Elsevier

Behavior Therapy

Volume 44, Issue 1, March 2013, Pages 39-50
Behavior Therapy

The Roles of Emotional Reactivity and Tolerance in Generalized, Social, and Health Anxiety: A Multimethod Exploration

https://doi.org/10.1016/j.beth.2012.05.006Get rights and content

Abstract

Emotion regulation difficulties have been implicated in the maintenance of many anxiety disorders. However, existing research has relied mostly on self-report measures of emotion regulation or one type of mood induction. The present study examined the relationships between anxiety symptoms and emotional reactivity and tolerance using multiple assessment methodologies. Participants (N = 122) completed measures of generalized, social, and health anxiety symptoms and reported tolerance of and reactivity to negative emotions (sadness, fear, anger, disgust) elicited by 4 film clips. Participants also completed a mirror-tracing persistence task, a behavioral measure of distress tolerance. Social anxiety symptoms predicted unique variance in tolerance of film-elicited emotions, whereas generalized anxiety symptoms predicted unique variance in total peak reactivity to film-elicited emotions. Health anxiety was not related to tolerance or peak reactivity, but it was predictive of greater anxiety following the mirror-tracing task. The results of this study suggest heightened emotional reactivity is a salient feature of generalized anxiety symptoms, whereas emotional tolerance is more strongly related to social anxiety symptoms. The unique association between health anxiety and anxious response to the distress tolerance task represents a novel finding that warrants further investigation.

Highlights

► Research implicates heightened emotional reactivity and poor emotional tolerance in anxiety disorders. ► Emotional reactivity and tolerance were assessed using emotional films and a behavioral distress tolerance task. ► Emotional reactivity was related to generalized anxiety symptoms and emotional tolerance was related to social anxiety. ► Symptoms of health anxiety were associated with anxious response to a frustrating task.

Section snippets

Participants

One-hundred and twenty-two participants were recruited through introductory psychology courses at a large southeastern university and completed this study as partial fulfillment of course requirements. All participants provided written informed consent for participating in the experiment. The sample was 59% female and ranged in age from 18 to 30 years (M = 18.78, SD = 1.3). The sample consisted of diverse ethnic groups: 77.9% were White (not Hispanic), 8.2% were Black (not Hispanic), 11.5% were

Correlational Analyses of Symptom Measures

The PSWQ was significantly and positively correlated with the SHAI (r = .35) and BFNE (r = .36), p's < .001, and the SHAI and BFNE were also correlated with each other (r = .26, p < .01). The DASS-dep was significantly correlated with the PSWQ (r = .25), BFNE (r = .36), SHAI (r = .25), and DASS-anx (r = .41), p's < .01. The DASS-anx was also correlated with the BFNE (r = .31) and the SHAI (r = .48), p's < .001. The DASS-anx was marginally correlated with the PSWQ (r = .22, p = .017).

Analyses of Response to Emotional Films

Average peak mood and emotional tolerance

Discussion

The present study investigated the relationships between anxiety symptoms and emotional reactivity and DT using multiple assessment methodologies. Though generalized, social, and health anxiety symptoms were correlated with each other, specific associations between task performance and each symptom emerged. When both measures of generalized and social anxiety were entered simultaneously in a regression model, generalized anxiety symptoms, but not social anxiety symptoms, accounted for unique

References (62)

  • P. Hajek et al.

    Breath-holding endurance as a predictor of success in smoking cessation

    Addictive Behaviors

    (1987)
  • T.B. Kashdan et al.

    Social anxiety and positive emotions: A prospective examination of a self-regulatory model with tendencies to suppress or express emotions as a moderating variable

    Behavior Therapy

    (2008)
  • M.E. Keough et al.

    Anxiety symptomatology: The association with distress tolerance and anxiety sensitivity

    Behavior Therapy

    (2010)
  • P.F. Lovibond et al.

    The Structure of Negative Emotional States: Comparison of the Depression Anxiety Stress Scale (DASS) with the Beck Depression and Anxiety Inventories

    Behavior Research and Therapy

    (1995)
  • K.A. McLaughlin et al.

    The contributory role of worry in emotion generation and dysregulation in generalized anxiety disorder

    Behaviour Research and Therapy

    (2007)
  • D.S. Mennin et al.

    Comorbid generalized anxiety disorder in primary social phobia: Symptom severity, functional impairment, and treatment response

    Journal of Anxiety Disorders

    (2000)
  • D.S. Mennin et al.

    Preliminary evidence for an emotion dysregulation model of generalized anxiety disorder

    Behavior Research and Therapy

    (2005)
  • D.S. Mennin et al.

    Delineating components of emotion and its dysregulation in anxiety and mood psychopathology

    Behavior Therapy

    (2007)
  • D.S. Mennin et al.

    Emotion regulation deficits in generalized anxiety disorder, social anxiety disorder, and their co-occurrence

    Journal of Anxiety Disorders

    (2009)
  • T.J. Meyer et al.

    Development and validation of the Penn State Worry Questionnaire

    Behaviour Research and Therapy

    (1990)
  • S. Reiss et al.

    Anxiety sensitivity, anxiety frequency, and the prediction of fearfulness

    Behavior Research and Therapy

    (1986)
  • L. Roemer et al.

    Mindfulness and emotion regulation difficulties in generalized anxiety disorder: Preliminary evidence for independent and overlapping contributions

    Behavior Therapy

    (2009)
  • M.T. Tull et al.

    A preliminary investigation of the relationship between emotion regulation difficulties and posttraumatic stress symptoms

    Behavior Therapy

    (2007)
  • M.T. Tull et al.

    Emotion regulation difficulties associated with the experience of uncued panic attacks: Evidence of experiential avoidance, emotional nonacceptance, and decreased emotional clarity

    Behavior Therapy

    (2007)
  • K.E. Williams et al.

    Are emotions frightening? An extension of the fear of fear construct

    Behaviour Research and Therapy

    (1997)
  • J.S. Abramowitz et al.

    Psychological treatment of health anxiety and hypochondriasis: A biopsychosocial approach

    (2008)
  • A. Bernstein et al.

    Multi-method evaluation of distress tolerance measures and construct(s): Concurrent relations to mood and anxiety psychopathology and quality of life

    Journal of Experimental Psychopathology

    (2011)
  • K. Cavanagh et al.

    The development of a measure of individual differences in disgust

  • J.M. Cisler et al.

    Emotion regulation and the anxiety disorders: An integrative review

    Journal of Psychopathology & Behavioral Assessment

    (2010)
  • J.R. Cougle et al.

    Distress tolerance and obsessions: An integrative analysis

    Depression and Anxiety

    (2011)
  • A.J. Ellis et al.

    Is dysphoria about being red and blue? Potentiation of anger and reduced distress tolerance among dysphoric individuals

    Cognition & Emotion

    (2010)
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