Top

Gepubliceerd in:

01-10-2013 | Original Article

Emotion Regulation in Depression and Anxiety: Examining Diagnostic Specificity and Stability of Strategy Use

Auteurs: Catherine D’Avanzato, Jutta Joormann, Matthias Siemer, Ian H. Gotlib

Gepubliceerd in: Cognitive Therapy and Research | Uitgave 5/2013

Abstract

Many psychological disorders are characterized by difficulties in emotion regulation. It is unclear, however, whether different disorders are associated with the use of specific emotion regulation strategies, and whether these difficulties are stable characteristics that are evident even after recovery. It is also unclear whether the use of specific strategies is problematic across all disorders or whether disorders differ in how strongly strategy use is associated with symptom severity. This study investigated (1) the specificity of use of emotion regulation strategies in individuals diagnosed with current major depressive disorder (MDD), with social anxiety disorder (SAD), and in never-disordered controls (CTL); and (2) the stability of strategy use in formerly depressed participants (i.e., remitted; RMD). Path analysis was conducted to examine the relation between strategy use and symptom severity across diagnostic groups. Compared to the CTL group, participants in both clinical groups endorsed more frequent use of rumination and expressive suppression, and less frequent use of reappraisal. Specific to SAD were even higher levels of expressive suppression relative to MDD, as well as a stronger relation between rumination and anxiety levels. In contrast, specific to MDD were even higher levels of rumination and lower levels of reappraisal. Interestingly, elevated rumination, but not decreased reappraisal, was found to be a stable feature characterizing remitted depressed individuals. These results may provide insight into ways in which emotion regulation strategy use maintains psychological disorders.

vorige artikel Commentary on Empirical Examinations of the Association Between Anxiety and Eating Disorders

volgende artikel Self Appraisals of Internal States and Risk of Analogue Bipolar Symptoms in Student Samples: Evidence from Standardised Behavioural Observations and a Diary Study

We use the term specificity to refer to relative specificity, indicating that use of a particular strategy is more elevated in one group than another, rather than present in one group and absent in another.

The data were collected as the first part of ongoing data collection in our labs. Participants were assigned to participate in additional tasks after completion of the diagnostic interview and the questionnaires, including tasks which were part of various sub- studies of depression and social anxiety. Separate advertisements targeting individuals currently experiencing (1) depression, (2) social anxiety, and (3) individuals with no current or past depression or psychiatric concerns (controls) were posted throughout the community. Individuals in the remitted depressed group were drawn from individuals responding to the depression ads who did not currently meet MDD criteria, but met criteria for a past episode. The ads described the symptoms of each disorder and invited individuals currently experiencing these symptoms to contact the lab if interested in taking part in the study. Throughout the course of enrollment, a greater number of depression ads were posted, reflecting a greater focus of studies in our lab on depression. This contributed to different sample sizes across diagnostic groups. Given the ads were identical with the exception of the symptoms being described, the nature of the ads should not have resulted in differential representativeness of the diagnostic groups.

As data on suppression and reappraisal was not collected until mid-way into enrollment for the study, this resulted in smaller sample sizes for analyses of these variables. Individuals missing this data were included in analyses of diagnostic group differences in rumination frequency, as well as in the SEM analyses, as missing data on these emotion regulation variables was missing at random.

As some prior studies have found different subcomponents of rumination to differ in relation to symptoms of psychopathology, we also examined diagnostic group differences in brooding, a subscale of the RRS assessing more maladaptive rumination, and reflection, the RRS subscale assessing a more adaptive form of rumination. Brooding and reflection were significantly correlated in the present sample, r = .47, p = .00. The MDD and SAD groups were elevated on both the brooding and reflection subscales compared to CTLs. However, the MDD compared to SAD group was elevated only in brooding, t(244) = 3.47, p = .00, not reflection, t(244) = .1.65, p = .10. In addition, compared to the CTL group, t(297) = 5.23, p = .00, only elevated brooding, but not reflection, t(294) = 1.84, p = .07, was seen in the RMD group. Both brooding and reflection showed significant positive correlations with BDI and STAI-T levels for all diagnostic groups, with the exception that only brooding, but not reflection, was correlated with BDI and STAI-T in the RMD group.

Abbott, M. J., & Rapee, R. M. (2004). Post-event rumination and negative self-appraisal in social phobia before and after treatment. Journal of Abnormal Psychology, 113, 136–144.PubMedCrossRef

Abela, J. R. Z., Hankin, B. L., Sheshko, D. M., Fishman, M. B., & Stolow, D. (2012). Multi-wave prospective examination of the stress-reactivity extension of response styles theory of depression in high-risk children and early adolescents. Journal of Abnormal Child Psychology, 40(2), 277–287.PubMedCrossRef

Aldao, A., & Mennin, D. S. (2012). Paradoxical cardiovascular effects of implementing adaptive emotion regulation strategies in generalized anxiety disorder. Behaviour Research and Therapy, 50, 122–130.PubMedCrossRef

Aldao, A., & Nolen-Hoeksema, S. (2010). Specificity of cognitive emotion regulation strategies: A transdiagnostic examination. Behaviour Research and Therapy, 48, 974–983.PubMedCrossRef

Aldao, A., & Nolen-Hoeksema, S. (2012a). When are adaptive strategies most predictive of psychopathology? Journal of Abnormal Psychology, 121, 276–281.PubMedCrossRef

Aldao, A., & Nolen-Hoeksema, S. (2012b). The influence of context on the implementation of adaptive emotion regulation strategies. Behaviour Research and Therapy, 50, 493–501.PubMedCrossRef

Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30, 217–237.PubMedCrossRef

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

Augustine, A. A., & Hemenover, S. H. (2009). On the relative effectiveness of affect regulation strategies: A meta-analysis. Cognition and Emotion, 23(6), 1181–1220.CrossRef

Baker, R., Holloway, J., Thomas, P. W., Thomas, S., & Owens, M. (2004). Emotional processing and panic. Behaviour Research and Therapy, 42(11), 1271–1287.PubMedCrossRef

Beck, A. T., Steer, R. A., & Brown, G. (1996). Manual for the beck depression inventory-II. San Antonio, TX: Psychological Corporation.

Beesdo, K., Bittner, A., Pine, D. S., Stein, M. B., Hofler, M., Lieb, R., et al. (2007). Incidence of social anxiety disorder and the consistent risk for secondary depression in the first three decades of life. Archives of General Psychiatry, 64, 903–912.PubMedCrossRef

Brown, T. A., Chorpita, B. F., & Barlow, D. H. (1998). Structural relationships among dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and autonomic arousal. Journal of Abnormal Psychology, 107(2), 179–192.PubMedCrossRef

Campbell-Sills, L., & Barlow, D. H. (2007). Incorporating emotion regulation into conceptualizations and treatments of anxiety and mood disorders. In J. J. Gross (Ed.), Handbook of emotion regulation (pp. 542–559). New York: Guilford Press.

Campbell-Sills, L., Barlow, D. H., Brown, T. A., & Hofmann, S. G. (2006a). Acceptability and suppression of negative emotion in anxiety and mood disorders. Emotion, 6(4), 587–595.PubMedCrossRef

Campbell-Sills, L., Barlow, D. H., Brown, T. A., & Hofmann, S. G. (2006b). Effects of suppression and acceptance on emotional responses of individuals with anxiety and mood disorders. Behaviour Research and Therapy, 44(9), 1251–1263.PubMedCrossRef

Campbell-Sills, L., Simmons, A. N., Lovero, K. L., Rochlin, A. A., Paulus, M. P., & Stein, M. B. (2011). Functioning of neural systems supporting emotion regulation in anxiety-prone individuals. Neuroimage, 54(1), 689–696.PubMedCrossRef

Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In R. M. Heimberg, M. Liebowitz, D. A. Hope, & F. R. Schneier (Eds.), Social phobia: Diagnosis, assessment and treatment (pp. 69–93). New York: Guilford Press.

Denson, T. F., Moulds, M. L., & Grisham, J. R. (2012). The effects of analytical rumination, reappraisal, and distraction on anger experience. Behavior Therapy, 43(2), 355–364.PubMedCrossRef

Edwards, S. L., Rapee, R. M., & Franklin, J. (2003). Postevent rumination and recall bias for a social performance event in high and low socially anxious individuals. Cognitive Therapy and Research, 27, 603–617.CrossRef

Eftekhari, A., Zoellner, Z., & Vigil, S. A. (2009). Patterns of emotion regulation and psychopathology. Anxiety, Stress, & Coping, 22(5), 571–586.CrossRef

Egloff, B., Schmukle, S. C., Burns, L. R., & Schwerdtfeger, A. (2006). Spontaneous emotion regulation during evaluated speaking tasks: Associations with negative affect, anxiety expression, memory, and physiological responding. Emotion, 6(3), 356–366.PubMedCrossRef

Ehring, T., Fischer, S., Schnulle, J., Bosterling, A., & Tuschen-Caffier, B. (2008). Characteristics of emotion regulation in recovered depressed versus never depressed individuals. Personality and Individual Differences, 44(7), 1574–1584.CrossRef

Erwin, B. A., Heimberg, R. G., Schneier, F. R., & Liebowitz, M. R. (2003). Anger experience and expression in social anxiety disorder: Pretreatment profile and predictors of attrition and response to cognitive-behavioral treatment. Behavior Therapy, 34(3), 331–350.CrossRef

First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1997). Structured clinical interview for DSM-IV axis I disorders (SCID I). Washington, DC: American Psychiatric Association.

Goldin, P. R., Manber, T., Hakimi, S., Canli, T., & Gross, J. J. (2009a). Neural bases of social anxiety disorder: Emotional reactivity and cognitive regulation during social and physical threat. Archives of General Psychiatry, 66(2), 170–180.PubMedCrossRef

Goldin, P. R., Manber-Ball, T., Werner, K., Heimberg, R., & Gross, J. J. (2009b). Neural mechanisms of cognitive reappraisal of negative self-beliefs in social anxiety disorder. Biological Psychiatry, 66(12), 1091–1099.PubMedCrossRef

Gross, J. J. (1998). Antecedent- and response-focused emotion regulation: Divergent consequences for experience, expression, and physiology. Journal of Personality and Social Psychology, 74(1), 224–237.PubMedCrossRef

Gross, J. J. (2002). Emotion regulation: Affective, cognitive, and social consequences. Psychophysiology, 39(3), 281–291.PubMedCrossRef

Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being. Journal of Personality and Social Psychology, 85(2), 348–362.PubMedCrossRef

Hankin, B. L. (2009). Development of sex differences in depressive and co-occurring anxious symptoms during adolescence: Descriptive trajectories and potential explanations in a multiwave prospective study. Journal of Clinical Child and Adolescent Psychology, 38(4), 460–472.PubMedCrossRef

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York, NY: Guilford Press.

Hilt, L. M., Armstrong, J. M., & Essex, M. J. (2012). Early family context and development of adolescent ruminative style: Moderation by temperament. Cognition and Emotion, 26(5), 916–926.PubMedCrossRef

Hilt, L. M., McLaughlin, K. A., & Nolen-Hoeksema, S. (2010). Examination of the response styles theory in a community sample of young adolescents. Journal of Abnormal Child Psychology, 38(4), 545–556.PubMedCrossRef

Hofmann, S. G., Heering, S., Sawyer, A. T., & Asnaani, A. (2009). How to handle anxiety: The effects of reappraisal, acceptance, and suppression strategies on anxious arousal. Behaviour Research and Therapy, 47(5), 389–394.PubMedCrossRef

Hofmann, S. G., Sawyer, A. T., Fang, A., & Asnaani, A. (2012). Emotion dysregulation model of mood and anxiety disorders. Depression and Anxiety, 29, 409–416.PubMedCrossRef

Jamieson, J. P., Nock, M., & Mendes, W. B. (2012). Mind over matter: Reappraising arousal improves cardiovascular and cognitive responses to stress. Journal of Experimental Psychology, 141(3), 417–422.PubMedCrossRef

Johnstone, T., van Reekum, C. M., Urry, H. L., Kalin, N. H., & Davidson, R. J. (2007). Failure to regulate: Counterproductive recruitment of top-down prefrontal-subcortical circuitry in major depression. Journal of Neuroscience, 27(33), 8877–8884.PubMedCrossRef

Joormann, J. (2006). Differential effects of rumination and dysphoria on the inhibition of irrelevant emotional material: Evidence from a negative priming task. Cognitive Therapy and Research, 30, 149–160.CrossRef

Joormann, J., & Gotlib, I. H. (2010). Emotion regulation in depression: Relation to cognitive inhibition. Cognition and Emotion, 24, 281–298.PubMedCrossRef

Just, N., Abramson, L. Y., & Alloy, L. B. (2001). Remitted depression studies as tests of the cognitive vulnerability hypotheses of depression onset: A critique and conceptual analysis. Clinical Psychology Review, 21(1), 63–83.PubMedCrossRef

Kashdan, T. B., & Steger, M. F. (2006). Expanding the topography of social anxiety: An experience-sampling assessment of positive emotions, positive events, and emotion suppression. Psychological Science, 17(2), 120–128.PubMedCrossRef

Keller, M. B., Lavori, P. W., Mueller, T. I., Endicott, J., Coryell, R., & Hirschfeld, R. (1992). Time to recovery, chronicity, and levels of psychopathology in major depression: A 5-year prospective follow-up of 431 subjects. Archives of General Psychiatry, 49(10), 809–816.PubMedCrossRef

Kline, R. B. (2005). Principles and practice of structural equation modeling. New York: Guilford.

Lam, S., Dickerson, S. S., Zoccola, P. M., & Zaldivar, F. (2009). Emotion regulation and cortisol reactivity to a social-evaluative speech task. Psychoneuroendocrinology, 34(9), 1355–1362.PubMedCrossRef

Liverant, G. I., Brown, T. A., Barlow, D. H., & Roemer, L. (2008). Emotion regulation in unipolar depression: The effects of acceptance and suppression of subjective emotional experience on the intensity and duration of sadness and negative affect. Behaviour Research and Therapy, 46(11), 1201–1209.PubMedCrossRef

Lyubomirsky, S., & Nolen-Hoeksema, S. (1995). Effects of self-focused rumination on negative thinking and interpersonal problem solving. Journal of Personality and Social Psychology, 69(1), 176–190.PubMedCrossRef

Lyubomirsky, S., Tucker, K. L., Caldwell, N. D., & Berg, K. (1999). Why ruminators are poor problem solvers: Clues from the phenomenology of dysphoric rumination. Journal of Personality and Social Psychology, 77(5), 1041–1060.PubMedCrossRef

Mauss, I. B., Cook, C. L., Cheng, J. Y. J., & Gross, J. J. (2007). Individual differences in cognitive reappraisal: Experiential and physiological responses to an anger provocation. International Journal of Psychophysiology, 66(2), 116–124.PubMedCrossRef

McRae, K., Jacobs, S. E., Ray, R. D., John, O. P., & Gross, J. J. (2012). Individual differences in reappraisal ability: Links to reappraisal frequency, well-being, and cognitive control. Journal of Research in Personality, 46(1), 2–7.CrossRef

Mennin, D., & Farach, F. (2007). Emotion and evolving treatments for adult psychopathology. Clinical Psychology: Science and Practice, 14(4), 329–352.CrossRef

Moberly, N. J., & Watkins, E. R. (2008). Ruminative self-focus, negative life events, and negative affect. Behaviour Research and Therapy, 46(9), 1034–1039.PubMedCrossRef

Moore, S. A., Zoellner, L. A., & Mollenholt, N. (2008). Are expressive suppression and cognitive reappraisal associated with stress-related symptoms? Behaviour Research and Thearpy, 46(9), 993–1000.CrossRef

Morgan, J., & Banerjee, R. (2008). Post-event processing and autobiographical memory in social anxiety: The influence of negative feedback and rumination. Journal of Anxiety Disorders, 22(7), 1190–1204.PubMedCrossRef

Murray, C. J. L., & Lopez, A. D. (1997). Global mortality, disability, and the contribution of risk factors: The Global Burden of Disease Study. The Lancet, 349, 1336–1342.CrossRef

Muthén, L. K., & Muthén, B. O. (2006). Mplus user’s guide (4th ed.). Los Angeles: Muthén & Muthén.

Nezlek, J. B., & Kuppens, P. (2008). Regulating positive and negative emotions in daily life. Journal of Personality, 76(3), 561–579.PubMedCrossRef

Nolen-Hoeksema, S. (1991). Responses to depression and their effects on the duration of depressive episodes. Journal of Abnormal Psychology, 100(4), 569–582.PubMedCrossRef

Nolen-Hoeksema, S. (2000). The role of rumination in depressive disorders and mixed anxiety/depressive symptoms. Journal of Abnormal Psychology, 109(3), 504–511.PubMedCrossRef

Nolen-Hoeksema, S., & Davis, C. G. (1999). “Thanks for sharing that”: Ruminators and their social support networks. Journal of Personality and Social Psychology, 77(4), 801–814.PubMedCrossRef

Nolen-Hoeksema, S., & Morrow, J. (1991). A prospective study of depression and posttraumatic stress symptoms after a natural disaster: The 1989 Loma Prieta earthquake. Journal of Personality and Social Psychology, 61(1), 115–121.PubMedCrossRef

Nolen-Hoeksema, S., Wisco, B. E., & Lyubormirsky, S. (2008). Rethinking rumination. Perspectives on Psychological Science., 3(5), 400–424.CrossRef

Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35(8), 741–756.PubMedCrossRef

Richards, J. M., & Gross, J. J. (2000). Emotion regulation and memory: The cognitive costs of keeping one’s cool. Journal of Personality and Social Psychology, 79(3), 410–424.PubMedCrossRef

Roberts, J. E., Gilboa, E., & Gotlib, I. H. (1998). Ruminative response style and vulnerability to episodes of dysphoria: Gender, neuroticism, and episode duration. Cognitive Therapy and Research, 22(4), 401–423.CrossRef

Schneier, F., Heckelman, L. R., Garfinkel, R., Campeas, R., et al. (1994). Functional impairment in social phobia. Journal of Clinical Psychiatry, 55(8), 322–331.PubMed

Scholing, A., & Emmelkamp, P. M. (1993). Cognitive and behavioural treatments of fear of blushing, sweating or trembling. Behaviour Research and Therapy, 31(2), 155–170.PubMedCrossRef

Sheppes, G., Scheibe, S., Suri, G., & Gross, J. J. (2011). Emotion regulation choice. Psychological Science, 22(11), 1391–1396.PubMedCrossRef

Shiota, M. N., & Levenson, R. W. (2012). Turn down the volume or change the channel? Emotional effects of detached versus positive reappraisal. Journal of Personality and Social Psychology, 103(3), 416–429.PubMedCrossRef

Siegle, G. J., Ghinassi, F., & Thase, M. E. (2007). Neurobehavioral therapies in the 21st century: Summary of an emerging field and an extended example of cognitive control training for depression. Cognitive Therapy Research, 31(2), 235–262.CrossRef

Spielberger, C. D., Gorsuch, R., Lushene, R., Vagg, P. R., & Jacobs, G. A. (1983). STAI manual for the state-trait anxiety inventory. Palo Alto, CA: Consulting Psychologists Press.

Spokas, M., Luterek, J. A., & Heimberg, R. G. (2009). Social anxiety and emotional suppression: The mediating role of beliefs. Journal of Behavior Therapy and Experimental Psychiatry, 40(2), 283–291.PubMedCrossRef

Treynor, W., Gonzalez, R., & Nolen-Hoeksema, S. (2003). Rumination reconsidered: A psychometric analysis. Cognitive Therapy and Research, 27(3), 247–259.CrossRef

Troy, A. S., Wilhelm, F. H., Shallcross, A. J., & Mauss, I. B. (2010). Seeing the silver lining: Cognitive reappraisal ability moderates the relation between stress and depressive symptoms. Emotion, 10(6), 783–795.PubMedCrossRef

Tull, M. T., & Roemer, L. (2007). Emotion regulation difficulties associated with the experience of uncued panic attacks: Evidence of experiential avoidance, emotional nonacceptance, and decreased emotional clarity. Behavior Therapy, 38(4), 378–391.PubMedCrossRef

Turk, C. L., Heimberg, R. G., Luterek, J. A., Mennin, D. S., & Fresco, D. M. (2005). Emotion dysregulation in generalized anxiety disorder: A comparison with social anxiety disorder. Cognitive Therapy and Research, 29(1), 89–106.CrossRef

Vassilopoulos, S. (2005). Anticipatory processing plays a role in maintaining social anxiety. Anxiety, Stress and Coping, 18(4), 321–332.CrossRef

Watkins, E., & Teasdale, J. D. (2001). Rumination and overgeneral memory in depression: Effects of self-focus and analytic thinking. Journal of Abnormal Psychology, 110(2), 353–357.PubMedCrossRef

Wong, Q. J. J., & Moulds, M. L. (2009). Impact of rumination versus distraction on anxiety and maladaptive self-beliefs in socially anxious individuals. Behavior Research and Therapy, 47(10), 861–867.CrossRef

Titel: Emotion Regulation in Depression and Anxiety: Examining Diagnostic Specificity and Stability of Strategy Use
Auteurs: Catherine D’Avanzato
Jutta Joormann
Matthias Siemer
Ian H. Gotlib
Publicatiedatum: 01-10-2013
Uitgeverij: Springer US
Gepubliceerd in: Cognitive Therapy and Research / Uitgave 5/2013
Print ISSN: 0147-5916
Elektronisch ISSN: 1573-2819
DOI: https://doi.org/10.1007/s10608-013-9537-0

Bohn Stafleu van Loghum

Deel dit onderdeel of sectie (kopieer de link)

Abstract

Log in om toegang te krijgen

Andere artikelen Uitgave 5/2013

Anxiety, Appearance Contingent Self-Worth, and Appearance Conversations with Friends in Relation to Disordered Eating: Examining Moderator Models

Exploring the Relationship Between Social Anxiety and Bulimic Symptoms: Mediational Effects of Perfectionism Among Females

Anxiety as a Mediator Between Perfectionism and Eating Disorders

Anxiety and Disordered Eating

Don’t Worry! Parental Worries, Alcohol-Specific Parenting and Adolescents’ Drinking

Negative Automatic Evaluation and Better Recognition of Bodily Symptom Words in College Students with Elevated Health Anxiety