ I = .88, p < .01) and adequate
construct and predictive validity (Gratz & Roemer, 2004; Gratz & Tull, 2010b),
and to be significantly associated with objective measures of emotion regulation, 131
including behavioural (Gratz, Bornovalova, Delany-Brumsey, Nick, & Lejuez, 2007;
Gratz, Rosenthal, Tull, Lejuez, & Gunderson, 2006; Tull, Gratz, Latzman, Kimbrel,
& Lejuez, 2010) and physiological (Vasilev, Crowell, Beauchaine, Mead, & Gatzke-
Kopp, 2009) measures. Items were recoded so that higher scores indicate greater
emotion dysregulation, and a sum was calculated. Internal consistency in the current
sample was good for the overall scale (αs ࣙ .96) and for the subscales (αs =.82 to
.95).

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 Nicole H. Weiss et al.

The UPPS-P Impulsive Behavior Scale (UPPS-P; Cyders et al., 2007) is a 59-item
self-report measure that assesses five distinct facets of impulsivity: lack of perseverance,
negative urgency, positive urgency, lack of premeditation, and sensation seeking.
Participants rate the extent to which each item applies to them on a 4-point Likert-
type scale (1 = rarely/never true, 4 = almost always/always true). Scores are provided
for each of the five dimensions of impulsivity. The five scales have been found to have
good convergent validity and good discriminant validity from each other (Cyders
et al., 2007). Internal consistency coefficients in the current sample were adequate
(αs = .69 to .92).
The Impulsive Behavior Scale (IBS; Rossotto, Yager, & Rorty, 1998) is a 25-
item, self-report questionnaire that assesses past-week engagement in a variety of risky
behaviours, including consuming large quantities of alcohol, engaging in unprotected
sexual intercourse, deliberate self-harm, driving while under the influences of drugs
and/or alcohol, and impulsive spending. Participants report the frequency of each
behaviour during the past week. Items are summed to create a measure of overall
frequency of past-week risky behaviours. The IBS has been found to have adequate
reliability and validity (Bender, Gordon, Bresin, & Joiner, 2010; Peñas-Lledó &
Waller, 2001).
Finally, all participants completed a demographics form assessing age, education,
employment, and family income in the past year. These characteristics were examined
as potential covariates.

Procedure
All study procedures were conducted in compliance with the university’s Institutional
Review Board. A study announcement was made in undergraduate psychology courses
at Jackson State University. African American women interested in participating
were asked to provide their contact information to a graduate research assistant. Of
the 30 women who provided their information, 4 could not be reached and 3 withdrew
interest. Thus, a total of 23 participants were randomly assigned to receive the EM
or IR manipulation, and scheduled for the first of two sessions. Following provision
of written informed consent at the beginning of Session 1, participants completed a
series of questionnaires (see Measures) and then received an hour-long skills-training
session. Participants were then scheduled to complete the follow-up assessment 6–8
days later (M days = 6.90, SD days = 0.45). Participants were also provided with
explicit instructions for using the skills outside of the lab, which included daily
monitoring of strategies employed (e.g., distraction, behaviour substitution), as well
as antecedents (e.g., emotion) and consequences (e.g., effectiveness of the strategy)
of skilful behaviour. The monitoring form was collected at post-assessment and scored
132 (with scores ranging from 0–100% [i.e., 0–1] complete). No significant between-group
differences in homework completion were detected, MEM = .55, SDEM = .45; MIR =.68,
SDIR =.43; t = −.64, p = .53. Three participants withdrew from the study prior to
completing Session 2 (resulting in a final sample of 20 participants; 10 per condition).
Session 2 was conducted by graduate research assistants blind to condition. During
this session, participants completed the same questionnaires presented in Session 1
(i.e., DERS, UPPS-P, and IBS). Participants were compensated $10 at the end of the
session.

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 Emotion Dysregulation, Impulsivity, and Risky Behaviours

Results
Preliminary Analyses
Prior to conducting the primary analyses, t tests and chi-square analyses were
conducted on demographic factors (i.e., age, income, and employment) and pre-
manipulation scores on the primary dependent variables (i.e., DERS, UPPS-P, and
IBS) to determine equivalence across conditions. Results indicate no significant
between-group differences (ts < 1.71, χ 2 s < 7.50, ps > .10), with one exception:
the EM condition reported significantly higher scores than the IR condition on neg-
ative urgency (t = 2.91, p < .05, Cohen’s d = 2.91).
Participants reported an average of 4.75 (SD = 6.60) risky behaviours during the
week prior to the pre-manipulation assessment. Descriptive data, as well as intercor-
relations between the primary variables of interest, are presented in Table 2.

Manipulation Check
A series of two (condition: EM vs. IR) × 2 (time: pre- vs. post-manipulation) repeated
measures analyses of variance (ANOVAs) were conducted to examine between-
group differences in changes in emotion dysregulation and impulsivity over time (see
Table 3). Results revealed a significant main effect of time on emotion dysregulation
(both overall and across all specific dimensions other than emotional non-acceptance),
as well as a significant time × condition interaction for overall emotion dysregulation
and the specific dimensions of difficulties engaging in goal-directed behaviours when
distressed, lack of emotional awareness, and lack of emotional clarity. Post-hoc paired
sample t tests revealed that whereas participants in the EM condition reported signifi-
cant decreases over time in overall emotion dysregulation and all specific dimensions
other than emotional non-acceptance (see Table 3; Cohen’s ds ranging from .78 to
1.09), participants in the IR condition evidenced no significant changes over time on
any dimension of emotion dysregulation (and all effect sizes were small; Cohen’s ds
ranging from .07 to .30).
Results also revealed a significant main effect of time on negative urgency, pos-
itive urgency and (lack of) premeditation, as well as a significant time × condition
interaction for (lack of) premeditation and negative urgency (see Table 3). Post-hoc
paired samples t tests revealed that participants in the IR condition reported signif-
icant decreases over time in (lack of) premeditation (Table 3; Cohen’s d = 1.36),
whereas participants in the EM condition reported significant decreases in both nega-
tive urgency (Cohen’s d = 1.12) and positive urgency (Cohen’s d = .83). Of note, all
non-significant effects in these analyses were accompanied by small to medium effect
sizes (Cohen’s ds ࣘ .46).

Primary Analyses
A 2 (condition: EM vs. IR) × 2 (time: pre- vs. post-manipulation) repeated measures
ANOVA was conducted to examine between-group differences in changes in risky 133
behaviours over time. Results revealed a significant main effect of time, Wilkes λ =.72,
F = 7.18, p = .02, np 2 = .29, such that participants reported a significant decrease in
risky behaviours from pre- to post-manipulation, M(SD)Pre-manipulation = 5.11(6.90),
M(SD)Post-Manipulation = 1.08(1.47), Cohen’s d = .62. The time × condition interaction
was not significant, Wilkes λ = 1.00, F = .002, p = .97, np 2 < .001.
Finally, we examined whether changes in emotion dysregulation and/or impulsivity
accounted for the reduction in risky behaviours over time. First, residualised gain scores

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Nicole H. Weiss et al.

TABLE 2
Intercorrelations and Descriptive Data for the DERS, UPPS, and IBS at Pre- and Post-Manipulation

1 2 3 4 5 6 7 8 9 10 11 12 13

1. DERS Total — .79∗∗∗ .76∗∗∗ .91∗∗∗ .90∗∗∗ .73∗∗∗ .68∗∗∗ .33 .68∗∗∗ .33 .24 .55∗∗ .52∗∗
2. DERS ACCEPT .83∗∗∗ — .37 .78∗∗∗ .66∗∗∗ .53∗∗ .42∗ .17 .43∗ .34 .02 .38 .50∗
3. DERS GOALS .75∗∗∗ .40 — .68∗∗∗ .79∗∗∗ .36 .41∗ .22 .67∗∗∗ .12 .27 .28 .25
4. DERS IMPULSE .91∗∗∗ .86∗∗∗ .55∗∗ — .92∗∗∗ .55∗∗ .37 .17 .62∗∗ .27 .15 .58∗∗ .47∗
5. DERS STRATEGY .80∗∗∗ .58∗∗ .75∗∗∗ .79∗∗∗ — .40 .44∗ .13 .70∗∗∗ .20 .32 .48∗ .50∗
6. DERS AWARE .73∗∗∗ .54∗∗ .41 .52∗ .26 — .71∗∗∗ .52∗∗ .36 .38 .19 .57∗∗ .34
7. DERS CLARITY .89∗∗∗ .74∗∗∗ .54∗ .77∗∗∗ .53∗ .80∗∗∗ — .42∗ .43∗ .29 .20 .31 .43∗
8. UPPS SS .52∗ .40 .56∗∗ .33 .22 .52∗ .53∗ — .20 − .02 − .06 .40 .11
9. UPPS NU .63∗∗ .47∗ .70∗∗∗ .47∗ .53∗ .46∗ .44∗ .58∗∗ — .05 .52∗∗ .54∗∗ .23
10. UPPS PREMED .46∗ .34 .30 .47∗ .27 .50∗ .34 .19 .61∗∗ — − .06 .26 .54∗∗
11. UPPS PERS .38 .03 .55∗∗ .22 .32 .41 .28 .20 .57∗∗ .70∗∗∗ — .37 .01
12. UPPS PU .62∗∗ .32 .65∗∗ .59∗∗ .49∗ .45∗ .56∗∗ .58∗∗ .64∗∗ .64∗∗ .59∗∗ — .31
13. IBS .62∗∗ .66∗∗ .34 .62∗∗ .58∗∗ .39 .43 .36 .50∗ .16 .03 .31 —
Mean pre 75.48 11.39 13.22 10.70 14.91 14.13 11.13 41.74 34.23 20.57 19.09 36.83 4.75
SD pre 29.72 6.34 5.92 5.68 7.85 6.28 5.00 8.32 6.16 5.22 5.61 6.41 6.60
Mean post 60.80 10.05 9.80 8.05 12.20 11.95 8.75 40.35 31.53 16.56 18.85 33.85 1.08
SD post 23.33 1.65 4.53 3.56 6.03 5.70 4.35 9.91 4.81 5.31 5.10 3.94 1.47

Note: DERS = Difficulties in Emotion Regulation Scale; DERS ACCEPT = DERS Emotional Nonacceptance Subscale; DERS GOALS = DERS Difficulties Engaging in
Behaviour Change

Goal-Directed Behavior When Distressed Subscale; DERS IMPULSE = DERS Difficulties Controlling Impulsive Behaviors When Distressed Subscale; DERS STRATEGY =
DERS Lack of Effective Emotion Regulation Strategies Subscale; DERS AWARE = DERS Lack of Emotional Awareness Subscale; DERS CLARITY = DERS Lack of Emotional
Clarity Subscale; UPPS-P = UPPS-P Impulsive Behavior Scale; UPPS SS = UPPS-P Sensation Seeking Subscale; UPPS NU = UPPS-P Negative Urgency Subscale; UPPS
PREMED = UPPS-P (lack of) Premeditation Subscale; UPPS PERS = UPPS-P (lack of) Perseverance Subscale; UPPS PU = UPPS-P Positive Urgency Subscale; IBS =
Impulsive Behavior Scale. Correlations at pre-assessment appear above the diagonal and correlations at post-assessment appear below the diagonal.
∗p ࣘ .05. ∗∗ p ࣘ .01. ∗∗∗ p ࣘ 001.
Behaviour Change

TABLE 3
Means, Standard Deviations, Repeated Measures Analyses of Variance, and Post-Hoc Paired Sample t Tests Exploring Changes in Emotion
Dysregulation and Impulsivity Dimensions Over Time

Emotion modulation (n = 10) Impulsivity reduction (n = 10)

Pre-M Post-M Pre-M Post-M Effect of Time ×

(SD) (SD) t (SD) (SD) t time F ηp 2 condition F ηp 2

DERS
Overall 83.70 56.10 3.13∗∗ 68.80 65.60 .24 8.72∗∗ 5.47∗

Emotion Dysregulation, Impulsivity, and Risky Behaviours

(37.00) (21.02) (23.01) (25.59) .33 .23
ACCEPT 12.50 9.70 1.56 10.40 10.40 − .80 1.79 1.79
(7.60) (3.71) (5.06) (5.62) .09 .09
GOALS 15.10 9.70 3.32∗∗ 11.00 9.90 .97 10.82∗∗ 4.74∗
(4.79) (4.06) (5.87) (5.17) .38 .21
IMPULSE 11.50 7.70 2.66∗ 8.90 8.50 .23 5.71∗ 3.74
(7.38) (3.68) (3.54) (3.50) .24 .17
STRATEGY 16.60 11.20 2.48∗ 14.40 13.20 .28 5.49∗ 1.22
(9.79) (4.85) (6.91) (7.15) .23 .11
AWARENESS 15.10 10.30 3.03∗∗ 13.20 13.60 − .94 7.20∗∗ 10.06∗
(6.05) (4.42) (7.07) (6.55) .29 .36
CLARITY 12.90 7.50 3.44∗∗ 10.90 10.00 .62 9.22∗∗ 4.71∗
(4.61) (3.06) (5.28) (5.21) .34 .21
135
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Nicole H. Weiss et al.

TABLE 3
Continued

Emotion modulation (n = 10) Impulsivity reduction (n = 10)

Pre-M Post-M Pre-M Post-M Effect of Time ×

(SD) (SD) t (SD) (SD) t time F ηp 2 condition F ηp 2

UPPS-P
SS 42.50 39.90 .73 41.30 40.80 .60 .71 .33
(7.62) (9.96) (10.11) (10.37) .04 .02
PERS 21.21 19.40 1.47 18.30 18.30 .00 1.30 1.30
(4.13) (5.56) (6.86) (4.83) .07 .07
PREMED 18.80 17.32 .74 22.50 15.79 4.32∗∗ 10.50∗∗ 4.28∗
(4.94) (6.06) (5.25) (3.84) .37 .19
NU 37.30 31.60 3.55∗∗ 31.04 31.46 − .35 6.84∗ 9.28∗∗
(4.81) (5.27) (4.81) (4.57) .28 .34
PU 38.70 33.80 2.61∗ 34.70 33.90 .56 5.87∗ 3.04
(8.58) (4.34) (4.08) (3.73) .25 .14

Note: DERS = Difficulties in Emotion Regulation Scale (Gratz & Roemer, 2004); ACCEPT = Nonacceptance of negative emotions; GOALS = Difficulties engaging in
goal-directed behaviours when distressed; IMPULSE = Difficulties controlling impulsive behaviours when distressed; STRATEGY = Limited access to emotion regulation
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strategies perceived as effective; AWARENESS = Lack of emotional awareness; CLARITY = Lack of emotional clarity; UPPS-P = UPPS-P Impulsive Behavior Scale; SS =
Sensation seeking; PERS = Lack of perseverance; PREMED = Lack of premeditation; NU = Negative urgency; PU = Positive urgency.
∗p ࣘ .05. ∗∗ p ࣘ .01. ∗∗∗ p ࣘ .001.
 Emotion Dysregulation, Impulsivity, and Risky Behaviours

TABLE 4
Hierarchal Regression Analysis Examining the Unique Contributions of Changes in Overall
Emotion Dysregulation, Negative Urgency, Positive Urgency, and (Lack of) Premeditation
in Changes in Risky Behaviours Over Time

β t R2 F

Step 1 .11 .66

Negative urgency .16 .63
Positive urgency − .16 − .65
(Lack of) premeditation .30 1.22
Step 2 .44 2.93
Negative urgency − .46 − 1.58
Positive urgency .14 .62
(Lack of) premeditation .25 1.23
Overall DERS .94 2.96∗∗
Note: ∗∗ p ࣘ .01.

(Tucker, Damarin, & Messick, 1966) were calculated for pre- and post-manipulation
scores on risky behaviours, overall emotion dysregulation, and the UPPS-P impulsivity
dimensions of (lack of) premeditation, negative urgency, and positive urgency. Next,
a hierarchal multiple regression analysis was conducted with the impulsivity residual
scores entered in the first step of the model, the overall emotion dysregulation residual
score entered in the second step of the model, and the risky behaviours residual score
serving as the dependent variable. Changes in impulsivity accounted for 11% of the
variance in change in risky behaviours over time, F = .66, p = .59; however, none
of the impulsivity dimensions emerged as significant unique predictors in this step
(see Table 4). The final model including change in overall emotion dysregulation
accounted for 44% of the variance in change in risky behaviours, F = 2.93, p = .06.
In this step, change in overall emotion dysregulation accounted for unique variance
in the change in risky behaviours over time, above and beyond changes in (lack of)
premeditation, negative urgency, and positive urgency (see Table 4).

Discussion
Findings of the present study extend the literature on the mechanisms underlying
risky behaviours by examining the effects of experimental manipulations targeting a
reduction in emotion dysregulation and impulsivity on risky behaviours. The results of
this study provide preliminary experimental support for the role of emotion dysregula-
tion in risky behaviours, revealing that improvements in emotion dysregulation from
pre- to post-manipulation accounted for the significant reduction in risky behaviours 137
observed over time. This finding suggests that maladaptive ways of responding to emo-
tions, such as difficulties controlling behaviours when distressed and lack of access
to adaptive strategies for modulating the duration and/or intensity of aversive emo-
tional experiences, may lead to greater engagement in risky behaviours. For example,
individuals who are unwilling or unable to approach or modulate emotional distress
may engage in risky behaviours to obtain short-term relief from emotional states per-
ceived as aversive. Likewise, individuals who experience difficulties controlling their

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 Nicole H. Weiss et al.

behaviours in the context of emotional distress may be more likely to engage in risky
behaviours when experiencing intense emotions.
Results of the present study also highlight the utility of these EM and IR skills
training modules as experimental manipulations. Specifically, and consistent with
expectations, 1 week post-manipulation, individuals in the EM condition reported
significant decreases in overall emotion dysregulation (as well as all specific dimensions
of emotion dysregulation other than emotional nonacceptance), as well as the related
UPPS-P dimensions of negative and positive urgency. Conversely, individuals in the
IR condition reported a significant decrease in (lack of) premeditation 1 week post-
manipulation. Importantly, results suggest that EM and IR manipulations successfully
targeted specific, non-overlapping constructs.
Although the results of the present study add to the growing body of literature
on the mechanisms underlying risky behaviours, several limitations must be consid-
ered. First, this study represents the first step in identifying potential mechanisms
that may underlie risky behaviours in African American women; consequently, this
study involved a small, homogeneous, non-clinical sample of participants, limiting
both our statistical power and the statistical conclusion validity and generalisability
of our findings. As such, non-significant findings should be interpreted with caution.
Furthermore, replication of these findings in larger, more diverse samples of African
American women in community and clinical settings is needed. Likewise, whereas
the focus on risky behaviours among African American women may be considered a
strength of this study, future studies would benefit from examination of these mecha-
nisms in populations with heightened rates of emotion dysregulation and impulsivity,
such as substance dependent patients (e.g., Fox, Axelrod, Paliwal, Sleeper, & Sinha,
2007; Fox, Hong, & Sinha, 2008).
In addition, although a growing body of theoretical and empirical literature sug-
gests that emotion dysregulation may underlie risky behaviours (Tull et al., 2012;
Weiss et al., 2012), it is also possible that this association is bidirectional, with regular
involvement in risky behaviours leading to or exacerbating emotion dysregulation.
Larger-scale prospective investigations may improve our understanding of the inter-
relations of risky behaviours and emotion dysregulation over time. Studies utilising
experience sampling methods may provide further evidence of the emotion-regulating
function of risky behaviours.
An additional limitation is the exclusive reliance on a self-report measure of emo-
tion dysregulation, responses to which may be influenced by an individual’s willingness
and/or ability to report accurately on emotional responses. However, it is important to
note that the measure of emotion dysregulation utilised in this study is strongly corre-
lated with objective measures of emotion regulation (see Gratz et al., 2006; Gratz &
Tull, 2010b). Nonetheless, future studies would benefit from multimodal assessment
of emotion dysregulation. Similarly, risky behaviours were assessed through a self-
report questionnaire, which may be limited by participants’ willingness or ability to
138 report on these behaviours. However, there is evidence that self-report measures may
provide more accurate reports of risky behaviours (e.g., risky sexual behaviour) than
other assessment methods (Fenton, Johnson, McManus, & Erens, 2001; Johnson et al.,
2000). Nonetheless, future studies would benefit from the inclusion of other methods
of assessing risky behaviours, such as timeline follow-back procedures (Weinhardt,
Carey, & Carey, 2000).
Despite these limitations, results of the present study add to the literature on
the role of emotion dysregulation and impulsivity in risky behaviours, providing

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 Emotion Dysregulation, Impulsivity, and Risky Behaviours

preliminary experimental evidence for the effect of emotion dysregulation on risky

behaviours. As such, the findings from this study highlight the potential utility of
targeting emotion dysregulation in interventions aimed at reducing risky behaviours.
Although treatments that include emotion regulation skills training have been found
to reduce risky behaviours (e.g., ERGT and dialectical behavior therapy; Gratz &
Tull, 2011, and Linehan, 1993, respectively), few studies have examined the effects
of these treatments outside the context of borderline personality pathology. Future
investigations are needed to examine the utility of these treatments in reducing risky
behaviours within other populations.

Acknowledgments
The research described here was supported, in part, by a grant from the National
Institutes of Health (T32 DA019426).

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