Emotion-regulation strategies across psychopathology: A meta-analytic review

We examined the relationships between six emotion-regulation strategies (acceptance, avoidance, problem solving, reappraisal, rumination, and suppression) and symptoms of four psychopathologies (anxiety, depression, eating, and substance-related disorders). We combined 241 effect sizes from 114 studies that examined the relationships between dispositional emotion regulation and psychopathology. We focused on dispositional emotion regulation in order to assess patterns of responding to emotion over time. First, we examined the relationship between each regulatory strategy and psychopathology across the four disorders. We found a large effect size for rumination, medium to large for avoidance, problem solving, and suppression, and small to medium for reappraisal and acceptance. These results are surprising, given the prominence of reappraisal and acceptance in treatment models, such as cognitive-behavioral therapy and acceptance-based treatments, respectively. Second, we examined the relationship between each regulatory strategy and each of the four psychopathology groups. We found that internalizing disorders were more consistently associated with regulatory strategies than externalizing disorders. Lastly, many of our analyses showed that whether the sample came from a clinical or normative population significantly moderated the relationships. This finding underscores the importance of adopting a multi-sample approach to the study of psychopathology.     

Implicit motives and explicit goals: two distinctive modes of motivational functioning and their relations to psychopathology

During the past two decades, increasing evidence has been gathered in basic research on motivation for the view that two separate systems direct human behavior: an emotion‐driven implicit system and a cognition‐based explicit system. In two studies we examined the associations between avoidance tendencies in both motivational systems and psychopathology (study 1, 53 undergraduates; study 2, 65 outpatients suffering from anxiety or mood disorders). Avoidance tendencies in implicit motives were assessed with a semiprojective technique (Multi‐Motive Grid, MMG). Avoidance tendencies of explicit personal goals were coded by two trained raters and by asking participants to judge the emotion they would expect to experience if they reached or failed to reach the goals. Psychopathology was assessed with various disorder‐specific and unspecific questionnaires. In both studies, avoidance tendencies in the implicit as well as in the explicit system were associated with clinical symptoms and other functional impairments. Implications of these findings are discussed. Copyright © 2006 John Wiley & Sons, Ltd.     

An exploration of emotion regulation in psychosis

The emotional experience of individuals who experience psychosis has historically been neglected, possibly due to the divide between the psychoses and neuroses. This study examined emotional experience and regulation in individuals who had experienced psychosis, individuals experiencing anxiety or mood disorders, and non‐patient controls. Participants completed validated measures of emotional experience and emotion regulation. Both clinical groups were found to experience similar levels of emotions, and in comparison to the non‐patient controls, they experienced greater levels of negatively valenced emotions and lower levels of happiness. Both clinical groups also used similar emotion regulation strategies, and in comparison to non‐patient controls, they used significantly more dysfunctional and less functional strategies, suggesting that the emotional experience and emotion regulation strategies of people who have experienced psychosis are more similar to non‐psychotic disorders than have previously been thought to be the case. The theoretical and clinical implications of these findings are discussed. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message: ? Individuals with psychosis experience similar emotions as individuals with anxiety and mood disorders, namely more unhappiness, fear and less happiness. ? People with psychosis attempt to regulate these emotions in similar ways to people with mood and anxiety problems, by using more dysfunctional emotional regulation strategies such as ruminating. ? Clinicians may want to pay closer attention to assessing the emotion regulation strategies of those who experience psychosis and consider the implications of these in therapy. ? They may also want to consider the role emotional dysregulation may play in the development, maintenance and course of psychosis. ? An emotion regulation approach to psychosis may be characterised by focussing on emotional experiences and the individual's response to these, as opposed to psychotic symptoms.     

How thinking hurts: Rumination,worry, and avoidance processes in adjustment to bereavement

Repetitive negative thought plays an important role in the maintenance of mental health problems following bereavement. To date, bereavement researchers have primarily focused on rumination (i.e., repetitive thought about negative events and/or negative emotions), yet the interest in worry (i.e., repetitive thought about uncertain future events) is increasing. Both cognitive processes potentially lead to poorer adaptation to bereavement by contributing to loss‐related avoidance and behavioural avoidance of activities. The current study aims to establish the differential associations of rumination and worry with symptoms of depression and prolonged grief and clarify if avoidance processes mediate the associations of rumination and worry with symptom levels. Four hundred seventy‐four recently bereaved adults (82% female) filled out questionnaires assessing rumination, worry, loss‐related and behavioural avoidance, and depression and prolonged grief symptoms. Rumination and worry were both uniquely associated with depression and prolonged grief symptoms. Compared with worry, rumination related more strongly to prolonged grief symptoms, whereas correlations of both cognitive styles with depression symptoms did not differ. Loss‐related avoidance and behavioural avoidance partially mediated the associations of rumination and worry with prolonged grief symptoms. Behavioural avoidance partially mediated the associations of rumination and worry with depression symptoms. Findings suggest that exposure and behavioural activation may be effective interventions to reduce repetitive thinking and psychopathology after bereavement.     

大学生负性情绪在反刍思维与睡眠质量间的中介作用

目的:探讨反刍思维各维度对睡眠质量的直接作用,以及负性情绪(抑郁和焦虑)在二者关系中的中介作用。方法:选取391名大学生,采用匹兹堡睡眠质量指数量表(PSQI),反刍思维量表(RRS)、流调中心用抑郁量表(CES-D)以及状态焦虑量表(SAI)分别考察其睡眠质量、反刍思维、抑郁情绪和焦虑情绪。结果:PSQI得分与RRS总分及各维度得分、CES-D得分和SAI得分均呈正相关(r=0.13~0.44,P均0.01)。回归分析显示,RRS的抑郁相关维度正向预测睡眠质量(标准化回归系数=0.49);抑郁和焦虑能够解释反刍思维与睡眠质量间关系40.74%的变异。结论:抑郁相关维度正向作用于睡眠质量;负性情绪在反刍思维与睡眠质量的关系中起到了部分中介作用。     

Circadian symptom fluctuations in people with anxiety disorders

Circadian rhythm abnormalities have been demonstrated in people with depression, including a tendency toward maximal symptom severity in the morning. Although a few studies have suggested that symptoms in people with anxiety are worse later in the day, no detailed study of this observation has been reported. In 86 patients with anxiety disorders (63 with panic disorder or agoraphobia with panic attacks), anxiety symptoms tended to be more severe in the afternoon or evening than in the morning, with no abnormalities of heart rate or oral temperature. This is the first systematic demonstration of a circadian fluctuation of mood in any disorder other than depression.     

Predicting responsiveness to a depressive mood induction procedure

Inducing various mood states—sad or depressed mood in particular—has become a widely employed and accepted means of experimentally examining the link between emotion and cognition, particularly with research on cognitive theory and depression. Using various criteria, studies utilizing mood induction procedures (MIPs) have reported successful induction of the desired mood in participants at rates ranging from 50 to 75%, clearly reflecting substantial individual variation. Individual differences in response to MIPs, however, have received little attention. Drawing on both theory and previous research, the present study identified and examined a range of possible predictors of response to depressive mood induction in a sample of 100 undergraduate students. Results indicated that of the examined predictors, experience with recent negative events prior to the mood induction and participant mood state, including self‐reported symptoms of anxiety, significantly predicted reported mood state following the MIP. The implications of these results for models of vulnerability and resilience to negative mood states are discussed, and future research directions are provided © 2008 Wiley Periodicals, Inc. J Clin Psychol 65:1–16, 2009.     

Rumination,goal linking,daily hassles and life events in major depression

Background: Rumination in response to stressful events and depressed mood leads to harmful outcomes. In addition to intra‐psychic processes, depression is also associated with daily hassles and major life events. Self‐regulatory beliefs such as goal linking could mediate the link between life events, daily hassles, rumination and major depression. Method: The relationships between depressed mood, rumination, goal linking, life events and daily hassles were investigated in a between‐groups design. Standardized questionnaire measures of these constructs were used to compare depressed participants with a group of people experiencing psychological distress, but not major depression, and a never‐depressed group. Results: Participants with major depression experienced similar numbers of life events as the other groups, though the impact of these was greater for the depressed group than either the psychological distress group or the healthy controls. Depressed participants also experienced greater daily hassles than either of the other two groups. Depressed participants were also higher in goal linking and rumination. Regression analysis demonstrated that neither life events nor goal linking predict rumination or depressed mood. Rumination appears to moderate the relationship between daily hassles and depressed mood. Discussion: Theoretical and clinical implications are discussed. Copyright © 2009 John Wiley & Sons, Ltd.     

Could worry and rumination mediate relationships between self‐compassion and psychological distress in breast cancer survivors?

Many breast cancer (BCa) patients experience clinically significant anxiety and depression in survivorship. Self‐compassion offers a bulwark to anxiety and depression in nonclinical, mental health, and some chronic physical health populations. We examined whether self‐compassion predicted lower anxiety and depression symptoms in survivors and whether this might be mediated by lower worry and rumination. The design was a cross‐sectional survey using self‐report measures. Female adult BCa survivors of mixed stages who had finished primary surgical, radiotherapy, or chemotherapy treatments completed self‐compassion subscales and worry, rumination, and anxiety and depression scales. Higher self‐compassion subscale scores were negatively associated with anxiety and depression. Depressive brooding and worry mediated any effects of self‐kindness and mindfulness on depression and anxiety, whereas common humanity directly predicted lower depression scores. Findings are consistent with the view that self‐compassion reduces threat‐related rumination and worry in BCa survivors, consequently reducing anxiety and depression. This may form a basis for prevention and treatment.     

Anger rumination,social support,and cardiac symptoms in patients undergoing angiography

Objectives . Socially isolated individuals report more cardiac symptoms, suffer increased cardiovascular morbidity and mortality, and experience higher levels of stress and anxiety than those with more effective support resources. However, the complex interactions of psychosocial factors implicated in the disease process remain to be fully elucidated. We sought to explore these relationships, with the addition of a novel psychosocial variable, anger rumination, which could be associated with increased cardiovascular risk. Design . We examined the association of psychological stress, social support, and anger rumination, with surgical anxiety, self‐reported cardiac symptoms, and angiographically documented coronary artery disease, using a correlational ex post facto design. Methods . One hundred and one patients scheduled for elective coronary angiography completed questionnaires during the week prior to angiography. Disease severity was objectively assessed using the Gensini scoring system. Results . Self‐reported cardiac symptom severity was significantly correlated with higher perceived stress, less social support, and higher anger rumination, but none of the psychosocial variables predicted Gensini score. Social support partially mediated the relationship between anger rumination and surgical anxiety. Perceived stress mediated the relationship between anger rumination and cardiac symptoms. Conclusions . For patients awaiting angiography, stress, and lack of social support are important predictors of self‐reported cardiac symptoms, irrespective of actual disease severity. Intervention could focus on reducing perceived stress by encouraging reappraisal and a support seeking, rather than a ruminative, anger coping style.     

Respiratory sinus arrhythmia reactivity across empirically based structural dimensions of psychopathology: A meta‐analysis

Low resting respiratory sinus arrhythmia (RSA) is observed in many mental health conditions, including anxiety disorders, mood disorders, schizophrenia spectrum disorders, disruptive behavior disorders, and nonsuicidal self‐injury, among others. Findings for RSA reactivity are more mixed. We evaluate associations between RSA reactivity and empirically derived structural categories of psychopathology—including internalizing, externalizing, and thought problems—among physically healthy adults. We searched multiple electronic databases for studies of RSA among participants who were assessed either dimensionally using well‐validated measures or diagnostically using structured interviews. Strict inclusion criteria were used to screen 3,605 published reports, which yielded 37 studies including 2,347 participants and 76 effect sizes. We performed a meta‐analysis, with meta‐analytic regressions of potential moderators, including psychopathology subtypes. The sample‐wide meta‐analytic association between RSA reactivity and psychopathology was quite small, but heterogeneity was considerable. Moderation analyses revealed significant RSA reactivity (withdrawal) specifically in externalizing samples. Additional moderators included (a) stimulus conditions used to elicit RSA reactivity (only negative emotion inductions were effective), (b) sex (women showed greater RSA reactivity than men), and (c) adherence to established methodological guidelines (e.g., higher electrocardiographic sampling rates yielded greater RSA reactivity). These findings indicate that associations between RSA reactivity and psychopathology are complex and suggest that future studies should include more standardized RSA assessments to increase external validity and decrease measurement error.     

Impact of psychotherapy on insomnia symptoms in patients with depression and multiple sclerosis

The purpose of the study was to evaluate the prevalence of insomnia in multiple sclerosis patients with comorbid depression, associations between psychological symptoms, multiple sclerosis symptoms and insomnia, and to test effects of a 16-week protocol-based psychotherapy intervention for depression on insomnia symptoms. Participants with multiple sclerosis and depression (n = 127) were randomized to telephone administered cognitive behavioral therapy and telephone administered supportive emotion-focused therapy. Multiple sclerosis functional limitation was measured at baseline. Depression, insomnia, anxiety and quality of life were evaluated at pre treatment, mid treatment (8 weeks), and post treatment (16 weeks). Prevalence of insomnia ≥3 times per week was 78% at pre treatment and 43% at post treatment. Insomnia at baseline was associated with depression, multiple sclerosis related mood symptoms and anxiety. Middle of the night awakenings were associated with swallowing and speech problems. Improvements in insomnia were associated with improvement in depression and anxiety. Participants with residual insomnia were more likely to have major depressive disorder, greater multiple sclerosis severity, elevated anxiety and lower mental components of quality of life. Results demonstrate rates of insomnia in patients with comorbid multiple sclerosis and depression are higher than those reported in the general multiple sclerosis population and additional insomnia treatment is indicated beyond the treatment of comorbid psychological disorders.     

Emotion‐related primary and secondary appraisals,adjustment and coping: Associations in women awaiting breast disease diagnosis

Objective: Different emotions are to some extent associated with different ways of coping. Cognitive processes involved in determining emotional reactions may influence coping (perhaps through directing attention or generating salient information). This study explored possible appraisal‐coping associations by examining whether a set of appraisal components identified in emotion theory were also associated with coping. Design: The study examined concurrent associations between appraisal components, emotional adjustment, and coping in 148 women with suspected breast disease. Method: Questionnaire measures of primary and secondary appraisal components identified in emotion theory, anxiety, depression, and coping were sent to women during the waiting period between GP referral and attendance at a ‘one‐stop’ breast‐disease diagnosis clinic. Results: Consistent with expectations, appraisal components were associated with both emotions and coping. Elevated anxiety was associated with appraisals of low emotion‐focused coping potential; avoidance coping was associated with motivational incongruence, self‐accountability, and pessimistic appraisal of emotion‐focused coping potential; acceptance/resignation coping was associated with self‐accountability and pessimistic appraisals of both future expectancy and emotion‐focused coping potential. Conclusion: This study presents a theoretically driven approach to exploring associations between emotions and adjustment efforts. In keeping with expectations, a number of appraisal components identified in emotion theory were found to be associated with both emotion and coping.     

大学生认知情绪调节策略对抑郁和焦虑的影响

目的 探讨大学生认知情绪调节策略对抑郁和焦虑影响的总体情况及特点.方法 329名大学生接受了"认知情绪调节策略量表"和SCL-90中的抑郁和焦虑2个分量表的评定.结果 大学生采用较多的认知情绪节策略依次是积极设想、自我负责,反思和积极关注;反思和灾难化对大学生抑郁和焦虑有较强的预测作用,其中在灾难化对抑郁的预测作用上存在显著的性别差异(P＜0.001).结论 大学生认知情绪调节策略对抑郁和焦虑有显著影响,且各有不同特点.本研究为进一步探讨大学生的抑郁和焦虑提供了一定基础.     

Symptom components of standard depression scales and past suicidal behavior

BACKGROUND: Global severity on depression scales may obscure associations between specific symptoms and suicidal behavior. METHODS: We studied 298 persons with major depressive disorder. Factor analysis of the 24-item Hamilton Depression Rating Scale (HDRS) and the Beck Depression Inventory (BDI) was used to compare symptom clusters between past suicide attempters and non-attempters. RESULTS: Factor analyses extracted five HDRS and three BDI factors. Suicide attempters had significantly lower scores on an HDRS anxiety factor and higher scores on a BDI self-blame factor. The factor scores correlated with total number of suicide attempts and with known risk factors for suicidal behavior. LIMITATIONS: The differences in factor scores between suicide attempters and non-attempters were significant but modest and may be most relevant in suggesting areas for further clinical studies. Structured diagnostic interviews in this study may have limited the detection of Bipolar II or milder bipolar spectrum disorders. CONCLUSIONS: Depressed suicide attempters exhibit comparably severe mood and neuro-vegetative symptoms, but less anxiety and more intense self-blame than non-attempters. This clinical profile may help guide studies of biological correlates and of treatments to reduce suicide risk.     

Cross system autonomic balance and regulation: Associations with depression and anxiety symptoms

The autonomic nervous system (ANS) has demonstrated utility for identifying alterations in emotion processing associated with common psychopathology, including depression and anxiety. To date though the majority of this ANS research has several limitations. Most studies have examined parasympathetic and sympathetic branches separately, requiring activity in the other branch be inferred. This is problematic as each branch may function independently. Composite indices such as cardiac autonomic balance (CAB) and cardiac autonomic regulation (CAR) which examine the relative input between respiratory sinus arrhythmia (RSA) and pre-ejection period (PEP) should provide more comprehensive measures of autonomic functioning and thus stronger predictors of psychopathology. However, the sympathetic branch is driven by multiple neurotransmitter systems, thus PEP does not necessarily reflect overall SNS arousal. We propose two new metrics for assessing ANS functioning associated with psychopathology: parasympathetic effects on cardiac control (RSA) relative to sympathetic effects on the eccrine system (electrodermal activity, EDA), which we term cross-system autonomic balance (CSAB) and regulation (CSAR). Eighty-five women (18–37) completed a baseline physiological assessment with parasympathetic (RSA) and sympathetic indices (PEP, EDA), along with self-reported depressive and anxiety symptoms. Lower CSAB, indicating sympathetic dominance driven by cholinergic neurotransmission, was associated with higher depressive and anxiety symptoms. Lower CAB indicating sympathetic dominance driven by beta-adrenergic neurotransmission was associated specifically with depressive symptoms. CSAB was a more robust index than RSA. Results support the utility of assessing multiple composite ANS indices for identifying physiological substrates of alterations in emotion regulation associated with internalizing disorders.     

Intolerance of uncertainty, depression, and anxiety: the moderating and mediating roles of rumination

Objectives: This study examined rumination as a moderator and mediator between intolerance of uncertainty (IU) and depression and anxiety symptoms. Designs: The study was a cross sectional study. Survey data were collected from 332 undergraduate students at a large Midwestern university. Results: The results from hierarchical analyses supported the moderator role of rumination. A high level of rumination enhanced the association between IU and depression symptoms. In addition, both high and low levels of rumination strengthened the relation between IU and anxiety symptoms. Results from structural equation modeling analyses indicated that rumination fully mediated the relation between IU and depression symptoms, but only partially mediated the association between IU and anxiety symptoms. Conclusions: The results supported rumination as a moderator and mediator in the association between IU and depression and anxiety symptoms. Future research and practical implications are discussed. © 2011 Wiley Periodicals, Inc. J Clin Psychol 67:1–20, 2011.     

Can EEG asymmetry patterns predict future development of anxiety and depression?: A preliminary study

Previous research has shown that those reporting symptoms of depression and anxiety tend to exhibit greater relative right frontal electroencephalographic (EEG) activity. Thus, Davidson [Davidson, R.J., 1995. Cerebral asymmetry, emotion, and affective style. In: Davidson, R.J., Hugdahl, K. (Eds.), Brain Asymmetry. MIT, Cambridge, pp. 361-387] has suggested that greater relative right anterior activity may act as a vulnerability marker for the development of depression and anxiety disorders. This study therefore examined whether anterior and posterior EEG asymmetry patterns predicted anxiety and depressive symptoms one year later. At time 1, participants completed the Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI) and had baseline EEG activity recorded. Participants then completed the BDI and STAI one year later. Those with relatively greater EEG activity in the right anterior region reported greater trait anxiety one year later. These preliminary results suggest that relative right frontal EEG activity may predict future development of anxiety symptoms.     

Symptom-focused rumination and sleep disturbance

Rumination can prolong negative mood, disrupt sleep, and increase depression risk. Although there is evidence that poor sleepers ruminate, no studies have identified the ruminative content relevant for sleep disturbance. This study investigated (a) the association between rumination and sleep and (b) the ruminative content of poor sleepers. Results revealed that self-defined poor sleepers (n = 104) were more prone than self-defined good sleepers (n = 139) to ruminate and that the ruminative content was symptom focused (e.g., poor sleepers ruminated on causes of dysphoria, concentration, and fatigue symptoms). As dysphoria, reduced concentration, and fatigue are all commonly experienced daytime symptoms of insomnia, this preliminary finding of symptom-focused rumination should be further evaluated as a risk factor for further sleep disturbance in clinical samples as well as a possible link between insomnia and depression.     

Eating disorders and associated psychiatric comorbidity in elderly Canadian women

This study examined the prevalence of disordered eating symptomatology and their associations with socio-demographic characteristics and health indicators in a nationally representative sample of Canadian women aged 50 years and older. The study also examined associations of disordered eating symptomatology with comorbid mood disorders, anxiety disorders and alcohol dependence. The study was based on secondary data analysis of the Canadian Community Health Survey, cycle 1.2. About 2.6% of women 50-64 years old and 1.8% of women 65 years or older reported disordered eating symptomatology. These women exhibited elevated frequencies of dieting behaviors and preoccupation with food intake and body shape. Disordered eating symptomatology was positively associated with stress level and negatively associated with physical health. Similar to findings in younger women, risk of eating disorders was strongly associated with mood and anxiety disorders. Results indicate that the risk of having eating disorders is a lifelong concern. Hence, older women should be screened for symptoms of disordered eating and associated psychiatric comorbidity.