The association between affect amplification and urgency

Background: Individuals lacking effective coping skills to manage aversive affective states are more likely to behave impulsively despite harmful long‐term consequences. Urgency or the propensity to act rashly in response to negative affect is associated with a host of maladaptive behaviors. However, relatively little research has evaluated the impact of affective variables—such as emotion regulation—on urgency. Moreover, the role of urgency has not been examined in populations with mood and anxiety disorders, a group for whom maladaptive coping and avoidance behaviors are common responses to heightened affect. This study evaluated the association between urgency and three variables associated with the amplification of affect (anxiety sensitivity (AS), access to emotion regulation strategies, and distress intolerance). Methods: Data were collected from an unselected community sample ( n = 297) and a clinical sample with a mood and/or anxiety disorder ( n = 99). Results: Results from a linear regression indicated significant associations between both distress intolerance and emotion regulation strategies and urgency. AS was significantly associated with urgency when considered alone, but did not remain significant when considered in the context of an alternative measure of distress intolerance and emotion regulation. Conclusions: These findings suggest that intolerance of distressing states and lack access to a repertoire of emotion regulation strategies are strongly associated with acting impulsively in response to negative affect. Treatment implications and future research directions are discussed. Depression and Anxiety, 2011. © 2011 Wiley Periodicals, Inc.     

Health anxiety,cyberchondria, and coping in the current COVID-19 pandemic: Which factors are related to coronavirus anxiety?

According to cognitive-behavioral models, traits, triggering events, cognitions, and adverse behaviors play a pivotal role in the development and maintenance of health anxiety. During virus outbreaks, anxiety is widespread. However, the role of trait health anxiety, cyberchondria, and coping in the context of virus anxiety during the current COVID-19 pandemic has not yet been studied. An online survey was conducted in the German general population (N = 1615, 79.8 % female, M_age = 33.36 years, SD = 13.18) in mid-March 2020, which included questionnaires on anxiety associated with SARS-CoV-2, trait health anxiety, cyberchondria_Pandemic (i.e. excessive online information search), and emotion regulation. The participants reported a significantly increasing virus anxiety in recent months (previous months recorded retrospectively), especially among individuals with heightened trait health anxiety. Cyberchondria_Pandemic showed positive correlations with current virus anxiety (r = .09–.48), and this relationship was additionally moderated by trait health anxiety. A negative correlation was found between the perception of being informed about the pandemic and the current virus anxiety (r=-.18), with adaptive emotion regulation being a significant moderator for this relationship. The findings suggest that trait health anxiety and cyberchondria serve as risk factors, whereas information about the pandemic and adaptive emotion regulation might represent buffering factors for anxiety during a virus pandemic.     

An examination of the incremental contribution of emotion regulation difficulties to health anxiety beyond specific emotion regulation strategies

Given the potential transdiagnostic importance of emotion dysregulation, as well as a lack of research examining emotion dysregulation in relation to health anxiety, the present study sought to examine associations among specific emotion regulation strategies (cognitive reappraisal and expressive suppression), emotion regulation difficulties, and health anxiety in a physically healthy sample of adults (N = 482). As hypothesized, results of a series of hierarchical multiple regression analyses showed that emotion regulation difficulties provided a significant incremental contribution, beyond the specific emotion regulation strategies, in predicting each of the three health anxiety variables. Among the six dimensions of emotion regulation difficulties, the dimension representing perceived access to effective emotion regulation strategies was the only emotion regulation difficulty dimension that predicted all three health anxiety variables beyond the effects of the specific emotion regulation strategies. Results indicate that emotion regulation difficulties, and particularly one's subjective appraisal of his/her ability to effectively regulate emotions, may be of importance to health anxiety. Clinical implications are discussed.     

Examining the associations between emotion regulation difficulties,anxiety, and eating disorder severity among inpatients with anorexia nervosa

ObjectiveThere is growing interest in the role of emotion regulation in anorexia nervosa (AN). Although anxiety is also hypothesized to impact symptoms of AN, little is known about how emotion regulation, anxiety, and eating disorder symptoms interact in AN. In this study, we examined the associations between emotion regulation, anxiety, and eating disorder symptom severity in AN.MethodsQuestionnaires and interviews assessing emotion regulation difficulties, anxiety, eating disorder symptoms, and eating disorder-related clinical impairment were collected from group of underweight individuals with AN (n = 59) at admission to inpatient treatment. Hierarchical linear regressions were used to examine the associations of emotion regulation difficulties, anxiety, and the interaction of these constructs with eating disorder symptoms and eating disorder-related clinical impairment.ResultsEmotion regulation difficulties were significantly positively associated with eating disorder symptoms and related clinical impairment only when anxiety levels were low and anxiety was significantly positively associated with eating disorder symptoms and related clinical impairment only when emotion regulation problems were not elevated.ConclusionsThis study adds to a growing literature suggesting that emotion regulation deficits are associated with eating disorder symptoms in AN. Certain individuals with AN may especially benefit from a focus on developing emotion regulation skills in the acute stages of illness.     

A model of BIS/BAS sensitivity,emotion regulation difficulties,and depression,anxiety, and stress symptoms in relation to sleep quality

Recent research has indicated that interactions between behavioral inhibition system (BIS)/behavioral activation system (BAS) sensitivity and emotion regulation (ER) difficulties increases risk for psychopathology. Considering sleep quality (SQ) has been linked to emotion regulation difficulties (ERD) and psychopathology, further investigation of a possible mechanism is needed. The current study examined associations between BIS/BAS sensitivity, ERD, and SQ to depression, anxiety, and stress symptoms in an undergraduate sample (n=459). Positive relationships between BIS sensitivity and both ERD and stress symptoms, and negative relationships between BAS-reward sensitivity and both ERD and depression symptoms were observed. Furthermore, ERD were positively related to depression, anxiety, and stress symptoms. Succeeding analyses revealed differential relationships between ERD and depression, anxiety, and stress symptoms among good quality and poor quality sleepers. The findings are discussed within the context of personality dimensions and self-regulatory mechanisms, along with implications for the treatment of depression, anxiety and sleep difficulties.     

The link between emotion regulation,social functioning,and depression in boys with ASD

PurposeSymptoms of depression are common in children and adolescents with an autism spectrum disorder (ASD), but information about underlying developmental factors is limited. Depression is often linked to aspects of emotional functioning such as coping strategies, but in children with ASD difficulties with social interactions are also a likely contributor to depressive symptoms.MethodologyWe examined several aspects of emotional coping (approach, avoidant, maladaptive) and social functioning (victimization, negative friendship interactions) and their relation to depression symptoms in children with ASD (N = 63) and typically developing (TD) peers (N = 57). Children completed a battery of self-report questionnaires.ResultsLess approach and avoidant, but more maladaptive coping strategies, and poor social functioning were uniquely associated with more symptoms of depression in children with ASD. Only less approach and more maladaptive coping were uniquely associated with depression severity in TD boys.ConclusionsUnlike TD boys, boys with ASD who report using avoidant strategies to deal with stressful situations report fewer symptoms of depression, suggesting that this may be an adaptive emotion regulation strategy. However, understanding the role of over-arousal in this process, inferences about long-term effects of this strategy, its causality and direction of effects will require additional research.     

Investigations into emotion regulation difficulties among adolescents and young adults with autism spectrum disorder: A qualitative study

Background Emotion regulation difficulties have been associated with depression and anxiety in typically developing individuals. However, until recently, the impact of emotion regulation difficulties for adolescents and young adults with autism spectrum disorder (ASD) has received little attention. We investigated emotion regulation difficulties from the perspective of those who would experience the sequelae. This included parents, teachers, and psychologists.

Method Seven focus groups with parents, teachers, and psychologists, and 7 interviews with adolescents and young adults with ASD were conducted.

Results Across the groups, participants discussed their triggers of distressing emotions, difficulties with emotional awareness, emotion regulation strategies, and the consequences of their distressing emotions. Both depression and anxiety were perceived as the most experienced distressing issues with the greatest consequences.

Conclusions The implications of the themes revealed in the interviews and focus groups are discussed in light in previous literature and may help to inform future interventions.     

Cognitive emotion regulation strategies contributing to resilience in patients with depression and/or anxiety disorders

Objective

Research suggests that resilience is associated with favorable treatment outcome in patients with depression and/or anxiety disorders. In this regard, the identification of specific characteristics related to resilience that could provide targets for resilience-enhancement interventions is needed. Since the type of cognitive coping strategies is a possible marker of resilience, we investigated adaptive and maladaptive cognitive emotion regulation strategies contributing to resilience in patients with depression and/or anxiety disorders.

Methods

A total of 230 outpatients with depression and anxiety disorders were consecutively recruited and completed the Cognitive Emotion Regulation Questionnaire, the Connor–Davidson Resilience Scale, the Beck Depression Inventory, and the State Anxiety Inventory. A linear regression model was used to determine which cognitive emotion regulation strategies predicted resilience after controlling for relevant covariates. Additionally, this model of resilience was compared with those of depression and anxiety symptoms.

Results

Adaptive strategies were more strongly correlated with resilience than maladaptive strategies. In the regression model, more use of refocus on planning and positive reappraisal as well as less use of rumination predicted high resilience after controlling for age, gender, marital status, depression, and anxiety. Among these strategies, refocus on planning was the common strategy contributing to resilience and depression.

Conclusion

These results suggested that the cognitive emotion regulation strategies of refocus on planning, positive reappraisal, and less rumination contribute to resilience in patients with depression and anxiety disorders. It might provide potential targets for psychotherapeutic intervention to improve resilience in these patients.     

Links between parental socialization of coping on affect: Mediation by emotion regulation and social exclusion

IntroductionParental socialization of coping strategies is associated with various emotion regulation difficulties and continues to impact individuals during emerging adulthood. As emerging adults’ transition into adulthood, they experience social stressors that put their emotion regulation skills to the test.MethodsThe current study examined the associations of the parental socialization of coping strategies and emotion regulation difficulties with emerging adult positive and negative affect in response to social exclusion. Emerging adults (N = 402, 206 males and 196 females) from a large Southern university in the United States were recruited for the study. Participants completed survey measures of parental socialization of coping, positive and negative affect, and emotion regulation difficulties before engaging in a social exclusion task called Cyberball. After the task, participants completed a measure of positive and negative affect again.ResultsPrimary parental socialization of coping was associated with emotion regulation difficulties, both of which were associated with affect after the exclusion task, thus supporting the indirect effect of parental coping socialization on affect through a preexisting variable (i.e., emotion regulation) and a causal manipulation (i.e., exclusion task).ConclusionsThe impact of parental suggestions of coping strategies and emotion regulation difficulties during emerging adulthood indicate that parents continue to be an important point of intervention as individuals’ transition to adulthood.     

Common and Specific Emotion-related Predictors of Anxious and Depressive Symptoms in Youth

This study examined whether specific emotion-related constructs may be uniquely related to anxious or depressive symptoms in youth. Although anxiety and depression are comorbid in both youth and adult populations, delineation of these disorders is a worthwhile endeavor given that such differentiation may lead to a clearer conceptualization of the disorders that in turn may facilitate more efficient diagnosis and effective treatment. Children in the 4th and 5th grades (N = 187; M age = 10 years, 3 months) completed measures to assess symptoms of anxiety and depression and emotion-related functioning. Using structural equation modeling, emotion-related variables were identified that were common to both anxiety and depression (poor emotion awareness, emotion dysregulation, poor emotion regulation coping, high frequency of negative affect), most strongly related to depression (low frequency of positive affect), and most distinctly associated with anxiety (frequency of emotion experience, somatic response to emotion activation). The findings suggest that comprehensive theoretical formulations of anxiety and depression in youth should consider emotion-related variables. The results also suggest potential avenues that may facilitate more efficient assessment and treatment of such youth.     

The importance of distinguishing between the different eating disorders (sub)types when assessing emotion regulation strategies

People with eating disorders (ED) have difficulties regulating their emotions adaptively. Little is known about differences and similarities between different types of ED and how these regulation difficulties relate to other emotional problems. The present study examines maladaptive (suppression) and adaptive (cognitive reappraisal) emotion regulation strategies in women with different ED and relationships with anxiety and depression levels. In 32 women with AN restrictive subtype (ANR), 32 with AN binge-purge subtype (ANBP), 30 with bulimia nervosa (BN), 29 with binge eating disorder (BED), and 64 healthy women, the ERQ (emotion regulation) as well as STAI-T (anxiety), BDI-SF (depression), and EDDS (eating pathology) were administered. Women across different ED subtypes were inclined to suppress emotions and lacked the capacity to reappraise emotions (except women with ANBP). Correlational relations of suppression and reappraisal with anxiety and depression levels differed across ED groups. Emotion regulation problems were found across ED subtypes. However, the types of emotion regulation problems, and the effect of coexisting other emotional problems such as anxiety and depression may differ across ED subtypes. These findings illustrate the importance to of considering ED subtypes in emotion regulation research rather than consider ED as a whole.     

Factors Increasing Suicidal Risk in Young Argentinean College Students With and Without Suicide Attempt History

Predicting suicidal behavior is one of the most challenging tasks in mental health-related disciplines. We addressed this noteworthy issue in young Argentinean people, since suicidal behavior is an increasing albeit meagerly studied phenomenon throughout this country. We aimed to compare mental health-related variables, impulsivity-related traits, and main demographic variables between groups with and without suicide attempt history and to assess potentially affecting factors related to increasing suicidal risk in each group. A cross-sectional sample of 451 young college students (M_age?=?21.74) answered online self-reported questionnaires. Differences and multiple linear regression analyses were performed. The group with suicide attempt history had worst scores in all mental health-related variables (suicidal risk, psychological discomfort, social functioning and coping, depression, anxiety, and alcohol-related consequences), higher positive urgency and (lack of) premeditation, and higher frequency of mental disorder history, than their counterparts without suicide attempt history. The best-fitted model to predict suicidal risk for this group included the following: psychological discomfort, social functioning and coping, depression, anxiety, negative alcohol-related consequences, positive urgency, and (lack of) premeditation. In the group without suicide attempt history, the best-fitted model included the following: sex, age, psychological discomfort, social functioning and coping, depression, anxiety, negative urgency, and (lack of) premeditation. Both depression and anxiety demonstrated to be the most relevant predictors of suicidal risk irrespective of suicide attempts. In addition to depression and anxiety, other predictors seem to act upon producing or restraining such outcomes. Our findings suggest that such predictors may be negative alcohol-related consequences and the positive and negative urgency impulsivity-related traits.

     

Degree,but not direction of grip strength asymmetries,is related to depression and anxiety in an elderly population

Despite the abundance of studies on asymmetries in manual laterality, a marker for atypical brain lateralization in depression and anxiety, findings in this area are mixed. Traditionally, research have looked at individual differences in depression and anxiety as a function of the direction of asymmetry. However, recent research has emphasized on studying the degree of asymmetry in addition to its direction. To these ends, the present study aims to unravel the associations between the degree and direction of manual lateralization, and depression/anxiety. Cognitively healthy elderlies (N?=?326, 91 males, M_age?=?68) were administered grip strength assessments on both hands and self-report measures of depression and anxiety. Partial correlation analyses controlling for age, education and sex revealed significant positive associations between degree of lateralization and anxiety in the overall sample and among right-dominant participants, as well as a significant positive relationship between degree of lateralization and depression among right-dominant participants. None of the correlations involving the direction of lateralization yielded significance, neither was there significant differences between left- and right-dominant participants on depression and anxiety scores. These findings suggest that the degree of manual lateralization, but not direction, is related to depression and anxiety at least among right-dominant individuals.     

Difficulties with emotion regulation in multiple sclerosis: Links to executive function,mood, and quality of life

Introduction: Little is known about the influence of multiple sclerosis (MS) on the regulation of emotion. The current study tested whether people with MS report more emotion regulation difficulties than healthy controls. The relationship between emotion regulation and other important variables (mood, quality of life, and executive function) was explored. Mediation models were used to further understand the links between emotion regulation, depressed mood, and executive function in MS. Method: A total of 31 people with MS and 31 controls completed the Difficulties in Emotion Regulation Scales and measures of executive function (fluency and a go/no-go task), mood (Hospital Anxiety and Depression Scales), and a multidimensional assessment of quality of life (World Health Organization Quality of Life, brief version). Results: People with MS reported experiencing more difficulties in emotion regulation than controls. Mediation analyses indicated that depression mediated the emotion regulation difficulties in MS, while executive dysfunction did not. Difficulties in emotion regulation predicted poorer psychological and social quality of life in MS, independent of problems with executive function. Conclusions: People with MS experience difficulties in emotion regulation, which predict poorer quality of life. These results indicate that emotional control skills should be investigated in further detail when considering interventions to enhance well-being in MS.     

Time course of panic disorder and posttraumatic stress disorder onsets

Purpose

Posttraumatic stress disorder (PTSD) often co-occurs with panic disorder (PD), with some etiological models positing a causal role of panic reactivity in PTSD onset; however, data addressing the temporal ordering of these conditions are lacking. The aim of this study was to examine the bi-directional associations between PD and PTSD in a nationally representative, epidemiologic sample of trauma-exposed adults.

Methods

Participants were community-dwelling adults (62.6% women; M_age = 48.9, SD 16.3) with lifetime DSM-IV PTSD criterion A trauma exposure drawn from the 2001/2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and re-interviewed in 2004/5 (N = 12,467). Cox discrete-time proportional hazards models with time-varying covariates were used to investigate the bi-directional associations between lifetime PD and PTSD, accounting for demographic characteristics, trauma load, and lifetime history of major depression, generalized anxiety disorder, and social anxiety disorder.

Results

PD was significantly associated with subsequent onset of PTSD (HR 1.210, 95%CI = 1.207–1.214, p < .001), and PTSD was significantly associated with onset of PD (HR 1.601, 95% CI 1.597–1.604, p < .001). The association between PTSD and subsequent PD was stronger in magnitude than that between PD and subsequent PTSD (Z = − 275.21, p < .01). Men evidenced stronger associations between PD and PTSD compared to women.

Conclusions

Results were consistent with a bidirectional pathway of risk, whereby PD significantly increased risk for the development of PTSD, and PTSD significantly increased risk for PD. Given the association between PTSD and subsequent PD, particularly among men, clinicians may consider supplementing PTSD treatment with panic-specific interventions, such as interoceptive exposure, to prevent or treat this disabling comorbidity.

     

Emotion regulation in pathological skin picking: Findings from a non-treatment seeking sample

Pathological skin picking (PSP) is characterized by excessive picking of the skin, resulting in significant distress or functional impairment. The aim of the present study was to investigate the emotion regulation hypothesis of PSP. University students with PSP (n = 55) and without history of PSP (n = 55) were asked to retrospectively rate the intensity of affective states before, during, and after skin picking episodes. The results showed that for a majority of the PSP sufferers, intensity of certain negative affective states (i.e. anxiety, tension or boredom) was pronounced just before picking, and diminished significantly in the period from before to after picking. Relief and gratification increased during picking whereas guilt increased afterwards. A similar pattern emerged in the control group, although a much lower level of intensity was reported. Participants were also asked to fill out questionnaires concerning emotion regulation difficulties, emotion reactivity, depression, anxiety and worry. Hierarchical logistic regressions demonstrated that emotion regulation difficulties as well as emotion reactivity predicted PSP diagnosis after depression, anxiety and worry were controlled for. Furthermore, emotion regulation difficulties statistically mediated the relationship between emotion reactivity and PSP. Overall, the findings support an emotion regulation model of PSP.     

Relations among co-occurring psychopathology in youth with autism spectrum disorder,family resilience,and caregiver coping

BackgroundCo-occurring mental health problems are common in youth with autism spectrum disorder (ASD) and are associated with greater caregiver stress; however, it is not known whether such challenges overwhelm caregivers’ ability to cope. Research has demonstrated that families of children with ASD are able to demonstrate resilience; yet, whether family resilience functions as a compensatory or protective factor in ASD families has not been investigated. This study aimed to examine the relations among family resilience, co-occurring psychopathology in youth with ASD, and caregiver coping.MethodData from this study were obtained from the 2016–2018 National Survey of Children’s Health (NSCH). Multiple binary logistic regression was run to examine the associations among commonly co-occurring psychiatric disorders in youth with ASD (i.e., anxiety, depression, attention-deficit/hyperactivity disorder, and behavioral/conduct problems) and caregiver coping. Another multiple binary logistic regression was run to examine whether family resilience moderates the aforementioned relationships.ResultsYouth with ASD and co-occurring conduct problems or depression were significantly more likely to be cared for by adults who were not coping well. High family resilience was directly associated with lower odds of poor parental coping; nonetheless, co-occurring conduct problems and depression were still associated with worse coping of caregivers after accounting for family resilience.ConclusionsFindings indicate that co-occurring depression and conduct problems in ASD youth may overwhelm their caregivers’ coping resources. Results also suggest that interventions targeting family resilience may improve the coping of adults caring for children and adolescents with ASD.     

Affective predictors of the severity and change in eating psychopathology in residential eating disorder treatment: The role of social anxiety

ABSTRACT

Despite evidence documenting relationships between eating disorder (ED) psychopathology, depression, and anxiety, little is known regarding how social anxiety is related to ED symptoms in treatment. Therefore this study examined associations between depression, general anxiety, social anxiety, and ED psychopathology at the beginning and end of treatment (EOT) among patients (N = 380) treated in a residential ED program. Participants completed measures of ED psychopathology and affective variables. Higher depression and general anxiety, but not social anxiety, were related to higher ED psychopathology at baseline. However, social anxiety emerged as a unique predictor of ED psychopathology at EOT such that participants with higher social anxiety evidenced less improvement in ED psychopathology. Findings suggest that social anxiety has specific relevance to treatment in EDs, which may reflect shared mechanisms and underlying deficits in emotion regulation.     

Emotion dysregulation and sleep difficulties in generalized anxiety disorder

Diagnostic criteria for generalized anxiety disorder (GAD) include sleep problems, which often persist even after successful treatment of the disorder. The purpose of this study was to examine emotion dysregulation as a potential contributor to sleep problems in GAD patients. Participants comprised two groups: 59 individuals diagnosed with GAD and 66 healthy controls. They were assessed for the presence of mood and anxiety disorders and then completed self-report questionnaires assessing problems with sleep and emotion regulation. Participants in the GAD group scored significantly higher on a number of sleep outcomes than did the control group. Importantly, difficulties with emotion regulation statistically mediated the relationship between GAD and a wide range of outcomes of sleep dysfunction independently of the effects of depression and secondary anxiety diagnoses. Emotion regulation difficulties that characterize GAD mediate the relationship between symptoms of this disorder and a wide range of sleep problems. Implications for treatment and future research directions are discussed.     

The role of anxiety sensitivity and difficulties in emotion regulation in posttraumatic stress disorder among crack/cocaine dependent patients in residential substance abuse treatment

Current research suggests the importance of anxiety sensitivity (AS) in the risk for posttraumatic stress disorder (PTSD), and a growing body of research has demonstrated that difficulties in emotion regulation may also play a role. This study examined the unique relationships between AS dimensions, difficulties in emotion regulation, and a probable PTSD diagnosis among a sample of inner-city crack/cocaine dependent patients in residential substance abuse treatment. Probable PTSD participants exhibited higher levels of the AS dimension of social concerns and emotion regulation difficulties. Emotion regulation difficulties reliably distinguished probable PTSD participants from non-PTSD participants above and beyond both anxiety symptom severity and the AS dimension of social concerns. Further, social concerns did not account for unique variance when difficulties in emotion regulation was entered into the model. Results provide support for the central role of difficulties in emotion regulation relative to AS dimensions in the prediction of PTSD within a crack/cocaine dependent population.